Speaker 1: Hi, welcome to our video today. Today, we're talking about the stress of unpopular decisions as a hospital administrator, something that I know strikes a chord in everybody watching this video. My name is Jeff Comer. I've been a hospital CEO for 20 years and counting, and I'm also educated at the doctoral level in psychology with research interest in stress management and specifically how to manage stressful situations, such as making unpopular decisions. I have a graph that I want you to take a look at, and you've seen this before in one of my other videos. This graph shows the stakeholders that a hospital administrator has to take care of. Now, there may be some variants. You may have additional ones in your organization or a few, you know, lesser or whatever. They may not be exactly the same, but in general, you can see as hospital administrators, we have a lot of different entities and groups and organizations and people that we have to work with, that we have to get on the same page, moving in the same direction. It is impossible to always make popular decisions that everybody's going to love. Eventually, you're going to make a very unpopular decision that is going to cause stress to you as well as stress to other people. Why, though, is it so difficult from a stress situation to make an unpopular decision? I mean, it's just business. It's not personal, right? I've heard that phrase so many times, and there are certainly circumstances when that phrase is quite accurate. It's very, you know, describes the situation very well. You have a business decision. It doesn't really affect anybody. It's not personal. It's just something you do and you move on. But when you make a decision that is unpopular, it is usually unpopular because it has affected people. It has struck them. It has made them either lose jobs, watch friends lose jobs. Maybe services were shut down. Maybe processes were changed. They have to do their job differently. All kinds of different reasons for why the decision may be unpopular, but usually it has impacted somebody. And so it is quite personal to them. When people experience psychological change as well as physical or logistical change, it is very stressful to them. People like to have routine. They like to have structure. They like to have certainty. And when they lose that, we all know that change can be very difficult for people. It causes stress. And with that uncertain component with the change, with the discomfort of the change, they express emotions. And it can be any type of emotion. Some people may love the change. They may be happy about it. It impacts them positively. But most people, it's going to cause anger, sadness, upset, confusion, uncertainty. And who are they going to direct that at? They're not going to direct it at themselves. They're not going to direct it at the overall situation. They're not going to blame the universe. They are going to blame you, that hospital administrator, in the center of that graph. That can be very stressful for you. All of a sudden, these people that you're trying to make decisions to help, you're trying to get your organization moving in the right direction and respond to threats that you're facing in your environment. You're trying to do the right thing. But you've now made people upset and they're going to direct it at you. So it makes you have a feeling of rejection. You may have a frustration yourself. You may have anger yourself. All of these emotions, though, invoke the stress response system. You've got a lot of cognitive dissonance going on, a lot of emotional dysregulation. You may feel isolated and you probably may feel personally attacked by some of these responses that you are hearing. So it's a lot of stress that you're taking on and you're trying to do the right thing. So, how? How do you deal with this from a psychological perspective? And again, I'm not going at this from a tactical perspective. I'm not saying, you know, schedule this number of employee forums, send out this memo. There's lots of videos on that kind of stuff. I'm talking about purely psychologically, how do you respond to this? And by the way, I did have a one person sent me a message asking what's on my coffee mug. This says Cave Creek. That's the town I live in. So the person did not ask questions about the content of my video or my thoughts or ideas. They wanted to know what was on my coffee mug. So it is Cave Creek. So, first of all, to deal with these kind of stressful situations, coffee does help quite a bit, I will admit. But there are three things that I like to focus on that have worked well for me as a CEO and that are also very well supported in the research. First, very simply, understand and acknowledge that this is personal. It's not just business. It is impacting people. It is impacting you. Psychologically, there is stress, as we talked about. There's a loss of control. There's a fear response that kicks in. Understanding this can help you feel better about the situation and it can help you to show empathy and understanding and listen to everybody else. It can help you to bring unity among your clan. You've heard me talk about clans in other videos, so I'm not going to get into that right now. But you do have a clan from a psychological perspective and you want to bring unity to it. You want to get them to understand that we're all in this together. This is not you trying to be mean to anybody. You're not staying up at 2 in the morning trying to, you know, make people's lives miserable or difficult. You may be staying up at 2 in the morning to try to figure out how the organization can survive and thrive going forward. That's the type of understanding and empathy that you want to convey to your people that are upset and hurt and uncertain. Trying to embrace a collectivist mindset, getting away from that individualistic blaming type of mindset, again, helps you to reduce your stress as well as not feel as rejected. So one way to do this gets into my second recommendation for dealing with the stress of unpopular decisions. You've heard me talk about this as well. Nurturing the clan. Nurture the people that work with you. Nurture your organization. I have always said leadership is very easy when times are going well. It's very easy to be a leader when finances are great and quality is great and you've got all this growth and momentum and energy, but that's not how most hospitals operate. I heard recently that 65% of hospitals are losing money right now. So you making unpopular decisions, me making unpopular decisions, we're in good company. A lot of unpopular decisions aren't being made right now. So do find some comfort in that. But during difficult times, that is when the communication aspect is so crucial. That's when you've got to get out and lead. Again, clans are so important in our psychological makeup and historically, tens of thousands of years ago, when a clan had changes, when the leader of the clan made changes to the structure of the clan, it usually meant there was an imminent risk of danger to that clan. Now, as you've heard me talk in other videos, technology, society, organizations, everything has progressed well past the clans of 10,000 years ago. But the human mind has not quite caught up to that. We still have psychological concepts that are operating as if we were in clans on the African plains and in the tundras. So understand that when you're working with your clan, with your people, with your organization. When the clan was changed, as I mentioned, it signified danger. When people see a change to your organization, they think the worst. They think that there is a dangerous situation, that there is a safety issue. And there probably is. You're making these decisions because something