Mary Jane Kornacki, MS, interviews Della Lin, MD, anesthesiologist and Senior Fellow in Patient Safety Leadership at Estes Park Institute, during the 2017 IHI National Forum.
Mary Jane Kornacki: I’m here at the IHI National Forum in Orlando, Florida, with Dr. Della Lin. Dr. Lin is an anesthesiologist practicing in Hawaii, and is also a leader of statewide collaboratives in Hawaii and a faculty member at Estes Park [Institute]. Welcome, Dr. Lin.
Della Lin: Thank you. It’s good to be here.
Kornacki: You were going to tell us a little bit about your leadership journey, and I believe you started your journey as a musician.
Lin: I did. I was supposed to be a concert pianist. That was my intended future at one point. I remember having a music lesson with my teacher, a Hungarian lady, very task oriented, and she had me, for one lesson, play not a single note — which was startling to me. I thought, “Oh, surely we’re going to get to the music part of this lesson soon,” but she had me spend time just walking out — “pretend that you’re on stage” — addressing the audience, the invisible audience, and sitting down. Then she said, “Pretend you’ve already played. Now, get up.” And getting up, standing, addressing the audience, bowing, and walking.
What she was trying to teach me was (1), [that] first impressions are incredibly important. Second, the way you connect to the audience — for me to be able to make sure that I took the time to look out to the audience, bow to them, acknowledge their presence, and that this was a journey we were going to go through together. The performance was going to be something that we were going to experience together, that I was gifted with their presence. So that was an interesting story to have experienced.
Kornacki: Today we talk about patient-centric medicine, but also I was thinking that’s an audience-centric performance. Thinking about it, it’s not just about me playing the piano. It’s about the audience’s part of this experience, and I need to also be focused on how I’m projecting to them.
Lin: Right. [Among] the other things that she taught me, or maybe I learned it in my music journey, [is] that performances never go the way you think they are going to go. You make mistakes, sometimes unintentionally, mostly unintentionally, but even so you have to go on. Execution doesn’t always go the way you’ve practiced it multiple, multiple, hundreds of times. That has served me well, knowing that things don’t always go as planned.
The third lesson that I learned in music was timing. I was fortunate in that I was not yet 16 when I graduated from high school, and I was admitted to Curtis Institute [of Music], so I would have been 16 years old going to Philadelphia from a smallish town. I lived in Champaign-Urbana, Illinois, which at that time had less than 100,000 people in its population, and my parents just basically said no. “There’s no way our daughter is going to go to Philadelphia.” Everything big city seemed like a scary and dangerous place for a young teenage girl.
They said, “No, you’re going to stay in Champaign-Urbana for a couple of years and go to the university, and then you can go on.” In those 2 years, there was enough that had happened with my colleagues who were competing — we were in this competing circuit in piano — that I realized I basically had given it a pass. That I was not going to go into music.
Interestingly, about a year before that, I had an aunt who told me, “You know, music is uncertain. It’s completely left to your critics; the next morning after your performance they could just completely say this was a horrible performance and then you’re totally at the whim of these critics, and science is exact.”
Kornacki: If only.
Lin: Now, I had no idea at that time that her information was deeply flawed — and in fact, science and medicine are far from exact — but at that time, at that impressionable age, I thought, “Well, I don’t know. Maybe going into science has a little more security than going into the music field.” So timing, performance, and intention, that intention with your audience, were important things that I learned.
Kornacki: You talked a little about the kind of people you drew close to you when you were trying to make key decisions, and how there could be a downside to picking like-minded colleagues.
Lin: One of my examples is from when I was a department Chief of Anesthesia. We had about 80 people in the department at the time, so it was a pretty large anesthesia department — for those listening, they might not realize that the department would be quite that large. [When] you become a department chief, you’re supposed to do things like make sure you are Joint Commission compliant, etc., and I thought, “I can’t do this alone. I need a core group” — whether you call it cabinet members, or core team, or executive council, or whatever.
I picked three people I had known, worked with somewhat, thought to be thoughtful people that could execute on what I felt, as a leader, was your charge. Your charge was to move forward and do these things. The decision that I made that was in error was that all these three people were exactly like me, which made it easy for us to get along. It made it easy for us to get that policy done, or get the initiative to the next level, but it made us, (1), very, very wedded to our ideas because we had set up this extra process of thinking it out, and spending the time and getting invested in it, and (2), nobody else was invested.
The people who were not like-minded had no idea where we were coming from or couldn’t understand why would they take the time. So I became fond of this notion of the wisdom of crowds and the importance of diversity of opinion. The importance of taking the time and saying, “Am I asking the right question? Do I have the right voice at the table? Should I change the focus, or should the focus at least take a different perspective? Do we need to take some time?”
Timing is a tough thing. I mentioned timing before, but the idea of timing and leaders, for me, I continually struggle with it. When do I need to push? When do I need to lead with urgency? When do I need to take a step back and let the group take the time to get to that point where they feel the urgency themselves? I don’t know if other people have ideas, or want to help me with that journey. I certainly don’t get it right all the time, but I think about that, that the timing is important.
