PCP's 5th annual Gregg Stracks Leadership Summit is coming up. Today on the blog, PCP's president tells the story of Gregg Stracks and why the summit is named for him. By Andrew Morris-Singer, M.D.
My junior year of Internal Medicine residency was a difficult, confusing time. A trainee committed to a career in outpatient primary care, I found myself spending a great deal of time on inpatient hospital wards with some of the sickest, most complicated patients I’ve ever encountered. While the medical conditions were fascinating, most were preventable exacerbations of chronic problems or late outcomes of diseases that could have been caught earlier with screening. It felt like we were perpetuating a failed health care system that did little to manage and protect patients’ health but rather waited until they got really sick, and then dumped everything we had in our medical armamentarium on them. It seemed divorced from good economic sense and completely at odds with both the skills that I wanted to learn to keep patients out of the hospital and the values that brought me into health care in the first place.
Despite the dysfunction in the system, my job was to care for those patients, manage the team of house staff and students, and strike the right balance between my clinical, educational and managerial responsibilities – a significant leadership challenge for anyone, let alone someone feeling as conflicted as I was.
My disdain for the disconnect between the care we delivered and what patients actually needed came across to everyone I supervised. “It was impossible to see this coming,” I’d sarcastically mutter to my team as we’d re-admit a heart failure patient who’d fallen through the cracks due to non-existent communication between the previous inpatient team and the outpatient providers.
This is how Gregg Stracks found me when he arrived to offer leadership training to a handful of residents in our program. He found someone who was overwhelmed and jaded; someone for whom team leadership meant modeling unyielding perseverance and determination, with no allowance for emotion or vulnerability.
“The stuff we’re seeing is so upsetting, so backwards, I’m afraid if we let any emotions out, we’ll be unable to work,” I told him at our first meeting.
Get done. Get out. Keep the emotions in. That was my game plan for surviving my ward time and helping my fellow residents survive.
One day Gregg observed our interdisciplinary care rounds on the medicine wards. The members of our large care team were overwhelmed by a particularly difficult patient and his family. We were tired of jumping through hoops to get him the best care only to be rebuffed and manipulated by him and his family. We were also frustrated with each other, convinced that members of the team from other disciplines were making the situation worse. On rounds that day, a social worker said the situation made her question going the extra mile for any patient and their family. After a long silence, to everyone’s surprise, a nurse on the team, who was typically quite contrarian, agreed with her and said she too was having a difficult time and was also questioning her values. But, concerned about “staying on track,” I interrupted and encouraged the team to focus on concrete tasks so we could “get the work done and all go home.”
After the meeting, Gregg pulled me aside and in his usual kind, curious, yet direct style, he asked why I had shut down the most intimate interaction he had ever seen our team have. It was the closest we had come to connecting and building real relationships with one another. Connections around values and personal experiences, he said, are the glue that binds team members together to get their work done in a sustainable way.
Gregg showed me that by avoiding the emotional, I was missing the opportunity to truly lead the team. Focusing exclusively on the technical and not allowing the team to publicly voice their emotions and values, I couldn’t harness the greatest motivations that had brought every member of the team into health care in the first place: commitment to helping others; to making a difference in someone’s life; to easing unbearable symptoms when there was no hope for cure. Deep connections between team members would only form when we identified our shared motivations and values.
Gregg taught me the importance of tapping into the heart. He assured me that it didn’t make our team less professional. In fact, it allowed us to expand our professional selves to bring all our values, strengths and passions to our work.
With Gregg’s guidance, teaching and unremitting support, my notion of leadership transformed. No longer was my job about getting the work done, the boxes checked. It was about helping each team member harness the full spectrum of their intellect, passion, commitment and values for the challenge at hand. Evoking the non-technical or non-analytical wouldn’t slow us down or take us off track. Rather, it would energize us, connect us, and keep us true to the values that seemed to frequently run counter to the system in which we worked.
