The Building Blocks of a Fortuitous Encounter

A fortuitous encounter in listening changes lives.  Failure to listen cost lives.  Davis and Spears define a fortuitous encounter as, “those moments where a person, place, or thing causes our lives to change in a more positive direction” (Davis & Spears, 2013).  This essay will define the fortuitous encounters that led to the building blocks of my healthcare management career.  Using relevant scholarly references, I will outline my own fortuitous encounters that acted as building blocks to my career in healthcare leadership and development. 

In 2009, I experienced a very difficult seven-month pregnancy.  As a highly modern 21st century executive-in-training, I envisioned a high stakes corporate management career and work life integration with one child and a husband who shared my career values.  In seven months we experienced a flood in our home; I fractured my hand; we lost our son’s identical twin; closure of my corporately-aligned very successful business due to contractual changes; jury duty without an opportunity to postpone due to illness; Swine Flu (H1N1); pre-eclampsia; hand reconstructive surgery; and being airlifted in critical condition by a fixed-wing plane in the midst of a blizzard and deep winter freeze.   Failure to listen negatively impacted my health outcomes and that of our (now) nine-year-old son Giovanni. 

Failure to listen occurred at every point that led to our son Giovanni’s micro-premature birth in 2009.  I developed an enchondroma on my right hand that led to a fracture by simply opening a door.  An enchondroma is a non-cancerous tumor that hollows out the bone, weakening it for easy fracture.  On the afternoon of July 3, 2009, I opened the back door to our ranch home and immediately clutched my right hand in excruciating pain.  My husband, disbelieving that someone could fracture their hand opening a door, placed my hand in a metal salad bowl of water and ice to determine if I could move the joint.  Two hours later I demanded a trip to the emergency room for an x-ray. After waiting some time in the emergency room, I was seen by a new resident. He reviewed my chart and clumsily stated that this fracture may be due to cancer with no treatment options until after I gave birth in seven months. I might die, but there was nothing healthcare could do for me.  The medical director overheard this and pulled him from my care immediately. When this resident did rounds in the NICU and pediatrics later, he apologized profusely, shamed by his behavior.  Ten days later I had my first ultrasound with my high-risk obstetrician where we found out we lost our son’s identical twin.  Days later my husband decided that I would be transferring to a local, brand new obstetrician right out of residency for my obstetrics instead of traveling to the high-risk provider 100-miles away.  Our son was due mid-winter and he did not want me traveling over a snowy pass even though my parents lived close to this high-risk obstetrics center. It was this pivotal decision to leave a high-risk provider that put both my life at risk and that of my micro-prematurely born son Giovanni at 30 weeks, 3 days gestation at 1131 grams (2lbs, 8oz). 

Powerful life-saving listening moments occurred within the inept healthcare system that contributed to our ability to survive.  An urgent care nurse practitioner diagnosed me with Swine Flu at six months pregnant.  Quietly but firmly, the nurse practitioner stated that I was only to visit the emergency department if my vitals required life-saving care.  My obstetrician echoed that sentiment inviting me to call his mobile phone privately at all hours in the event of a significant physical crisis. 

On December 8, 2009, one fortuitous encounter not only saved my life but set me on a new path to Servant-Leadership.  Her name is Katie Brown.  A newly licensed, very young nurse, I came out of hand reconstructive surgery appearing very lethargic, ashen-white, and barely able to focus on her or the bright, multicolor rice-shaped lights.  Looking at my casted arm where the surgeon took bone from my wrist to put into my fractured finger for repair, I felt like I had a terrible hangover with the flu.  Shaking with chills, I could barely sit up.  The surgeon signed off on my discharge papers without seeing me, but Katie Brown intuitively double-checked my blood pressure.  At 155/115 I belonged in the Intensive Care Unit, especially given I could not sit upright without support.  She brought this to the attention of her nurse manager who ignored her.  The surgeon ignored her.  I was 29 weeks, 6 days pregnant so she had me walk to the birthing center without the support of her more qualified management.  The birthing center provided immediate care that included starting an IV with magnesium sulfate.  As the liquid entered my body, it felt like a burning sensation that forced me to stay in bed.  A nurse entered and gave me a Betamethasone shot.  According to the American College of Obstetricians and Gynecologists, two doses of Betamethasone, a steroid, is recommended for any pregnant woman in an imminent state of giving birth within seven days to mature a neonate’s lungs (2017). 

