July 1, 2020

How To Make Changes Without Being Disruptive, Part 2

Wear the Right Hat at the Right Time: The Anthropologist’s Hat

By: Dr. Mark Jaben 

Now that you have become clear on Rule #1: stop being a doctor, let’s talk about:

Rule #2: put on your anthropologist hat.

Replacing your doctor hat with a little ‘l’ leader hat is part of the first rule.  In actuality, though, your hat is more like one of those hats with an umbrella attached on top. The umbrella stays on; the hat underneath can change depending on the situation.

An anthropologist studies other societies, observing their culture, language, customs, learning how they operate.  To get your concerns heard, acknowledged, and moved onto the Leader’s radar screen of what matters, it is crucial to understand how the Leader’s world works and how they work in their world.

How does the Leader prefer to receive information?  How do they like to give information?  Do their words mean the same as you understand them to mean?  How do they go about making decisions?  What are their goals and priorities?  What are the top issues they struggle with?  What does success look like to them?  Where do you fit into that vision?

But don’t stop there – ask yourself all these same questions.  In the process, you might just learn something about yourself.  Find out if those you work with have a vision you can live with.  It’s unusual to encounter a doctor who leaves a position without there being a significant disconnect between their values and those of their Leader or organization.

Rule #3: Cultivate a Relationship.

The time to observe and learn all of these traits about your Leader is not in the middle of a crisis, or whenever you feel the urge to raise an issue in the coal mine.  Set up a meeting to get to know them away from any controversy.  Find out their expectations and how you can contribute to their image of success.

Schedule a meeting every so often (say, every quarter) to keep in touch. Here are some power tips for these meetings:

  • Know who this Leader is, and the scope of their Leadership. It won’t help to study someone who is not in a position to help you get what you want.
  • The continuation caveat. The way the meeting ends sets the stage for the next meeting. Always end on a positive note, no matter the issues discussed.
  • Schedule the next meeting before the current one ends.

Rule #4: They won’t listen to you if you don’t listen to them.

Listening is critical for you in cultivating the relationship with your Leader.  When the time comes to share your story, there’s little chance they will hear it - even if you are right - unless they see you as trustworthy and credible.

British ethicist and philosopher Dr. Onora O’Neill provides some guiding principles.

Demonstrate credibility by not being deceptive, even inadvertently so; don’t be coercive, intentionally or not:

  • Both parties should use words and terms the same way. Many times, confusion here is the obstacle to the kind of conversation you want to have.
  • The data you use need to accurately capture what is truly happening.
  • The metrics being measured need to reflect the true desired outcome. There is often a real disconnect here.
  • If any of these are not clear, ask.
  • Your solution should not make someone else less likely to be successful in their responsibilities.

Trustworthiness takes these:

  1. Be honest. Offer only what can reasonably be done.
  2. Be competent. Be sure you have the skill and ability to deliver on what you pledge to do.
  3. Don’t overreach. Do what you say.
  4. Two out of three are not enough.

Here is the summary:

Once you can ‘stop being a doctor’, put on your little ‘l’ leader hat and let the anthropologist in you go to work. Figure out how decisions really get made in your coal mine. Take some time to build credibility and trust in the eyes of those who are in a position to help you get what you want.

And for now, my question to you: What does your anthropologist hat look like?  And my challenge to you: Practice putting yours on.  Then have a look around.  What do you see?

Next time: what to do with what you learn.


This is PART 2 of a series, How to Make Changes Without Being Labelled as Disruptive, by Dr. Mark Jaben.

Dr. Jaben was member of an independent EM group for over 20 years, during which time he wore many hats including a managing partner, associate director, and EMS medical director.  He then moved on to locums and independent work.  For the past 13 years, this has included active clinical practice as well as coaching emergency departments, hospitals, administrators, managers and individuals on system improvement. For the past 5 years, an emphasis has been coaching physicians struggling with both burnout and their bureaucracy.

He has had ample opportunity to experience firsthand the stress of medical care and the health care world, not only here in the United States and abroad, but in institutions ranging from small critical access hospitals to large urban centers in both non-profit and for profit systems.

He has observed the obvious disconnect between physicians and administrators, and in many situations a real missed opportunity for the kind of dialogue each institution must have in order to learn what actions really matter in their own unique situations.  We are delighted for him to share some insight into pursuing a successful relationship that leads to change.

Away from work he spends a good deal of his time kayaking the local whitewater rivers in North Carolina and hiking its beautiful wilderness.