The Path to Health Lies in Nature by Sharen McDonald

I have a treat for readers today. My great friend and excellent thinker and writer, Sharen McDonald of Pointe Claire in Quebec has agreed to do a guest blog on Biophilia. This is an excerpt from a lecture Sharen gave at McGill last week.

How often do we exclaim over a magnificent sunset? Why do we request rooms with “an ocean view” on seaside holidays? What causes us to inhale with deep satisfaction upon entering a forest of pine trees? In these incidences and many more, we invariably derive deep comfort from all our senses. During the latter part of the 20th century psychoanalyst Erich Fromm used the term ‘biophilia’ to describe “the passionate love of life and all that is alive.” Biologist E.O. Wilson later popularized the term with the belief that nature nurtures and calms us.

A century earlier, Frederick Law Olmsted, founder of American landscape architecture and designer of Central Park, presciently believed in the power of nature to refresh our minds, and thus restore our entire body to harmony and health. Olmsted realized that increasing urbanization would become problematic for humans unless parks were introduced to cityscapes. Bit by bit, technology did affect our innate bond with nature through buildings and vehicles that were centrally-heated or air-conditioned depending on the season.

In the 1980s, Stephen and Rachel Kaplan proposed their Attention Restorative Theory, noting that viewing nature combatted mental fatigue and psychological distress. In 1984, Roger Ulrich’s “View through a Window” post-op study was hailed as “groundbreaking.” Despite this, and his similar 1993 study in Uppsala, Sweden, few meaningful changes were introduced to hospital design until recently. Alas, windowless rooms existed still.

Now is the time for innovation. Firms such as Human Spaces are promoting biophilic design in workplaces. The impact on hospital settings is immense, witness the Olson Family Garden at St. Louis Children’s Hospital in Missouri. Unsurprisingly, healing gardens benefit not only patients and their families, but also significantly reduce stress-related fatigue for staff. Maggie’s Centres for cancer patients and their families, first introduced in the U.K. in the 1990s, are now popping up across the world. Skylights of blue skies with fluffy clouds are now found in elevator ceilings in The Montreal General Hospital and elsewhere. The City Tree Project offers constructions of moss, each of which may remove pollutants from urban air as effectively as the planting of 275 trees.

Countries and cities worldwide are implementing biophilic strategies to encourage the maintenance of health as well its restoration. In Japan, shinrin-yoku (forest bathing) achieves notable positive health results, not only reducing cortisol levels and the harmful effects of other stress indicators, but also significantly increasing the production of NKC (Natural Killer Cells). (The Nature Fix – Florence Williams) Currently, there are 48 Forest-Therapy Trails in Japan with plans to double this number in a decade. At Alnarp, Sweden, the world’s largest rehabilitation garden offers nature-based treatment for stress-related mental exhaustion. At Chungbuk University in South Korea, one can pursue a degree in forest healing. Saneum Healing Forest is one of 37 such forests in that country. In Singapore’s Changi Airport, you can visit a butterfly garden or nature trail, and their hospital’s ICU was designed with windows 6 feet in height so that every patient may view trees. Finland and Scotland are also on the list of countries making positive strides towards better health through biophilia.

Heading towards the future, there is legitimate concern for children in the fast-paced, stress-inducing 21st century world of technology. Forest kindergartens (Waldkindergartens), so popular in Germany, are now being introduced in other parts of the world. We can look to Chippewa Nature Center’s Pre-School in Michigan, Jaureguiberry Primary Nature School near Montivedeo, Uruguay, and the Hudson Forest School in Hudson, Quebec. These initiatives are encouraging signs of progress, reconnecting young people with nature and establishing a lifelong bond that will enhance their health and their lives.

Irish-Canadian medical biochemist and botanist Diana Beresford-Kroeger, notes, “For every breath you take, thank a tree.” Outside we go!

