Relational Leadership: a Trust Accelerator for UNC-Chapel Hill

“Relational Leadership helps us all come together as a community that sees the value of connection; that sees how our effectively communicating, collaborating, and working interdependently not only helps us thrive as individuals but has the potential to advance the causes that even our independent communities are so passionate about, whether that’s patient care, research, education, or community engagement.” — Sarah Smithson

We spoke with three leaders at the University of North Carolina at Chapel Hill (UNC-Chapel Hill) who were instrumental in bringing Relational Leadership (RL) to UNC and in sustaining RL @Carolina. We wanted to learn more about the current and potential impact of RL on them personally and professionally, on program participants and the institution, and on the wider healthcare sector. RL @Carolina began as a pilot in early 2019, and three years, six cohorts, and more than 200 participants later, the program is going strong with a waiting list and a growing number of relational leaders at the institution.

Relational Leadership at Carolina sits within the Office of Interprofessional Education (OIPEP), which was established in 2018. The office was created by the provost to support a campus-wide initiative for the intentional integration of interprofessional learning and collaboration. A director from each of UNC’s professional schools serves on the OIPEP leadership team. Sarah Smithson was the inaugural director for the school of medicine and is now the director of the RL @Carolina program. Meg Zomorodi is the assistant provost and director for OIPEP and Mindy Storrie was the inaugural director of interprofessional education and practice representing Kenan-Flagler Business School.

Relational Leadership Supports the Goals of UNC and OIPEP

Smithson, Zomorodi, and Storrie each speak of the Chapel Hill campus as a special place with a prevailing climate of interdependence, community, and a desire to move forward together. Smithson notes that, “with so many professional schools colocated within a couple of miles of one another, there is an embarrassment of riches in talent, creativity, and professional achievement gathered here.” Even so, it is a large university, and the schools within it tend to practice independently. The concepts behind Relational Leadership are helpful in breaking down silos and are well-aligned with the strategic plans of both the university and OIPEP.

The University published a strategic plan called Carolina Next that comprises eight core strategic initiatives. The first initiative, which is the primary focus, is “to build our community together.”

“Relational Leadership really helps build movement and momentum for doing the hard work that we need to do together."

According to Zomorodi, Relational Leadership is well-aligned with the university’s focus on building community together. “RL really helps build movement and momentum for doing the hard work that we need to do together. If we can't do it together, we can't do it. And so to me, RL supports our goals perfectly.”

“For our office in particular, we know that interprofessional education and practice fall apart when you don't have strong communication and don’t have effective tools to navigate conflict,'' Zomorodi adds. "These two key components are Relational Leadership concepts, and they are essential for helping us get the work done. The mission of our office is to be better together. We can't be better together if we don't have a relational approach.”

Storrie agrees, noting the natural alignment at the university level with the University’s most important strategic initiative, and adds, “To me, Relational Leadership is just perfect for Carolina. I've been here 23 years, and if I knew how to bottle what happens on this campus, I could be a very rich person selling Carolina’s natural tendency to engage with others for mutual benefit, moving forward together while not just thinking of ourselves. It helps us engage in a more positive way with all stakeholders, both internal and external.”

Navigating Challenges With Relational Leadership

The challenges in healthcare today, both longstanding and recent, are now widely known, in part due to the COVID-19 pandemic. Burnout, already high before COVID-19, has soared, the healthcare workforce is shrinking, and there is now a long-overdue spotlight on health inequities to be addressed. In addition to technical solutions, this increasingly complex environment requires new, interpersonal approaches to navigate, with high levels of coordination, collaboration, and trust among the healthcare workforce, their institutions, and leaders.

Smithson notes several challenges that are particular to academic medicine. “Traditionally, academic medicine isn’t structured for doing the work in a relational way; you’re out there hustling for yourself and trying to demonstrate why you are great. And traditionally, interprofessional collaboration is not highly valued.” She also notes tendencies toward hierarchical thinking and doing things the way they’ve always been done.

“The challenges of the past two years have amplified some of the underlying issues that we were previously able to just manage through. COVID-19 laid bare how close we are and have been operating to this line of fragility.”

Smithson continues, “We have not built in ways to support the people doing the work. We train you to withstand and bear emotional trauma, long work hours, and isolation, and by the time we send you out into the workforce, you’re ready. And then you drop a pandemic on this group of professionals, and the truth comes out — it’s not bearable for years at a time. We’re seeing people leaving medicine for a lot of reasons, but in part, because it’s not sustainable for the long term, practicing with this expectation that we’re superhuman — that our drive to serve others will be all-sustaining. That drive certainly brings many of us to this space; it does sustain us to a certain degree, but we’re human. The drive, desire, hope, optimism, and love of serving others can only take us so far. We’re starting to see many people pushed to the limit of what they can withstand.”

