If healthcare leaders want to transform our healthcare system so it is truly patient-centered and cost-effective and if we are serious about creating a culture of health in which we are preventing diseases long before they result in sickness, the place to start is with ourselves.

All healthcare leaders—no matter whether you practice in a small office or a large hospital—because more often than not, physicians set the tone. But what you may not realize is that your mental and emotional state has a significant effect on the people around you. In his book Primal Leadership: Unleashing the Power of Emotional Intelligence, psychologist Daniel Goleman revealed: “The actions of the leader account for up to 70 percent of employees’ perception of the climate of their organization.”[1]

Leading Means Showing the Way

Unhappy, dysfunctional leaders cannot create high-functioning, compassionate practice environments, and a stressed out, unhealthy organization cannot take care of the health of others. So as physicians, we need to ensure that the effect we have on others is positive and beneficial.

As leaders:

♦ If, when facing a problem, we display thoughtful intelligence rather than anger or frustration, we will inspire that behavior in others and promote creative solutions.
♦ If we are trustworthy and nurture a culture of trust, our colleagues will feel safe enough to communicate honestly, therein creating an environment in which real change is possible.
♦ If our words and actions demonstrate a deep commitment to cost effective, patient care, others will follow our lead, resulting in an improved practice environment.
♦ If we hold ourselves accountable for the vision and if we foster a culture of ownership for that vision, more people will participate, leading to bigger and better outcomes.

 It’s not unlike throwing a pebble into a pond. A leader’s internal state creates ripples—which can either be good or bad—that extend throughout an organization.

Self-Awareness with Informed Mindfulness

But how do we become more thoughtful, more trustworthy, more committed and more visionary? After working with this concept for 2 decades, Integrative Healthcare leaders have found that one of the most effective ways to engage in transformative self-development is through the practice of informed mindfulness.

Mindfulness refers to a particular way of deepening self-awareness and increasing one’s ability to stay present in the moment. Jon Kabat-Zinn, PhD, founder of the Center for Mindfulness in Medicine, Health Care and Society at the University of Massachusetts Medical School, first brought this practice into healthcare in 1979 as a means to help people reduce stress. It was so successful that it quickly exploded across the nation and now nearly half of the medical schools teach a form of mindfulness, and many healthcare systems offer classes for both patients and providers.

Practicing mindfulness means practicing being aware in the moment. You are not thinking or daydreaming or worrying. You are not judging. You are simply watching and noticing what is happening internally and externally. By watching, you increase your awareness of yourself, your thought patterns and your automatic behaviors.

For example, as self-awareness increases, we can begin to identify and understand our triggers. Under what circumstances do we become angry? Or frustrated? Once aware of these negative emotions, we can stop and ask: Is this really how I want to behave in this situation? Is this my best choice to resolve the situation? In this way, reaction can change into thoughtful action.

This process of becoming self aware develops a person’s ability to respond to what is actually occurring in the moment rather than on what one thought was going to happen, was afraid might happen, or thinks should happen.

Making an Informed Choice

Informed mindfulness connects mindful self-awareness with educated decision-making. The mindful leader is aware of what is occurring in the present moment and understands that his or her response is a choice. But that is not enough. We need to understand what our choices are, and which choices are the best. Hence, the concept of informed mindfulness. As situations arise and decision points are faced, a mindful leader will be able to place what is happening in its larger context and, having clear values and being sufficiently educated, make an informed choice.

We are furthering this concept in the Leadership Program in Integrative Healthcare at Duke University and will be publishing more about it. But the bottom line is that healthcare leaders who engage in self-development—embracing those qualities and behaviors that better serve themselves and their organization while changing those that don’t—will energize and inspire others to join in and bring transformative change to our healthcare system.


Adam Perlman, MD, MPH, is the associate vice president for Health and Wellness for the Duke University Health System, the executive director of Duke Integrative Medicine, and director of the Leadership Program in Integrative Healthcare at Duke. For more information, visit: www.integrativehealthleaders.org.