The greater trauma wasn’t my health situation.  Being cared for in a hospital unequipped to provide neonatal medical care in a blizzard and deep, deep winter freeze at -1 degrees outside is terrifying.  The new obstetrician, young but open to a solution, asked if I had emergency airlift insurance.  Two months earlier, a friend recommended critical airlift insurance for $44.  Listening to a trusted friend saved my life and an $11,000 non-refundable critical airlift bill. 

In a hospital bed six hours after surgery, emotionally too numb to process the terror of my situation, I hear shuffle and conversation at my door. The curtain opened with two people wearing red jackets and an “Emergency Airlift” patch.  Emotions suddenly flooded me with hope as they opened a blue burrito-like sleeping bag on a gurney.  Unable to sit up, four healthcare providers used the sheet to transfer me into the sleeping bag and wrapped me up for transport.  My newly casted hand exposed, a nurse provided a red, white and blue infant hat to protect my fingers from the chill. I was transferred by ambulance to a fixed-wing plane, over a 5500’ mountain and again by fixed-wing plane to a birthing center with an intensive care unit. 

In Robert Sardello’s book, “Silence: The Mystery of Wholeness”, he writes, “our body’s center is the necessary meeting point where the inward silence of solitude meets up with the great Silence of Cosmic Wisdom” (Sardello, 2009).  Alone in the jet with a paramedic, a critical care nurse, and a pilot, I was invited to look outside of the small window where the twinkle of the lights felt like a promise of new life.  The parting of clouds revealed the cosmos in a way that only a hypervigilant patient with life-threatening high blood pressure could seek comfort.  In the 45-minute journey over a 5500’ mountain, the transformative power of silence led me to realize I no longer held the reins of a leader, nor was I in control any longer.  In those silent moments of care and promise by my evacuation team of healthcare providers, I willingly handed over my trust to healthcare leaders I perceived as trustworthy and competent.  Greenleaf (1977) writes: “A new moral principle is emerging which holds that the only authority deserving one’s allegiance is that which is freely and knowingly granted by the led to the leader in response to, and in proportion to, the clearly evident servant stature of the leader (Greenleaf & Spears, 1977)”

Four days later, Giovanni Victor Angelo Cascamo was born 2 ½ months premature at 2 ½ pounds.  We spent 56-days in the neonatal intensive care unit (NICU) in a servant-led hospital that modeled patient- and family-centered care. 

As I research patient- and family-centered practices through the lens of Servant-Leadership, I discover the foundational construct is based in what Robert K. Greenleaf wrote: The best test, and the most difficult to administer is this: Do those served grow as persons?  Do they, while being served, become healthier, wiser, freer, more autonomous, more likely themselves to become servants?  And, what is the effect on the least privileged in society?  Will they benefit or at least not be further deprived? (Greenleaf & Spears, 1977)

Experiencing two very different hospitals transformed how I perceive the importance of organizational leadership in healthcare.  Sky Lakes Medical Center in Klamath Falls, Oregon operated at a very low level of healthcare organization and trust that resulted in dysfunction and chaos.  Greenleaf (1977) writes, “A low-trust culture that is characterized by high-control management, political posturing, protectionism, cynicism and internal competition and adversarialism simply cannot compete with the speed, quality and innovation of those organizations around the world that do empower people”.   Asante Rogue Valley Medical Center in Medford, Oregon exceeded patient- and family-centered care leading me to yearn to understand the seeming interconnected human development and teamwork that led to deep, deep trust. 

