A Hartman Perspective on Thailand’s Rescue
C. Stephen Byrum, PhD

In a world so often filled with bad news, the unfolding of the rescue of the young soccer players and their coach from the mountain caves of Thailand was remarkably positive.  Even with all of our joy in their rescue, I doubt that we could ever be able to fully appreciate the magnitude of what took place there.  This may be one of—if not the—greatest rescue efforts of our lifetime.  People have asked, “Was it a miracle or was it science?” It was probably something of both.  How refreshing and constructive of hope when something turns out so well!

I have not been able to keep from seeing these events through the lens of the work of Robert Hartman; maybe I do that with everything, but I believe Hartman would have seen the events clearly through his three “value lenses.”

Without any question, we can see a powerful force of the Intrinsic—People Judgment—directed at these boys and their coach.  There were all kinds of expressions of care, love, and concern directed at those trapped in the cave and those trying to help.  This peaked, of course, in the loss of the life of the heroic Thai cave diver, Saman Gunan.  The Intrinsic brings people together and focuses their concern in ways that provide powerful motivation and actions beyond the normal scope of human energy.

There was also plenty of evidence of the Extrinsic—Work/Task Judgment—in the equipment and processes that likely made the rescue possible.  Without the hard and disciplined task competency and effectiveness, the story could never have turned out as well as it did.  Skill sets and disciplined practice is always incredibly vital.

Yet, I am convinced that as important as these two aspects of the rescue were, the really significant dynamic was the Systemic—Big Picture Judgment—plan.  This part of the process took longer, and I’m sure was exasperating to the families.  However, if the rescuers would have rushed in with all kinds of Intrinsic love and Extrinsic equipment—without a detailed, comprehensive, and tested plan—the results could have been very different.  We should forever see this moment as a primary example of how a well-developed Systemic plan allowed the Extrinsic efforts and Intrinsic care to be guided to a successful conclusion.

One of my greatest professors, a man named Rolf-Dieter Herrmann, always greeted people in what at first seemed to me to be a very strange way.  Instead of saying “Hello” or “How are you doing?” he would ask, “What is your plan?  What is your plan?”  I am certain that he believed that action without a “plan” was likely to be well-intended (Intrinsic) and even well-executed (Extrinsic) at times, but—in lieu of the plan—was likely to be spasmodic or inadequately directed.  The rescuers in Thailand certainly gave us a profound example of the integration of all three dimensions of Hartman’s axiology.

Thailand is culturally a place where meditation, deliberation, and reflection are honored and used with intention and high consciousness.  We have even learned that the boys’ coach used priestly training in mediation to keep the boys calm and strengthened for their arduous experience. The rescue was a success thanks to a multitude of circumstances; it is almost as if the stars aligned, and what a great outcome for the boys and their coach to be able to reunite with their families when everything pointed towards an ominous ending. My old teacher was so right: “Do you have a plan?”

 Culture—a Foreground Issue—Once Again:

The Perils of Getting Stuck

Stephen Byrum, PhD

As long as organizations are running well with plenty of money, few external threats, and a normal level of stress, “culture” is more of a background issue.  All is going well, so we conclude that we must have a pretty good “culture” of shared values, common goals, and mutual objectives—at least that is the all-too-common assumption.

It is only when an organization is tested and challenged by some sort of adversity or some reality that creates fear that the true depth and credibility, the true power of “culture” can be seen.  Numerous factors of potential negativity and uncertainty in modern life and work are making “culture” a foreground issue, once again, and it is very clear that simply throwing the word around in various shallow platitudes will not create a sustainable reality that really matters.

Sociologists have long talked about two types of “cultures” that appear under the challenge of adversity and fear. Now, they are talking about a third type that they believe is actually growing faster than the other two.  In the intentional construction of modern “culture” paradigms, some knowledge of these three types can be instrumental in helping to have the right kinds of productive conversation and dialogue.  If Jim Collins is correct, one of the most significant responsibilities of an authentic leader is to create a “culture,” and especially a “culture” in which people can thrive with insightful visions of what can be accomplished in the future.

First there is an honor culture.  Problems that come up, especially between individuals and groups of individuals become a matter of honor in the setting.  The “Old West,” modern urban street gangs, or overly zealous sports fans would be typical examples of an honor culture.  In honor cultures, people actually fight, or find themselves advancing violent and hyper-belligerent attitudes toward individuals or perspectives that are “different” in belief or life practice.  We see this kind of “defense of honor” in headline-making situations of workplace and societal violence that while perhaps exceptional it does make us feel uncomfortable at times, unsafe, or having the need to take some kind of preventative precautions.  When circumstances of human interaction, on whatever levels, become “tribal,” the impact of honor culture is usually at hand.  There is great division along lines of “difference” that once might have been more contained by the need of people to cooperate together to advance common goals.  In Abraham Maslow’s terms, the “Me Generation” and the “My Group” generation has returned with a literal vengeance, and the highest water mark of human existence—Self-transcendence—has gotten lost in the process.  To use Robert S. Hartman’s terms, there is a transposition of value in which intrinsic, human values takes second place to extrinsic process and economic values.

