Relationship leadership

Narrator: The ABIM foundation paired frontline physicians and leading experts to discuss building trust in healthcare. Brian Park, a physician and professor and Richard Frankel, a professor of medicine focused on efforts to build trust through relational leadership.

Brian Park: Rich, it’s great to meet you. So I’m Brian Park. I’m an assistant professor at the Oregon Health & Science University in Portland, Oregon. I’m also the director and co-founder of the Relational Leadership Institute at OHSU as well. It’s great to meet you.

Rich Frankel: It’s great to meet you too, Brian. So I’m Rich Frankel. I’m a professor of medicine at Indiana University School of Medicine and a senior researcher at the Regenstrief Institute, which is part of the school of medicine. And I am the director of the A SPIRE Fellowship program. A SPIRE stands for the Advanced Scholars Program for Internists in Research and Education.

Brian Park: Wonderful.

Rich Frankel: Yeah. Great. So what a great opportunity having read your challenge essay and I wanted to start by asking you, how did you get interested in the Relational Institute?

Brian Park: Yeah, absolutely. Well, you know, before I started medical school, my prior career was actually in filmmaking. I wanted to be a screenwriter. And the way that my brain always works was through stories. And so I had moved up to New York City to be a filmmaker because that’s what I thought that you did to be a filmmaker. And you know, the freelancing life was just not fit for me. So I was looking for other jobs and happened to stumble backwards into a job at a diabetes clinic in Harlem, New York City. And I absolutely fell in love with that work and I fell in love with that community cause I learned so much about the ways that social determines of health impacts health and how I learned all of those lessons were through the stories that I heard from patients, their families, community members. And I got a funny notion in my head of, oh, this is what medicine is. I’ll apply to medical school. Very quickly within my first semester of medical school, I remember, I think, I was thinking to myself, I have made a huge mistake. I felt completely like a fish out of water in medical school. And everything that I’d learned about narratives were gone.

And I remember I got together with my mentor in internal medicine at that point, Dr. John Song. And he had sat down with me just to catch up over lunch. And he had said, you know, Brian, you can do anything in healthcare. There’s clinical medicine, education, research, advocacy, whatever you want. And I remember that was just this really enabling moment for me where I felt like I really could do whatever I want to. So that started my journey of seeking out my true north. And I think for me, that was really the intersection of narratives and health equity. And so that’s really been what my career has been focused on.

And so the Relational Leadership Institute really started for me when I saw that there was, the kinds of leadership models I was being exposed to in medical school as a resident in family medicine, they were really limited. There were a lot about the executive leadership skills of leaders. And those things were really, really important. But as I thought about the best mentors, the best leaders in my life, like this mentor I mentioned to you, Dr. Song, I mean certainly there were master strategists and skill builders and at the same time, they understood the relational components of leadership so well. And I remember at that moment in residency, I got really interested in the literature of what makes a good leader in healthcare. What makes a healthy team in healthcare? And the evidence very quickly shows that the most effective leaders and not just healthcare but cross all industries, what they do very well are not just the what and the how of changed the technical skills of change. But what I like to think of is that the who and the why of change, these relational components that really enables a team promotes psychological safety.

So that was kind of an aha moment in my own trajectory. And I said, this is a gap in leadership training in healthcare that I have not been getting. So maybe we try to fill that gap. And I was really fortunate. I had so many partners at OHSU who are wanting to work with me in that work and build a community around that. And that’s how the journey began.

Rich Frankel: That’s wonderful. Yeah. Yeah. Brian, could you talk a little bit about the mechanics of the institute? What are the elements that go into it?

Brian Park: Absolutely. So the Relational Leadership Institute or RLI’s a three-month leadership learning collaborative where we’re really trying to help participants rec-enter psychological safety, trust and relationships and health care. And we do that by delivering through a hybrid learning model when we’re doing large group didactic, small group practice skills and having people do homework or we call it work-work, little activities that they can practice back at their place of work. Just these little ways of inculcating into their way of being an existing on a team, characteristics of high performing teams, things like shared power, growth mindset, psychological safety. And we’ve been blown away. We’ve had four cohorts now and we’ve had amazing evaluation results. 100% of our participants reporting that they have learned things that have helped them in their work, seen significant improvements on wellbeing scores, a sense of community score as well, and relational skill competencies as well. So it’s really great to see that we’re making an impact for this program.

Rich Frankel: So tell me about the growth of the program and where it stands right now.

