Aspirations for an Ideal Future in Medicine: Implementation and Pivoting

This week we are putting a couple of finishing touches on the action plan for moving into your ideal practice of medicine. If you’ve been following along, we have:

-Reviewed some perspectives on the hope for the future of medicine

-Developed goals and visions for your individual practice

-Tackled mindset obstacles, including limiting beliefs

-Turned other obstacles into strategies

-Prioritized and calendared your plan

Now it’s time for implementation and what to do when new obstacles arise.

Which emotions are you experiencing as you look at your plan on the calendar? This is important for you to reflect on. (Yes, even in action weeks, I’m returning to mindset and emotions – you’re not really surprised, are you? 😉)

Emotions such as confusion, doubt, self-pity, fear, and overwhelm will stall your action plan. With all the best intentions, desires, and work you’ve put in, you need to keep an eye on your emotions and the thoughts your unsupervised mind will offer. Nothing has gone wrong here – your more primitive brain is on autopilot to keep you safe, help you seek immediate pleasure, and avoid expending energy. The good news is that you have been gifted a prefrontal cortex to check in and clean up that mindset so you don’t sabotage your plans.

Which emotions are the most enlivening for you?

Which ones naturally lead you to take action?

Motivated

Energized

Curious

Determined

Committed

Willing

Disciplined

Excited

Empowered

Hopeful

One that is very useful for many of us, albeit less pleasurable, is courage. These emotions lead us to consistent action despite the naturally unpleasant feelings that arise.

What ways of thinking or beliefs help fuel those emotions for you?

“I’m made for this. “

“I will practice medicine on my own terms.” (borrowing Dr. Una’s phrase)

“I can serve patients in a way that aligns with my core values despite the challenges.”

“I will figure out how to enjoy life and thrive in my career.”

“My family, patients, and staff deserve this.”

“I deserve this.”

“I refuse to give up.”

Brainstorm…which thoughts and beliefs do you need to have a laser focus on to drive the emotions that will lead you to the action of implementing your plan - one step at a time, keeping your appointments and timeline with yourself?

My friend and colleague, Dr. Amelia Bueche, shared a couple of essential steps to overcoming implementation inertia that I’ve slightly modified for this blog:

            Tune in. Listen to the stakeholders' needs – that includes YOU. Ask questions, get details, and review your options.

            Trust yourself. Remind yourself of your experience and capability to figure things out, even hard things (confidence). Create something that aligns with your mission, vision, and values (clarity). Be selective in your feedback from others and be compassionate yet objective with your feedback to yourself (curiosity).

            Try it out. Every new practice has a first edition. Start by getting started. You have to start somewhere. Set your intention, observe the impact, and allow for innovation.

For a couple of other models of implementing change – especially within systems, I offer the following:

1. The Logic Model is sometimes easier for systems changes. (I recommend starting with the end in mind (goals first) as CHARM's approach taught me in my GME Wellbeing Leadership Course) https://thecompassforsbc.org/how-to-guide/how-develop-logic-model-0 
2.  Kotter’s 8-step model of change to effect change with a team. https://www.kotterinc.com/methodology/8-steps/
3. The MedEd Model for curricular development for you medical educators. https://www.mededmodels.com/curriculum-development-1

Now back to those inevitable unpleasant emotions that will be part of the process. Accept that they are coming along for the ride. As Brooke Castillo, Master Certified Coach, highlights – “Discomfort is the currency to fulfill our dreams. Be uncomfortable on purpose… You’ll either experience temporary discomfort now while working to achieve your dreams, or you’ll experience discomfort in the long term when you don’t achieve your dreams. It’s the only trade that makes sense when you have big dreams and goals.”

And things will absolutely not go perfectly according to your plan. And so you use your mental flexibility muscle you’ve been working on. And then, you review the outcomes and processes, fine-tune your plan, and go again around each obstacle. You learn to pivot and try various iterations. It’s essentially a multi-PDSA cycle (Plan, Do, Study, Act). This is where the “Done is better than perfect. Perfection is the enemy of progress. Progress over perfection” type of mindset comes in handy.

Dr. Una always uses the analogy of the iPhone. The first iPhone wasn’t perfected. They put it on the market, studied it, refined it, and improved it as they continue to do. There is so much more learning to inform your plan and process that you can know independently without the PDSA cycles.

And one other very cool thing that happens FOR you during this is what Dan Sullivan calls “strategic byproducts.” Throughout this process, you learn, grow, and become a better version of yourself.

Enjoy the journey!

Have a joy-filled week! Tonya