This post kicks off a 7-part series in leadership competencies we find most critical for driving meaningful transformation in healthcare. Details below.

A few months ago, we reviewed key leadership competencies we’ve found most critical in driving meaningful transformation as conditions change in unpredictable ways. It is not a coincidence that Emotional Intelligence (EI) is at the top of the list. 

I (Gary) think about Emotional Intelligence as the Meta Competency through which individuals come to know themselves or, as Socrates said, “Know Thyself.” In knowing oneself, individuals discover a quiet confidence and inner strength and it’s from this place they can uniquely and authentically express not just the other competencies, but also their full potential. 

I first heard about emotional intelligence when Daniel Goleman’s book by the same title was released in the mid-90s, well after medical school and residency. I was still relatively early in my medical career, busy clinically and already involved in leadership roles. The book resonated with me and I remember being curious about the topic because of its bold claim: that a person’s success and effectiveness in life is determined more by EQ, a measure of emotional intelligence, than IQ, a measure of cognitive intelligence. This ran counter to my education, training and experience up to that point, and it was good news for me. 

It was about this same time I had an incident where I fully experienced and grasped the importance of emotional intelligence. I was on call managing one clinical situation after another in two separate hospitals, 12 miles apart. I was tired, stressed and like riding my bike over a mountain pass, I was just grinding away through a long holiday weekend. 

After finishing up a C-section at one hospital, I was paged to the Emergency Department at the other hospital to care for a critically ill patient who needed immediate attention and action. After assessing her situation, my only thought was: “If we don’t act quickly, she’ll die.” I asked the staff to gather what was needed for a quick procedure before bringing her to the OR and it was in that moment that I was informed that a “new policy had been put in place that prohibited many procedures we had routinely performed in the ED for years. In a heartbeat, I was out of my mind, angry and on the verge of exploding, and it was obvious. 

Fortunately for me, and the patient, the charge nurse recognized my emotional state and literally got in my face to get my attention. She calmly asked what was needed and I could actually feel myself coming out of my hijacked, reactive state of mind. I had lost all self-awareness and was hanging onto my self-regulation by a thread. On the other hand, the charge nurse was fully aware of my state of mind, and immediately stepped in to manage it.

What is Emotional Intelligence?

Emotions and thoughts drive behaviors. Emotional Intelligence (EI)  is simply a combination of recognizing and managing emotions, both your own and others’. In other words, it entails awareness of your own and others’ emotions, and using this “intelligence” to guide your actions. 

Goleman also includes motivation, a person’s internal drive to better themselves, in the construct of EI. When highly motivated, you recognize through self-awareness or otherwise that you’re lacking in some area of your life, and you will almost instinctively be motivated to improve that area. 

In this post, we’ll examine self-awareness and self-regulation. We’ll examine other components of emotional intelligence in future posts. 

We each form our own unique way of understanding the world, our beliefs, paradigms and perspectives, early in life. Our perspective is what determines our behaviors, or to say it another way, our response to a situation. Typically, the process of going from perception to behavior is unconscious, but it involves emotions which inform our thinking, which in turn drives our behavior. Ultimately, this process leads to an outcome. 


From a competency point of view, we can say that our process determines our level of competence, and our level of competence determines our effectiveness and performance.

Emotional Intelligence starts with awareness: understanding and paying attention to this unconscious process. Without this awareness, we simply auto-react with a conditioned response (habit) which we developed early in life. These conditioned behaviors seemed to work when we were young and were therefore reinforced. They kept us safe, helped us maintain some level of control, and allowed us to fit in with others, to gain approval and status. They then became subconscious.

Self-awareness is the exercise of becoming aware of these conditioned tendencies; to bring them into consciousness and understand what’s driving them. Self-Regulation is the follow-up exercise to awareness: choosing an appropriate response given the situation rather than defaulting to a conditioned, subconscious response that may be suboptimal.

Social awareness, which we’ll discuss in a subsequent blog, is the ability to recognize and share the emotions in others. In other words, to empathize with others. Social regulation is simply the ability to manage or influence the emotions of others, like the charge nurse who helped me in our opening scene.