Our local newspaper, the Herald and News (2010), interviewed me for a front-page article titled, “Early Arrivals: Premature babies receive special care” where I described our Asante Rogue Valley Medical Center experience as “the Nutcracker Ballet of healthcare”.  As a patient it felt like observing magic.  Of the 30+ providers at Asante-Rogue Valley Medical Center that provided care, all performed as a single interconnected, mission-driven team.  Sky Lakes Medical Center, from my fractured hand to discharging me without observing my condition, left me vulnerable and terrified.  During my four days in the intensive care unit, followed by 56 days in the neonatal intensive care unit with my son, Asante-Rogue Valley Medical Center rebuilt my trust and led me to discover characteristics of Servant-Leadership.  They invested in rebuilding my psychological capacity of worth and value as they taught me to overcome the barriers of caring for a medically-fragile infant.  Nursing staff invited me to take a leadership role in the hospital for non-clinical activities so when Giovanni was discharged, I had the tools to become a healthcare leader in my family.  Two years later I recognized these characteristics of Servant-Leadership when I discovered Larry Spears’s writings that set me on a new path of serving underserved, dysfunctional healthcare systems like Sky Lakes Medical Center. 

Following our NICU discharge, Giovanni had breathing difficulties due to the 4200’ elevation and I took him to the Sky Lakes Medical Center Emergency Department – the same place where previously I had a traumatizing experience.  Giovanni’s oxygen saturation was at 83% and we could not travel the 100-miles back to Asante-Rogue Valley Medical Center with him in this condition.  We spent three days in the birthing center post-NICU where, once again, we felt trapped with healthcare providers that failed to listen to our needs or equip us with any confidence of their capacities to care for our family. 

Returning to a community after the NICU with a hospital that almost cost our lives led to a deep-seeded discontent and fear of the local healthcare system.  My husband agreed to look for academic administration positions closer to sea level near my home of Walnut Creek, California.  At a Ph.D intensive a few months after our trauma, my husband met a colleague who lived in a place called San Luis Obispo, California.  My husband shared that we were looking to relocate and our NICU story.  This colleague responded:  we live in paradise; hills and valleys and ocean and mountains; great healthcare and schools are world-class; endless hiking trails and outdoor activities. But my community college never hires, especially out-of-state Deans.

Two months later Cuesta College posted a dean of workforce and economic development position and six months from that conversation, we packed everything we owned to move sight unseen to San Luis Obispo.  Amid our relocation plans, San Luis Obispo was awarded the title of, “The Happiest Place in the United States” by National Geographic. 

To many it appears we were part of the movement that ballooned the population, while in fact we were caught in a river of societal change we never knew existed.  Eight years from this relocation I have come to know San Luis Obispo as a beautiful healing community, a place people come for a few months to a few years to then embark on a wholehearted journey to serve elsewhere. San Luis Obispo has developed a significant absence of leadership as the leaders who built San Luis Obispo as “The Happiest Place in America,” have moved on and those seeking what is perceived as happiness have moved in without the emotional depth to invest in a borrowed community. 

One year after our relocation to San Luis Obispo, I received a postcard in the mail.  My husband was finishing up his Ph.D. dissertation at Walden University. This fortuitous encounter with a postcard invited me to select a course for a $99 technology fee at Walden University.  Dr. John Horsman (2019) writes, “there is also an abundant nature to (healthy) serving in that it inherently stimulates an inclination to pass it on”.  Parents who experience trauma through a neonatal or pediatric intensive care event often relate a motivation to give back to the healthcare providers or parents after their neonatal or pediatric experience.  Giovanni and I volunteered during his first year of life to the Children’s Miracle Network and I loved contributing financial strength to a non-profit that provided necessary tools to families in healthcare crisis.  Unbeknownst to me, this $99 course was a doorway to opportunities I never imagined could exist. 