Zomorodi adds, “Healthcare is on a precipice, where we can continue to do it the way we've always done it, or we can fix what has been a long-term systemic problem. Our workforce is tired, … and we need to find the bridge to connect with each other again.”

“Relational Leadership gives us a framework to have the conversations that people have wanted to have for some time. It gives us an action plan as a community."

Smithson, Zomorodi, and Storrie each mention challenges with a divisive social climate, injustice, racism, and a critical need to address and overcome health inequities. These are not new challenges, but they have been highlighted by the pandemic and can no longer be ignored.

Zomorodi says, “Relational Leadership gives us a framework to have the conversations that people have wanted to have for some time. It gives us an action plan as a community, and we know we're not in this alone. That community influence is key, and it helps us achieve our goals.”

Storrie notes the tension surrounding interactions that are “incredibly polarizing here, as across the nation. I believe if we would step back and talk about Relational Leadership, which is less divisive, we still have a chance; there's an opportunity for reconnection that people still are not recognizing.”

“The tools that we learn together in Relational Leadership help us create infrastructure that raises all voices. RL concepts are foundational elements that can make difficult work possible."

Smithson describes how Relational Leadership is supportive and useful in these challenging spaces. At UNC-Chapel Hill, they have evolved the RLI curriculum to include more conversations about power and identity. “If we’re going to have those really difficult conversations, we need to do them in a psychologically safe space, a space that feels comfortable for risk-taking. And that’s not a space that has been traditionally cultivated in medical settings, especially in academic medicine. We’re going to need specific skills and strategies to make sure that we’re creating diverse communities of people that represent the communities we serve. Then, once there is representation in shared spaces, we need to make sure to use certain skills and techniques with intention, to bring all voices to the forefront. Just trying to be a nice person is not going to be effective, because we have too many blind spots. There are too many traditional, structural processes and policies that prevent even nice people from being effective in these spaces.”

“The tools that we learn together in Relational Leadership help us create infrastructure that raises all voices. RL concepts are foundational elements that can make difficult work possible. It’s still challenging with the RL tools, but if you don’t use those tools, in some ways, it can be harmful.”

Relational Leadership in the Larger Healthcare Ecosystem

"The tools of Relational Leadership have the potential to create a sense of ‘us’ as a medical community, help us reframe our identity, and call us into a shared space where we can take collective action together. That’s where there’s a lot of potential power.”

When asked how the concepts underpinning Relational Leadership might be helpful in the larger healthcare ecosystem, especially in this moment, Smithson says, “Relational Leadership, when modeled by key leaders, has the potential to shift culture. I don’t want to oversell it by saying it can make everything better, but if key leaders create spaces to demonstrate and share their own vulnerabilities, this shift brings people together. That is what we need right now in healthcare and in academic medicine, more than we’ve ever needed it before. People are working through big, difficult challenges, and in some ways they’re doing it alone. The tools of Relational Leadership have the potential to create a sense of ‘us’ as a medical community, help us reframe our identity, and call us into a shared space where we can take collective action together. That’s where there’s a lot of potential power.”

Zomorodi says, “There are many studies that reference empathy and connection as a key finding of effective leadership. RL also teaches that psychological safety is not possible without empathy and both are needed to do this work. We have to do this work, or our healthcare system will be irreparably broken.”

Storrie adds, “Relational Leadership seems so intuitive. It is about investing in effective communication and relationships, managing conflict, and building strong teams. We think we don't have time for it. It's really the opposite. We need this now more than ever.”

The Impact of Relational Leadership at UNC-Chapel Hill

"Relational Leadership is a trust accelerator."

With six cohorts of more than 200 having participated in the program, the feedback has been overwhelmingly positive.

Zomorodi says, “Through the participant evaluations, it is clear that Relational Leadership is a trust accelerator. In terms of psychological safety, empowerment to get to know colleagues, and in risk-taking to actually want to get to know someone, this is a trust accelerator. The work that I do, interprofessional education, is the ability to learn from, with, and about each other. RL is helping me achieve that. It's not just what I do as a nurse, what I might learn from you as a nurse, or what I learn with you as a nurse. It’s, ‘let me learn about you. Why did you go into nursing? What values do you bring that are like mine or different from mine?’ That's going to make a better connection than me saying, ‘This is the role of a nurse.’”

“It's a very different way of engaging in this work. There's somebody who knows somebody, because of Relational Leadership. This connection helps pave the way for the work, because we've already been through something together. There's a level of comfort there.”

Formal assessments of the program demonstrate striking outcomes, according to Smithson. “In our most recent assessment, we asked people if, before and after the program, there was a difference in their ability to advocate in empowering other people. The assessment showed a 113% increase in participant’s confidence to work in ways that could empower others. I can’t think of another leadership program I’ve participated in where this outcome is measured, valued, and so impactful. We’re trying to create more inclusive communities, and people are saying, ‘Now I have strategies to empower other people’ in academic medicine. That’s pretty remarkable.”