Second, there are dignity cultures which place a high priority on the dignity of all people, and act in ways to protect that dignity at almost all costs as a highest priority or highest value.  When problems occur in a dignity culture, there are mechanisms in place for conversation, mediation, and mutual resolutions.  The test, of course, of an authentic dignity culture comes when circumstances become so overwhelming in some way that actions based on human dignity are easily set aside or apply to only a select few.  The interactions with Native Americans of the character played by Kevin Costner in the famous movie Dancing with Wolves is a prime example of how honor cultures with the right leadership can evolve into dignity cultures.  In dignity cultures, intrinsic value leads the way.

Third and finally, new research describes what is being called a victimization culture.  This cultural type shows up when in the midst of challenge and adversity. People feel that there is nothing they can do to improve a situation and that they are powerless, or that no one really cares about them and their situation as persons.

To feel like a victim is one of the lowest ebbs that a human being can fall to in either work or personal life.  Victims become passive-aggressive; they often mope and show signs of depression.  They stop caring about the quality of their work; in other words they become disengaged.  Their attitude and morale suck!

There is increasing evidence that this victimization culture is growing and that it spreads infectiously like a metastasizing cancer.  It becomes almost impossible to see any “good,” and when this dynamic of life is lost, the ability to value and evaluate clearly is dramatically compromised.  As long as human beings can see some “good,” they can continue to experience value.  When it becomes difficult to see any “good,” even the slightest negative tends to get blown all out of proportion.  People begin to make narrowly-informed, spur-of-the-moment decisions as if consequences do not matter.  The phenomenon of “perspective”, a bigger picture vision goes wanting.

We commonly see this victimization culture today when we see college graduates who cannot find a job appropriate to their training and educational efforts, when we see middle-aged employees laid off because their jobs have been replaced and their old skills are no longer needed, when we see jobs “going overseas,” and when we see work that is so mind-numbing and lacking in meaning that this wonderful “engagement” that we talk so much about is fundamentally impossible to achieve.  We see this victimization culture advance when income levels are so low that individuals cannot even reasonably take care of their own families—one of the finest earmarks of a dignity culture.  We see this victimization culture become more and more firmly ensconced and solidified when the gap between general worker pay and general “boss” pay becomes wider and wider, and the increasingly fewer “rich” have all  of the political clout necessary to create favorable circumstances for themselves; the increasingly growing numbers of “non-rich” become dispossessed of power, feel that they can do nothing to advance change and fair accommodation, and feel loss of personal “dignity” and “humanity” in the process.

A major issue facing modern organizations and their leaders: we seem to fall more and more into the trap of creating honor cultures; we are not sure how to advance dignity cultures; and, we have few if any clues about holding the line and reversing the growing trend toward victimization cultures that we know from past experience only leads straight into tribalism of one kind or another.

This major leadership challenge becomes even of greater magnitude when the leader (or leadership group) begins to feel that he/she/they are a victim.  There are all kinds of “victim” statements: “We’ve lost control!”  “We are just trying to react to the last challenge.”  “It does us no good to plan.”   “Who knows what will happen next.”  “I’m sorry.  There is nothing I can do.”  And, it is never enough to simply “excise” the person advancing a victim mentality.  The moment we do this, five more people start desperately believing that they are “next,” and a spirit of victimization escalates.

The only “solution” comes in determining (the gut-felt determination) that you are still in control, and that this control can be demonstrated in advancing a dignity culture so strongly, so regularly, and so adamantly that the sense of victimization and the defensiveness of tribal honor does not have a chance to become rooted and grow.

Now, apply the following example to our discussion.  At the 1876 Philadelphia Exposition (like a modern World’s Fair), the Japanese exhibit introduced a plant to Americans.  The plant was known as kudzu, and it was used in Japan to control soil erosion.  By the early 1900s, especially in the Southeast where erosion had become horrific because of clearing of virgin forests, kudzu was planted as a defensive measure.  It worked!  The creeping vines spread at remarkable rates, sometimes as much as 150,000 new acres a year.  But, the plant would not stop, and finally became invasive in ways that it began to attach itself to forests of trees that were killed by its choking vines and impenetrable shading.  Most people in the Southeast constantly are fighting kudzu to keep it off their farms, out of their yards, and away from their gardens and landscaping.  Victimization cultures and honor cultures, fueling and feeding off of each other, can grow like kudzu.

I recall one summer when I was a teenager that my father decided he had had all the kudzu he could stand.   For weeks, he attacked it with every kind of cutting tool and weed spray that he had.  He even, at one point, resorted to using gasoline and starting fires that my mother argued were threatening our home and neighborhood.  My younger brother and I pulled kudzu vines until our hands were blistered and raw.  I hated the prospect of my father coming home and announcing that we were taking the kudzu battle up again.  Then, one day my father created a vivid memory: he stood before a bank of kudzu cascading down across the trees at the edge of our property, threw his hands into the air, and announced that he was giving up.  He washed his hands of the kudzu, went back into our garage, and tried never to even look in the direction of the victorious vine again.

There are not always immediate or easy “answers” to the quandaries that surrounds a great deal of modern life and modern work environments.  This fact, in itself is a problem because we love “easy answers,” and tend to even believe at times that we deserve “easy answers.”  I’m not sure there is an “answer,” especially an easy one, but I am sure that to surrender control and give up is not the way to go.  My guess is that there are some kinds of unique responses that can begin to work in maybe even unsuspecting ways if people will keep searching.  The key is not to surrender to some pseudo, false inevitable.  Maybe even as we fight not to give up, we advance our own “dignity.”  Maybe as we refuse to settle for something “less,” we advance our own “dignity.”

