Leadership for change

Townsend Letter for Doctors and Patients, Nov, 2006 by Elaine Zablocki

When conventional and Complementary and Alternative Medicine (CAM) educators gathered at Georgetown University in June 2005 for The National Education Dialogue to Advance Integrated Health Care (NED), they were looking for ways to create common ground in the education of health care professionals. Since creating major change is never easy, they took time to reflect on the basic principles underlying change.

Dale W. Lick, PhD, the facilitator of the NED meeting, was selected in part due to his experience working with leaders of diverse institutions to create common ground for change. Lick, a professor in the Learning Systems Institute at Florida State University, told NED participants, "even the word 'change' scares people and makes them feel uncomfortable. When you're seeking change, learning must precede change. If you're thinking about a really major change, you need a lot of learning first." Traditionally, Lick said, you work to change people's behavior, so that eventually you'll change their beliefs and assumptions. But when you're seeking major organizational changes, you often need to start by looking at, and changing, basic assumptions. Then it becomes possible to change beliefs and behaviors, and that leads to sustainable change. Transformational leaders must create a shared, inspiring vision that provides direction, motivation, and commitment to your desired long-range future, Lick said. "In change efforts, vision is the essential direction-setter, people-aligner, and emotion-grabber!"

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Lick invited NED participants to think about key roles they can play as part of any change process:

* A change sponsor has the power to sanction or legitimize change--it might be the organization's board, or a president, division director, or department head.

* A change agent is an individual or group responsible for implementing the desired change.

* A change target is an individual or group that must change as a result of the change process.

* A change advocate is someone who desires change but doesn't have the authority or power to sanction it; they can recommend actions to those who do have the authority to legitimize change.

"The key thing is, if you don't have strong sponsorship, your project, is almost certain to fail," Lick said. "If your sponsorship isn't strong enough, first work to strengthen it." Change advocates should find ways to help people change appropriate assumptions and increase learning among potential sponsors and others, he advised.

Innovative Curriculum at Georgetown University School of Medicine

Faculty at the Georgetown University School of Medicine have been working to develop an improved curriculum in ways that exemplify the principles put forth by Dr. Lick. Their primary goal is to train better physicians. One step in that process, they find, is to train physicians who are familiar with CAM.

"Mind-body approaches are particularly important ... by their very nature they put high value on and teach the power of self-awareness and self-care," says the Georgetown website. "In so doing, they help shape the new integrative model of healthcare--one in which treatment is balanced with teaching; in which prevention and self-care are given as much respect as procedures and pharmacological interventions."

If you go to that website today, you'll see that information on CAM is integrated throughout Georgetown's curriculum. For example, the anatomy course looks at the anatomy of acupuncture; physiology includes biofeedback and neuromuscular manipulation; while human endocrinology discusses stress hormone modulation through the relaxation response, meditation, imagery, and breathing. Georgetown also offers a master's level course in CAM (within the physiology department) and a five-year program combining that course of study with an MD degree.

In part, this wealth of information and options is due to a five-year, $1.7 million grant from the National Institutes of Health (NIH) that supported the planning phase to incorporate CAM into the curriculum. Even more, this integration is due to a step-wise strategy that started on a small scale and gradually gained support from many levels of the organization. For example, a course for first-year medical students on "Mind-Body Medicine: An Experiential and Didactic Introduction" started as a pilot program. The course is held two hours a week for eleven weeks and includes approaches such as relaxation, meditation, guided imagery, biofeedback, writing exercises, movement, music. and art. It's designed to help students become self-aware and foster self-care strategies that should help them in their own lives (this is particularly important for stressed-out medical students.) It also gives them a clear sense of how helpful these skills can be for their future patients.

"Initially we planned to get a pilot started, look at outcomes, gauge student reactions, and see how it went," says Aviad Haramati, PhD, professor of physiology, biophysics, and medicine. "Based on that, we'd make modifications. As the program improved, we'd scale it up." Haramati's research interests for 20 years focused on regulation of renal and electrolyte physiology during growth, and cardiovascular-renal-endocrine regulation of volume homeostasis in heart failure--not exactly CAM-centered. However, he is keenly interested in improving the training of physicians and other health professionals and, over the years, has helped develop major curricular initiatives at Georgetown. His solid professional background (and numerous teaching awards) give him additional credibility when he talks about the ways mind-body training will benefit medical students.