What’s Different About Relational Leadership

“Most leadership development programs are focused on developing you alone as a leader. What's different about Relational Leadership is that it develops leaders while recognizing others and how all work together. That's a paradigm shift.”

When asked how Relational Leadership differs from or complements other leadership training, Smithson says, “What sets this apart is the modeling. What you see and experience in this program are people actually doing what they’re teaching the participants to do. In a professional space, participants see others congratulate their colleagues, support them, cheer them on, offer them constructive feedback, and help them share the value that they feel for others. This sounds obvious, but we don’t really have practices modeling this on a day-to-day basis in a professional setting.”

“This program offers participants permission to engage with each other in a professional space while modeling Relational Leadership practices. There’s a lot of value in traditional leadership programs and the knowledge they impart, but they are different in that participants are not necessarily seeing the practices being modeled in real time. With Relational Leadership, space is created to engage in the practices, try them yourself, and reflect in a small group setting.”  

Storrie says,“The quality of the content as a package is off the charts relative to other leadership development experiences in which I have participated or helped to develop. The level of detail and thought that has gone into the RL curriculum design is incredible.”

Zomorodi adds, “Most leadership development programs are focused on developing you alone as a leader. What's different about Relational Leadership is that it develops leaders while recognizing others and how all work together. That's a paradigm shift.”

Advice for Other Leaders Considering Relational Leadership

Smithson says, “This program brings people together and helps them find support and strength through each other. Your people are your greatest asset and this is a program that definitely invests not only in the people who go through it, but it invests in their ability to empower and engage those around them, to really empower their team.”

Zomorodi says, “Do it; you won't regret it. The return on investment is so large that it's hard to capture, because of the subtle experiences that will change your team. Every person who goes through this will take away something as a priority to bring back to their work and their team. By investing in this program, you might find that one group runs with their story of who they are, another group runs with a project focused on how they work, and then another group works on how they make change on a system level. These are three different, massive projects resulting from one leadership program alone.”

Storrie emphasizes the value of retention, noting that Relational Leadership helps people build stronger relationships, making it easier to do their jobs as a result. “The most difficult part of a job, the piece that often causes the most talented people to leave, is the relational piece. It’s the most overlooked aspect of how to do the job, and it’s typically not appropriately trained or supported.”

The Challenges of Success

According to Smithson, “We have a list of about 200 interested for 40 to 50 slots in the next cohort and, usually within 24 to 48 hours, our registration is closed, and we have a waiting list.”

Zomorodi adds, “Every single person who goes through the program is wanting more, and they want to invite five friends. We’re trying to figure out how to meet that need. How do we keep the momentum going and keep our facilitators trained? Our biggest challenge and concern for the future is around how we can control the growth of RL in a quality and intentional way.”

Participants are asking for boosters or want to sign up for facilitator or trainer training. Some are coming up with new content themselves. Smithson cites an example of an intact team that asked if they could go through a form of RLI, because they see the need to increase their level of trust, to be more nimble and confident in their decisions, and to have more comfort with each other. “I think we’re starting to see the potential to impact intact teams in a meaningful way and to do so at a leadership level, which could be powerful,” Smithson says. Our hope is that all of this work benefits our healthcare teams, and ultimately, our patients.”

Smithson adds, “One of our associate deans thinks that the way we move forward successfully with RL @Carolina is to find ways to infuse RL content into different programs and settings. If we’re really looking at the possibility of culture change through this RL work, we won’t be able to do that by getting however many thousands of people here on campus through a long RLI program. It will be in bits and pieces, with people starting to see it and feel it in different settings, in different ways, from different people and role models. We view this as both a top-down and bottom-up approach that starts to diffuse through the UNC community.”

“If we step back and ask ourselves, ‘what is our greatest asset?’ Is it our technology, our research infrastructure, or the actual people who come together to do all of this work? I would argue that we can’t do any of it — the fancy technology, the research, or the education, without the people – a strong people, a diverse people, working interdependently. This leadership development program helps your greatest investment flourish.” — Sarah Smithson

‍Sarah Smithson, MD, MPH is the assistant dean for clinical education at the University of North Carolina School of Medicine, the director of Relational Leadership @Carolina, and a senior advisor to Intend Health Strategies. Smithson was the inaugural director for the UNC Office of Interprofessional Education and Practice (OIPEP) and was in this role when the Relational Leadership work at UNC began.

Meg Zomorodi PhD, RN, ANEF, FAAN is assistant provost and director for the Office of Interprofessional Education and Practice at the University of North Carolina at Chapel Hill and a professor for the UNC School of Nursing.

Mindy Storrie, MBA is the interim assistant dean of the undergraduate business program at UNC Kenan-Flagler Business School, executive director of the Smith Leadership Initiative, and was the inaugural director of interprofessional education and practice representing Kenan-Flagler Business School.