Ugo Luigi Aparo
Docente di Strategic Management
La Sapienza Universita Roma
We are living in a very turbulent time: new, difficult, and often perceived as negative. To cope with it, we have to train ourselves to deal with the “resilience factor”. Medical Directors must be able to evolve from decision-making processes based on cause analysis to ones based on the effective actions and reactions to the effects. They have to move from reaction to pro-action, from past experiences to future possibilities.
The Stockdale Paradox
Adverse events happen to everyone; it is absolutely normal to face problems. It is a scale invariant phenomenon, problems show up at any scale: personal, family, team, organisation, and society. We have to train ourselves to cope with difficulties. Yet, despite all the preparation and training, some people are devastated by the unexpected. Others come out from the turmoil strengthened. Why is this?
If one analyses the adverse cases with positive outcomes, it turns out that all those that have been strengthened by the experience, show a psychological dichotomy in the way they respond to a crisis.
Crisis has almost always a negative connotation. It may be interesting to know that in Japanese "crisis" is written as a combination of two ideograms. The first means “danger”, the second “opportunity”. If you are able to see the opportunity and have sufficient expertise and experience to tackle it, then the result can be positive. Some scholars translate the abovementioned combination of ideograms as "luck".
We mentioned the psychological duality needed to positively react to a crisis. Those who come out strengthened accept, from the very beginning, without compromise, the harsh reality of the facts, but they have an unshakable confidence that the final result will be positive. They are totally committed to never give up. This duality is known as the "Stockdale Paradox".
Jim Stockdale, United States Navy vice admiral is one of the most-highly decorated officers in the history of the U.S. Navy. On September 9, 1965 he was shot down over enemy territory and until 1973 was a “guest” of the infamous "Hanoi Hotel," the most notorious Vietnamese prison camp. Eight long years in prison with no rights whatsoever and not knowing if and when he would be released. His life was in constant threat yet he never gave up his beliefs, values or his role.
Stockdale was the highest-ranking prisoner of war in the “Hanoi Hotel” and the entire Vietnam conflict. Therefore he had a responsibility to all other American prisoners. He was their guide and inspiration, an example to them all. It was his responsibility to keep them motivated and unwilling to give up. Stockdale did this in many different ways: by cutting his face, and deliberately injuring himself in order not to be recorded in a propaganda movie to show the world how the war prisoners were well-treated; inventing a protocol to hide classified information in the letters he sent to his wife. He was tortured twenty times, and he developed ways to survive, defining which apparently important confession to make, and at what level, in order to sound sincere and stop the torture sessions.
To reduce the sense of isolation of the prisoners, he created a language in order to communicate without being noticed. A sequence of pauses and noises, fingers’ snapping, tapping on a pipe, sweeping the yard etc. Eventually he and his men were released.
Stockdale recounts his years at the Hanoi Hotel in the book "In Love and War", co-written with his wife. It is a difficult and emotional book but each chapter is worth reading. The reader feels the anguish of uncertainty, the brutality of the captors. One can experience the terror that a harsh reality can induce, day by day. You turn the pages knowing that the story has a happy ending but you constantly ask yourself how all that has been possible, how one can live through those experiences not knowing that there will be a positive outcome.
Stockdale was asked how he did it and his answer was disarming: "I never lost faith that all would be OK. I never had any doubt that I would come out alive. I knew that at the end I would be the winner.” Are we dealing with a sort of maniac optimist? No, not at all. Indeed when asked to describe those who did not make it, his answer was immediate and withering: "The optimists. They did not make it.”
The lesson of Stockdale is very, very important: never forget that the confidence and faith that things will be OK in the end must be sustained by a method, by self-discipline, in order to cope with the daily challenge presented by a brutal reality, no matter how fierce.
We must be wary of optimistic companies where negative data undergoes cosmetic treatment to make it pleasing and acceptable. Worry when you are told that yes, there is a problem to be solved, and the solution will be found tomorrow, the day after tomorrow, or in the near future.
