On frost and sunflowers

As the dog and I walked down the street early this morning, I heard the scraping of a car windshield, heralding this season’s first frost. I’m reminded that it’s the autumnal equinox today, and I brace myself for the coming shorter days with a sense of dread by pulling my sweater tighter around me.

I return home and sit down at my desk to look through coursework for a class I’m taking with MIT and the Presencing Institute called u.lab: Leading change from the emerging future. After nearly a decade in healthcare advocacy, my tools and models don’t seem robust enough for the changes we’re trying to make. Our healthcare system is struggling at the precise moment that our ecological system, our educational system, our political system and our financial system seem on the verge of collapse, and I can’t help but suspect that we need something more than small incremental change, root cause analyses and evaluations. I’m looking for inspiration and new ideas.

This is the first week of the class, and I’m still getting oriented. The course team offers a welcome:

“The disruptive social, environmental and cultural changes we face confront us with challenges of a new order of magnitude. These challenges hold the seeds for profound levels of breakthrough innovation while also holding the possibility of massive disruption and breakdown. Whether it’s one or the other depends on our capacity to rise to the occasion and to reframe problems into opportunities for system-wide innovation and renewal. We believe it’s possible to create profound societal renewal in our generation. It will take all of us. We’re glad you’ve joined for the journey.”
The u.lab team

After some readings and videos, I shift to the reflection questions and journaling. There are no small questions here. Their richness and depth makes me feel hopeful, like I’m in the right place:

Where do you experience a world that is ending and dying?

Where do you experience a world that is wanting to be born?

At mid-day, the dog and I head out again. This time I stand in front of a brick wall warmed by the sun. The anemones, the sunflowers, the verbena are all in full bloom and show no signs of quitting soon. As summer wanes, a source deep inside them tells them to pick up the pace, creating the seeds that will sprout next spring. The flowers are dying; they are also wanting to be born.

I have spent the past few months seeing the endings of things. Endings at work, endings of my children being kids, ending of phases. But there are things that have been waiting, wanting to be born. Today I see them, too.

Where do you experience a world that is ending and dying, and one that is wanting to be born?

Making change or being changed?

If you’re reading this, you’re probably trying to make a change in the world, even if you don’t call yourself a change agent or an activist. Maybe you’ve spoken up or shared a link on social media around an issue in your community. At work, you might be leading your organization through a big transformation or simply trying to improve how things get done. Perhaps you’re trying to right a bigger wrong and have joined a protest, signed a petition or are running for office.

Large or small, the actions we take to enable people to thrive, communities to flourish, society to become more just and the world to become more beautiful are steps worth taking.

Peace activist A.J. Muste reminds us that even when our efforts don’t succeed, we take them to honor our soul and live in integrity. A reporter once asked him, “Do you really think you are going to change the policies of this country by standing out here alone at night in front of the White House with a candle?” He replied, “Oh, I don’t do this to change the country. I do this so the country won’t change me.” Even when we don’t succeed, taking some action has value.

Lately I’ve been noticing how this work has the potential to make me feel less aligned with my wholeness than I’d like it to. I’m starting to wonder: Do I create a false duality of “us and them”? Do I use this as an excuse to treat people in a way I don’t want to be treated? Am I so attached to a particular outcome that I feel despair and outrage when it doesn’t come about? Do I talk about what isn’t working in ways that cause me to see myself and others as victims? Have I internalized the stories I tell to move others so that I forget that I am more than those moments? Have I pushed myself so hard that I’ve burned myself out or neglected other roles in my life that are equally important to me? Have I pushed others so hard that they burn out too? Have I pursued continuous improvement so deeply that I’ve forgotten that I am enough just as I am?

I have to admit I can answer yes to all of those questions from time to time. So I’m questioning my theories about change.

One way I’m doing this is through an on-line course called Unlearning: For Change Agents with Charles Eisenstein. Throughout the class, we are encouraged to explore and rethink:

How we frame issues and problems. What assumptions and beliefs do we have that cause us to define issues and sides in conflicts?
How we relate to others. What stories are we making up about others, and how can we relate them in a way that invites them to live into their gifts?
How we make change. Must we force open the door to change, or do we have alternatives to struggle? Is change even something that needs to be “made”?