It is interesting to see what is happening to kudzu today.  There may even be a different metaphor than kudzu as a creeping, overwhelming evil.  Today, researchers, and at times simply informal entrepreneurs, are finding all kinds of wonderful and very profitable uses for the ugly, creeping vine.  The broad leaves can be processed into paper products and cardboard-like shipping containers; ironically saving lots of trees in the process.  The stems can be used to create beautiful basketry.  There are all kinds of food and medical applications, even kudzu preparations that are appearing in the handiwork of the finest chefs and restaurants in the world.  Livestock seem to see green piles of kudzu as a delicacy.  The economic prospects have become so appealing that intentional cultivation is occurring all over the world.   Kudzu may even help solve the hungry problems of many poverty-stricken areas where nutrition and starvation are still problems; it can grow anywhere!

The new metaphor is not built on images of standing, overwhelmed before the spreading, choking vine is surrender with nothing to do but give up and walk away in frustration.  The new metaphor is to keep believing that better solutions can be found, that human dignity can surmount the demeaning and defeating onslaughts of victimization cultures and tribal, divisive honor cultures that seem to surround our lives today.  Even the old honor culture saw value in “heading them off at the pass.”

Modern organizations and their leaders need to have frank and honest discussions about what kind of “culture” they are creating or simply allowing it to take hold.  It may even be possible to measure and assess environments to determine strengths and intensities of engagement, or the presence of helpful or harmful “attitudes” and “stressors” that might sustain one of these cultural types.  One fact is for certain: where victimization cultures and honor cultures triumph, process, product, and profit can only be jeopardized.  When tribalism takes over, we allow competition to become the prevailing dynamic that drives our lives—the person who has the most toys wins.

I recall being about ten years old, and taking a “dare.”  I was always taking a “dare” to prove myself in some way.  I was, by far, the number one dare-taker in our neighborhood.  On this occasion, the “dare” was to crawl through a drainage culvert under our front yard and driveway that was about twenty yards long.  Without hesitation, I crawled into the pipe and, with some concern for possible hidden snakes, proceeded forward.  I did not realize that there was a slight turn in the culvert piping about halfway through, and as I navigated the turn I got stuck.

At first, this being stuck was of little concern, as I had been stuck before and always figured out some option to extricate myself.  This time, the more I squirmed and wiggled, the more stuck I became.  Then, as panic set in, I became totally wedged in and could not move at all.  I began to wail for help.  Being “stuck” is a terrible feeling, but there was nothing I could do.  Then, to make matters worse, it began to rain.  The rain water flowing into the culvert piping began to slowly mount up in front of me.  I had become a dam that blocked the flow of the water through the pipe.  I knew what would happen.  Finally, the water would fill the pipes, and I would drown.  I simply lay there quietly and awaited death.  As the singer, Delbert McClinton, says in one of his most famous songs, I was a “victim of life’s circumstances.”  This is victimization culture to the extreme.

Several of my friends ran off.  They did not want to get blame for what was happening.  They also did not want to get wet in the rain.  They exemplified, in covering their own backsides, honor culture.  However, my little brother, exhibited “dignity.”  He was good at “fixing things” mechanically; he had learned that from my father.  He ran to our garage, found a small rope, and after returning, crawled into the culvert and tied the rope to my feet.  He told me to go completely limp; in fact, I had probably already achieved that status.  He crawled out, shamed and threatened some other boys who had retreated to their homes but were still watching to come and help, and they jerked me loose from my stuck spot and pulled me free.  I still have an occasional nightmare about that event as it is awful to feel “stuck.”  Victimization is, indeed, the lowest ebb of human existence.

Simply stated, a primary task of a modern leader is to become an expert in getting people and their situations “un-stuck.”  The modern leaders must be like by little brother, believing that there was still an option, racing for the rope, crawling into the pipe with me, and pulling me free.  If victimization and honor are allowed to triumph, the water keeps building up and the kudzu keeps spreading.   In dignity cultures, true leaders crawl into the dark pipe with you and make every possible effort to resolve the situation favorably.

Double Tracking

C. Stephen Byrum, PhD

In the early 1960s, Abbey Road Studios in London—yes, the same Abbey Road as the Beatles—were pioneers in advancing the technique of “double tracking.” Tracks of music could be layered on top of each other, first manually, and then electronically to give greater depth—the integrated sounds of multiple instruments and voices, with differences in effect like those between a solo instrument, a quintet of several instruments, or a full symphony orchestra. Early on, many of us who had been around even before the Beatles, learned the difference in the “depth” of the sound with stereo as opposed to mono. Of course, we have lived to see multi-track recording is almost infinite in its possibilities, both in high-tech, professional studios and even driven now by laptop computer synthesizers.

The whole idea had started with John Lennon. Lennon insisted his voice be “double tracked”—again, first manually and then electronically. Lennon wanted the added depth to conceal—maybe to enrich—his own voice. Basically, as hard as it is to imagine, John Lennon hated the sound of his own voice! It was only after his death, that Yoko Ono, his wife, began to release non-doubled tracks of his singular voice performing, and it was unique and beautiful.

You might imagine when a singer hates the sound of his/her own voice, that self-side issues—self-esteem issues—are being encountered. A person has a beautiful voice, but he does not see it, nor hear it himself. So, what does he do? He adds depth in order to conceal and hide, and ends up concealing and hiding something very important about his own Self from others and from his self.

