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Informed Mindfulness and the Art of Decision Making
Author’s Accepted Manuscript Informed Mindfulness and the Art of Decision Making Adam Perlman
www.elsevier.com/locate/jsch
PII: DOI: Reference:
S1550-8307(16)30252-X http://dx.doi.org/10.1016/j.explore.2016.12.014 JSCH2174
To appear in: Explore: The Journal of Science and Healing Cite this article as: Adam Perlman, Informed Mindfulness and the Art of Decision Making, Explore: The Journal of Science and Healing, http://dx.doi.org/10.1016/j.explore.2016.12.014 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
SECTION HEAD: Leadership
Informed Mindfulness and the Art of Decision Making By Adam Perlman, MD, MPH
Throughout our day, we all face multiple decision points. On a personal level it may be things like what to eat or where to invest our money. On an organizational level, it might be decisions about how to reduce spending while still increasing productivity or who to hire out of the three applicants who have just been interviewed. Our ability to move in the direction of, and actually achieve, our larger goals and purposes are, to a great degree, dictated by these many decisions that we make daily. Every decision gives rise to a consequence, a result. These consequences can be large or small, but either way, the resulting outcomes then become causes for future decisions and actions, and on and on it goes. Understanding the full impact of our decisions and the ripple effects therein is a key component to making better decisions and becoming a more effective leader. AN OBLIGATION TO YOURSELF If you are in a leadership position, you have an obligation to keep evolving as a person and a leader. Just as you expect the best from your team, you should also expect the best from yourself. Maslow’s Hierarchy of Needs states that there are five interdependent levels of basic human needs (motivators) that must be satisfied in a strict sequence starting with the lowest level. They are: Survival — the physiological needs to stay alive and reproduce Security — the need to feel and be safe Love — the social needs for love, belonging and intimate relationships Self-esteem — the need to feel worthy, respected, and have status Self-actualization — the need for self-fulfillment and achievement If we agree with Maslow that the highest human need is for self-actualization — achieving one’s aspirations and living up to our full potential — then that should be our goal for ourselves. In his book, Motivation and Personality, Maslow said, “The growth of selfactualization refers to the need for personal growth and discovery that is present throughout a person’s life.” It is not about achieving some static state of perfection. Each of us continually moves toward or away from personal growth and self-actualization. But it is through a process of reflection and self-discovery and the pursuit of achievement that we discover the meaning in life that is both real and important to us.
This is why we practice mindfulness. Without the practice of paying attention to our thoughts, feelings, intentions and actions, without a thorough examination of our own desires and goals, it would be hard to have a clear understanding of our higher purposes and how our thoughts, feelings, intentions and actions are contributing to our self-actualization or how they are getting in our way. For example, if you have an intention related to a higher sense of purpose to influence your culture in a way that promotes well-being and you recognize that a core component of that is to emulate that which you hope to create; that then puts your decisions around your own wellbeing and need for self-care into a very different context. You have to set the example by appropriately prioritizing self-care activities throughout your day and within your life. Another example might be when you are managing an employee who is performing well from a productivity perspective, but is not behaving in a way consistent with the values of the organization and the culture you are striving to achieve. If they can’t be coached and ultimately adjust their behavior, you might need to sacrifice some short term financial gain by terminating that person’s employment. Making the right decision requires understanding the priority of your goals and intentions. In recognizing that values and culture come before short-term financial success, you let the employee go, which of course likely leads to even better financials in the future through better culture that in turn results in happier, more engaged and more productive employees. FROM UNDERSTANDING TO IMPLEMENTATION How do we move from understanding to implementation? First and foremost, we need to be mindful about our highest goals and intentions. We need to drop into mindfulness and use that awareness to move our decisions into action. Uncomfortable feelings may come up. Process those uncomfortable feelings – lean into them so that you understand where they are coming from and if, in fact, they serve you. It’s a part of life for any leader, a part of the chosen role. Sometimes when a decision is very emotionally charged, it is best to involve others. Check your own thinking and actions with people you respect. Let’s say you have an employee who you like a lot on a personal level but whose productivity is not meeting organizational expectations. Informed mindfulness about the situation will ultimately lead to a decision related to that employee that will deliver the best outcome attainable. Examine your priorities. We often have subtle competing priorities. Sometimes our thoughts are related to things we crave or wish to avoid. We need to be very clear about our own state of mind and emotions. If we deal with that employee from a place of needing to be liked or avoiding conflict or from a place of demanding respect or for increasing our own financial