is wrong in the environment. There is a threat that you have to respond to so that the organization can survive and thrive. So there is a threat. It's not going to kill you. Okay, it's not going to kill anybody in the organization, but the human mind doesn't quite differentiate that very well. So reassure them, nurture the clan, show the empathy, listen to them, and try to be a part of them. One of the things that is really important for you when you're going through difficult times as a leader is to break down depersonalization. Depersonalization is when people don't know you, they don't see you, and if they're not hearing communication from you during these difficult times, if you're not explaining the change, if you're not explaining the rationale behind it, psychologically, humans have a need to explain, to have control. And what they will do is they will make stuff up, okay? Rumors, speculation, you've all seen it in your organizations, in your careers. They are almost always wrong. They're almost always overblown, and they do nothing but start to spiral out of control. They make the situation worse. They increase people's stress even more, and you're not there. You're not present. So they depersonalize you. They don't see you as this caring clan leader, this caring person who's in it with them. They see you as the stuffy hospital administrator sitting in your office making decisions that affect them without you understanding what they do or how it affects them. So you need to break that down, and the best way to do it, nurture the clan. Get out of your office. Be visible with them. Talk to them. Let them understand you do care. Let them understand the rationale for your decisions. Guys, it's okay to say, I'm sorry this is impacting you. I feel bad that it is. I don't want it to. You're my family. You're my clan. I don't want anybody hurting or angry or upset, but here's why we're doing it, and be honest with them. That's really what people want. So if you take those approaches, then people will see you more genuinely. Your trust, your credibility will go up. The rumors will go down, and by being authentic, by being yourself and sharing this with them, you will feel better. You'll feel much more comfortable. Your stress levels will go down. You'll feel less rejected and less isolated. It is a win-win for everybody. The third thing I want to talk about, and I tend to not get too much into this in my videos, and maybe I will do a specific video on this, but when you're going through really difficult changes as a leader, you have to figure out what you can control. A lot of what you're doing is out of your control. It really is. You make these decisions, you implement them, and then you just have to let them play out and see what the results are, and if the results are good, fantastic, it worked well. If they're not, you have to regroup and you have to start all over again. So you want to find what you have control over. Well, what do you have control over? Yourself. That's what you have control over. This is the time when difficult things are occurring, when you're making unpopular decisions, when there's uncertainty in the organization and fear and you're trying to nurture the clan and you're trying to take all the appropriate steps to get people through this difficult time. Don't lose sight of your own health, your own wellness. Keep your balance in your life. Be with your family still. I promise you working 14 hours a day does not get you anywhere in your career. I've done it. I've spent many years of my life working those kind of hours, and it does not make you a better hospital administrator. It does not make you more effective. It will burn you out. Three-quarters of hospital administrators now are completely burned out. You throw in difficult times like this and you don't take care of yourself, you will definitely be one of those burned out people, and then you're not as effective. You really want to try to step back, do what you need for your organization, but do what you need for yourself. When you are stressed, stress reactivity, one of the things that it causes, it's a fascinating process and at a very high level. When you get a stressor that produces your stress response system, the amygdala in your brain is roughly the emotional center of your brain. It goes into immediate action, immediate overdrive. It gets the sympathetic nervous system going, which sends this cascade of physiological downstream effects. It gets your hormones going, your cortisol, your testosterone, estrogen. All these other things are taking place in your body. But what is not taking place in your body? Your prefrontal cortex. That is your executive logical functioning center of your brain. That's where you make your decisions. You are physiologically, biologically, evolutionary wise, you are programmed for your prefrontal cortex not to start working when a stressor occurs. Because again, you're still wired for emergent stress, stress that will kill you. That's how your brain and your stress reaction system still works. So if you're attacked by a bear, you don't want your brain to look at that bear and say, well, what kind of bear is this? Is it a brown bear? No, I think it's a black bear. Now, okay, it's a black bear. Now, am I supposed to climb up a tree or do I run from a black bear? No, black bears you run from. You don't climb. You're doing all that stuff. The bear just ate you. So you biologically have a safe mechanism from that. Your amygdala goes into overdrive. You immediately jump out of the way. You immediately climb the tree, run, whatever you need to do to get away from that emergent danger. Then your prefrontal cortex starts to kick in again. And the reason I'm saying this, when you are stressed at work, you want your prefrontal cortex to be working. Okay. That's why you need to keep your stress under control. So taking care of yourself, nurturing your clan, doing these things that I've talked about in this video can really, really help you to keep your stress levels down. Which the other interesting aspect about that stress is contagious. Humans are a herd animal. Now you watch a herd. Let's give an example, the caribou up in Alaska, huge herds of caribou. You have one little isolated, standalone caribou who freaks out. He hears something, he sees something, he catches a smell something and he runs. All the caribou run behind him. Humans do the same thing. When somebody is stressed, when somebody reacts negatively, people tend to gravitate and follow that. That's one of the reasons we get in this negative vicious cycle that we have. It also works the other way. When you're positive, when you're upbeat, when you're calm, collected, not stressed, that is contagious as well. So folks taking care of yourself will keep you from being burned out. It will get your prefrontal cortex working. It'll keep the amygdala in check, keep your hormones in check, your sympathetic nervous system in check. To where your brain is working, you're making much more effective decisions. And it is contagious to the people that are so stressed in your organization because of these unpopular changes. Okay. I've covered a lot today. I could spend another hour on this topic. I'm trying to keep this very high level though, give you some things that you can work with right now. I think I probably will do another video or two on the stress behind unpopular decisions. But I hope this gets you started. Please. I'm in this with you guys. I make them every day on public decisions. You do. I do. We all do. You're not alone. You're not isolated. Please reach out to me. Message me. Leave comments. I'm happy to respond and talk more. And again, I do hope this is helpful and good luck with those unpopular decisions.