In working with Judgment Index, we have typically seen about 30% of the people in our database exhibit a very “abstract” and incomplete view of Self—an under-appreciation and shallow view of Self. Our most regular response is to create developmental approaches in which individuals are encouraged to see the greater “depth” of uniqueness and singularity they possess and, once recognized, could redefine them in more profound and significant ways. I think this approach is right and appropriate in many instances.

However, Lennon’s “double tracking” may teach us there are also times in which people do not have sufficient self-awareness and self-appreciation because they have added unnecessary “depth.” Sometimes, it may be as important for us to look for “depth” that has been added as it is to look for “depth” that has yet to be discovered. Who we are, on the most intrinsic level of our existence as human beings, can be missed because of a lack of awareness and appreciation of the “depth” of our uniqueness. Who we are on this most intrinsic level could also be missed because we have intentionally and consciously added “depth”—double-tracked our own Selves because we don’t like the sound of our own “voice.” Perhaps, Lennon (and we, in turn) would have been better served to simply hear himself singing “Let it be, Let it be, Let it be, Let it be. Whisper words of wisdom, Let it be, Let it be.”

Netflix has just released the first season of a new series it has created entitled “The Crown.” It is the most expensive series ever created by the online network, and it is gaining phenomenal reviews. The story being told—and this year’s release of ten episodes will be the first of a multi-year process—is about the coming to power and reign of Queen Elizabeth II of England, a woman whose commanding presence has now crossed three generations.

In this first season, we see a very young Elizabeth being thrust into the role of Queen as a 20-something because of the untimely death of her father. She is not ready for her new role, much less to “rule.” Her father knew that as well as he knew he was dying. He called in his friend, the iconic British leader Winston Churchill. At the time, after World War II, Churchill was in retirement and had few political plans. The King convinced Churchill that the new Queen and the Empire would need him now more than ever. His daughter would need an advisor and close confidant to help her through the maturity of her first years. Churchill agrees, reasserts his place of leadership, has the new Queen’s full confidence, and begins to mold her and help her through the first movements of her reign.

At one moment of major crisis, a time when the roles of government and the crown are being challenged by changing times, she does not know what to do. Churchill comes quickly, and his advice is profound. He reminds the Queen that when the English Constitution was created that the role of the parliamentary government and the role of the monarchy were very, very clear. The parliamentary government was to take care of efficiency, getting things done in an orderly and strategic manner. The monarchy—the Queen—was to take care of dignity, the unassailable quality of presence that gave stability—the glue that held everything together.

The concept is deeply meaningful, especially if you have spent most of your life dealing with the Judgment Index. As many people who have studied the assessment know, there are two parts. Part 1—often called the work/external world side—has to do with the capacity for judgment that will advance the efficiencies of work and general activity in the world. Part 2—often called the Self/internal world side—has to do with the capacity for judgment that will advance the strong impact and stability of factors such as personal presence, character, and personal dignity.

In my mind, the concept being advanced by Churchill in “The Crown” is a fundamentally core concept about life. We need efficiency, the ability to run the “machine” of our world in an orderly, qualitative, and productive way. But, we also need dignity, a “machine” run well by people of character, dignity, and purposeful meaning. It may well be that the Judgment Index gives us a means to measure, assess, and develop the two factors in ways that they can mutually reinforce and inform each other. To try to go forward in our lives and work without efficiency and without dignity would seem to be an ill-fated pursuit, although our world of modern work seems much more concerned—in a singularly obsessive way—about efficiency, and dignity sometimes gets lost in the dust. The real challenge seems to have both —together—in highly complementary ways.

I’m not sure if there are many people who embrace both dynamics—efficiency and dignity. Maybe the English constitution knew to be both might have been asking for too much. I have known a couple of people who have embraced both—most prominently a man named Dan Wilford who lead the Memorial Hermann Healthcare System in Houston for twenty years to exceptional levels of success—but these have been few and far between. These kinds of people are, however, the true exemplars of leadership.

Maybe that is the reason we need conscious and intentional teams, understanding that some people will contribute more on the efficiency end and others on the dignity end; that some will technically advance the highest process agendas in exceptional ways, and others will provide elements of stability, character, and dignity. A tool like the Judgment Index can even make this process very clear and distinct, making sure that the right people are in the right efficiency places, and the right people are in the right dignity places.

If we look at the long history of the British Empire, we see a history speckled with moments of great power and great challenge. We see an Empire that has sustained itself through great and unrelenting change, and yet—as the old saying goes—“the sun never sets” on this Empire and its influence in our world. Many dynamics of Empire have changed, but stability, substance, and leadership—efficiency and dignity—have always been there and remain for us today.

We spend huge amounts of time thinking about efficiency. Maybe we need to spend more time thinking about dignity. Dignity even seems to be something more of a “spiritual” quality, and our modern world sometimes seems so uncomfortable with the idea of “spiritual” that it is ignored and pushed to the side. Maybe we need to understand that true leadership, whether it is companies or countries, will always be keeping both efficiency and dignity in focus and both advanced in a synergy that allows the whole to become greater than the sum of its parts.