I selected, “The Character of Leaders” course .  I had been in corporate management and engaged in community leadership prior Giovanni’s birth and I dreamed of re-entering my corporate executive career.  One of the texts in this class, “Practicing Servant Leadership: Succeeding Through Trust, Bravery and Forgiveness” by Larry Spears and Michele Lawrence (2004), introduced me to Servant-Leadership at a time when I spent a considerable amount of energy resolving my broken career, my healthcare crisis, and re-defining my future call.  My husband asked that I not follow his academic footsteps to Walden University and seek my own journey.  My husband often has conversations with his colleagues at Cuesta College and he mentioned off-the-cuff that he heard Gonzaga University had a Master’s in Leadership program. Intrigued by the idea that I could attend a university online just five miles from Whitworth University where I completed my undergraduate studies, I immediately inquired by calling and speaking to a Program Manager at Gonzaga University.  In this pivotal conversation, the program manager asked, “What interests you about leadership studies?”  Excitedly (while dramatically shaking my newfound text on Servant-Leadership), I replied that I just discovered this author named Larry Spears.  Like a born-again person, I shared my minimal knowledge of Servant-Leadership and why it excited me.  The program manager must have had a smile on his face as his tone of voice changed and he replied, “Larry Spears is an adjunct at Gonzaga University.”  Silence.  Once I could speak again, he invited me to apply to the program.  The fortuitous encounter with a postcard, a comment, and a book enveloped me into a community that continues to transform my life daily. 

To make meaning from a fortuitous encounter requires we listen.  Even if we do not fully know the path that is being laid out before us, our intuition acts like a GPS with turn-by-turn directions.  According to John Horsman (2019), “an inclusive micro, meso, macro, mundo systems approach to development requires the assumption and understanding of the nature and processes of human and organizational transformation”.

A few months into my graduate school coursework, I met Dr. Adrian Popa, who invited me to climb Mt. Adams as part of a course titled, “Leadership & Hardiness.”  The absurdity of such an idea that a mom would climb a mountain and his persistent persuasion led me to trust his wisdom and climb 9500’ of the 12,276’ mountain.  At 9500’ Dr. Popa shared that he spent several years as a social worker in a neonatal intensive care unit.  This course on resilience aligns perfectly with healing from a prematurity journey.  Lane Baldwin writes in Fortuitous Encounters, “The only way to notice these quiet, unobtrusive offers is to listen with your heart and spirit, to be open to the very possibility that it can happen for you – and it will, if you let it” (Davis & Spears, 2013).  One does not need to fully listen for comprehension when opportunities present themselves as Dr. Adrian Popa’s invitation to climb Mt. Adams (and later pursue the doctorate in leadership studies program).  Listening can create a false narrative, deepening one’s fears to a point of immobility.  More integral than listening is trust.  While listening provides guided instruction, deep generative listening that results in trust creates growth.      

Returning from Mt. Adams, I reached out to a grassroots non-profit called Hand to Hold (www.handtohold.org) that provided parent support resources for babies born premature, complicated births, and the loss of a baby.  I offered to write a blog post titled, “Raising a Preemie is like Climbing a Mountain” (2013).  This blog post began a dialogue with Kelli Kelley, Executive Director of Hand to Hold, who invited me to do a graduate level project exploring non-profit credibility.  The strength of this project led to Kelli inviting me to serve Hand to Hold remotely as an Organizational Development Consultant for 18-months while I finished graduate school.  Through my time at Hand to Hold I met world-renowned researchers, neonatologists, parent-leaders, and a collaborative of parent-led organizational leaders through an organization called the Preemie Parent Alliance.  These series of introductions invited me to serve as a global speaker for the Speaker’s Bureau where I have presented from 850 neonatal nurses to 85 global neonatal leaders and additional opportunities yet to come. 

