The role I play in the health-care process can be hard to define. We call it “engagement,” but what does the word even mean? My role is to bring patients and families together in planning and improving treatment. But it’s a lot harder than it sounds.
Earlier this year, I proposed including patient or family advisors within a staff working group, as an important way to improve the cancer patient experience. As I shared my knowledge about engagement, one of them politely turned to me and asked: “Why would we bring a patient or family member into the group? We’ve had plenty of good ideas about how to improve for years; some of them are similar to what our patients and families suggest, but no one listens to us. Why would we do that to a patient or family member?”
Many others around the table agreed with the statement. A discussion of ethics ensued and I listened carefully: no one was trying to be oppositional, but they were sharing the truth of their experience.
It dawned on me: while I could bring patients and their families to the planning table, the work of “engagement” wouldn’t be successful unless staff felt they also had a voice. I saw that, without having staff feeling empowered or engaged, we could never bring about the changes we need. Without having all the pieces of the puzzle in the conversation, we could never see the whole picture. This was practice-changing for me. I changed my philosophy, from advocating for the importance of patient and family engagement to seeing engagement as a way of increasing everyone’s systems intelligence. This is a form of “systems thinking.”
Peter Senge defines systems thinking as “the whole being greater than the sum of its parts.” We live in a web of interdependence and everything we do, even if it’s a tiny change, has influence. In a system as complex as health-care, we cannot predict that impact. Systems intelligence means that we need collective intelligence: we need balanced perspectives and generative conversations between all of the smart people in the room. We don’t need just one smart person to tell us what to do. We have to be prepared to be wrong, to listen to opposing views, to create teams where it’s safe and there’s enough trust to disagree with each other and to be committed to trial and error.
That reflection brings me back a leadership concept that I find inspiring: if we define leadership as changing the world, it’ll be too big and beyond us – it’ll become an excuse to become a victim of the system. However, if we acknowledge that true leadership happens in the moments we create with each other, day to day, then we shift the paradigm. Suddenly we’re all accountable.
Now I approach the work of engagement with “systems smarts,” and I try to foster the same in our patient and family advisors, staff and leaders. It changes the conversation. Knowing that I am not right, that I only have one piece of the puzzle (and that’s true of everyone at the table, no matter what their title is) but also knowing that each person is infinitely able to make a difference at the same time is a powerful paradox to hold. Collectively, we can start to see what one individual cannot. This new interpretation of the word engagement (or engagement redux) renewed my sense of fulfilment in my work.
Jessica Dollard is the patient-centred experience advisor on the Calgary Cancer Project. As a consultant in engagement and patient experience, as well as an actor, film and theatre producer, programmer, medical skills trainer and executive certified coach, she brings a creative background to this work.
Watch Drew Dudley’s TED talk on Lollipop Leadership to be fully inspired by this concept.