Despite the profound impact Gregg had on my approach to clinical team leadership, the greatest gift he gave me was confidence that we could take these same team-building approaches into the world of primary care advocacy to do things that many of us never thought possible. We could use this leadership style to build new teams that could push for family medicine divisions at institutions where they didn’t exist, accelerate innovation in primary care delivery, or advocate for curricular reform.
Many people in primary care at the time knew that we needed a new approach to advancing the field. At Harvard, my own medical school, the primary care division had recently been defunded. At other academic medical institutions around the country, primary care and its practitioners faced constant devaluation and marginalization. We needed to bring our diverse community of primary care professionals together and depart from the traditional siloed approach that only increased animosity among primary care disciplines and professions. We needed to pull average primary care health professionals or trainees out of primary care despondency syndrome. We needed an antidote to the helplessness many of us felt. Most importantly, we needed an approach that harnessed our full potential power and raised a united voice.
Starting in Boston, we adopted a grassroots organizing approach that essentially builds mini-campaigns to promote careers in primary care, advance innovation in care delivery and accelerate reform in training. Three years later, over 26 chapters of this network have taken root. What unites us is a commitment to building powerful relationships between individuals and using those connections to spawn action.
Just like Gregg taught us, we now see that when we bring a group of people together to fix a difficult problem, we must spend as much time eliciting people’s emotional response to the problem as we do their logical response to have the best chance of creating and sustaining a new team that can solve the problem. The head steers us, but the heart is the engine that makes us go. Just like I discovered on the wards, our job as primary care leaders is to create spaces where like-minded individuals not only can brainstorm solutions to the problem, but where they can express and subsequently harness their emotions and values as well.
Sharing ourselves with others and inviting others to do the same is at the heart of PCP’s effort to lead change in primary care. In my travels around the country and my communication with many of you, it warms my heart to see this leadership approach manifest in all of your great work. Your commitment to this practice has grown the network. Others join us not because their heads tell them to, but because their hearts compel them to.
As one faculty member recently confessed to me while we were watching a group of interprofessional students share their values and experiences at a PCP meeting, “It’s not only inspiring to watch this…it’s totally intoxicating.”
Gregg Stracks passed away in January of 2012, at the age of 40, from metastatic ocular melanoma, years after he had been told he had months to live. All of the work we did together – all of which occurred after he was suffering from metastatic disease – was the greatest gift I’ve ever received.
I believe two things helped Gregg survive so long. First, the deep love, devotion and companionship of his wife Sara and his family and friends. And second, his work with Primary Care Progress and others, helping people like me share our emotions and values and exercise our responsibility to enable others to do the same. Simply put, Gregg was energized by helping people connect with one another. It helped him survive and helped spawn a primary care movement.
Gregg’s passing was a great loss to everyone who knew him. He took a piece of our hearts with him, but he left a piece of his heart with us, too. He left us with an approach to leadership, connecting with others, understanding ourselves and building teams that can help each of us do our best work during whatever time we’re lucky enough to have in this life.
Please join me in reflecting on our collective luck at being a part of a network and movement connected to such an amazing person as Gregg Stracks, who gave so much of himself, at such a difficult time. Let’s commit to using his leadership summit to reconnect with the values that brought us into primary care. Through those values, we can connect with one another to build new visionary teams to fight for the health of our patients, our families, our communities, and this nation.
Andrew Morris-Singer is a physician and former community organizer and trainer. As president of Primary Care Progress, Dr. Morris-Singer has been instrumental in igniting an interprofessional trainee-led grassroots movement to reform primary care delivery and training. Dr. Morris-Singer writes and speaks regularly on the topics of primary care community advocacy, utilizing organizing strategies to advance primary care clinical innovation and the critical role of trainees in the revitalization of primary care. Dr. Morris-Singer is board-certified in internal medicine and is an affiliate instructor at Oregon Health and Science University. He lives in Portland, Oregon.Read more about the Gregg Strack's Leadership Summit.