Brian Park: Sure. When we started in 2016, we launched as really a grassroots movement at OHSU, just a small group of us really interested in relational leadership. And through word of mouth, we had 18 participants of folks who are just really interested in relational leadership and we jumped in thinking this could fall flat on its face or it could, it could work, and we’ll see where it goes. And that first cohort was such an amazing experience, you know, so many people sharing with us. One participant shared with us in the very last session, I’ve been waiting my whole career for a community like this. And so when we got those kinds of evaluations back, we felt a responsibility to keep it going. So it’s almost been, you know, with my other background has been in community organizing and really building that community and building a mini social movement at OHSU around the importance of relationships.

Yeah, it’s just been a tremendous way to just continue building more and more interest around that work to the point that we’re now about to launch our fifth cohort and we’ve had over a hundred participants go through our lives and experience. And we’re just on the brink of this fall of expanding to the University of North Carolina, Chapel Hill and University of Utah as well. So we’re in this really fortunate position where I think that the demand is outstripping our supply. So we’re really wrapping our minds around that.

So yeah, we’re in a good spot. But you know, I’m really excited to sit down with you because I think one of the eternal challenges that I felt ever since that I’ve been in healthcare and medical school and a lot of that I’ve made a huge mistake feeling for me was that feeling that I had a recognition that so much of us, we get into a career in medicine because we feel as though humanism and compassion for our patients and community is so critical. But immediately, I remember my first semester of medical school, I felt that that didn’t always exist amongst physicians or in the care team, that trust between medical student and attending physician, between physician and physician. Has that been your experience and how do you feel as though we start chipping away that? How do you rebuild trust, not just between physician and patient, but between physician and physician within that care team?

Rich Frankel: Well, as you know, the part of the trust challenge involves the question of physicians’ trust of one another. And interestingly enough, there’s virtually no literature on this topic. There’s lots about physicians and nurses, physicians and patients, physicians and administrators. But when we did a literature search, we came up with almost nothing on physicians’ trust of one another. So that was sort of a touchpoint for us in terms of trying to figure out why isn’t there a literature on this topic. And so we started to elicit stories from colleagues last year. We elicited a number of stories from colleagues here and we heard a lot about the lack of trust that some physicians are experiencing. And we believe that that relates to lack of… to burn out and lack of resilience. And I prefer the term ‘resilience’ to ‘burnout’ because resilience is, I’m sure you would agree, is a more positive term. It’s something that you can move toward. Whereas burnout has this negative connotation, negative connotation to it.

So I started my career in 1979 in Wayne State University. And there was a very unfortunate incident in which a third year resident was treating an elderly African American woman who was dying of pancreatic cancer. And unbeknownst to others, this resident’s father was dying of pancreatic cancer in Arizona. And against the protests of the medical residents, attending nurses who were there, this person drew a bolus of potassium chloride, injected the patient and killed her. And the residents had gone to the department chair asking to start a resident support group. And the chair who was a very wise man but didn’t see much value in resident support, said, I don’t think we need it.

After this unfortunate incident, and after we interviewed people, all of whom said we knew something was wrong, but there was no mechanism for getting the information to people who could have intervened. The chair reversed himself and said, I think we need resident support groups. So for 12 years at Wayne State and then another 11 years at the University of Rochester, I ran a resident support group and tried to create the context in which there were safe space for people to talk about what was troubling them. And I think that’s one of the places where trust can be built, creating a space where people can speak from the heart as well as from the mind.

And I remember one resident who had injected a patient, was doing a femoral stick and got an artery instead of a vein, injected the patient and the patient died. So she came into the residence support group and it was clear she was distressed. And when she was asked, she said, you know, 36 hours ago, I killed a patient and I haven’t been able to sleep. And I’m questioning whether medicine is the right profession for me. And she was just, she was distraught. And so spontaneously and without any prompting, each of the 18 residents who were in the room at that meeting started to tell stories about the mistakes that they had made. And it all came right from the heart and none were as serious as killing a patient, but they spoke to how it felt to make a mistake and how it felt for them to, you know, having made a commitment to do no harm, that they had done harm. And at the end of the group, I turned to the resident, I said, is there anything that you need or want from the group? And she paused and she said, I sure could use a hug. And 18 people got up and there was a group hug.

Brian Park: Wow.