Anyway, going through learning about the diversity of the wisdom of the crowds, it became clear to me that culture had a lot to do with decision-making and leadership, and that leaders have an important job of creating the culture for an organization. I became a big student of culture and I had the fortune of having tea with Edgar Schein, which was just a huge gift to me.
Kornacki: Do you want to say a word about who Edgar Schein is for people who might not be familiar with his work?
Lin: He’s basically the guru of organizational culture. For listeners out there, anything you can get your hands on, Humble Inquiry, Helping, those are smaller books, but he has larger texts as well.
Kornacki: Corporate Culture and Leadership is in its [fifth] edition. I think that’s his big book.
Lin: Yes, and it’s not dated. People might say that it’s dated, but it’s still timely, speaking of timing. What he taught me was, culture is really about relationships, when you boil it down. It may be a big textbook and he has lots of great examples, but when it comes down to it in one word, or one sentence, it’s all about relationships.
Now, I had come to understand that culture is a lot about problem-solving, because we often hear the phrase, “Culture is the way we do things around here.” The only way we get to the way we do things around here is that a problem occurs. A group of people come together to try to solve the problem. They solve it successfully, and that team, the next time they are confronted with a problem, says, “This way worked before. Let’s use this process again.”
When an organization does that over and over, and over again, that becomes “the way we do things around here”, and that becomes the culture. If culture is about problem-solving, and culture is about relationships, then problem-solving is all about relationships. With the one-on-one relationship, or the group’s relationship, I’m understanding what’s important for each person on the team.
When I was a department chief, I tried to make sure that I knew something about every single person in my department. [Among] the ones I remember still to this day, even though it was decades ago, was one individual who loved to paddle every morning for 30 minutes before coming into the OR. That was incredibly important to him, and I would never ask him to have a meeting before the OR because that would be crazy. I would have taken the one thing that was so important to him and he would lose that.
Somebody else loved to fish, whatever it happened to be. Somebody else was a marathon runner, and somebody else coached soccer. For that person, we couldn’t have a meeting at 3 o’clock or 4 o’clock because coaching was important. But also, I could take his coaching skills that he was learning from his kids’ soccer team and try to bring that to our understanding of strategic planning and initiatives.
So [it’s about] understanding what’s important to people, and what I’ve done with that in more recent times is I have the fortune of bringing all Chief Medical Officers within the state of Hawaii together. There are about 15 to 20 of us, and we, prior to this the group, never met on any formal basis. They come from different systems. They all are well-established leaders, but you might say that sometimes we have competitive interests in mind.
The idea of this group was to think about the patient journey and to think about what we could do in the state of Hawaii to ensure that no patient is harmed. How can we ensure that we don’t, unwittingly, in our competitiveness, destroy our commons? How do we make sure that we support each other in the important areas that we need to support? How do we think about some of these upstream things like food security, or homelessness, and how do we think about that as a group of individuals?
One of the things that I’ve done to think about this idea of relationships is that we start every meeting with one of us telling our personal narrative. That personal narrative is a tool I learned from Marshall Ganz, and it’s about talking about the story of yourself, the story of us as a group, how that connects, and then the story of now, which is, why is it so urgent for us to approach a problem now?
We get to know each other at a level totally different than the usual introduction. The usual introduction is, “I’m an anesthesiologist and this is where I trained, and this is my job now. It was at a deeper level of, why do you value what you value, and where did you have an important decision point where that value became critical in your decision-making? To know that about each other puts our room at a very different tone, and the ability for us to possibly do anything much more real.
For me, the reason I’m still in leadership at this point is that I like to shoot for the moon. I don’t think anything is impossible, and as long as I go to bed and say, “I just discovered something new today,” and I’m in a constant mode of learning and discovery, I don’t think I’m going to retire. This leadership work is too much fun to give it up. But what I’ve come to know as the important lesson from Edgar Schein is that the relationship fundamentally is the important piece.
The other thing for me that was important in that lesson is when I came to this job as a female leader, there was a concern of mine — and maybe it doesn’t exist now, but at least it was a concern of mine back then — of not appearing to be squishy . . . [thinking] you’re going to be squishy in talking about relationships. So I tended to be a little more task oriented, and check boxes, and deliverables, as opposed to really understanding the importance of the personal relationship. I have enough years behind me now that I understand that that is so important, and I regret that maybe I took that harsher thought initially.
Kornacki: Thank you for sharing. Those are impressive lessons and really important, and I think the readers are going to get a lot out of that.
Lin: I hope so. And if anybody has any advice for me, please speak up.
This story was recorded at the Institute for Healthcare Improvement’s 29th Annual National Forum in Orlando, Florida, on December 10–13, 2017, by Mary Jane Kornacki on behalf of NEJM Catalyst. We wish to thank IHI for support of this project, especially Madge Kaplan for her technical advice and guidance. Click here for more Lessons in Leadership stories.