The Stockdale Paradox, this duality of mind, is the signature of all those who lead companies and organisations that grow continuously over time, generating wealth and value. Look for companies that accept the reality, without being paralysed or removing the difficulty of the situation in which they find themselves. Search for firms certain of their ability to survive and continue to grow and you will be fine.
If you develop the ability to get the right signals out of the thousand noises around you, if you do not panic, and do not follow the chimera of illusions, if you are not fascinated by sensational short term successes, if you are able to keep your attention focused until the final result has been achieved, always knowing where to go and discovering how to get there when it is needed, then you are like Jim Stockdale and you will succeed in the end.
These are abilities that can be learned, they are abilities to prevent adverse events and face adversity with resilience.
Resilience is a term derived from materials science and indicates the property that some materials have to retain their structure, or to regain the original shape, after being subjected to crushing or deformation. In psychology it describes people's ability to cope with stressful or traumatic events, and to re- organise their lives in a positive way in the face of difficulties. People with a high level of resiliency are able to respond effectively to negative experiences, to give new impetus to their existence, and even to achieve important goals. Exposure to adversity seems to strengthen rather than weaken them. They tend to be optimistic, flexible and creative, have a high social intelligence, know how to work in teams and treasure their own, and other people’s experiences.
Resilience is a sort of mental function that changes over time in relation to the experience, to what has been lived and, above all, to changes in the mental mechanisms that underlie it. According to Susanna Kobasa, a psychologist at the University of Chicago, people who are best able to cope with adversities of life, the most resilient in fact, show three personality traits:
1. Commitment. The tendency to get involved. The person with this trait is active; has a high stamina; stays in the game; is attentive and alert but not anxious; examines the difficulties realistically. There is commitment if the goals to fight for, to believe in, are clearly stated: If something, properly defined, has to be achieved in a due time.
2. Control. The belief that one can dominate what has to be done, the actions to be undertaken; belief of not being at the mercy of events. People with this trait, in order to be able to dominate the different situations of life, are poised to change, even radically, the strategy to be followed; in some cases intervening with great promptness; in other cases stepping back, taking time, waiting.
3. Love for challenges. Openness, flexibility, willingness to accept changes; the ability to see the positive aspects of the changes, and minimise the negative ones. Change is seen more as an opportunity to grow than a threat. Changes are challenges that reinforce strength.
Commitment, control and love for challenges are personality traits that one can be aware of, and therefore can be cultivated and trained. Resilience is not a characteristic present or absent in an individual. It is a set of behaviours, a way of thinking, and actions that anyone can learn.
Having a high level of resilience does not mean that one does not experience difficulties or the stress of modern life. It implies the ability to accept the possibility of doing something wrong, and at the same time to believe that whatever error or wrong decision he/she could encounter, he/she will always acknowledge it, take responsibility, and correct the course of action.
A high level of resiliency is the result of the interplay of several factors. The most important one is a high level of social intelligence, which allows the defining of a set of relationships with supportive individuals who share the same ethical values and characteristics. This set creates and feeds an environment permeated by love and trust, which provides encouragement and reassurance. The final result is a higher level of resilience.
Other factors are involved:
• Self-Esteem: Knowledge of personal abilities and capabilities, together with a strong character;
• Ability to be define challenging, but achievable, goals and the incremental plan to reach them;
• Good communication and problem solving skills;
• Ability to control impulses and emotions.
There are many ways of increasing your level of resilience. Focusing your attention on past experiences and identifying your personal strengths can help find the most appropriate strategy.
Answering the following simple questions can facilitate this process:
•Which past events have been particularly stressful?
• How have these events affected me?
• In difficult times, who have I found it helpful to talk to?
• In difficult times what did I learn about myself and what was my interaction style?
• Was it useful for me to provide assistance to someone going through difficult times similar to ones I had experienced?
• Was I able to overcome the difficulties? How did I do it?
• What has allowed me to look with greater confidence to my future?
According to Boris Cyrulnik resilience is the art of surfing white waters. A trauma disrupts the actor by dragging him/her in a direction she/he would have not have taken. Being swept up by the eddies of the stream that is dragging him/her towards a waterfall, the resilient subject has to resort to his/her internal resources, to memory, in order to fight against the forces that are tossing incessantly.
