Text: Associate Director of Patients Care (CHUV)

Managing with uncertainty

The vast majority of us, as human beings, would refuse an invitation to scuba dive, citing our fear of the unknown, of darkness and of danger.

If you ask a group of people, who would like to go scuba diving? The majority will decline the invitation. When asked why, they mainly answer, “fear of the unknown, of darkness, of danger”. However, most people would agree to go snorkelling, saying that they have more control over this familiar environment and can gauge risks that they think they can identify. Yet most scuba diving accidents occur at the water’s surface, in that zone of comfort and certainty where we think we are protected from danger.

In the history of industry, there are many examples of managers who, clinging to their certainty and belief in a static world, have watched their companies sink. Ken Olsen, founder of DEC (Digital Equipment Corporation), which developed and manufactured the first computers, the size of an entire room, remarked in 1977: “There is no reason anyone would want a computer in their home.” Twenty years later, DEC disappeared. More recently, we’ve seen what happened to Nokia, the showcase of Finnish industry, which almost disappeared because it couldn’t keep up with Apple’s inventions.

This does not only happen to captains of industry holding on to their certainty. It’s a human phenomenon to use one’s own experience as a basis for what to expect in the future, confusing certainty and reality. Any theory or research that does not apply to one’s own view is too often dismissed for this very reason.

What about the world of health care? It is increasingly described by those involved in it as “volatile, uncertain, complex and ambiguous”, four adjectives that point to uncertainty. Uncertainty hinders planning for the future and making informed decisions. Professionals therefore base their views on their certainty to avoid looking into new alternatives and opportunities. But admitting to uncertainty is the most appropriate path in these situations. In clinical care, two American studies conducted on panels of doctors – the most recent in 2013 – show a positive correlation between doctors who express their uncertainty and an improvement in patient relations, more information shared with the patient and better pain management.

"In the history of industry, there are many examples of managers who, clinging to their belief in a static world, have watched their companies sink."

Managers of institutions must stop protecting their teams from uncertainty, but instead acknowledge it and embrace it as a management tool that can boost investment, commitment and loyalty from professionals. This means recognising the ability of each staff member to point out unknown areas, provide different insight to a new issue and identify opportunities and responses that meet new needs.

When the traditional toolbox used by managers is turned upside down by major changes and uncertainty, when strategies lose their clarity, when forecasts become useless for lack of information, when proven solutions based on best practices become ineffective in handling unknown challenges, managers must display “resistance” – i.e. the ability to question oneself, reassess the situation and learn constantly (humility, adaptability, scepticism and tact) – and “momentum” – the capacity to continually move forward with energy and conviction (courage, resolution, optimism, honesty). Today, managers integrate these two opposing characteristics to develop integrative leadership, mitigating any extreme reactions to prevent employees from feeling disbelief, frustration, guilt, despair or indifference. They do that by instilling employees with a sense of challenge, competitiveness, adventure and collaboration.

Transforming mistakes into progress, giving value to novelty rather than comfort, turning threats into opportunities. That’s what it means to have the entrepreneurial spirit, the spirit that leaders should inspire in the world of healthcare. We must build the future but still have much to learn and discover. We need to remain curious, exploring all the opportunities created by a situation of uncertainty.

As managers, we need to remember three things in planning for the future:

  • Uncertainty is not the problem; our certainties are
  • We need to understand uncertainty and work with it
  • We must develop an entrepreneurial spirit