“That’s not how we do it here”. I always cringe when I hear these words. Yet this is often what we find ourselves saying to new staff joining us, either from another ward, hospital, province or country. Well intended, we instinctively want to help orient our colleagues. While it is important to establish our foundational policies, we also need to remind ourselves that we are not perfect, and new people bring new ideas, and this is how we grow.
Growth mindset means recognising that we can and must continue to expand our knowledge, and the ways in which we do things. It is much more than simply growing. We need to adapt, which means changing and evolving, and this is more difficult than simply growing.
Why do we do things differently here versus there? Shouldn’t we be practicing the same medicine everywhere? I believe the answer lies in the difference between what and how. “What” is the realm in which we strive for consistency and to uphold standards, whereas “how” is really about our culture. “What” may be the same in Toronto and Tofino, but “how” will be very different: the local application of what we do, based on many factors. These two components produce the ultimate outcome of patient care.
As a senior physician, I understand all too well the comfort and ease that sameness provides. If I was taught one way, presumably the right way, I need to remember that this was only within the context of a time and a place. Medicine is always changing and so too is the way we practice. This is something we all know yet we all naturally resist. Is it possible that a new graduate could know better than me? Definitely.
More importantly, the reality is that we do not work independently but within a large and complex system. Not only is it essential that we as individuals must be open and able to change, so too must our institutions. Our institutions must possess their own growth mindset. This may be even more difficult than simply changing the way we ourselves work. Our systems are not inherently designed to adapt, they’re designed to manage and administer. This is most effective for determining “what”, such as our efforts with harmonization of care, and developing guidelines to reduce variances of practice, each of which are important elements of quality care. However, it is not as effective when it comes to resolving “how” which occurs more organically from the front lines of care. We need to improve our systems for identifying and building on quality improvement ideas, and how we take these to implementation. Efforts to restructure and design our systems for change is one of the greatest challenge that we face as an organization, and one which we as leaders must be held accountable to.
President John F. Kennedy once said, “Conformity is the jailer of freedom and the enemy of growth”. While our systems require consistency, we also need to allow for change and evolution. If our culture is defined by how we do things, let’s work to create a culture of curiosity, openness and willingness to change. And let’s create an organization that follows the same principles, with structures that appreciate the important difference between what and how.
It’s summer time, the season of new growth and new life. It is also when we have new staff (nurses, physicians and other workers) starting at sites across the island. They bring new enthusiasm and energy, as well as new ideas and ways of looking at things.
The next time you hear someone at work (or yourself) say, “That’s not how we do it here”, remember that while conformity has it’s role, the real opportunity for growth comes from what others have to offer us. Take pause and be curious. Let’s change the conversation. New ideas are not threats but opportunities, at whatever level they appear. Learning is growing, and this is our life long journey.