Enhanced, Strategic Approaches Using the Processes of Judgment Index USA

The Facts of the Matter

In major writing and research projects from sources such as Mayo Clinic, The Journal of the American Medical Association, Atlantic Monthly, and the Huffington Post, it has become abundantly clear the anecdotal experiences relating to physician burnout are being confirmed in exceptional research. Healthcare organizations across the United States are rushing to find ways to respond to the growing magnitude of the problem, fully realizing the implications for physician partners, organizational reputation, and—most significantly—patient care.

Here are the facts:

• One-third of extensively surveyed physicians reported experiencing what they personally identify as burnout.
• Physicians are 15 times more likely to experience burnout than any other professional career.
• 45% of primary care physicians surveyed report that they would quit their jobs and change professions if they could afford to do so.
• There is currently a 20% higher divorce rate among physicians than other professionals.
• 300-400 physician suicides a year.
• Medical students report treated depression at rates 30% higher than a decade ago.
• There are 6.2 times more medical errors being reported by burnout physicians.
• A 2011 Mayo study reported 50% of physicians reporting at least one major symptom of burnout.
• The number of physicians reporting “suicidal ideation” (thinking about taking their own lives) rose from 4.0% to 7.2% in past five years.
• 20% of physicians reported worst work-life balance issues in past five year.

Therefore, we are well past either wondering or assuming that there are physician burnout issues. The magnitude of the problem is obvious. To leave this particular situation unaddressed would create massive “exposure” issues for healthcare in the United States. The question is: how can the problem be approached strategically?

As a minor disclaimer, there are individuals and organizations that do not like to use the word burnout. There is also a certain mentality that suggests that an individual using the term is advancing a form of “weakness” that a truly strong person should never use and be able to “suck it up” and overcome. If anything, this mentality probably adds to the problem, and creates unnecessary, additional pressure on those struggling. However, if there is ever a need to avoid these kinds of negative associations, we are completely willing to use the terminology “renewal” or “Physician Renewal Program.”

Developing Specific Programs

The present response to these critical issues has been quite simple—we need a “program” where physicians will be encouraged to become involved in the “program,” and that will help make the problem go away, give resiliency for dealing with the problem, or at least give us the chance to say that we have tried to approach the problem. Such programs are certainly well intended and should be pursued. To date, participation in the programs that have been offered has been negligible, and often there has been no constructive way to create awareness proactively among physicians of the degree to which they may need the program. It is also very important that anyone becoming involved in these kinds of programs have great experience and credibility relating to healthcare environments.

The “Judgment Index” is an assessment instrument that is designed to give additional—and unique—insight into human beings relating to both the work-side and the self-side of their lives, and the alignment and connection between these two dynamics. The instrument can be used with other assessment tools and processes in order to give a fuller and more complete set of insights. The more that we can know about human beings, the better we will be positioned to give additional items for both prevention and remediation.

The “Judgment Index” is not a cognitive, rational intelligence—IQ type—instrument. This fact is very important, as reality such as physician burnout have not proven to be enhanced by high rational intelligence. In fact, very highly rational individuals suffer the most ominous problems because they cannot “reason” their way to solutions. The “Judgment Index” is also neither a psychological nor—most importantly—a personality tool. In regard to physician burnout, psychological tools can be of benefit if they are designated; however, it should not be assumed that they should be used. “Personality” is simply not a fully adequate mechanism for dealing with a complex issue such as physician burnout and is a lagging indicator of behavior not a leading indicator.

Uniquely, the “Judgment Index” looks at a person’s judgment, along with trained skill sets and experience, the most significant functional asset possessed by a physician. Patients, peers, and organizations depend on physician judgment, and this asset is most profoundly made vulnerable by the variety of factors that create burnout.

Our Process

1. We begin by administering our assessment instrument, assimilating information, and creating reports for physicians and physician groups. In most instances, we do our work for those who are coming into physician burnout programs. A much better strategy would be to get as many physicians within a healthcare setting to take the assessment. In this way, we can absolutely know who needs the burnout work the most, and we can report on the intensity of the problem as it is being revealed in real-time settings. We hope that physicians will be made aware of the degree of their problem and then will participate in the programs designed. Some will choose not to for a variety of reasons. For these individuals, there is still valuable information that can be provided that will enhance awareness, and perhaps cause engagement with some of our (or other) learning management system materials designed to help in areas of weakness.

2. For those involved in specific programming, both group and individual feedback is made based on assessment interpretations. The key aspect here is awareness, and we have found awareness to be a profound catalyst to change and improvement. We regularly provided program presentations and follow-up counseling.

3. We are fully capable to engage with other assessment instruments and processes in addition to our specific areas of concern noted below if so desired. Our processes are not “canned,” and we customize based on a full understanding of individual organizational needs.

4. We can also, unlike most other assessment instruments, provide pre- and post-testing which will give a clear indication of progress made and—perhaps—progress still needed. Such incremental information can continue beyond the formal program at intervals desired by the participants.

The Maslach Burnout Inventory

In our experience, the MBI is the best Likert-style instrument that has been created to address these issues of burnout. By “Likert-style,” we mean an instrument that asks various questions of physicians to determine frequency of symptoms or indicators that have proven to align with burnout manifestations. The tool’s usefulness has been advanced with credibility at Mayo Clinic and other critical institutions. The information that is gained is very helpful.