Eisenstein is more metaphysical than the mainstream, so this course may be a bit out there for some. But if like me, you’re feeling a cognitive dissonance about how you relate to others and change, you might find something here.

If you decide to check it out or if you have ideas and sources for a new way of creating change, I’d love to hear from you.

_____________________________

After spending years coordinating healthcare and other services for my son, I now lead and support initiatives in which patients and their families, clinicians and policy makers collaborate to create better health and care. I welcome you to join in an on-going conversation about healing health care by subscribing to this blog, in which I write regularly about the experience of living in a complex special needs family and working to create and support change, or by connecting on Twitter or LinkedIn.

Finding courage

“Courage is not the absence of fear, but rather the judgement that something else is more important than fear.”
Ambrose Hollingworth Redmoon

I stood with my family above Omaha Beach this summer. From the safe distance of 75 years away, we learned about the 160,000 soldiers who landed on a 50-mile stretch of heavily guarded coast on June 6, 1944: the day often referred to as “the longest day,” one of the largest military actions in history.

Standing on the actual terrain in the wind and rain helped me take in just how little cover and safety there was on for these men. What made it possible for them to get through that day—to take a step off the landing craft, onto the beach, into the gunfire? Surely they were not fearless, but yet they did what they felt they needed to do in the face of great danger.

Since that trip I’ve been thinking about courage. Of being afraid but doing what needs to be done anyway.

The threats I face in my comfortable life are nothing compared to theirs of course. Yet I’m often afraid. As a parent of a child with multiple disabilities who needs lots of support, I can find so many things to be afraid of. (I wrote about this fear I called the Terror of Scarcity back in 2011.) In my work trying to help improve healthcare, I am often afraid to raise my hand or open my mouth. In my relationships, I’m afraid to say that I need help, that I’m sorry and even “I love you.”

It’s easy to feel ashamed of feeling afraid, and we rarely talk about it. But fear is like sneezing or the hiccups. It just arises naturally even if we don’t like to talk about it. (If you don’t believe me, a web search for fear quotes reveals that we’ve been trying to psych ourselves up as a species for a long time.)

But less natural and automatic is courage. Courage is sometimes used as a synonym for fearlessness, but for me, it means facing a challenge in spite of fear. The root of the word courage is cor, the Latin word for heart, and suggests that when we bring our heart into the situation, we find the power to act despite the fear. When I listen to my heart tell me what is more important to me than avoiding an immediate threat, the courage to act can suddenly appear.

Poet Mary Oliver captures this so well in The Journey: “One day you finally knew
/ what you had to do, and began, / though the voices around you / kept shouting
their bad advice—/ though the whole house/ began to tremble /
and you felt the old tug / at your ankles.”

Listening to our hearts isn’t always easy. Luckily there are many people and organizations who help people do just that. I’ve found guidance in several places:

The Center for Courage and Renewal helps leaders bring integrity and trust into their organizations and communities. From them, I learned that it’s easier for me to live wholeheartedly (i.e. with courage) when I’m in the company of others who are seeking to do the same. Through their programs and books I’ve found my way back to my voice and my sense of adventure.

RAIN is a mindfulness technique that helps me with any emotion as it arises. Its four steps are Recognize what’s going on, Allow the feeling to be there, Investigate the feeling with curiosity and Non-identification or not equating who you are with your thoughts or emotions. Tara Brach has written about it shares talks about it frequently on her website. She is a wonderful teacher.

Vulnerability researcher Brené Brown shares the link between vulnerability and courage in much of her work, including her now famous TED talk and her recent Netflix special called The Call to Courage. She’s shifted the way we talk about fear and courage.

As I write this, there’s part of me wondering if I’ll actually share it publicly. It’s scary to admit I’m scared. But something tells me that you feel fear, too. And that just like me, you have things that are more important than fear.

What scares you? And what’s bigger than your fear?

_____________________________

What matters to me

When our son was about six years old, my husband and I were faced with a difficult healthcare decision. His rare genetic syndrome made it nearly impossible for our son to keep his attention on anything for longer than seconds at a time, and he moved from activity to activity without landing or learning. (I captured a snapshot of a that time in a blog post here.)

