A true change causes significant disequilibrium and those resistant to change try to reduce disequilibrium by either attacking the leader of change or delaying the change.

A true change causes significant disequilibrium and those resistant to change try to reduce disequilibrium by either attacking the leader of change or delaying the change.

This week I learned about the story of a family medicine resident who discovered a nearly fatal medical error and questioned the senior physicians about how to prevent future patients from suffering similar harm. As a consequence of his questioning of his superiors he was labeled as a trouble maker who did not respect authority. He has been suspended from his residency for the past 5 months, and as a consequence of reaching out to the press he has escalating a private disagreement into a public firestorm.

What went wrong? This resident is a member of the millennium generation, a generation that was raised differently than past generations. Parents of the millennium generation have treated their children more as colleagues and explained to them the reasoning behind each rule and family decision. These children have been closely supervised and encouraged to participate in formal activities such as sports teams, music lessons, dance lessons, acting lessons, and many other supervised activities. Their close supervision has encouraged an acceptance of authority and of institutions. As a consequence of the recommendations by the famous pediatrician Dr. Benjamin Spock, this generation has been nurtured, and rewarded for their every achievement. Everyone on the children’s soccer and baseball team received a trophy. Most people in this generation have been raised to think that they are special.

What does this mean for health care? These young people are not about simply following orders and deferring to those in authority. Rather, they want their work and the systems they work in to have meaning and purpose. They want to know the reasons behind every decision. The millennium generation asks “Why?”.

In my view this generation has the potential to transform health care. They promise to be the leaders of change. Because they have no stake in the status quo, they are far more likely to challenge it. They have altruistic goals and want to improve our society. Whenever someone tries to bring about a change in the way things are done, he or she is an adaptive leader. Health care badly needs adaptive leaders because the status quo (over 100,000 deaths and over 1 million life-altering injuries per year in the United States caused by preventable medical errors) is not and never should have been acceptable.

The dangers associated with adaptive leadership are well known. This quote by Noccolo Machiavelli, 1515 insightful describes the age old impediments to change:

There is nothing more difficult to carry out, nor more doubtful of success, nor more dangerous to handle, than to initiate a new order of things. For the reformer has enemies all who profit by the old order, and only lukewarm defenders in all those who would profit from the new order. This lukewarmness arises partly from fear of their adversaries who have the law in their favor; and partly from the incredulity of mankind, who do not truly believe in anything new until they have had actual experience of it.

Whenever a meaningful change in the way things are done is attempted disequilibrium occurs. Those in favor of the status quo feel a sense of loss. As shown in the figure above, they try to reduce the discomfort of change by attacking the leader who is trying to bring about the change, or by delaying the change. The key to effective adaptive leadership is to maintain the degree of disequilibrium in the productive zone. If there is no discomfort meaningful change is not being achieved. However, too much disequilibrium can lead to outright rebellion. If leadership can moderate the degree of disequilibrium eventually the change will become the new “way it is” and will be regarded as the status quo (far right of the figure).  Those in charge should avoid punishing those who are leading change because punishment will serve to maintain the status quo. Adaptive leaders need to be protected and rewarded. Our patients are counting on them!

To read more about adaptive leadership please go to:
Critically Ill: A 5-point plan to cure healthcare delivery (Chapter 5) by Frederick Southwick also available in Kindle

Leadership on the Line Staying Alive Through the Dangers of Leading by Ronald Heifetz and Marty Linsky