We make full use of MBI data when an already existing program has acquired it. We build exacting correlations between our interpretative scoring patterns and this data to give synergistic information based on both tools. When the MBI data is not present, we are able to do the surveying and assessment ourselves without outside or additional consultant help. We can provide all individual and group feedback based on the MBI, and we strongly suggest that we be allowed to incorporate this information as part of our data feedback and interpretation.

Please note carefully that the “Judgment Index” is not a Likert-style questionnaire, assessment instrument. We come from a completely rational and deductive base while the Likert-style assessment is more inductive. Induction has not been traditionally seen as providing the most dependable data, and questionnaire types of devices have been prone to idealistic “halo effect” in their answering process. This being said, we are still strong supporters of the MBI as compared to other Likert-style assessments. We simply provide measurable and quantifiable scoring patterns which give real numbers for participants to work with in their assessment and development. Correlating anecdotal measures with quantifiable measures becomes a stellar means to gain greater, more functional insight.  Our approach with the MBI and the “Judgment Index” would be decidedly “both-and” and not “either-or.”  Again, we can provide the MBI services as part of our contribution to a physician burnout program.

Specific Measures

While there are a wide variety of approximately 80 different measures that can be discerned from the “Judgment Index” that provides a comprehensive view of human judgment and decision-making capacity (both available or impaired), we have tended to focus on the following areas as they relate to physician burnout:

• Stress that is present (in four categories), the intensities of these stressors, and the coping ability that a person has for dealing with these stressors.
• The importance to an individual of control and—correspondingly—the impact of the lack or loss of control.
• The capacity that a person has to set limits so that there are abilities to integrate rest, recreation, recharging.
• The intensity of a person’s self-expectation and self-criticism.
• The capacity of a person to distinguish between what is really “important” and what is merely “urgent.”
• The strength (or absence thereof) of work-life balance.
• The capacity to recognize and act upon implications, consequences, and “bigger picture” realities that transcend present-moment realities.
• The presence of strong self-esteem and its relationship to confidence.
• The presence of a sense of the value, meaning, and purposefulness of work.
• The capacity to deal with difficult situations and difficult people.

In addition to these specifically related burnout indicators, we also will look at indicators that have high implication for safety and risk management. We will be able to create awareness around scores show strong judgment (or lack thereof) that contributes to greater safety and risk management. These indicators include:

• Attention to the ability to remain focused in the midst of distractions.
• Attention to the ability to hold value for following directions, protocols, best-practice solutions.
• Attention to noticing, that which is subtle and nuanced in a situation.
• Attention to cleanliness of larger environment.

In addition, we will also use one of our very most insightful reporting instruments, “The Engagement Report,” to analyze the degree to which a person is fully engaged in the work that is being done. We closely look at four primary core indicators of engagements and three sub-categories within each major indicator. The report is often used as the core of its own separate presentation in a program. It is able to “thin slice” and demonstrate precisely what issues are creating a lack of positive engagement.

The Importance of Rest

Almost without exception, our work in this particular area has seen a strong correlation between burnout and rest. Most physicians, when they are working with a wide variety of maladies impacting patients, will give strong emphasis to the reality of rest. Yet, most physicians do not apply this same formula of inquiry to their own lives. Most people, even physicians, do not have concrete, measurable insight into their own unique dynamics of rest. Therefore, we suggest that accompanying the other activities suggested in our strategies that an individual add a formal sleep study in order to determine these unique elements of rest. What is enough sleep?  What kind of sleep is actually being achieved?  Are there obstacles to sleep and good rest?  All of these kinds of questions are essential.

At a recent presentation, I asked a group of 100+ physicians how many had done some sort of cardiovascular testing in the past year. Almost 100% raised their hands to acknowledge a positive response. I asked how many had done gastrointestinal testing, and with some degree of laughter knowing what is involved with this testing, about 75% raised their hands. When I inquired about sleep studies—with lack of proper rest a common component of both cardiovascular and gastrointestinal problems—two individuals in the large group indicated a positive response.

How People Change

Clearly, if there is physician burnout, there is a desire to change to a better situation. Therefore understanding how people change becomes important to the way in which we carry out our work. In our studies, the most compelling way that people change is because of pain. This is, of course, why many people would find their way into a burnout program initially due to physical or mental anguish. Of course, it would be hoped that such pain could be proactively approached, but often it simply is not.

The second, most significant way that people change is awareness. Awareness can be a powerful catalyst as attention is captured and motivation increased. The “Judgment Index” does a profoundly significant job of capturing awareness, and demonstrating how it can best be channeled to produce sustainable change.  The tool is like a scale on which a person is weighed. The scale, particularly because it has numbers, captures awareness and also provides a benchmark that can be used to assess change—hopefully productive—in the future.

Change can be greatly assisted with conscious and intentional mentoring. Most mentoring is haphazard and neither very conscious nor intentional. By using quantifiable scores from the “Judgment Index,” mentoring can be carefully calculated so that individuals who are strong in one particular area of need can be matched precisely with individuals of weaker scoring patterns. This process has been proven to create highly predictable improvement. In addition, if used properly, can establish informal bonds of communication and support that are important in any kind of improvement process.

Finally, it is true that change can be advanced in positive directions by instructional information. Having been a college and university professor for twenty-five years, I certainly have an appreciation for instruction. However, instruction is not an immediate or guaranteed remedy, and should follow other strategies as reinforcement. Our Learning Management System (LMS) has programming specifically designed to help in areas usually impacted by burnout.  Incorporating these web-based, independent study elements into an overall physician burnout program has proven to be of substantial benefit.