His neurologist recommended that he try medication for ADHD. His teacher was supportive, since she watched his struggle to maintain focus in school. But others weren’t so sure. His cardiologist was concerned about side effects that could affect his vulnerable heart. His gastro-enterologist, endocrinologist and his dietician pointed out that he was already struggling fiercely to grow with the help of a feeding tube and growth hormone shots. Did we really want to jeopardize his growth with a medication that would most likely decrease his appetite?

I remember asking friends, family and other parents of children with complex health care needs what they thought we should do. Everyone had an opinion based on what they would do if they were us. The problem was, they weren’t us; it wasn’t possible for them to put themselves in our shoes. Clinically, there was no one perfect choice, and the professionals couldn’t say for sure, either.

Ultimately the decision came down to us. We thought long and hard and boiled the issue down. What mattered more: physical growth or mental/social growth? What mattered more to him? To us as his parents? To our family? With this in mind, we made a choice. Who knows if it was the right one, though in hindsight it still feels right.

I’m grateful that we were allowed to become informed and to make a choice. But that wasn’t always the case. For many years, patients and families were not given choices, and simply told what to do according to clinical guidelines.

Little did I know that almost exactly the same time, across town at Massachusetts General Hospital (the very hospital in which my son was born!), researchers Susan Edgman-Levitan and Michael Barry were writing about an important shift in health care called shared decision making.

In their article Shared Decision Making — The Pinnacle of Patient-Centered Care, they described a process “by which the optimal decision may be reached for a patient at a fateful health crossroads … and involves, at minimum, a clinician and the patient, although other members of the health care team or friends and family members may be invited to participate. In shared decision making, both parties share information: the clinician offers options and describes their risks and benefits, and the patient expresses his or her preferences and values. Each participant is thus armed with a better understanding of the relevant factors and shares responsibility in the decision about how to proceed.”

Edgman-Levitan and Barry go on to say that to work this way, both patients and clinicians need to change:

“Patients should be educated about the essential role they play in decision making and be given effective tools to help them understand their options and the consequences of their decisions. They should also receive the emotional support they need to express their values and preferences and be able to ask questions without censure from their clinicians. Clinicians, in turn, need to relinquish their role as the single, paternalistic authority and train to become more effective coaches or partners — learning, in other words, how to ask, “What matters to you?” as well as “What is the matter?”

Asking “What matters to you?” as well as “What is the matter?” It doesn’t sound like a big change, but it is. The question of “What matters to you?” has become a rallying cry within healthcare among those who wish for healthcare to become more empowering and inclusive for patients, their families and their communities.

In fact, this week marks the fourth annual ‘What matters to you?’ day, celebrated at healthcare organizations around the world to encourage healthcare ask patients, the public and professionals what matters to them.

Here in Sweden, I’m organizing a digital conference. (Info in Swedish here.) I’m excited to show how the question is being asked and used to improve health and care. In the hustle and bustle of the program, there probably won’t be time to think about what it felt like all those years ago when we were stepping into empowerment and involvement, but it’s there in my heart.

So, what matters to me? Connection, respect, learning. A good cup of coffee and saying thank you. Remembering to take the time to smell the roses (and if I’m honest, sometimes picking one as I did this morning on the way to the office). And of course, being allowed to make choices for me and my family. How about you? What matters to you?

If the lights go out, just move

This past winter I spent a long weekend on retreat in stillness and good company. The theme of the retreat was hidden seeds, the way nature can look as if it’s sleeping or even dead, when in fact it is gathering strength, getting ready to burst forth when the conditions are favorable.

I myself was coming back to life after several months of feeling in the dark, disconnected from myself and the people I cared about. Like the winter landscape outside me, I felt used up and in need of rest. Worse still, I felt disengaged and cynical. I hoped the retreat would help me move through this inner winter.

The retreat took place in England, in a wonderful house filled with quirky landings and hallways, double taps at the sink, with a huge vat of tea standing at the ready. Perhaps less notably English but more eco-friendly were the light fixtures in the bathroom stalls. A friendly note near the door latch explained that the lights were motion activated and what to do if one found oneself sitting in the dark:

If the lights go out, just move.

Poetry filled a special purpose throughout the weekend, allowing us to get to the heart of the ideas we needed to talk about in the way only poetry can. This poem by John O’Donahue closed the retreat.