success, we risk making decisions that ultimately don't take the greater good of the employee and the organization, and potentially even our own ability to create a greater good on this earth, into account. Continuous mindfulness, continuous self-reflection and self-understanding is key. We all have a multitude of purposes. I classify them as little p’s and big P’s. A little p might be to get an advanced degree. A big P might be to change the way medicine is practiced. When we are dealing with that employee, we need to understand what his or her needs are, what his or her p’s and P’s are, and how they relate to the big P’s, the goals and purposes, of the organization. Fully recognizing his or her strengths and weakness and how they align with larger purpose (mission) of the organization is critical. In the long run, we want to invest in people who can help us get the big P’s done. A key component of the value an employee brings to you and your organization relates to how well they make decisions, how effectively they perform and how they can advise us about their area as it relates to the big picture. A PERSONAL STORY Here is an example of mindful decision making in action. One of my managers and I disagreed on an issue about our budget. Both of us felt very strongly that we were right and the other person was wrong. Before making a final decision, I went to great lengths to ensure that she felt heard and to bring in the opinions of others. I don't like conflict but I was aware of that and did not avoid it. Instead, I engaged in healthy conflict, in discussions that looked at both sides. I had to step back and not heed the need to make myself right and someone else wrong. At the end of the day she still didn't agree with my decision but I felt I had done what I had to do to be consistent with my P’s. I want to be someone who does listen but who can also make decisions even if that decision isn’t the consensus. At the end of the day, if it’s my decision to make, I reserve the right to make the decision and be accountable for that decision. But I also hold the expectation that others on the team (after having been heard) will commit to that decision. It is only with that commitment that accountability and ultimately results can be achieved. In this case, everyone did commit and the team was able to put the issue behind and move forward. That likely would not have been the case had I, instead of being mindful, simply mandated the direction I wanted to go. IN SUMMARY Here are five things to do: 1. Commit to achieving your highest potential 2. Practice mindful awareness 3. Understand your own goals and purposes. 4. Lean into your fears and discomforts
5. Always act in the best interest of your highest goals and purposes.
AUTHOR BIO Adam Perlman, MD, is an Associate Professor of Medicine and works within the Duke University Health System as Executive Director of Duke Integrative Medicine and in a leadership role as Associate Vice President for Health and Wellness. Additionally, he is the Founder and Director of the Leadership Program in Integrative Healthcare at Duke University.
www.elsevier.com/locate/jsch
PII: DOI: Reference:
S1550-8307(16)30252-X http://dx.doi.org/10.1016/j.explore.2016.12.014 JSCH2174
To appear in: Explore: The Journal of Science and Healing Cite this article as: Adam Perlman, Informed Mindfulness and the Art of Decision Making, Explore: The Journal of Science and Healing, http://dx.doi.org/10.1016/j.explore.2016.12.014 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
SECTION HEAD: Leadership
Informed Mindfulness and the Art of Decision Making By Adam Perlman, MD, MPH
Throughout our day, we all face multiple decision points. On a personal level it may be things like what to eat or where to invest our money. On an organizational level, it might be decisions about how to reduce spending while still increasing productivity or who to hire out of the three applicants who have just been interviewed. Our ability to move in the direction of, and actually achieve, our larger goals and purposes are, to a great degree, dictated by these many decisions that we make daily. Every decision gives rise to a consequence, a result. These consequences can be large or small, but either way, the resulting outcomes then become causes for future decisions and actions, and on and on it goes. Understanding the full impact of our decisions and the ripple effects therein is a key component to making better decisions and becoming a more effective leader. AN OBLIGATION TO YOURSELF If you are in a leadership position, you have an obligation to keep evolving as a person and a leader. Just as you expect the best from your team, you should also expect the best from yourself. Maslow’s Hierarchy of Needs states that there are five interdependent levels of basic human needs (motivators) that must be satisfied in a strict sequence starting with the lowest level. They are: Survival — the physiological needs to stay alive and reproduce Security — the need to feel and be safe Love — the social needs for love, belonging and intimate relationships Self-esteem — the need to feel worthy, respected, and have status Self-actualization — the need for self-fulfillment and achievement If we agree with Maslow that the highest human need is for self-actualization — achieving one’s aspirations and living up to our full potential — then that should be our goal for ourselves. In his book, Motivation and Personality, Maslow said, “The growth of selfactualization refers to the need for personal growth and discovery that is present throughout a person’s life.” It is not about achieving some static state of perfection. Each of us continually moves toward or away from personal growth and self-actualization. But it is through a process of reflection and self-discovery and the pursuit of achievement that we discover the meaning in life that is both real and important to us.