Taken together, and used in strategic process can create enough of a focused exposure that long-range reinforcement of concepts and activities can allow for a greater assurance of success.

Individualized Process

We are prepared to create and carry out a fully developed physician burnout program for an organization on a single or ongoing basis. We can provide a “turn key” activity, or we can contribute elements to an overall program. We are able to do one presentation or several presentations relating to an overall program. At a minimum, we would like to do the following pieces:

• Assessment and introductory interpretation presentation on findings, resulting in a developmental plan for improvement.
• In depth presentation correlating “Judgment Index” findings and Maslach findings.
• In depth presentation on “Engagement” and other key indicators, resulting in developmental enhancements.
• Post-testing to assess improvements.

Also, please keep in mind that we see it as ideal to engage participants in face-to-face encounters and conversations over prescribed periods of time. If/when this ideal cannot be achieved in a program-like setting; individual assessment and feedback can be much better than nothing.

Financial discussions obviously involve a number of variables depending on what parts of options are selected for incorporation. We are committed to the idea of providing quality programming that has high impact as costs that are not prohibitive. It would be very difficult to calculate precisely the return on investment relating to reducing physician burnout and its implications for peer interaction and patient care.

In our work with the Judgment Index, we spend a lot of time talking about hierarchies. At the core of our entire work is Robert S. Hartman’s “Hierarchy of Value” in which he moves from Systemic, conceptual forms of judgment and valuation, to Extrinsic, process, and then to an Intrinsic, human dynamics. Most people who have heard our presentations know that Hartman and Abraham Maslow were great personal friends, and that Maslow’s “Hierarchy of Needs” was created after an evening dinner conversation with Hartman. Maslow famously talks about survival, social, and self-actualization/self-transcendence needs. Both end up seeing the ability to “give” ourselves to the larger whole of life as the highest form of human living.

The way that most hierarchies are graphically presented, a pyramid figure is created with a wide, strong base on one end and a high peak on the other—the top, and there is always a great deal of conversation (as with Zig Ziglar’s famous book) about wanting to “get to the top.” The hierarchical graphic is iconic in the way it implies a progressive upward movement, a growth and development that calls upon people to always be creating themselves in new ways. I have no problem agreeing with most of these hierarchical sentiments.

However, the hierarchical model is somewhat deceptive. It seems to imply that the “top” is always better, and that the “bottom” is—well, obviously—the less-important bottom. In fact, real life is usually more integrated and inner-dependent that the graphic would imply. You don’t have a “top” without the support of the middle and the bottom base. I have often seen Hartman’s hierarchy as an interactive, integrative circle. And, with regard to Maslow, there is very little self-actualization unless the survival needs are totally being covered. Life works together in greater interactive wholes rather than loosely aligned parts.

With these “adjustments” to the normal, iconic hierarchical models, I would offer two new “hierarchies” to our teaching paradigms:

In both of these additions, we continue to see, in the first example, the influence of Hartman’s Systemic, Extrinsic, and Intrinsic, and also in the second example the influence of Jim Collins’ concept of an ideal organization that has strong workers, managers, and executive leaders. But, what I think you really see is more simple—people, people, people. People doing different kinds of works with different training and experience to be sure. But, people integrating and supporting each other in mutually inclusive ways. When it comes to people, we must be careful to diminish the sense of “top,” “middle,” and “bottom.” It is impossible for one part of these new hierarchies to function without the other parts. In that famous “Gestalt Theory” concept that suggested that the “whole is synergistically greater than the sum of the parts,” the function of the parts is never diminished. Again, there is no “top” or “bottom.”

All of this conversation—even with perhaps helpful additions to our new teaching graphics—brings us back to one of our seminally important topics: all work is done through people and groups of people—so the more you understand people, the better you will become at accomplishing work. That’s what we do—help organizations understand their people better, and—in that sense—a better understood and fully maximized human being who “fits” in the right place at the right time in the right hierarchical sector is allowed to contribute to and advance the potential of the entire enterprise.

We will probably never stop talking about “top” and “bottom,” and hierarchies will remain as iconic teaching paradigms. In life, and in real organizations, real people are not so easily pigeonholed. We may relate functionally along hierarchical lines, and organizations may have functional templates relating to specialized tasks. But, in the end, it is people, people, people, and ultimate success always rises from seeing all people as synergistic parts aligning with each other and recognizing each person’s vital necessity to the whole.

“Let’s Just Admit it…”

Dr. Steve Byrum, PhD

            We have been too idealistic. We have worshipped at the altar of Jim Collins, and have built our work around the maxim of finding the “right person for the right seat on the bus.” In our hiring applications of the Judgment Index, we have delivered on the promise of helping organizations find best performers who will be good team members, and who will stay longer in a more engaged manner. We have staunchly advocated that it is better to wait for the ideal person to appear than to fill a slot with a warm body. Honestly, we are still firmly in the Jim Collins, “right person” camp. Our idealism is having a hard time going away.

But, we can’t help listening to our clients, and often sensing a deep emotion in what they are saying: “We’re ahead of the game if we can just get someone to show up dependably”; “We no longer have the luxury of choosing the best person of five, great candidates”; “The candidate pool is nowhere close to what we would like”; “We have markets in some cities where we are operating at 70% of needed staffing”; or “Companies and internet services who are supposed to be sending us good candidates are a churn of mediocrity.”