For a New Beginning
In out of the way places of the heart
Where your thoughts never think to wander
This beginning has been quietly forming
Waiting until you were ready to emerge.
For a long time it has watched your desire
Feeling the emptiness grow inside you
Noticing how you willed yourself on
Still unable to leave what you had outgrown.
It watched you play with the seduction of safety
And the grey promises that sameness whispered
Heard the waves of turmoil rise and relent
Wondered would you always live like this.
Then the delight, when your courage kindled,
And out you stepped onto new ground,
Your eyes young again with energy and dream
A path of plenitude opening before you.
Though your destination is not clear
You can trust the promise of this opening;
Unfurl yourself into the grace of beginning
That is one with your life’s desire.
Awaken your spirit to adventure
Hold nothing back, learn to find ease in risk
Soon you will be home in a new rhythm
For your soul senses the world that awaits you.
John O’Donahue, from To Bless the Space Between Us. 2008, Penguin Random House

Receiving those words that Sunday morning, I realize I have firmly stepped up to the threshold; no, I’ve crossed it. A seed has been lying dormant inside of me for many years, gathering vitality, waiting for conditions within it and around it to be right. The safety and ego that once offered a feeling of competence and accomplishment suddenly felt constricting, bursting at the seams like a jacket that is still considered beautiful but is now too small.

Then, with no effort besides the willingness to be a channel for something bigger than myself, I find myself standing here in delight, ready to head out again with just a few essentials. With spare abundance in both things and company, I trust that whatever I need is here. That there is enough. I trust that whatever I have inside me might just be what someone else needs. That I am enough.

The adventure begins. I notice I already have a map in my hands. I look at it and see that there are several paths; I don’t need to worry yet about which one to take–the exact way will present itself in due time. All I need to do is take a step, and trust. Welcoming what comes next, welcoming myself to come along.

If the lights go out, just move.

To start a movement, tell a story

I was recently asked to talk about why I became an advocate for change in healthcare. I could have shared statistics about how patient engagement leads to better outcomes and safer care, but instead I told a story about an evening I had in a hotel bar that changed my life.

My son was about nine years old, and I was attending a training program for parents of children with complex healthcare needs. I was exhausted and overwhelmed, having spent years doing whatever the doctors told me to do—refilling prescriptions, booking appointments, and organizing health records into huge binders that I carried with me to every healthcare visit. On the outside I looked like I had it together, but on the inside, I felt anxious and afraid. Would he ever learn to walk? To read? Would he grow old enough to fall in love? There was so much that wasn’t clear. The fear left me disconnected from myself and from him.

The training involved an overnight in a hotel and I was so happy to get away. In the evening I sat in the hotel bar with another mom, and I made a comment about how hard our lives were. “Cristin,” she said, “if you want me to listen to you talk about how hard this is I will, but if you want to talk about how to make things better, I’m really much better at that.” I was flooded with embarrassment. Over the next few days, the shame turned to hope. How might things be different if I stopped focusing on how hard and scary things were, and instead focused on what I could do to make things better?I

I told how within a year, my life had completely changed. I was able to find a diagnosis for my son—something his geneticists hadn’t in 9 years. I had advocated for a better school and for activities where he could make friends. I connected with some strong, fun-loving parents who faced challenges but didn’t let it define them. We got organized with other families and went to visit our politicians in Washington to make health care affordable, so that families like ours could be safe and healthy. It felt so good to get in the driver’s seat – and it’s something I want to help others to feel.

In healthcare, we talk a lot about evidence. We believe that by telling people the facts, they will change how they think–and more importantly, what they do. We talk to their heads, using reason and logic. Facts matter when it comes to healthcare. Scientific inquiry has helped us live longer, healthier lives. But why doesn’t knowing the facts always lead people to change?

“It’s not a movement unless someone moves,” it is said. We can’t think our way to action. Knowing is important, but at some point, we must also do. Finding the strength and courage to take action almost always requires more than statistics and facts.

Activists, advocates and change agents are increasingly using their own personal stories to awaken leadership in others. Stories speak the language of emotion, the language of the heart. They not only teach us how to act, but also inspire us with the courage to act. Our stories help us translate our values into action by accessing our emotions.

