There are some books you read that change your life. In this new series at St. Emlyn’s I’m going to tell you about one that changed mine – and I think there’s a good chance it might change yours too. It was 2010 when I read this book. I was about to start the NIHR leadership programme, learning how to be a ‘good leader’. I trawled Amazon looking for books on leadership. I bought lots, started reading most of them and quite often gave up half way through. Most of them were a little dry and ‘business like’, which made them difficult to read. The worst thing about most of the books, however, is that they tried to teach readers to act in certain ways in order to maximise their own personal gain. Such encouragement to practice selfishness and apparent hypocrisy seemed to be spawned from a ruthless businessman’s insatiable desire for continually increasing profit at any cost.
Stephen Covey’s ‘The 7 Habits of Highly Effective People’ was very different. Not only was it extremely easy to read but, from the first word, it focused on principle-centred leadership – a concept I could really buy into. I’m going to tell you about why I think you should read this book, and what we can learn from it in medicine. Because there’s so much to talk about, this will be a 7-part series: one post to discuss how each of the 7 habits that Stephen Covey described is relevant to us in medicine.
[DDET Who was Stephen Covey? ]
Stephen Covey was a guru on leadership who wrote quite a number of books. The 7 Habits was, without doubt, his most famous. In 2012 Stephen Covey died, aged 79, of complications following a bicycle accident that occurred 3 months earlier. You can still find his account on Twitter and it’s well worth a trawl through his archive of tweets. You’ll find some pearls as great as this…
Becoming principle-centered is a process of becoming. It’s a lifetime quest. We all, at times, get off track. Just get back on track.
— Stephen R. Covey (@StephenRCovey) December 6, 2011
Perhaps what Stephen Covey stood for the most was principle-centred leadership. He said:
“There are three constants in life: change, choice and principles”
[DDET What were the 7 habits and why is the title so funky?]
If you’re anything like me, there was one thing putting me off buying this book: the title. What does it say about you if you’re reading a book about the habits of ‘highly effective people’ in the park or on the beach? It’s definitely one for the Kindle. But once you get over that, the book is awesome. And, sooner or later, you realise what Covey meant by a ‘habit’.
[DDET How are the seven habits broken down?]
The 7 habits will take you on a journey from ‘dependence’ to ‘independence’ to ‘interdependence’. Why is this important? Well, in Stephen Covey’s words…
“Dependent people need others to get what they want. Independent people can get what they want through their own efforts. Interdependent people combine their own efforts with the efforts of others to get the greatest success”.
The first 3 habits are about personal development: moving from ‘dependence’ to ‘independence’. The second 4 habits are about building interpersonal relationships and moving from ‘independence’ to ‘interdependence’. In this post, we’ll be focusing on the first habit: be proactive.
[DDET Be proactive. What does this mean and how is it relevant to leadership in medicine?]
It sounds pretty obvious, right? There are two ways to be: proactive or reactive. A proactive person goes out and makes things happen. A reactive person waits until things happen and reacts. It really doesn’t take a genius to realise the benefits of being proactive. But there’s so much more to this than first meets the eye.
When things aren’t going so well – be it with a patient, a relationship or a system – we’re naturally tempted to think about the root causes outside of ourselves and to, quite frankly, moan about them. How often do we all do that? We moan about colleagues, about politicians, about hospital managers. And there’s the lovely word “they”, which allows us to blame ‘others’ without actually having to name them. Think about it. I’ll bet you’ve done it at least once in the last month.
Stephen Covey taught us to focus on ourselves, on what we can change:
“If I really want to control my situation, I can work on the one thing over which I have control – myself”.
He broke this down into our Circle of Concern and our Circle of Influence. The former includes all the things we might worry about. The latter includes (within that) only the people or things we might have some influence over. What’s the point in worrying (or moaning) about things we can’t influence? If you can’t do anything about it, you may as well get on with it. That’s what our patients with chronic disease have to do, after all. Focus instead on what you can change. That’s what proactive people do – they focus on their Circle of Influence. Reactive people focus instead on the Circle of Concern.
“When we succumb to thinking that we are victims of our circumstances and yield to the plight of determinism, we lose hope, we lose drive, and we settle into resignation and stagnation”.
I doubt that I need to point out the lessons in this for each of us in our work. I think Stephen Covey’s message comes across loud and clear. To put it simply, when things aren’t going well we need to stop moaning and do something positive. And even when nothing is going wrong, do something positive.
[DDET Is there anything else to ‘proactivity’?]
The other important thing to realise about ‘proactivity’ is what it tells us about how we should respond to what happens in our lives. How often do we hear that things go wrong ‘because a certain thing happened’? We reacted angrily to a colleague because they provoked us. We were off hand with an abusive patient because they abused us. We failed an intubation because the airway was difficult and the laryngoscope didn’t work.
In his book, Stephen Covey reminded us to:
Be Proactive. Remember that between stimulus and response there is a space. http://bit.ly/JbstC
— Stephen R. Covey (@StephenRCovey) July 21, 2009
Our reaction needn’t be driven by what happens. We still have a choice about how to respond.
“The ability to subordinate an impulse to a value is the essence of the proactive person. Reactive people are driven by feelings, by circumstances, by conditions, by their environment. Proactive people are driven by values”.
If a colleague provokes us, we still have a choice – and (while it not seem it at the time) the better choice may not be to react angrily but to wait. Is a patient abuses us, the better choice may still be to remain compassionate. And if we fail an intubation, the choice is about how we react. We can bemoan our terrible luck; we can get nervous and start thinking about the adverse consequences for the patient (and ourselves); or we can crack on and make the best of a ‘challenging’ situation (as Richard Levitan would say).
— jeremy faust (@jeremyfaust) March 18, 2014
[DDET A final word on what ‘proactivity’ really means]
Lastly, and very importantly, our proactive choices extend even to include our own mood. As Stephen Covey also said:
“Happiness, like unhappiness, is a proactive choice.”
This is one of the lessons that I think SMACC Gold taught me very well. It was full of people who were happy and fulfilled. They were all enjoying their jobs – remembering what it was that had made them so passionate about doing them in the first place. We too have that choice.
Our jobs and our lives are very busy; not everything goes well for us (and for our patients) – sometimes they go incredibly wrong; we put up with some terrible abuse; and we have to work antisocial hours when everyone else is socialising, seeing their family or sleeping.
But the world is as it is. There are some things we can’t change. If we accept that, we then have a choice about how to conduct ourselves and to deal with the things we can change.
So be proactive – change the things you don’t like within your Circle of Influence; if there are things you don’t like but can’t influence then either accept them or work to expand your Circle of Influence; and, whatever happens, be happy in what you do.
In tribute to Stephen Covey