Why are you here?

Why are you here?
Drug charts, cannulae & discharge summaries? Ward rounds? Clinic reviews? Doing caesareans, hysterectomies, ultrasounds or more paperwork than you care to think about?

These are the things we do every day, they keep the cogs of the department turning and the patient flow flowing. All very important stuff.
 

But, why are you really  here?
Remember back when you applied for entry to medical school. What did you tell the interviewer when they asked the question. That one we were all asked. None of us said we want to do drug charts or episiotomy repairs. Most of us were pretty clear about why we wanted to do medicine.  And we were fortunate to have the intelligence and opportunity to be able to pursue the career we’ve chosen. The reasons that led you to study so hard to become a doctor are still the reasons that you’re here. It’s your purpose, cause or belief in life, and it’s WHY you get out of bed in the morning. It is the force behind everything that you do. It definitely is for me, and it’s why I’m passionate about the work we do in our department.
 

The Golden Circle
Simon Sinek calls this the Golden Circle and it predicts the driving behaviours of individuals, teams and organisations.  Every person, team and organisation knows WHAT they do. We can all describe our daily functions within the systems we work.

If you think about it, you’ll likely be able to describe the HOW. Our HOW is everything from the organisational structure of the hospital, the guidelines we follow, the rosters and timetables we work to, and the facilities at our disposal.

But the WHY is deep inside YOU, me and our organisational culture. It is what brings us here each day and drives the HOW and the WHAT. Without a strong WHY, you are just going through the motions, without commitment, resolve or real reward.

Some people don’t discover their true WHY until later in life, after they’ve already made some career choices. This explains their difficulty in finding happiness and flow in their work life. If you really have to build things to be happy, or create art or change people’s lives through third world development projects, then you are not going to be happy sitting in a GP surgery all day. Once you know your WHY, you can firmly get your life on track. There is no reason we can’t have more than one WHY for different aspects of our lives. But you will only be truly happy and do your best when you spend most of your time doing the one that is most important to you.
 

Communication and actions
Most people, organisations or teams can articulate clearly WHAT they do, many have ideas about HOW they do it, but not all are clear or consistent on their WHY. Or the WHY gets lost in the daily grind and we forget (or receive mixed messages about) the things that are important.

This concept can be used to understand a variety of human accomplishments ranging from why the Wright brothers managed to create the first flying machine when so many others had failed before them, how Martin Luthor King was able to lead the civil rights movement and why Apple is one of the most successful companies in the world. With strong, explicit WHYs and inspiring leadership comes success.
 

An example
If I tell you that the hospital management have set a target that 90% of discharge summaries must be completed on the day the patient leaves hospital and that this will be your new Key Performance Indicator, how will that make you feel? It’s not the most inspiring of jobs but most doctors will have a diligent stab at doing what is asked of them and while it’s high on the list of measured outcomes, you’ll likely be on target.

One day, you are called to theatre after the ward round, you’re tied up much of the morning with a PPH and hysterectomy and there are tons of postnatal discharges building up. By the time you hit the ward it takes you most of the afternoon to get through them. When you go home, you remember that you missed that one discharge summary of old Mrs Jones who had the laparoscopic oophorectomy yesterday. She is being converted from clexane to warfarin due to her AF & needs GP follow up in 2 days time. The following day it falls off your radar and is forgotten. Until Mrs Jones comes back to clinic in 6 weeks time. She has normal histology and you’re pleased to be seeing her and give her the good news.

But when she comes into the room you discover she has a hemiparesis and impaired speech. She didn’t realise that she had to continue the clexane after going home and assumed the warfarin was enough. She missed her GP appointment and presented to ED 6 days post-op with a stroke.

How much more likely are you to be diligent about transfer of care between providers after that? WHAT you do and HOW you make it happen will be driven by the emotional investment you gained from that experience with Mrs Jones. And the lesson will last the rest of your career. I know it would, because it did for me after I saw Mrs Jones.

I’m not suggesting that every message about our HOWs and WHATs have to be wrapped up in a risk management disaster story - that is just one example - but they do all have to be filtered through our WHY. Doing so will bring about the same visceral (limbic) response, the same clarity of purpose and commitment to goals. It is why I share our patient stories with you.
 

Leading from the inside out
Everything I do as a doctor and a leader comes from my WHY. This actually isn’t particularly clever and you might be wondering why it even needs to be explicit. If this is obvious to you, then as individuals, as a team and organisation, we are already on the same page. My WHY is very straightforward and is distilled down to six simple words:
 

Healthy women. Safe babies. Supported staff.
 

Everything I do is about this. It is my WHY and vision for our department. I know for a fact that we can be the best O&G department in the state - in Australia even - provide the highest quality care to our women and babies and all be happy in our daily work. When you know your WHY and when you focus, teach, communicate and lead through it - from the inside out - you will have a successful and happy work life.

These words are more than a company strapline or an organisational vision statement (but they could be that). I own them and I’m personally accountable to them.

I need you to share my WHY and understand that it underpins everything I ask of you. I want you to find your own WHY and bring it to your daily practice, with your patients, work colleagues and when you teach medical students and registrars. I know that you do already, I see it in the excellent work and the quality, empathic healthcare we deliver each day. Clarity and explicit understanding of your own WHY will inspire those you come into contact with and help you go that little bit further toward your goals.

I’m going to say more about this later. If you want to hear about the bigger picture and why the Wright brothers, Luthor King and Apple succeeded where others failed, watch Simon Sinek’s TED talk: Start with Why

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