Emotional Intelligence is Not New

Rule your mind, or it will rule you.
~ Horace

Today, with the help of Functional MRI studies, neuroscience is expanding and changing our understanding of how emotions and emotional intelligence play out within the brain. However, the construct of EI has been understood for millennia. Stoic philosophers recognized the elements and importance of emotional intelligence. Being aware of and regulating your thoughts and emotions are the foundation for Buddhist meditation practices as well as various types of therapy. 

Over the last century, particularly in the western societies, there has been an emphasis on the rational and analytic mind, rather than the empathic mind. However, during the last century, researchers in the field of intelligence recognized that there was something more than just IQ. They could see that the most successful people in life had something more than just cognitive intelligence. They described this other form of intelligence as “social intelligence” or “non-intellective” intelligence. 

By the 1990’s, Salovey and Mayer coined the term “Emotional Intelligence” which they described as the ability to discern one’s own and other’s feelings and to use this information to guide one’s thinking and actions. Along the way, researchers were also interested in developing ways to measure emotional intelligence and it was Daniel Goleman who coined the term EQ, a measure of emotional intelligence, in his book “Emotional Intelligence: Why It Can Matter More Than IQ.”

The Link Between IQ, EQ, and Success

In most professions — engineering, medical, scientific to name a few — there is a base IQ: a measure of cognitive intelligence, necessary to meet the requirements of school and training. However, without the skills associated with EQ, those with a high IQ alone are more likely to have difficulty when they find themselves in roles requiring them to work effectively with others. 

Various studies estimate that IQ accounts for only 4–25% of effective performance on the job. On the other hand, studies on EQ have shown that 80% of a person’s success (think effectiveness and performance) is a result of EQ. 

In management and leadership roles, the skills required to be competent include what are sometimes referred to as “soft skills” or “people skills” and it’s these other competencies that require more EQ than IQ.

EQ as the Meta-Competency

So we know what emotional intelligence is, but what are the behaviors and actions (regulation) that result from this awareness that lead to success and effectiveness? 

In other words, with EQ as the meta-competency, what are the other social and emotional competencies that stem from EQ? Characteristics such as realistic optimism, humility, empathy, influence, the ability to manage feelings and stress and knowing when and how to express emotions are some of these characteristics. 

At MEDI Leadership, in addition to emotional intelligence, we’ve identified six competencies we see in the highly effective healthcare, physician and nursing leaders we coach: The ability to connect with others, the capacity to manage complexity, the ability to create and lead through effective teams, having a developmental or growth mindset, the ability to strategically adapt to changing realities, and to lead large, geographically diverse parts of a system virtually. Competence in each of these six domains is rooted in EQ. 

Furthermore, as the pace of change and complexity increases, and the world of work makes ever greater demands on a person’s cognitive, emotional, and physical resources, this particular set of abilities will become increasingly important. Over the next several weeks we’ll take a deeper dive into these core competencies.

Developing Your Emotional Intelligence

Between a stimulus and response there is a space and in this space lies your power to choose your response. In your response lies your growth and your freedom.
Viktor Frankle

The good news is that EQ can be learned and developed. First it might be helpful to know a little of what neuroscience is teaching us. 

The brain has two modes of operating: 

  • The task mode network, where the brain is focused on an activity such as solving a math problem, reading a book, or (hopefully!) performing surgery. 
  • The default mode network, where the brain is unconstrained by focused thought and spends the majority of its time. Have you ever had a moment, perhaps while on a walk, where you’ve found yourself lost in thought? That’s the default mode and it’s always on, even while you’re asleep and dreaming. The only time it’s off is when it’s in the task mode network. Studies show that 95% of the time we operate on automatic pilot and auto-pilot is the default mode network at work.

Developing your EQ starts with becoming aware, or conscious of your thoughts, emotions and behaviors. Without this awareness we’re hostage and frequently blind to our default habits. Developing awareness requires an active interruption of the automaticity of the mind, being attentive to your emotions, attitude, feelings, and thoughts and then, coming to know your habituated reactions. The “stimulus” Frankle is talking about is a thought or emotion. The response he refers to is your behavior.  