How we tell our story matters. I’ve been to conferences and meetings where a patient or family member was there to tell their story, but rather than moving people to change, the story left listeners feeling accused, resentful or frustrated. I’ve done it myself. Telling my story was hit-or-miss, and I couldn’t quite put my finger on why it sometimes worked and sometimes didn’t. And it wasn’t just from a stage; I would use personal stories in meetings and sometimes got a great response, sometimes lost the listeners entirely.

A couple of years ago I learned about a specific way to use my story to create change. In community organizing, public narrative is a practice in which we exercise leadership by linking our own story to the stories of others and to the story of what is needed in this moment. Public narrative involves motivating others to join you in action on behalf of a shared purpose. These stories have detail and structure. They paint a picture of a problem, a choice and an outcome. Listeners see a way forward and are are moved. Told well, moving stories start movements.

So when I told my story recently, I knew that data and evidence was important. But it wouldn’t be enough to move the listener to action.

How do you use your story to create change? Does it feel too personal or inappropriate? What moments show rather than tell what you care about? Learning to craft your story is a leadership skill. Listen to the stories that are being told and see how they affect you.

Do you want to learn how to use your story to create change? I’ll be teaching a class in Stockholm on June 12, 2019. The aim of the program is to help change agents, improvers, advocates and activists learn the skill of using their story of self to connect with others to awaken leadership and engagement. Find out more about the one-day program Public Narrative–Using story to recruit leaders and build relationships. Contact me for a discount code for my blog readers and other friends. If you’re in Sweden, I hope you’ll join me and my colleagues.

The tyranny of Norman doors

As a person who considers herself often on the threshold — though of what I’m not always sure — doors and doorways catch my attention. They create a boundary between here and there, allowing us to be in one place while looking into another

One particular style of door fascinates me. It’s best summed up in this photo of a door at my office with its many pieces of flair. It has a button with a key on it to show us where to unlock it, and a sign and arrow telling us to do so. There is another lever that releases the lock but should only be used in an emergency, hence the running guy icon. There is also a button to open the door and hold it open, for example if one is wheeling through a cart or wheelchair; this button needs to be held open for a longer-than-obvious period of time, so it too has a note on it telling us how long to hold it. And because we frequently trigger the alarm by standing with the door open too long, there are not one but two signs in English and in Swedish telling us to get a move on. It’s a wonder we ever get out.

Yesterday I learned that this type of door has a name — the Norman door.

A Norman door is a poorly designed door that confuses or even tells you to do exactly the opposite of what you’re supposed to do. It was named after Don Norman, the researcher, professor and author of The Design of Everyday Things, the bible for the field of human-centered design. This video, It’s not you. Bad doors are everywhere. tells the story of Norman doors and the principles behind good design.

It turns out that through their design, objects subtly communicate instructions to people on how they should be used. Certain handles just feel like they should be pushed, and others pulled. Bad design sends us signals that are confusing.

And when things go wrong, it’s usually the user who is blamed, not the designer. Sometimes we even shame the user, as in this Far Side classic. I remember a coffee shop in my old neighborhood that had this panel taped to the door because so many people opened the door incorrectly. But it wasn’t the door’s fault, it was ours.

In the film, Don Norman reflects that “if you continually get it wrong and if other people get it wrong, that’s a sign that it’s a really bad door.”

Swedish designer Sara Tunheden shared the video this week and challenged those of us working in health care to think about the services we deliver and design. Are they really as great as they think we are, or are they Norman doors?

As a person who works within the health care system to improve it, I know I want patients and families to experience health care as a place of partnership, agency, responsibility, power and health. As a patient and family member, sometimes I can get there. Though often the door is surrounded by confusing and unintuitive mechanisms that keep me scratching my head, struggling needlessly, or even worse, locked out.

Good design, according to Norman, offers discoverability (the ability to discover what operations one can do) and feedback (a signal of what happened). For those of us in a position to be offering a health care service, we can ask ourselves some questions:

Are the doors people need to pass through to reach us easy to open, or are they overloaded with gatekeepers and signs in the forms of wait lists, complicated referral or intake processes and inefficient booking systems?

Does the entrance feel truly welcoming for everyone, regardless of race, gender, sexuality, language, intellectual ability and culture? Are people treated with dignity and respect, or as if they should be grateful to have been let in at all? Does the door actually open when the person does all the things they are asked to do? And if it doesn’t, do we blame — or even shame — them for not getting in?

