Experience and skills are not enough to assure the highest levels of success and sustainability with improvement initiatives in healthcare. The reason this is true has to do with … quicksand.

When I was a kid, quicksand seemed to show up in movies quite a bit. People would be on the beach or in the jungle walking on what seemed like solid ground and suddenly get stuck. In quicksand, you lose freedom of movement. The more you try to move, the more stuck you get.

The solid ground of successful improvement is established by the evidence-based changes and quality improvement methods that guide us. This technical approach is essential for success.

But, the highest levels of success and sustainability depend on integrating a relational approach. Relationships which facilitate psychological safety and intrinsic motivation improve learning, innovation, and performance. This requires maintaining open, honest conversations which elicit and explore each person’s feelings, disagreements, ideas, and concerns.

So, the true solid ground for the best success requires integration of technical and relational approaches. This demands a lot of mental and emotional agility to fit the needs of each unique situation. The technical approach involves the logical, objective, and systematic. Its focus is role, task, and performance-centered. The relational approach involves the subjective, intuitive, and nonlinear. Its focus is person-centered—that is, on others’ feelings and concerns.

Just as real-life quicksand restricts freedom of movement, two major factors are quicksand-like in restricting mental and emotional agility by pulling us strongly toward the technical. First, our professional culture has greatly emphasized the technical over the relational. Second, even minor stresses trigger automatic habits of mind hard-wired into our brains. These habits cause leaps to quick solutions and a fast-paced task orientation. This leads to over-emphasizing the technical and a high risk of relational difficulties like resistance, disengagement, meetings that go awry, and unresolved conflict.

The quicksand-like effects of professional culture and automatic habits occur in our blind spots. It is astonishingly easy to over-emphasize the technical even with high relational commitment, experience, and skills. In my years as an improvement leader, despite my strong relational orientation and skills, I now see that I would think I was being relational in my friendliness and positive engagement of others in problem solving. But, under the pressure to get results, I did not slow down often enough to assure each person was engaged around deeper questions about feelings, what they really cared about, and personal challenges.

While quicksand never goes away, we can diminish the frequency and duration of getting stuck in over-emphasizing the technical through a steady practice which continuously enhances our mental and emotional agility. This practice involves reflecting about work situations before and after using questions that hold the mirror to our own thinking and feelings. Here are a few examples that I find powerful.

• How am I thinking, feeling, and acting in this situation?
• What is my vision for the results, relationships, and culture I want to achieve?
• Where are there discrepancies between my current actions vs. my vision?
• What are my options for improving my next conversation?

The more we reflect about work situations before and after, the more agility we develop in-the-moment, in the midst of work, to assure progress on both relational and the technical issues in ways that fit each situation.

Reflective practice is hard to develop and sustain entirely on our own. Ideally, we would receive support through our leadership teams in a group practice. But, this is too often not available. Episodic individual coaching is another option.

Through many years of working and helping others with reflective practice, I am excited about the success that can be achieved. There are usually far more good intentions and skills to tackle relational difficulties than seems apparent from current behaviors. Even just 15 to 20 minutes of practice a week can have a positive impact. By taking the time, we get out of quicksand more quickly and ultimately save a lot of time.

Neil Baker is a physician and founder, Neil Baker Consulting and Coaching.

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