This is why we practice mindfulness. Without the practice of paying attention to our thoughts, feelings, intentions and actions, without a thorough examination of our own desires and goals, it would be hard to have a clear understanding of our higher purposes and how our thoughts, feelings, intentions and actions are contributing to our self-actualization or how they are getting in our way. For example, if you have an intention related to a higher sense of purpose to influence your culture in a way that promotes well-being and you recognize that a core component of that is to emulate that which you hope to create; that then puts your decisions around your own wellbeing and need for self-care into a very different context. You have to set the example by appropriately prioritizing self-care activities throughout your day and within your life. Another example might be when you are managing an employee who is performing well from a productivity perspective, but is not behaving in a way consistent with the values of the organization and the culture you are striving to achieve. If they can’t be coached and ultimately adjust their behavior, you might need to sacrifice some short term financial gain by terminating that person’s employment. Making the right decision requires understanding the priority of your goals and intentions. In recognizing that values and culture come before short-term financial success, you let the employee go, which of course likely leads to even better financials in the future through better culture that in turn results in happier, more engaged and more productive employees. FROM UNDERSTANDING TO IMPLEMENTATION How do we move from understanding to implementation? First and foremost, we need to be mindful about our highest goals and intentions. We need to drop into mindfulness and use that awareness to move our decisions into action. Uncomfortable feelings may come up. Process those uncomfortable feelings – lean into them so that you understand where they are coming from and if, in fact, they serve you. It’s a part of life for any leader, a part of the chosen role. Sometimes when a decision is very emotionally charged, it is best to involve others. Check your own thinking and actions with people you respect. Let’s say you have an employee who you like a lot on a personal level but whose productivity is not meeting organizational expectations. Informed mindfulness about the situation will ultimately lead to a decision related to that employee that will deliver the best outcome attainable. Examine your priorities. We often have subtle competing priorities. Sometimes our thoughts are related to things we crave or wish to avoid. We need to be very clear about our own state of mind and emotions. If we deal with that employee from a place of needing to be liked or avoiding conflict or from a place of demanding respect or for increasing our own financial
success, we risk making decisions that ultimately don't take the greater good of the employee and the organization, and potentially even our own ability to create a greater good on this earth, into account. Continuous mindfulness, continuous self-reflection and self-understanding is key. We all have a multitude of purposes. I classify them as little p’s and big P’s. A little p might be to get an advanced degree. A big P might be to change the way medicine is practiced. When we are dealing with that employee, we need to understand what his or her needs are, what his or her p’s and P’s are, and how they relate to the big P’s, the goals and purposes, of the organization. Fully recognizing his or her strengths and weakness and how they align with larger purpose (mission) of the organization is critical. In the long run, we want to invest in people who can help us get the big P’s done. A key component of the value an employee brings to you and your organization relates to how well they make decisions, how effectively they perform and how they can advise us about their area as it relates to the big picture. A PERSONAL STORY Here is an example of mindful decision making in action. One of my managers and I disagreed on an issue about our budget. Both of us felt very strongly that we were right and the other person was wrong. Before making a final decision, I went to great lengths to ensure that she felt heard and to bring in the opinions of others. I don't like conflict but I was aware of that and did not avoid it. Instead, I engaged in healthy conflict, in discussions that looked at both sides. I had to step back and not heed the need to make myself right and someone else wrong. At the end of the day she still didn't agree with my decision but I felt I had done what I had to do to be consistent with my P’s. I want to be someone who does listen but who can also make decisions even if that decision isn’t the consensus. At the end of the day, if it’s my decision to make, I reserve the right to make the decision and be accountable for that decision. But I also hold the expectation that others on the team (after having been heard) will commit to that decision. It is only with that commitment that accountability and ultimately results can be achieved. In this case, everyone did commit and the team was able to put the issue behind and move forward. That likely would not have been the case had I, instead of being mindful, simply mandated the direction I wanted to go. IN SUMMARY Here are five things to do: 1. Commit to achieving your highest potential 2. Practice mindful awareness 3. Understand your own goals and purposes. 4. Lean into your fears and discomforts
5. Always act in the best interest of your highest goals and purposes.
AUTHOR BIO Adam Perlman, MD, is an Associate Professor of Medicine and works within the Duke University Health System as Executive Director of Duke Integrative Medicine and in a leadership role as Associate Vice President for Health and Wellness. Additionally, he is the Founder and Director of the Leadership Program in Integrative Healthcare at Duke University.