In my experience, we spend a lot of time thinking about what we want patients and families to do, how we want them to behave and act. This isn’t just about access, but even about following our instructions, being engaged, and taking responsibility. When they don’t do that, maybe it’s worth considering that it there may be a Norman door in their way.

Please subscribe, share or comment. I’d love to hear what you think.

Beginnings

After four years of wonderful work within a large healthcare agency, I’ve been feeling called to step out from the safety of a big organization and explore having more power over my voice, my time and my energy. Ever since I became so incredibly lucky enough to get my heart broken wide open over 10 years ago, what I have loved most to do is to work with others to make things better, so I hope to keep doing that.

I’m not exactly clear where this new path is going and I’m giving it time to unfold. It’s a bit awkward when someone asks what I’ll be doing next and I have to struggle to find an answer; I’m ok with that. But the practicalities of the everyday world force me to put words around ideas.

For example, moments ago I hit the send button and submitted the registration of a new business, a necessary step to be able to do some work I’m being asked to do. As I completed the field on the form asking for a business description using the language of industry and commerce, it started to feel like I was ruining a great detective novel by skipping straight to the end. So I split the difference and let it be playful. I do hope that should anyone ever read the form, they will accept this description of the venture:

“The business will conduct consulting and training for leaders who work with development and innovation, with a focus on developing health and social services with patients, service users, their families and their advocates. Consulting services include project and process management, coaching and guidance, and planning and moderating conferences. Trainings will increase participants energy and ability to create positive change for society.”

To myself though, I describe it like this.

I choose to inhabit my days,
to allow my living to open me,
to make me less afraid,
more accessible,
to loosen my heart
until it becomes a wing,
a torch, a promise.

–Dawna Markova

It may not be good enough for a form, but it’s good enough for me. If either description sounds appealing, let me know and maybe we can find something fun and useful to do together.

Oh, s*#t

The speech therapist sent over some new communication cards a couple of weeks ago. They are laminated sheets that contain about a dozen icons that our family can use to have better, more focused conversations with my son. Without them, there’s often whining, interruptions and repetition. With these cards, we still do all those things, but we also do a little bit more chatting about the day and our plans for the weekend, specifically whether or not we will eat tacos on Friday night. (Spoiler alert: We will.)

fredagsmys — Communication card for the weekly Swedish phenomenon Cozy Fridays, aka Fredagsmys

This particular pack of cards is aimed at older kids, now that my son is well into his teen years. You can probably imagine my surprise when I see that on the cards is a pictogram for a swear word. “Oh, shit” shows a generic-ish person with a palm to the forehead. Useful for many contexts, but not the kind of language I promote with my kids.

I easily forget that my son is getting older, mostly because he’s physically small but also because he needs help with things that kids his age have figured out how to do long ago. But that doesn’t mean he’s a child in every way. Because he needs my help, it’s also easy to believe that I should be allowed to make choices about things that parents normally wouldn’t–his clothes, his music, his activities, and even his language. People with disabilities have been pointing out how society infantalizes them for decades. I do not want to be that parent, so we laugh and practice saying it together.

There are so many areas where I’m going to be pushed out of my comfort zone. Swearing, friends, alcohol, sex. His body is changing, his needs are changing. He’s getting older, and so am I. Oh, shit.

Turn your face to the sun

flowers plant spring macro — Photo by Pixabay on Pexels.com

”Like Spring secretly at work within the heart of Winter,
Below the surface of our lives
Huge changes are in fermentation.
We never suspect a thing.
Then when the grip of some
long-enduring winter mentality
begins to loosen,
we find ourselves
vulnerable
to a flourish
of possibility
and we are suddenly negotiating
the challenges
of a threshold…”

Thresholds, John O Donahue

The snowdrops came up this weekend. Their reappearance every year brings a shock of hope so unexpected and intense it’s almost violent. It only took a few hours of sunlight on a warm brick wall and there they were.

It’s easy to forget, when things are hard, that there are forces waiting just below the surface. Dormant, gathering strength, looking for their moment. Not just in nature. Remember the snowdrops, Idealists, and turn your face to the sun.

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