Developing a Culture of Innovation

    I’ve been thinking a lot about innovation – the concept has crossed my desk from several different directions recently. I always take notice when I see something several times in short succession from variable sources. It usually means something is moving away from the edges and hitting the mainstream. I like to think of the application to healthcare-which is in need of significant innovation. A few interesting definitions of innovation (which can be a vague over-used term) are emerging from different sources.

    Innovators are people who apply new and original ideas and methods to solve existing and potential issues and problems. Using creative thinking and idea development, innovators are willing and prepared to embark on an initiative that will advance their profession, organization, business, and/or goal. Turning their ideas into action, they play a key role in driving something forward (adapted from Donner and Wheeler).

    An HBR article on Twitter today by Soren Kaplan provided some further insights. Innovation he says can be categorized into 3 different types: incremental (small tweaks that advance the core business), evolutionary (changes that evolve with other changes), and disruptive (defined as an innovation that creates a new market and value network, eventually disrupting an existing market and value network, and often displacing established leading market firms, products, and relationships). A lot has been written in recent years about disruption and disruptive innovations (see Christensen HBS).

    Most organizations today want more innovation. They want employees to be focused on how things could be done more efficiently, smoothly and with more positive outcomes. The highly competitive environment demands this kind of thinking and action. Organizations need people who will find a problem, create an innovative solution, evaluate its functionality and scale it up. Often what stands in the way of more innovation is organizational culture, known to be one of the areas that are hardest to change. Strategies proposed by Kaplan are: embedding innovation in structures and processes across the organization, getting people in all roles and levels involved, training and development in innovative and design thinking, ensuring that good ideas get traction and are widely publicized, and supporting a few key leaders to effectively champion the ideas and keep up the momentum. Many people believe there are no bad ideas; what counts are the early ideas.

About Fractals

I have been cottaging for a couple of weeks with our family. I’m really enjoying the ease of summer, the sunny mornings where all the wet towels (which spend the night in the screened porch) are hung outside to dry and freshen up in the sun before the day’s events. Ah the sun – how would we ever manage without it!

I’m nurturing an interest in fractals, trying to understand them better, and see them more readily both in nature and eventually elsewhere in the built environment. I take my paddleboard out in the early mornings to explore the trees along the banks where the fractals are numerous and diverse – once you develop the eye for them. My interest in fractals stems from a broader interest in complex adaptive systems, and how an understanding of CAS can help us to better understand and adapt to changes in our organizational structures and activities, our relationships, even the ups and downs of family life.

There are many interesting definitions, and excellent photographs, of fractals on the web. I’ve tried in this post to pull out some of the simplest, most informative and easy to understand ones – so that I can find them more readily. Continue reading “About Fractals”

Liberating Structures

I have stepped away from this Blog for a while now keeping busy with other things. I am hoping to commit to more writing about things that interest me, and affect the work we do developing health care leaders.

Today I want to talk about Liberating Structures, which, in its simplest form, is a suite of tools that enable people in organizations, teams, communities – groups of all kinds – to engage with each other in meaningful and collaborative dialogue, and work together sharing thoughts, ideas and experiences in order to achieve the outcomes they want. Liberating Structures have the power to alter the way individuals and groups interact with each other, and transform workplace culture.

Henri Lipmanowicz, former President of Merck Intercontinental and a founder of The Plexus Institute, and Keith McCandless, a founder of the Social intervention Group have published their suite of tools in The Surprising Power of Liberating Structures. “So why is it” the authors ask, “that so many organizations of all stripes are filled with disengaged workers, dysfunctional groups and wasted ideas?”

Feeling that improvements could be made in the way people work together, and recognizing that Complexity Science has tremendous potential and practical application to support transformational learning, the authors began to collect ways that people can use to engage everyone, bring out thoughts and ideas, and get people talking and problem solving together. “Gleefully we cut across academic disciplines, tapped spiritual practices, roamed the planet and deepened scientific insights along the way.”