It’s helpful to distinguish here a chosen response from a habituated reaction (habit). Without awareness, one might be tempted to say that they’re responding to someone’s “behavior” or some “thing,” but in reality, the behavior or thing is simply a behavior or a thing. Instead, with awareness, one comes to see that it’s our mind that’s subconsciously made up a “story” about the observed behavior or thing. The story is our own unique perception of the behavior/thing and without awareness your trying to cultivate with mindfulness, we simply react to it.  

Most of the time, this automaticity works well: It helps us survive, be efficient with our mental capacities and thrive in the world. However, it’s with practice and developing EQ, one can surface their stories, thoughts and emotions into consciousness, examine them and then respond in a way that is best, especially when a situation calls for something different than one’s conditioned response.

Interrupting and Examining Your Default Responses 

Mindfulness is the practice of paying attention to and recognizing your emotions and thoughts. It’s the practice of actively interrupting the default mode of the mind and bringing the mind into real-time awareness as an emotion is felt or the mind is “running away” with thought. 

The somatic feelings, or bodily sensations, associated with emotions such as anger, sadness, fear and joy are frequently noticed prior to the emotion. Examples might be the gut-wrenching feeling associated with intense grief, or a constriction of the chest felt with fear. Like the notifications that pop up on a phone, it might be helpful to think of the somatic feelings as a notification or signal. By simply recognizing and attending to the notification, you’re put into the “space between a stimulus and response.” 

The follow-up step in this practice, when developing your EQ, is the practice of pausing in this space. As Frankle so simply understates, it’s within this space that “lies your power.” It’s easy to overlook this wisdom but, by pausing in this space, you escape the automaticity and engage the cognitive brain for the next practice: to acknowledge, label, accept the emotion or thought as is, and then reflect on what it’s telling you in order to use the intelligence as you formulate a response. 

As you continue to practice, you will begin to recognize your habits, conditioned responses to various “signals”, and then think about the underlying emotions, thoughts and desires which are driving the habits. Behaviors that might be good candidates for executive coaching include: a habit of avoiding opportunities or situations for a fear of taking risks, a habit of self-aggrandizing to obtain approval, a habit of micromanaging others to maintain a sense of control, a habit of getting frustrated as a result of unaligned expectations, or a reliance on sources of power that come with a cost. 

With practice, the emotions, thoughts and habits are quickly realized for what they are and you come to know your power to choose an intentional response with quiet confidence and inner strength. And then, once again as Frankle said, it’s in this new response that lies your “growth and freedom.”

Developing Emotional Intelligence in Others

Growth and development starts with oneself. So it is with EQ: Self-awareness and regulation typically precede the development of social awareness and regulation. Social awareness and regulation is simply being aware of and managing the emotions of others, just as the charge nurse did for me. 

In a follow-up post, fellow MEDI Leadership Coach Amy King will explore this other domain of emotional intelligence and its importance in managing relationships.

 


ABOUT THE LEADERSHIP COMPETENCIES SERIES

These are turbulent times in healthcare. Today’s leaders need an expanded set of competencies to manage growing ambiguity, uncertainty, and risk. MEDI’s new blog series is a masterclass in Leadership Competencies we’ve found most critical for driving meaningful transformation in 2023 and beyond. 

Series shortcuts:

  • Emotional Intelligence (Part 1) 
  • Emotional Intelligence (Part 2) – coming soon
  • Connection – coming soon
  • Complexity Fit – coming soon
  • Teams Thinking – coming soon
  • Growth Orientation – coming soon
  • Strategic Ability – coming soon
  • Virtual Leadership – coming soon



About the author

Gary Hoffman, MD, is a seasoned executive coach with rich, first-hand experience as a physician executive. His expertise is working with fast-changing healthcare organizations, executive and physician leaders, and clinical leaders transitioning from clinical to executive roles.
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