The Origin Story of the Relational Leadership Institute at OHSU: Part 1

I remember the bar was loud — so loud, that I almost missed hearing the secret.

About ten years ago during my first-year of medical school, my mentor in community organizing, Adam R., and I went out to celebrate over a cheesy plate of nachos at a local bar. We had just wrapped-up a grueling, often messy campaign to stop the then-Governor of Minnesota from cutting the state’s safety-net health insurance. He had supported me in bringing together healthcare professionals and communities experiencing houselessness to act collectively against this bill, and after months of one-to-one meetings, research actions, and sleep-deprived days, we had learned that the Governor was going to preserve the safety-net health insurance.

My hands were shaking as I lifted a nacho chip to cheers to our efforts, feeling overwhelmed from a delirious mix of excitement and exhaustion. We had done it, and I still didn’t know how — so, over the basslines of hard rock blaring, I asked Adam, How did we do it? And how did he do this, as his job, year after year?

“It’s a secret, Brian,” Adam said, grinning in between cracking peanut shells. “But I’ll share it with you.”

It’s the people, not the issue. So often, he explained, we focus on the problem, and the strategies and resources needed to fix that problem. And what we often overlook in that process are cultivating the relationships needed to address the complex problems we face in our society today: the need for diverse individuals to come together — sharing experiences, knowledge, social networks, resources — around a shared vision, in service of creating positive change.

As all of this sunk in, I realized that was exactly how our campaign to protect our state’s safety-net insurance was built. I had never been on a core team so diverse across age, culture, profession, and life experiences. Under Adam’s leadership, we spent a lot of time focused on connecting with one another: why we were involved in the campaign, how the issue had impacted us personally, and the values that compelled us to come together on weeknights and weekends in our spare time. And when times got hard, we didn’t stick together because of the campaign — we stuck together because of the values and vision we shared with one another. And because we knew the stories that brought us to this team, we felt safer with one another — safer to be honest in our feedback, vulnerable in our interactions, and bold in our strategies. Ultimately, those social connections were the key ingredient to success for our efforts.

RLI: The Intersection of Opportunity and Reality

Community organizing’s relational orientation and collective approach to driving upstream change was so influential to my perceptions of promoting health, that after my third-year of medical school at the University of Minnesota, I took a year off to pursue my Public Health degree. That year, I attended a Grand Rounds presentation by a primary care provider with a previous career in community organizing. He spoke passionately about the importance of harnessing people’s stories and how to surface shared values, to bridge diverse groups in healthcare, all in service of building a primary care movement. His name was Andrew Morris-Singer.

I was immediately captivated by his message. Until that moment, I had been driven by a vision of integrating a relationally-oriented, narrative-driven, team-based model of leadership to help communities to drive change out in society. I had never considered before the potential for those same tools to help us within healthcare to address some of the immense problems facing the system, like the daunting primary care shortage.

I immediately introduced myself to Andrew after his talk, and months later, he supported an interprofessional, cross-generational core team at the University of Minnesota to start a PCP Team. We were able to use many of the Narrative Leadership principles to start a public health curriculum at the Medical School.

Little did I know then that this would be the beginning of the origin story for the Relational Leadership Institute (RLI).

Due to sheer coincidence, our paths crossed again a few years later at Oregon Health and Science University (OHSU). I’d come for my combined Family Medicine-Preventive Medicine residency, while Andrew had signed on as an adjunct professor. We got together about halfway through my first year of residency to catch-up with each other, and the conversation quickly turned to several shared experiences in our clinical lives.

On one hand, we were both working in a system with strong leadership buy-in and resources to support team-based, interprofessional care. However, we both witnessed colleagues feeling overwhelmed and overburdened by the demands of our system. We both heard other team members share their experiences of feeling devalued, disempowered, and unseen. We witnessed first-hand the negative impact those collective experiences had downstream on care delivery initiatives, on quality improvement projects, on patient care and health outcomes. So many colleagues across the system — providers, learners, staff — were feeling trapped, hopeless, and in some instances, burnt-out.

We also shared that we both experienced something much different: opportunity, innovation, hope.

At that strange intersection of hopeful opportunity and our challenging reality seemed to be a gap: a chasm in the system that separated our collective aspirations for what we knew the healthcare system should be, and the difficult reality of the system as it actually was. Adam’s “secret” from my community organizing days in Minnesota resurfaced — we were quick to identify and try to fix problems in the system, but in doing so, it could be at the expense of overlooking the people and relationships within the system that mattered most.

Building the Foundation for RLI

Intrigued by our observations, we dug into the existing literature on teams, both within and outside of healthcare, in order to test our hypotheses. We found that the overwhelming majority of failures in team-based efforts in healthcare weren’t due to shortcomings in techniques and strategies to address problems, but rather due to gaps in relational practices to support people. On the other end of the spectrum, across a variety of professions and disciplines, including healthcare, the highest performing teams consistently exhibited relationally-oriented leadership skills that focused on engaging with and investing in the people on teams, such as acknowledging and valuing differences, sharing power and decision making, and cultivating psychologically safer spaces.

Supported by these findings, we sought to develop a new leadership model, one that would not only draw from Andrew and my backgrounds in community organizing, but also, implement best practices from our research from sociology, social psychology, anthropology, and organizational development. In that process, we kept coming back to the fundamentals of Relational Leadership™ and how to build a collaborative that would create a different kind of leader.

We had our theories and framework for the Relational Leadership Institute in place. It was time to find impassioned people to start our movement.

Stay tuned for "Part 2" on the Progress Notes blog.