Managers and Adverse Events
We are living in a very turbulent period. It is new, difficult and often perceived as adverse. There is no escape from this situation and those in charge must be able to switch quickly from the analysis of the situation to a viable action. We must be “resilient managers”. Once the adversity is here, we have no choice: we must move from cause-oriented thought to an action-oriented one. We have to focus on the future.
There are four lenses through which resilient managers observe adverse events so to make the above mentioned shift in thought:
1.Control:When a crisis erupts focus attention on what can be done, rather than trying to identify all the factors that caused the crisis;
2. Impact: Resist the temptation to look for the causes of the problem in yourself, or other people, maybe trying to identify who is responsible for it, but focus attention on the positive effects that may result from the possible actions;
3. Extent: Find out if the cause of the crisis is specific and if it can be contained, or might cause long repercussions;
4. Duration: How long will the crisis and its repercussions last.
The first two lenses characterise the personal reaction in the face of an adverse event. The other two describe the feeling one has of the magnitude of the event. Resilient managers must use all four lenses together to fully understand their instinctive responses to personal and professional challenges, successes and failures.
When an adverse event occurs commonly we fall into ontological emotional traps. The first one is deflation. He who has walked a long way on the road of success can easily think about him/herself as a hero capable of solving any problem. A traumatic event can bring him/her back to earth. They may find themselves disappointed, dejected, discouraged and under siege.
The second trap is victimisation. Many of us, confronted with an adverse event, take on the role of the helpless spectator. We ignore any criticism. We do not want to be helped. We want to go on our way. We pretend to be right. The rest of the world is plainly wrong. Nobody understands us. These two traps are very, very dangerous.
How to Develop the Ability to Be Resilient
Most of us, when faced with an adverse event, do a quick check on the causes, magnitude, and duration of the consequences of the event. For example, we find out, almost immediately, what forces are under our control, and if the event could be forecasted.
Resilient managers do not waste time on this reflective thinking and instead move directly to active thinking, identifying which aspects of the crisis can be controlled and their impact. The immediate goal is to respond to the incident, containing its amplitude and duration.
Three types of questions facilitate this change of direction:
1.Specific Questions:What can I do?
2.Visual Questions: How can I focus my attention on what needs to be done instead on what is going on?
3. Collaborative questions: Am I searching for elements to solve the problem, or am I looking for assertions or accusations about the problem?
The goal is neither the definition of an action plan, nor the ultimate understanding of how the team has to react, but to create opportunities, designing, in an appropriate and practical way, an inventory, a process, of what should be done.
• What factors can I act on to change the course of the adverse event?
• What would my mentor or manager do in the same setting?
• Who in my team can help, and how can I get them on board?
• What should I do to get the most positive immediate impact?
• What positive effects could my efforts have on my team members?
• How do I mobilise the efforts of those who are not collaborating?
• What can I do to reduce the negative effect of the specific event by 10%?
• What can I do to get a positive outcome?
• What efforts and resources do I have to allocate within my team to get a positive outcome?
• What can we do individually and what can we do together to contain the damage and turn this into an opportunity?
• What can I do, right now, to move in the positive direction?
• What are the different facets of the incident?
• What steps need to be undertaken by the team, and what processes must be implemented to overcome this crisis?
Managers, specifically medical directors, have to increase their resilience, and must be able to switch from cause-oriented to responseoriented thinking (Table 1). Managers need to acquire the resilience of the famous cartoon character Wile E. Coyote. Fighting his fiercest enemy, gravity, he never gives up, no matter what, the pursuit of his primary objective, the Road Runner.
The lesson of vice admiral Stockdale is very, very important. Never confuse the confidence and faith that in the end we shall make it with the discipline and method needed to cope with the brutality of everyday life, no matter how fierce.
Life is not always kind. Often it is pretty unfair. Sometimes we are lucky and sometimes things don’t go our way. We have all lived through unpleasant experiences and suffered disappointments. Often there was nothing, and no one, to blame: an illness, an accident, a death, the end of a love; a prison camp in Vietnam. It is not important what these experiences do to us but what really matters is what we do with these experiences.