Rich Frankel: 20 seconds, maybe. The next week, she was at the resident support group. And people ask, so how’s it going? And she said, well, you know, I went home, and I slept for 14 hours straight and I woke up feeling refreshed and knowing that I had right made the right choice to go into medicine. I think that’s the ultimate kind of trust that we can build in the profession where people can reveal their vulnerabilities and share their vulnerabilities and be stronger, not weaker as a result of doing that. And so, you know, we hear a lot about the negatives where people distrust one another, but as we were talking about a little earlier, I think there’s great reason for optimism. I think the young people who are going into medicine these days are hungry for this kind of connection, this kind of relationship. And in order to give trust to others, you have to receive trust yourself. And unfortunately, the medical education system has an exactly operated to bestowed trust on young physicians and in training.

Brian Park: Yeah. I just loved the story that you shared because of what the emphasizes to me is that trust is—I mean, we heard earlier today trust is a bi-directional street, but trust is a structural issue in the culture of medicine and even languages around resiliency, I sometimes resist it because it places the onus on the individual. Whereas I think what your story beautifully articulated to me is that it’s really about a community that changes. And as I think about the work that we’ve done at the Relational Leadership Institute, as you said, people are hungry for community. It’s as though, you know, people come back to our program, not only because of the content and the skills, but I think once you find likeminded people with a shared vision, it’s hard for people to unsee that or to unfeel that feeling. It’s like they carry that with them everywhere.

And I remember so many folks have shared with us that they just stick around because it’s the only place in medicine where they can get that feeling again. And I’m curious about how do we get more and more people to feel that feeling. You know, we can tell people to meditate or do yoga or to find structural interventions around spending less time around the EHR. But there’s this whole gap in this conversation around how do we share these stories where we’re being honest and vulnerable about all the mistakes that all of us have made. Where we have these proverbial group hugs that you’ve outlined for us. I’m curious about that. How do we do that more?

Rich Frankel: So from a structural point of view, we can start with entry into medical school. Who are we selecting to go into medical school? We’re selecting people who have great content knowledge and great content understanding. We don’t put as much emphasis on the relational aspect of what they’re capable of or what they already have. So I think that’s, you know, that’s one place. I think these are skills that can be taught, learned, and put into practice. And you know, there’s a lot of concern about intergenerational differences.

Brian Park: Yes.

Rich Frankel: And here we are two people from two different generations talking about trust, which spans generations. And so I think that looking for those places in which we’re more alike than different is another great way of inviting people in and not just saying, well, you’re a young person. You don’t know what it’s like on the wards. I’m an old person, I’m an old pro. Well, let’s put that aside and say, what do we have in common?

Brian Park: Absolutely.

Rich Frankel: What we have in common is our humanity and our love of the work that we do.

Brian Park: Yeah. I think we’re kindred spirits in that way and that you just said, I believe that this can be taught, these relational components can be taught. I so believe that. You know, I mean, that’s the crux of the work that you and I are both doing. And I’m always reminded of how, you know, ultimately, when we take our white coats and our stethoscopes off, we’re humans just like everyone else. And as social creatures, we’re all hardwired for connection and community and seeking out what connects all of us. And I think the conversation you and I are having in the work that we both do; we continually return to that. Well, and it’s almost like how do we help other people to jump into that with us too.

Rich Frankel: So overall, it sounds like the people in your program feel like there are better doctors, better healthcare professionals for being involved in RLI. How about you? Do you feel like you’re a better doctor for leading this program?

Brian Park: That’s a great question. I feel like a better doctor and I think the ways that I know that are that when I go to work, I don’t feel this boundary between my professional identity and my personal identity, my values underlying both of of those identities are present and the same. And so I feel like I can, I had the fortune of showing up to work every day being who I am without these alternate notions of what it means to be a physician or provider. I think that’s the joy that I get to find in my own work.

Rich Frankel: And that’s a wonderful description where the mask of professionalism and everyday life sort of drop away. And you’re the same person in the exam room as you are in the lunchroom or at home.

Brian Park: Absolutely. Yeah.

Rich Frankel: Great.

Brian Park: Yeah. Well, thank you so much for talking with me, Rich.

Rich Frankel: Yeah. The pleasure is all mine. Thank you. Keep up the great work that you’re doing as well. Thanks for everything you’ve done. So we’d never met face to face before, but I feel like if the camera could catch it, I’d love to give you a hug.

Brian Park: Oh, that’d be awesome. That’d be great.

Rich Frankel: Why don’t we do it?

Brian Park: That’s great.

Narrator: Visit buildingtrust.org to learn more.