Mindful Organizations

Nov 21, 2023

By Ron Epstein, MD

For those of us who work in complex, clumsy and chaotic work settings, the idea of mindful organizations might seem aspirational at best, and maybe an oxymoron. That said, suspend your disbelief for a moment and imagine what a mindful organization might be like. If you need to, close your eyes, and imagine that a miracle has happened: you went to sleep one night and the next morning your health care setting was transformed. It might be easy to imagine that some of its problems had been dealt with effectively so that it had become 10% better, or 20%. I ask you, though, to stay with me and imagine that your organization was transformed so that it lived its clear person-centered and relationship-centered health-promoting values and attended effectively to the needs of patients, clinicians and staff. Imagine that patients routinely feel seen and heard. Imagine that you feel a sense of connection to your work, relatively unimpeded by mindless bureaucratic and administrative tasks. Imagine that this combination results in greater improvements in health and well-being – on the patient’s terms, not just in terms of quality metrics. Now, think of words – and feelings – that come to mind that would characterize such organization.

You wouldn’t be the first to engage in this exercise. Starting in the 1990s, leaders in organizational psychology started looking at high-reliability organizations, those in which small failures could be catastrophic. At the same time, psychologists started exploring how individual minds interact, and understanding that “minds”, in one sense, extend beyond the brain, and even the individual, leading to serious talk about collaborative cognition, organizational attentiveness, collective mind, emotional resonance, and ultimately organizational mindfulness. After 25 years, some principles of mindful organizations have emerged, and continue to evolve.

I’ve become more and more interested in promoting mindful healthcare organizations – not just individuals’ efforts to become more mindful – recognizing that a facilitating environment helps individuals to thrive and flourish. Some large organizations have successfully identified and enacted principles of collective mindfulness. These principles map onto the principles of mindful practice that we teach in our workshops: attentive observation, curiosity, beginner’s mind and presence. Attention, in the form of situational awareness, means noticing and speaking up when things don’t seem quite right. Curiosity means the capacity to be curious and step outside of routine when encountering the unexpected. Beginner’s mind means appreciating complexity and contradictory truths rather than oversimplifying.

Consider what the two photos of a beach during a hurricane evoke in you. For most people, the one with the pier evokes danger and fear (would you take a walk on that pier?). The surfer photo evokes adventure and mastery (assuming the young surfer is neither psychotic or suicidal). Both are true representations of an event. Presence involves attention to others and their contexts. Sometimes efforts to standardize roles and protocols for every eventuality narrow our attention; we focus on the transactional aspects of our work and neglect the context and human interactions that are the backbone of any organization. Greater fluidity can lead to flexibility in responding.

Just as individual mindfulness is a moral choice about focusing your attention on the most important thing, organizational mindfulness is also a moral choice about crafting organizational structure to realize values of health and healing. Organizations are little more than a collection of conversations, and it really matters what, with whom and when we talk about the most important things, those that are health-enhancing and relationship-building. We are all part of those conversations, even if only in a small way, and we can bring mindfulness not only to ourselves but to those with whom we interact.

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