Habits of mind for turbulent times.

Are these tough times? Lets put it this way: Health care executives in the late 1990s sleep like babies--they wake up every two hours and cry.

I'm writing this in a lovely, capacious beach side suite at the Amelia Island Plantation in Florida. Fate, disguised as an invitation to speak at a health care conference, has conspired to give me 24 hours in this beautiful spot. And it's raining. It has been raining all day and all night. At the moment, in fact, lightning is tall-walking the oak scrub forest, and thunder is hammering my ribcage every few seconds.

Where do I file my complaint? My brief time to enjoy this vacation spot is ruined. Do I call the front desk and rant at them: "You tricked me! The photos in the brochure definitely show sunshine, not thunder and lightning." Maybe I would do better to rave at the clouds, standing on the porch and shaking my fist at the sky: "You can't do this to me! Don't you know who I am?"

If I was really lucky, that might earn me, like Job, a visitation from the Lord of Thunder, who asked him a pointed question: "Where were you when I fixed the foundations of the deep and wrestled with Leviathan?" More likely, it would earn me a visit from the police.

The question really translates to: Are you in control of this? Do you have influence over this? What power do you have here?

We make clear distinctions between what we can control and what we cannot. The rain has ruined my plans for laying on the beach, so I'll stay in and write. I have made all the proper arrangements to get to the airport on time tomorrow. Making the arrangements is under my control. But if the weather delays the plane or closes the airport, I will just call my wife and tell her that I'll be late. Some changes are under my control, some are not, and I simply adapt. Most of us can carry that off just fine.

But what about changes other people cause? What if I miss my plane because the driver was late? Or because the travel agent gave me the wrong information? Or because the bellman inexplicably impounded my bags? That would seem to be a completely different matter, cause for some table pounding, a little therapeutic venting, wouldn't it?

Why?

Do I have any more control over the work habits of a tram driver in Florida I have never met before than I do over the weather? Yet, when a human being causes us to have to change our plans, maybe in a way that is harder, less fun, more expensive, or even more dangerous, we tend to direct our basic emotional response toward that person: They could have done that differently. They caused this problem. It's their fault.

And too often we hurry right on to the next stage, the assumption that says: "They are doing this to me." Or: "This is happening to me because of my shortcomings."

These emotional reactions get in our way. They color our perceptions and drastically reduce our ability to notice what the situation really is, and to plan our best course.

Here's the key: It's all weather. Whatever you can't control, no matter who does it or why, is just part of the weather--where you are right now.

How do we treat weather? We try to find out as much as we can about what's coming, but we keep its unpredictability in mind. We prepare for its extremes as wisely as possible. We grieve any losses it causes us, and celebrate the lovely spring days and quiet summer evenings it gives us. And never once do we take it personally, think that the weather is out to get us, or that lousy weather means that somehow we have failed. We just know that it's not personal.

What if we dealt with change that way? When corporate headquarters decides to move oncology to the other facility across town, when the enthusiasm level for the new Quality Teams hovers in the single digits, when the vendor for the new computer system announces a six-month delay?

It's easy to see that these examples are not personal--they're not aimed at you--and to see how, with some practice, we could learn to treat them like weather, without anger, with clear eyes and full faculties.

But what if it really is personal? What if they really are out to get you? (Remember the saying, just because you're paranoid doesn't mean they're not out to get you.) What if it really is because of your personal failings?

Think about Ronald Reagan. Any president automatically becomes the world's biggest punching bag, and Reagan was no exception. But Reagan was the Teflon President. No matter what they threw at him, nothing stuck. Why? Because of his attitude. He didn't seem to take anything personally. The most negative response he came up with in election debates was, "Now there you go again," accompanied by a wry smile and a shake of the head. This gave him enormous room to maneuver. What a contrast with Richard Nixon, who took everything personally, dug in, and fought back with everything he had--and in the process drew greater attacks and cut off his options. Nixon ended up going over the lines of legality and resigning in disgrace. Reagan became the first president since Dwight Eisenhower to serve two full terms.

Reagan did not give power to his enemies by rising to the bait. Don't give your power to the problems of a changing environment. Treat it like weather: Maybe you need to fill sandbags, maybe you'll have to relocate the town. But you don't have to waste energy screaming at the river. That's the essential difference between reacting to a situation and responding to it.

