The March/April 2000 issue of The Physician Executive (volume 26, issue # 2) is a splendid contribution to health care management literature. The theme of the issue is "reconciling the inner self with the business of health care." Articles contain words and phrases like spirituality and humane reconstruction of the U.S. health care system. In the lead article, Leland Kaiser, PhD, speaks of moving "beyond simple marketplace values to promote the social, political, and economic good of the community as a whole." There is neither sermonizing nor moralizing in these articles. Rather, the reader finds fresh and bold management advice.
As our 20th Century minds grapple with these 21st Century ideas, and as we decide what to do, if anything, and when, we must deal with at least four predictable problems:
1. Fear of the unknown. Many executives project their official status onto their personal life and beliefs, instead of the other way around as suggested in these articles. Such a person may not be eager to add a whole new dimension to his or her life. So, rather than risk discovering the true nature of his or her "soul," such an executive might simply decree these "soft" activities a "waste of time," and order that they not be included on meeting agendas or in internal educational sessions.
2. Running afoul of management's habitual implementation approach. "Wow, this is great stuff! Quick, let's create and appoint the Spirituality Committee and start joint meetings with the Ethics Committee, staffed by the Spirituality/Ethics Officer, which duty can be added to the job description of one of our vice presidents!"
3. Introducing spirituality into high echelons of leadership offers great potential for abuses of personal power. The classic historical example is the religious charlatan, Rasputin, who briefly gained control of Russia by influencing Czar Nicholas II and, it is said, particularly the Czar's wife, Alexandra. A similar, even if less dramatic, scenario in a health care corporate palace may sound far-fetched, but probably isn't.
4. Using the terms ethics, morals, spirituality, and religion synonymously. Ethicists codify human values, whereas moralists classify choices of human behavior as "good" or "evil." The following two quotes from the March/ April issue indicate differences between spirituality and religion. John Babka, MD, suggests that, "spirituality (means) a commitment to...society in general; (plus) an open pursuit of peace through God, nature, or our inner soul." (The italics are mine.) Openness is important, and so is allowing the individual choice of the avenue through which spirituality is pursued. Lee Kaiser points out, "Unlike religion, which has often separated humanity, spirituality unites diverse peoples in a common effort to improve the human condition." Such distinctions between ethics, morals, spirituality, and religion will not be immediately acceptable to some. It will be important to respect the need for religionists to adjust to this 21st Century, indeed Third Millennium, way of thinking.
Richard E. Thompson, MD
Our inner relationship with Spirit
Kudos to The Physician Executive for bringing to the forefront issues of spirituality in health care in the March/April issue. Leland Kaiser, PhD, is absolutely right when he suggests that "a new mental model [will be] adopted that views limitations in consciousness as the most basic problem facing health professionals and their organizations," and that "the physician executive should be a primary proponent of spirituality in his or her organization."
My experience is one of coming to peace with being rather than doing. By making it a priority to expand my awareness, I was able to foster spirituality in my environment and with others through executive coaching. Spirituality is not about what you do or how you set up work or the environment--it is about who you are, what your level of consciousness is.
The higher our awareness, the more integrated and elevated our experience. Expanding consciousness does not have to be painful or difficult; it simply has to be remembered as being of critical importance and given some priority in our lives. The results: clearer vision, integrity, economy of means, and deeper, and more satisfying relationships.
Many organizations jump to "incorporate spirituality," missing the groundwork that the top executives need to do. It becomes even more difficult for those executives and their organizations, as they struggle to make things "look spiritual," when, in fact, spirituality is an "inside-out" experience of life. The key is integrity, maturity, and expanded awareness as an individual first.
Thanks again to The Physician Executive for providing several outstanding consciousness-raising articles in the March/April issue. Hopefully readers will look within themselves and find inner peace before they try to change their environments.
Marsha Milburn Madigan, MD, MPH, FACHE
Open to higher thought
I have observed with pleasure the gradual change in tone of The Physician Executive, from a predominantly technical, professional journal to one more open to higher thought, and to systemic realities. The March/April issue (volume 26, issue # 2) was a beauty (an Australian term of enthusiastic approval). Starting with Leland Kaiser's wise and compelling case for more spirituality, to Andre L. Delbecq's profile and the work he is doing, to the always eagerly anticipated Joe Flower. I'd like to work with Richard Thompson, MD, whose understanding of practical ethics seems to match my own.
Half a decade ago I was concerned at the preoccupation evinced in your journal with how to get the greatest slice out of the managed care cake. Now, in articles by Gleicher and Coulter, the journey back to the core business of professional medicine seems to be well under way. Hallelujah!
My theses of the early-mid 90s, which I presented to limited audiences, were that you should not, by losing professional independence, abrogate responsibility for professional standards, nor allow "health" capital to be controlled by a command hierarchy, whether it be dominated by short-term, profit-taking rent seekers, or by political opportunists manipulating government. Under such circumstances, as the evidence worldwide shows, physicians, starting with primary care physicians, become trapped as wage slaves, answering to lowest common denominator (or worse) standards set by content-free bureaucrats. Or to the short-term interests of the most powerful (who control the capital). This doesn't build an efficient or effective health system--or one with compassion or spirituality.
Virtually all the contributors to the March/April issue look forward from these principles. I congratulate you all.
Maarten de Vries, MBBS, MHP FRACMA, FAFPHM, FAIM
MDV Leadership & Management