What stands out to you/has surprised you about your leadership development through the Fellowship to date?

First, it is the amount of stress that leadership is creating on me. Everybody knows a talented person somewhere, who has chosen wisely not to be a leader because of the possibility of a stressful life. The recurrent polarity here is that leaders are struggling between the forces of sameness and the forces of change. The forces of sameness are well known, including: not moving out of town, not taking the job even if it is a dream job, not stirring the pot of complacency, being comfortable and unchallenged and ingrained with bad habits. The forces of change include learning new things, meeting people, creating good habits and facing the possibility of failure while seeking success. Leadership is not only changing me, but implies changing people, structures and systems. It creates busyness and stress, not only in the leader but in the immediate family and close circle of friends. Divorce is one of the consequences that I had to endure; I'm not sure if it has anything to do with this. Then, there is the tension (stress) between the two forces (sameness and change) that could make the potential leader unhappy and unfulfilled. I am asking: How do I manage this stress, and the tension between sameness and change?

Although stress is a natural protective body mechanism against any threat that requires a fight-or-flight reaction, that is to say, a lion approaching a cave man, the majority of tasks associated with exercising leadership are purely psychological. Some are properly justified, while others are not. Add decades of stressful situations, and the chronic and pervasive liberation of neurotransmitters could put the leader in a permanent state of hypervigilance. Chronic stress is a risk factor for depression and cardiovascular problems, among others. I think it is important to grade stress in different categories, to name and classify them, and to be exquisitely aware of them. Awareness creates choice. Interestingly, not only do I find myself mostly overwhelmed with unjustified stress, but in denial and defensive about changing the situation.

There are three types of fatigue: mental, physical, and emotional. Needless to say, they are interrelated and interconnected. Depending or whether we are blue-collar or white-collar workers, we could recover from the mental and physical fatigue by the mere act of eating and sleeping well. Yet it is difficult to recover from an emotionally draining job without asking for relational help that involves another human being listening (coaching for example). Like an extrovert who feels re-energized by meeting people, a good job means feeling reenergized at the end of the day. For this reason, self-care is fundamental for a leader. For instance, I seek to be surrounded by people who remind me that resting, eating well, and exercising are fundamental to creating an adequate life balance. Leadership is a long-term commitment and must be emotionally sustainable to be lasting and impactful. Those are as basic as food and water are to life; and if compromised, then it might not be advisable to pursue leadership without risking burnout.

I wonder how much of the stress we endure is just a perception or how much of it is self-inflicted. Leaders are usually efficient people. They can do many things that the average people cannot squeeze in 24 hours. Some have to pay the price of stress and physical detriment. However, I believe that it is possible to be effective at doing multiple challenging tasks without the body liberating disproportionate amounts of adrenaline, nor cortisol in the bloodstream, which is the physiological measurement of stress. Designing the work and making it efficient is one of those mechanisms to avoid stress. For example, planning in advance, devising ways to do things better, deciding what tasks or projects to take, being mindful to protect resources, such as people, time and space, and choosing the usual battles (workplace problems) carefully. But it must be emphasized that the space created by efficiency must be protected by all means to be occupied by emotional needs. That space is the main incentive to be efficient. Efficient is not about just saving resources, but avoiding errors and choosing how to feel about challenging work (logotherapy).

Once I have planned everything to the finest detail, then any leadership work should be done with a “fun” and playful purpose. In this case I have noticed that I still get stressed regardless, even with things that have nothing to do with leadership work itself, such as plain life tasks of taking a vacation or a business trip. It took a close friend of mine to make me aware of it. It is noticeable because I tend to lose presence and connection to anybody who is around me (the eye contact is gone) and my jaw is tense. It is the concentrated look, the deliberate introversion, the endless checklist mental review to make sure everything goes perfectly. After this huge awareness, I have changed my view of work. For instance, listening to music helps me because it evokes feeling of dancing and enjoying life while doing task such as writing this essay, for example. Yes, leadership can be fun, and less stressful if due diligence is done to make all tasks efficiently. I can still manage to relax and smile at life and people. I don’t have to aim for perfection, either. A systematic person should be able to relax and trust his own processes and go with the flow. Get efficient first, then relax and enjoy the leadership ride.

As part of my fellowship, I would like to build the Institute of Efficient Medicine, which implies changing the healthcare system. As a result I have created the strategy which was part of my dissertation for the Executive Master for Consulting and Coaching for Change (CCC). The thesis was delivered and presented successfully. The Institute also developed a website and a logo to start building the brand. It will start by creating knowledge through qualitative research, like finding the most efficient practices in the country and the world in the form of documentaries. The dissemination of this knowledge will be given through education, consultation and coaching. Next, is to invite and manage the qualified people who are going to be part of the dream team.

Another aspect of leadership is about the concern about getting educational degrees without my commitment to action. It is safe to stay in the means rather than the ends. I am graduating this June with the CCC Master which is the most objective educational accomplishment using the Bush Foundation funds. This adds to the baseline MBA that I had since 2007 and the MD obtained in 1995. The third one will be the Master of Health Care Management (MHCM) at Harvard starting this July 2017. I am graduating with the ICF Executive Coaching Certificate from the Gestalt Institute of Cleveland in May 2017. However, knowledge itself is just part of the change equation because executing the ideas to make impactful change needs to happen out in the field and reality. Another part is the skill of persuasion as a critical communication tool. I am developing the capacity to inspire groups of people through electrifying speeches appealing to emotion rather than academic content. The simpler the message the better. All these developments are building a powerful confidence. Confidence is critical to carry forward the mission of the Institute of Efficient Medicine: Healing better faster safer while using fewer resources and less stress.

Finally, I am surprised by the amount of energy that I have found within myself and how it has exponentially grown by asking help from my network of collaborators and friends. The learning experience has been extraordinary.