Reaction shuts down true learning. A tiny child knocked over by a large, playful dog reacts emotionally and imprints the learning: Dogs are scary and evil. If the same child approached the dog with his mother, in a calm state, he would learn something more complex, such as: Dogs can be big and scary, but sometimes they're nice and fun to pet.

Horse trainers say that a horse that is quick to learn has a soft mouth, that is, it responds to the tugs of the reins easily and quickly. If I am responsive rather than reactive, if I treat the changes like weather, I will have a soft mouth, learning easily whatever the situation offers me.

Learning to respond instead of react is a two-step process. First I have to alter my perception, then I have to alter my habits.

What happens, and the story about what happens

There's what happens, and there's the story I tell myself about what happens. They are not the same.

What happened might be: Andersen has asked for a review of the budget for the operating nurses. The story I tell myself might be: Andersen is looking for fuel for his campaign to replace circulating nurses with non-registered OR techs.

Maybe later I will find out my story was correct. But if I am to treat the situation like weather, and think it through with all my faculties, I have to make sure that I know that difference between the facts at hand, and the story I am constructing about those facts.

Most people, most of the time, live in the story they are telling themselves about the moment, rather than in the moment itself which means that they miss (or misinterpret) any detail that doesn't fit the story line.

I am not my acts. I am my habits.

Aristotle put it this way: "We are what we repeatedly do. Excellence, then, is a habit, not an act."

How did you become a doctor? It wasn't just learning the facts, hard as that was. There came a time when you realized that being a doctor had become a part of you, through long and constant practice. You no longer had to think about it. How did you get there? Through a long period in which you acted as if you were a doctor. You put on the white coat and the stethoscope. Perhaps the first time a patient addressed you as Doctor, you looked over your shoulder to see who else was in the room. Maybe you felt like a bit of a fraud for a while. But over time, the learning, the professional stance, the physicians set of mind, became habitual. They came to you automatically whenever you needed them.

If we need new habits of mind to deal with an increasingly turbulent universe, we have to go through the same process. You might pick up new ideas by reading a column like this one, or a book, or by going to a seminar, or through talking with a friend. But knowing an idea is not enough. To make it work in your life, you have to put it on daily like a lab coat, practice as if it were really a part of your deep armamentarium--until one day it is. One day a crisis arises, a problem blows up in your face, a change comes barreling around the corner--and you handle it with the finesse, power, and subtlety you've been pretending to possess.

I talked to tennis great Arthur Ashe a decade ago. I have always been fascinated by people who achieve true mastery, in whatever area. So I asked him: If he could give one piece of advice to young tennis players--or to anyone attempting to master something--what would that advice be?

He said something that deeply surprised me. He said, "Don't try 100 percent. Try 95 percent." The comment was opaque to me, so I asked him to explain. He said (paraphrasing from memory) that coaches are always telling their charges to "go all out" or "give 110 percent" in the tournaments. But by the time you're in a tournament, whatever you are trying to put out there should be second nature, drilled in by the thousands of hours of practice. Go all out in practice, to make the moves a part of you. Then in the tournament, when it really counts, relax so that those habitual moves can come out.

His comment made me think of that famous scene in Star Wars: The Empire Strikes Back, in which Yoda, the wise, ancient pipsqueak Jedi knight, is telling young Luke Skywalker that he can raise his starship from the swamp it has sunk into by using the Force. Luke says, "I'll try." Yoda says with barely veiled contempt, "No try. Do or do not. There is no try."

As long as we are still trying, exerting ourselves to use new ways of thinking to deal with change, we will not be effective. Only when we have put them on daily like a lab coat and stethoscope for a long period of time, will they become habits--new, strong, and useful parts of ourselves.

Joe Flower is Principal of The Change Project, in Larkspur, California. He has written about change in health care for over a decade. Author of hundreds of articles, he is a Contributing Editor for the Healthcare Forum Journal and New Scientist, a system host of The Well Computer Conference, and a faculty member of HealthOnline. If any of the ideas presented in this column resonate with your experience, drop Joe a line at The Physician Executive, or at [e-mail] on the Internet.