I have been interested in these kinds of practices for 25 years or more. I heard long ago that “the answers are in the room”. I don’t know where I heard it – probably in the Lippitt living room in Ann Arbor, Michigan where I was involved in a Planned Change Internship in the early 90s, working with a small group of diverse others interested in organization and leadership development. This kind of thinking has stayed with me as I navigated the very hierarchical healthcare system working to support transformative change. We know from personal experience that everyone has significant contributions to make, and we know how important engagement in the workplace is to people and outcomes. The question is: How do we engage everyone, provide a safe environment, and enable new ideas to emerge and grow? Liberating Structures effectively support these efforts. Check it out at liberating structures.com. Communities of practice around liberating structures are popping up around the world. If you’re interested in organization development (OD), developing leadership, engaging people and teams, it’s a movement worth following.

DWHLI 2017

The 2017 DWHLI was held May 23-26 at the BMO Institute for Learning in Toronto. Eighty five participants from across the health professional spectrum of roles and disciplines, and representing several provinces, participated in 4 long days of concentrated leadership development programming. More information about the program, the speakers and facilitators, and the innovative projects that were launched by the attendees can be found at healthleaders.ca

DWHLI and CNA celebrate their partnership and plan 2016 events

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Earlier this month Judith Skelton Green, Julia Scott and I sat down with Anne Sutherland Boal, CEO of the Canadian Nurses Association, and Carolyn Pullen, Director of Policy, Advocacy and Strategy to put the final touches to our partnership agreement to offer together our 27th Leadership Institute.

Dorothy Wylie, retired Professor of Leadership at University of Toronto Nursing, after whom the Institute is named, and Karima Velji, President of CNA, joined us for dinner and celebratory toasts.

A few collaborative events are scheduled for 2016. In February we will offer a webinar about leadership competencies for health care professionals, and their importance in today’s complex and rapidly transforming environments.

We are hard at work designing a leadership workshop for participants at CNA’s Biennium in June in St John’s NB. In October we will offer our 27th week-long Institute with CNA. We are thoroughly enjoying our collaboration – truly a “meeting of the minds” – as we are very much on the same page about the value and importance of leadership at every level and in every discipline providing healthcare today.

Self Organizing on First Day in the Polyclinic

I had been anticipating my first day at the Polyclinic and had some natural apprehensions. Where to go and how to get there on the subway and then streetcar? How much time to allow? How to find the Workforce Entrance Gate on that huge perimeter of the Athlete’s Village? Would I know what to do at the clinic? What would my colleagues be like? Did I have all the necessary badges and uniform parts? Really helpful to have had the Olympics experience! (See earlier blogs on this site).

On arrival Day 1, I realized I was not alone with my questions. As a dozen or so of us gathered in the entrance hall to find out what’s next, I could sense there were many others who felt the same way. A brief welcome by the leaders who had been working for months and even years to plan for this day, and a quick tour of the facility, and it was “let’s get to work to get this place setup and operational”.

Teams self-organized in minutes to get at the jobs. Some got busy setting up lines on the floor to direct people to different stations (ER, Pharmacy, Family Medicine, Sports Rehab and Specialty Clinics, which included Radiology, Ultrasound and MRI). Others began to get reception desks and appointment books ready for action.

One of my jobs that day was to count and organize splints and braces, setup a cart with a sample of each, and store the others for easy access. The storage room looked like this! IMG_4405

The athletes weren’t in the Village yet so we had some time to get organized but teams were starting to come in soon. It was Game On to be ready.

The Polyclinic as a Complex Adaptive Human System

As well as supporting my country and city – and the benefits of international Sport in general – I love my volunteer gigs at the Games (2010 Olympics and 2015 PanAms) for 3 main reasons: i) it keeps me in touch with what’s new and different in clinical practice in healthcare; ii) helps me understand how younger, newer practitioners are the same or different from my demographic group, and iii) fuels my curiosity and understanding of complex human systems and how they operate and learn.

Thus this blog, which I’m using as a personal discipline to categorize my learning in some meaningful way. Putting pen to paper – actually fingers to keyboard – forces me to clarify for myself, and for you the reader, some of what is swirling in my head about systems, how they develop, learn and change, and hopefully continue to grow and improve.