The Preemie Parent Alliance invited me to present to 35 national executive directors on Servant-Leadership in 2015.  My overly academic presentation led to the wise advice of a neonatologist, Dr. Sue Hall, who encouraged me to pursue more practical, hands-on experience as a servant-leader.  Listening intently to her wisdom, I left Hand to Hold and spent a year and a half leading a welfare-to-work program at Goodwill Industries while growing my own grassroots organization Courageous Steps.  At Goodwill Industries, I was straddled between practicing as a wholehearted servant-leader-in-training and absence of moral and ethical leadership by organizational leaders.  During my tenure, I grew a welfare-to-work program from a 45% completion rate (national average) to a 100% completion rate in one year simply by listening to the needs of participants.  It was generatively listening to participants that gave me the information I needed to guide them to a career that was equally meaningful as it was financially beneficial.  As participants shared the stories that led them to the welfare program, I empathized with their story and they brought awareness to what society perceives as the character of a family on welfare.  All participants had one or more adverse childhood experiences, a comprehensive research study that connects childhood trauma to negative adult risk for socio-economic, health, psychological behaviors (Anda & Felitti, 2016).  The mismanaged organizational change that occurred a year into my work at Goodwill Industries led to an increased level of responsibility without the tools or pay to effectively navigate the change.  An opportunity that began wholeheartedly left me broken and experiencing burnout. 

Through the brokenness and burnout, hope rekindled.  A colleague named Mary whom I met through Hand to Hold invited me to develop a Poster Presentation on the role of Servant-Leadership in the NICU.  Unemployed and seeking to rekindle my soul, our family spent two-weeks in Europe, visiting London, UK; Bruges, Belgium; and Paris, France.  By early 2018, I submitted over 300 targeted resumes and cover letters to companies in San Luis Obispo with no acknowledgment of my efforts.  I felt hopeless with my talents under-utilized. A few days prior to embarking on this adventure I received a telephone call from a recruiter at CEP America, a healthcare management and staffing company near San Francisco. Days before we left for Europe, I had two telephone conversations with a healthcare recruiter.  First, he called from a company called CEP America.  Two days later, the recruiter called from a company called Vituity. 

Healthy skepticism reigned and I shared openly my purpose for traveling to Europe, my upcoming Poster Presentation titled, “Examining the Role of a Servant-Leadership Paradigm Within Existing NICU Initiatives” and my passion for growing Servant-Leaders within healthcare.  I shared that there is an emerging belief that Servant-Leadership helps decrease physician burnout and my career dream is to work part-time serving healthcare providers while growing Courageous Steps.  While the recruiter did not fully conceptualize Servant-Leadership, he had enough intuition and listening to recognize that Vituity rolled out a new provider wellness initiative just weeks earlier introducing the term Servant-Leadership.  It was what he didn’t know that led to the fortuitous encounter that crafted the perfect scenario for my work. Vituity embarked on major organizational change starting in 2018 that I have helped cultivate that at my local site with two medical directors and 32 physicians and advanced providers.  This fortuitous encounter with Vituity led not only to practicing Servant-Leadership in a hands-on, meaningful, contributive way but also to learn what Servant-Leadership looks like in clinical healthcare management. 

In early 2019, the Founder & CEO of RaceSLO, an endurance training organization, invited me to join a half-marathon training team for an upcoming half-marathon.  While running a 5-miler, I met a program director for an organization that provides employment opportunities to adults with disabilities.  While running one morning, I mentioned my training in Servant-Leadership. The program director excitedly shared that he used to have to evaluate his staff at Nordstrom on Servant-Leadership but never understood it.  I shared Greenleaf’s Best Test and he invited me to submit a proposal to train his workforce staff.

Fortuitous encounters are the building blocks of a congruent, mission-driven life.  While not fully expressed in the early years after my son’s micro-premature birth, through a collective of people who crafted a vision I knew intuitively the direction I felt called to serve. 

