Wisdom

This program is called Wisdom and Wellbeing for a reason: we have an intentional focus on helping people move through difficult circumstances (which is an inevitable part of life in the health care environment) with the best possible chance of doing well, of learning and growing through their experiences. 

So how does one go about fostering wisdom?

• Assure that unnecessary stressors (insufficient supplies, inefficient or unsafe processes and environments) are given the attention they deserve and addressed quickly.
• Help people to have a healthy internal set of resources, a platform of positive emotion, an openness for engaging with uncertainty.
• Create a “wisdom atmosphere”—an environment that is supportive of growth, that brings out the best in people, that supports exploratory processing of difficult events, of creatively and courageously  engages with each other.
• Help people to regularly touch down on the deep meaning of their work, and how their work connects to the larger picture.
• And finally, pay attention to the critical events and how they are managed.  Assure that when a critical event occurs, people have the necessary and guidance to move through these experiences in the best possible way—these are situations like adverse events, mistakes, difficult conversations.

Think about a person whom you would consider wise. Who comes to mind? This might be a grandparent, a beloved teacher or mentor, a famous current or historical leader, or an artist. Something about them embodies wisdom for you.

• What about them makes you think they are wise?
• What qualities do they have? 

How do you think this person became wise?

• Were they born that way?  
• Did they experience adversity from which they found meaning or purpose?
• Did they become wise, or wiser, by learning from their teacher or mentor?

And finally, how does this wise person influence those around them?  Do they inspire others?  Make the world a better place?  If so, how?  Do their actions (decisions, leadership, courage) have a lasting impact?

The Wisdom and Wellbeing Program is built on a foundation of wisdom because striving to become wise individuals within an organization that fosters wisdom will benefit everyone. For example, in addition to providing extraordinary patient care, a wise healthcare organization would strive to foster the well-being of all, not only patients or the financial bottom line.  A wise organization would implement policies after taking into consideration the perspectives of employees as well as patients.

Wisdom researcher Monika Ardelt has done some very nice work delineating what characteristics exemplify a wise person.  She has separated these characteristics into three main domains.  

REFLECTIVE: Wise people can see things from multiple perspectives, rise above their own perspective.  This requires self awareness and self-insight.  

COGNITIVE: Wise people can see the deeper meaning, can apply knowledge and skill to right action, can deal with ambiguity and uncertainty, and they know what they don’t know.

AFFECTIVE: Wise people are compassionate.  And finally they have a focus on the greater good, and in their actions try to make the world a better place.

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High levels of knowledge and skill, with the capacity to apply that knowledge and skill to a particular circumstance, Compassion, intellectual humility, learning from mistakes, seeing the bigger picture, these are all particularly important qualities in health care professionals. Maybe these are exactly the qualities that make us worthy of the trust that our patients put in us.

One thing that comes out consistently when people talk about their wise person is that they are not perfect.  In fact, Becoming wise is really all about how one handles ones imperfections rather than about being perfect—a very very important distinction.  Wise people are humble, and VERY aware of their vulnerability to mistakes—but they also see their mistakes as an important window into how to get better.  So they look carefully at them, take them in, and learn from them.  So helping clinicians deal with imperfection is a big part of enhancing wellbeing and wisdom both. 

Now, back to that wise person—how do you think they got that way?

It turns out that wisdom has a special relationship with adversity.  And it does appear from the 20 or so years of research into how wisdom is developed, that adversity is a particularly fertile opportunity for the development of these qualities that define a wise person.

It is what we bring to the table when adversity strikes?

Or is it what happens during and after—our social supports, what we do, the circumstances?

Maybe it’s a little bit of both.

There are likely predispositions (capacities, ways of seeing events) that predispose us to wisdom formation through experience (openness to experience, positive emotion, gratitude, forgiveness) (Gluck 2013, Plews-Ogan et al 2018, Jayawickreme et al 2017). There are ways of reflecting on/processing experiences that are associated with wisdom gained (Gluck, Bluck and Westrate 2018, Plews-Ogan 2013, 2017).
Their findings demonstrate that “wisdom was positively associated with exploratory processing of difficult life experience (meaning-making, personal growth), whereas redemptive processing (positive emotional reframing, event resolution) was positively associated with adjustment.” (Gluck and Westrate 2017).

Redemptive processing: less psychologically risky.  Results in adaptation rather than growth. 

Exploratory processing: “This type of self-reflection is rare, probably because it is less pleasant than other processing modes. 

Dialectical integration: a synthesis of regular life with trauma in which a person is able to “simultaneously hold in mind two opposite positions on the basis that they are but part of a wider picture in which the opposition is subsumed” (Linley 2003).

Green zone interventions include ones to build both internal and unit or departmental positive emotion.I do believe, and the research is beginning to bear this out, that cultivating curiosity, forgiveness, compassion, gratitude, openness, these emotions, can set the stage for a wisdom-generating response to adversity. 
It takes work, and intentionality, to firmly establish these emotions.  At UVA, we have multiple partners  build this atmosphere including the Center for Appreciative Practice, Compassionate Care Initiative, FEAP, all focused on cultivating these emotions in our community, so that when challenges occur, as they inevitably will, we have the best chance of responding in a way that will generate wisdom rather than hate or further suffering.