So, let’s just admit it… our ability to hire the “best of the best,” or even to hire those who stand near the top echelons of our best-performance templates has become significantly diminished. In spite of all of the frustrations involved, “taking what we can get” is becoming more and more the standard operating practice of many modern businesses.

This does not mean that assessment as part of the hiring process goes away. In fact, its value is greatly sustained in a new and vital way. Now, we may have to “settle for less,” but extremely high priority is now placed on knowing better what we are getting. Onboarding now takes on an even greater significance.

Even if the Judgment Index does not determine who is hired, it will allow managers and supervisors to know before the fact exactly where a new worker may have weaknesses that can be monitored and addressed. Awareness of development needs or potential performance inadequacies can be available in a preventative manner beginning the very first day of employment.

There is an old saying that says, “Better the devil you know than the devil you don’t.” Meaning if you have to choose between a familiar but unpleasant situation and an unfamiliar situation, choose the familiar one because the unfamiliar situation may turn out to be worse. Having to take an employee with lesser abilities and lesser judgment is one thing, but not knowing exactly what these lesser capacities are can create problems of a whole different magnitude. Always see the Judgment Index as a tool to help with who you hire, but when control of who diminishes, be sure to let the tool help you with how your overall employment process moves into those essential, first movements of onboarding.

We have said, “What you see is not always what you get.” Now, we are often compelled to say, “I see what I am getting, and I wish it were more.” The Judgment Index helps us see a bit more—how we can monitor and develop weaknesses at the onset of employment, and—who knows—by helping a person grow and contribute in a positive manner it may be possible to gain a level of commitment and engagement that more than compensates for some lack in ability.

My friend rides a motorbike. He has always ridden a motorbike. He loves it and he doesn’t think twice about the risks. A couple of weeks ago he took me for a ride on the bike, and my muscles are still sore from holding on for dear life! The sensation of riding was great fun, but I won’t do it again unless I really have to.

Despite having had a motorbike license since before she had kids, my mother is a worrier. She hasn’t been on a bike for over 30 years and, for 2 weeks after I told her about our little jaunt, she went to the trouble of finding, tearing out and saving an article each week for me from the West Australian newspaper about the risks and current local injury and death toll for motorbike riders.

All three of us know the risks of riding a motorbike. We’ve all enjoyed the thrill of riding motorbikes at one time or other. We are all intelligent people and we all know how to reduce the risks of having an accident but only one of us is likely to get on a bike again, ride fast and expose himself to those risks. The question is… why?

It was seriously frightening to read in ‘The West’ the other day that over a two year period 38 weapons had been discovered at Australian airports after supposedly high-quality screening had failed to detect them. This included a passenger twice (yes that’s right not once) carrying an undetected pistol in their hand luggage on a domestic flight.

In an era of increasing fear and red alerts pertaining to the threat of global terrorist acts WHY do these things happen? Put simply, HUMAN ERROR. While we may have, according to the aviation experts, highly sophisticated screening technology at Australian airports, no amount of equipment or technology can account for the fact that people make mistakes. In some cases these mistakes could cause a loss of many lives.

So, WHAT can be reasonably done to address this issue of human error? All security staff that are employed to detect these potential hazards are presumably well trained and are clear on the requirement of the job. Further training is unlikely to address what is effectively an issue of concentration, focus, and NOTICING the small (but critically important) things in the job. In essence that means placing a high value on not missing anything.

Therefore rather than try and train employees to, or request they realign their values, surely it is more efficient, cost effective and SAFER, to recruit employees who intuitively place a high value on noticing the small things that can become a big deal.

The Judgment Index is a 15 minute assessment that screens, with a high degree of accuracy, for employees who value these things and will ultimately make good decisions even when under pressure.

Modern day life and lifestyles both at work and in our personal lives expose us to more and more stressors all the time.  So much to do, so much to fit in but only limited time.  How do we deal with all the competing demands? Do we adapt – build up a tolerance over time? Or do we gradually get worn down by constant exposure to stressors? This is a challenge that as Manager of EAP Services at The ORS Group I see more and more clients who are attending EAP counseling struggling with.

Have you ever wondered why it is that some people can tolerate highly stressful situations or prolonged stress and still perform at a high or adequate level (e.g. sporting athletes, successful executives and other high achievers) and yet others in the face of multiple stressors crumble?

Factors that contribute to coping with stress

There are many factors that contribute to coping with stress.

• Coping styles and strategies
• Support networks
• Adequate rest
• Participation in restorative activities

Stress and coping – we need all of these things and more but most of all it is a matter of having a (positive) attitude, the willingness to push through, persist and be resilient despite the situation.

A positive attitude is essential

There is no use in having coping strategies if you don’t have a positive attitude – chances are you won’t be using your coping skills!

If you have a positive attitude, if you are self-aware and practice good self-care you have a much better chance to be resilient enough to cope with most stress that comes your way.

Having a positive attitude is often influenced by a person’s  locus of control.  If you feel like you’re just being pushed around by external forces with no capacity to influence outcomes then you are more likely to experience stress and have your capacity to perform diminish.  But what if you can challenge the external forces and find a way around what is presumably being imposed on you. If you have a positive attitude and a belief that you can influence outcomes, it might not totally extinguish the stress, but it might be able to limit the impact and help you strive and cope despite adversity.