I love watching complex adaptive systems in action – how the many parts of a rich, intricate and complicated system make the whole, how the system’s purpose – in this case to provide welcoming, meaningful healthIMG_4408care to the athletes and team members of the Toronto Pan Am Games – is played out by hundreds of people learning how to work in concert with others to make it happen.

The Polyclinic pictured here is a temporary structure located in the centre of the Athletes Village in the Donlands in Toronto. It is surrounded by Athletes’ living areas that will be turned into beautiful condos after the Games. It is a really nice part of town, easily accessible public transportation, easy access to lots of great spaces, with a brand new YMCA on site, and I’m told most of the condos are already sold.

Volunteering in the Polyclinic Pan Am Games Toronto 2015

Canada Day was my first volunteer shift in the Polyclinic in the PanAm Athletes Village Polyclinic. If you don’t know what a Polyclinic is, you’re not alone. My understanding is that it is a European term that denotes a health/medical clinic that provides a wide variety of services – thus “poly” from the Greek meaning “many”. In this case, many services.

The PanAm Polyclinic provides all kinds of services from Family Medicine to a fully-stocked ER, Specialty Services such as Dermatology, Cardiology, Dental, Optometry – Bochner Eye Institute and Loblaws are donating time, expertise and hundreds of pairs of glasses for the teams – and of course, full Sports Rehab Services (Physio, Massage, Chiropractic, and Sports Medicine, Physiatry).

There is also a Public Health office staffed with City of Toronto nurses to deal with any outbreaks or other public health concerns – there are thousands of condoms on all the services desks for the taking – they are snapped up quietly by many – and not just the athletes!

I am one of 3000 volunteers in the Health/Medical Services at the Polyclinic and the many Competition Venues and Fields of Play across the Games. There are about 6500 participating athletes from 41 different Pan American countries, competing in 36 different sports.

Planning has been in the works for 6 years and has involved 16 different communities surrounding Toronto the north, west and east. According to the Chief Chef for the Games, 500,000 meals will be served in the Athletes’ Village alone. These Games are the largest multi-sport event ever hosted in Canada. The cost for public security and traffic management is in the neighbourhood of $250M.

If you watched the Opening Ceremonies Friday night – or better still were actually there, you’ll know that it’s all very exciting for Toronto!

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Thinking about Occam’s Razor

While watching an episode of Madame Secretary the other night, I was interested to hear the main character mention Occam’s Razor as she wrestled with a complex issue and the need to get at the variables, understand them and make decisions about how to proceed. Knowing my interest in complexity and complex adaptive systems (CAS) theory, a friend told me about Occam’s Razor awhile ago. I had never come across it before, despite lots of reading about complexity and complex systems – obviously not reading the right things, Ann! Thanks.

Wikipedia tells us that Occam’s Razor (which is also sometimes written as Ockham’s Razor) is a problem-solving principle devised by William of Ockham in the 13th C – believe it or not. William was a respected English Franciscan friar, philosopher and theologian.

The principle of Occam’s Razor states that among competing hypotheses which predict equally well, the one with the fewest assumptions should be selected. Other, more complicated solutions may ultimately prove to provide better predictions, but—in the absence of major differences – the fewer assumptions that are made, the better – according to the theory.

Called also the Law of Parsimony, it tells us to KISS or keep it simple, and not over-complicate. This of course makes a lot of sense and it also reminds us to quantify, qualify and verify our assumptions. Wikipedia goes on to say “ For each accepted explanation of a phenomenon, there is always an infinite number of possible and more complex alternatives, because one can always burden failing explanations with ad hoc hypothesis to prevent them from being falsified; therefore, simpler theories are preferable to more complex ones because they are better testable and falsifiable.”

The fact that we are still considering William of Ockham’s ideas, 7 centuries later boggles the mind, and makes me question how much more we know or don’t know today than we did centuries ago.

It also makes me wonder about the fit between Occam’s Razor and complex adaptive systems’ theory. This is for another time.