149. Ask Forgiveness Not Permission to Overcome Learned Helplessness - Here's how ... MYB1

Stepping Out of Learned Helplessness

Introduction

In this episode, you'll discover some keys to stepping out of the learned helplessness we are all conditioned to accept as residents. I'll show you some ways to begin taking back your practice, both in your leadership role and in your clinical role, by understanding when to ask forgiveness and when to ask permission.

This is how you can step out of the constraints and rise above the classic way we do things around here. Check it out.

Change Without Asking Permission

In this episode, you'll discover how to rise out of the drudgery of the day-to-day of your practice, whether it's on the leadership or the clinical side, by running small improvement projects under the radar, stepping out of learned helplessness, stepping out of the way we do things around here.

To change the way you work for the better, to stop playing the victim, and the key is to understand how you can change things inside a large, multi-layered bureaucracy, i.e., your employer, without necessarily having to get anybody's permission for the changes that you want. Check this out.

Residency and the Culture of Helplessness

So residency for doctors is a very interesting learning experience. What you do is learn to be helpless because you actually have no autonomy.

The key to surviving residency, and remember, residency is a pure survival contest. There's only one objective—making it to the finish line—and it doesn't matter if you get there all in one piece.

You can be missing three fingers off your left hand and your right eye. But as long as you make it to graduation—what do they call the person who graduates last in their medical school class? Yep, doctor.

That's how you make it. Along the way, you can't color outside the lines. You must follow the requests and demands of your faculty and staff at all times. If you step out of line, you're gone.

So what we learn is that we're helpless. It's like the old story about the elephant that won't break the rope that ties his foot because they first started tying it to his foot when he was a little baby and couldn't break it.

Start with a Vision of Change

Well, let me just teach you a couple of quick skills. First, we have to start with the setup.

So I'm assuming you're a physician out in practice. I'm assuming that you've listened to our episode 130 and you have an ideal practice description.

You know what your ideal practice would look like, and there's something that you want to change about your current job or your current practice—some little thing that would make your day easier, some way that you interact with your staff, something that you do in pre-charting, something that you do to avoid certain meetings.

This little change that you want to make would definitely increase the overlap between your ideal practice and this practice—increase your overlap in the Venn diagram of happiness.

Why You Hesitate

But the challenge is: you're not the boss here, and since you learned in residency that you're not the boss anywhere, you may be hesitant to make the little changes that you want to make.

But here's how you set yourself up to be able to ask forgiveness and not permission.

Managing Bureaucracy

Your practice is inside an organization, and you have to navigate this bureaucracy and influence your team and your boss to get what you want.

What I'm going to teach you right now is what I call "Manage Your Boss Skill #1."

Let's just notice the bureaucracy. The bureaucracy is typically your practice, but you could be talking about inside a hospital or an ACO or an insurer.

The challenge is that this bureaucracy is not your practice. It's a group endeavor. You're not in charge.

So you have to stop acting like a doctor, stop trying to give orders and expecting people to obey, and understand there are rules inside of bureaucracy—and you have to learn these.

You have to study the way people interact to get what they want, the same way that an anthropologist studies a newly discovered tribe in the Amazon rainforest.

So stop giving orders, stop expecting people to do what you say. Stop being so urgent. Physicians are always trying to solve things in 10 minutes because that's how patient visits go.

Instead, ask questions. Observe behaviors carefully. Make requests and be patient.

Formal and Informal Rules

Now there are formal rules in a bureaucracy.

Formal rules in your bureaucracy—it's the mission and vision and values.

And if your organization has a mission, vision, value statement, I encourage you right now to memorize it, to know it by heart, because I guarantee you nobody in the C-suite knows your mission statement.

There will come a time in the later lessons on how to manage your boss that you will use the mission statement as a weapon to fight hypocrisy in the performance of your employer.

You can always use the mission to your advantage, because you're the only person in the room who will know it.

And you need to also understand the informal rules about how things get done around here. I call it TWWDTAH: "the way we do things around here."

And as you already know, I'm sure, the way we do things around here is just as important and just as confining as the formal mission and vision statement.

Notice how people get things done. Notice the kind of behavior and schmoozing and conversations that have to take place for change to happen, and notice how attempts at change fail because those anthropological rules of the way that we do things around here are violated.

Understanding Your Administrator’s Mindset

Now you also have to know an administrator's mindset, because typically, your boss is not a doctor.

Now you may have a doctor who's up the org chart from you, but the person who has the most control over your day-to-day reality—how you see patients, the scheduling, the workup of the charts, the way you're staffed, and whether you have a regular MA—all of those things are usually determined by an administrator.

And administrators have several concerns you have to honor that you don't necessarily share with them.

• Firstly, they're always concerned about money—what will this cost?

• They're also always concerned about manpower—who's going to do this new thing that you want to do?

• And they're also intimately concerned with policy—"the way we do things around here."

• They're always concerned with the mission, but that’s typically bottom of the stack, behind money, manpower, and the way we do things around here.

The Green Light for Taking Action

What this means is that if you have a plan to make a change in the way you work with your team that:

• Doesn't require more money or manpower

• Doesn't violate the way we do things around here

• Is consistent with the mission of the organization

I’m going to say this kind of loud:

Just do it.

The old Nike saying, right? Just do it.

And if anybody says anything about your planned change in your workflow—ask forgiveness.

You don’t have to worry about permission.

Example: Running a Mini Pilot

And another thing that can happen: if you've got a little pilot project that you want to run—just a real quick example.

Let’s say that when you start every day, you're going to instruct your MA (or whoever's assisting you in rooming your patients) to ask the patient upfront for their list—the list of things they want addressed in this visit.

Have them give that to your assistant, and have them give that to you before you go into the room, so you can negotiate what you're going to do today.

That may not be a piece of the onboarding or workflow of your existing staff, but you know:

• This doesn’t require more money

• Doesn’t violate the way we do things around here

• Is consistent with the mission

• Will be better for you, your team, and your patients

If someone challenges you in making this request of your personal roomer, ask forgiveness.

"Hey, this is consistent with quality care. It doesn’t require more resources. It helps patients."

The Secret Weapon: Innovation Pilot Projects

If they still want to kill your little project, whisper into the ear of the administrator who’s trying to shut you down that you could have this, in fact, become an Innovation Pilot Project.

Administrators love innovation pilot projects.

When administrators gossip, they talk about these little side projects—they’re the bright spots in their day.

Let your project be one of those.

And if they go along with it, they’ll say:

"Yeah, that’s a great idea. Glad I thought of it."

Let them have the project—just so that your project can live another day.

Final Thoughts

This is obviously for simple things.

If you're going to do something that's bigger, that takes more money or manpower, or changes routines, you’re going to need a more involved process to launch your project—and we’ll talk about that in a future episode.

But for now—what’s a little change you want to make in your practice, either on the leadership side or in your clinical practice?

Check the boxes:

• Does it require more money or manpower?

• Does it violate the way we do things around here?

• Is it consistent with the mission?

If yes—just do it.

If anybody asks—ask forgiveness.

And if they’re still against it—ask to be an innovation pilot project and watch how that little phrase can work its magic.

Go ahead and make the tweaks. You’re not hopeless anymore. You’re not a resident. You can stretch the box that you’re in. You can color outside the lines under these circumstances.

Good luck with your project.

That's it for today. Until we’re together again in the next podcast—you keep breathing and have a great rest of your week.