Recommendations for implementing a listening culture in healthcare is far more complex than our texts could ever fully acknowledge.  First, healthcare systems change rapidly and regularly.  Communicating hourly, weekly or monthly systems change at the rapid level required is leading to over a 47% burnout rate among emergency care physicians.  Burnt out and without a purpose increases a staggering depression and suicide rate.  Second, healthcare providers develop a clinical numbness, a situational deafness, to hearing only what is necessary for patient care.  Various self-medicating measures (some healthy such as surfing and the outdoors) and addictions or unhealthy self-meditating follows.  Thirdly, denial.  Less than one-quarter of healthcare systems accurately track the costs of healthcare provider turnover.  The best estimate is one turnover for every healthcare provider costs 1.5 million dollars.  By 2025, we will already have a shortage of healthcare providers notwithstanding the burnout rate (Shah, 2016).

As I reflect on my own journey from patient to healthcare administrator, at the heart of my call to serve right now is by lessening the stress on my two medical directors.  Quietly, I am using my graduate and doctoral studies to research organizational solutions and lessen the impact of negative patient healthcare outcomes. 

In closing, as I developed this essay, I felt called to research the patient experience data of Sky Lakes Medical Center in Klamath Falls, Asante-Rogue Valley Medical Center in Medford, Oregon and French Hospital Medical Center (my hospital) in San Luis Obispo, California.  Sky Lakes Medical Center is rated between 35-43%.  Asante-Rogue Valley Medical Center is rated between 79% and 83%.  French Hospital Medical Center is rated between 92% and 98%.  My years of searching to re-create Asante Rogue Valley Medical Center and it’s right here, right now, and I get to be part of something greater than myself. 

 

References

 

Aho, J. (2010, January 03). Early Arrivals : Premature Babies Receive Special Care. Herald and News.

Anda, R., M.D., & Felitti, V., M.D. (2016, April 01). Adverse Childhood Experiences (ACEs). Retrieved March 31, 2019, from https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fviolenceprevention%2Facestudy%2Findex.html

Autry, J. A. (2004). The servant leader: How to build a creative team, develop great morale, and improve bottom-line performance. New York, NY: Three Rivers Press.

Cascamo, K. (2013, September 20). Raising a Preemie is Like Climbing a Mountain [Web log post]. Retrieved March 31, 2019, from https://handtohold.org/feature-friday-raising-a-preemie-is-like-climbing-a-mountain/

Cliff, B. (2012). Excellence in Patient Satisfaction Within a Patient-Centered Culture. Journal of Healthcare Management, 57(3), 157-159. doi:10.1097/00115514-201205000-00004

Davis, P., & Spears, L. C. (2013). Fortuitous encounters wisdom stories for learning and growth. New York, NY: Paulist Press.

Greenleaf, R. K., & Spears, L. C. (1977). Servant leadership: A journey into the nature of legitimate power and greatness. New York, NY: Paulist Press.

Hesse, H. (2017). Siddharta. Barcelona, Spain: Debolsillo/Penguin Random House Grupo Editorial.

Horsman, J. H. (2019). Servant-Leaders in Training: Foundations of the philosophy of servant-leadership. Palgrave Macmillan. doi:https://doi.org/10.1007/978-3-319-92961-3

Sardello, R. J. (2009). Silence: The mystery of wholeness. Berkeley, CA: North Atlantic.

Shah, S., M.D., M.B.A., F.A.A.E.M. (2016, January 25). The Real Cost of Emergency Department Physician Turnover. Retrieved March 31, 2019, from https://www.studergroup.com/resources/articles-and-industry-updates/insights/january-2016/the-real-cost-of-emergency-department-physician-tu

Spears, L. C., & Lawrence, M. (2004). Practicing servant-leadership: Succeeding through trust, bravery, and forgiveness. San Francisco, CA, CA: Jossey-Bass.

The 2009 H1N1 Pandemic: Summary Highlights, April 2009-April 2010. (2010, June 16). Retrieved March 30, 2019, from https://www.cdc.gov/h1n1flu/cdcresponse.htm

Wanzer, M. B., Booth-Butterfield, M., & Gruber, K. (2004). Perceptions of Health Care Providers' Communication: Relationships Between Patient-Centered Communication and Satisfaction. Health Communication, 16(3), 363-384. doi:10.1207/s15327027hc1603_6

What You Need to Know About Enchondroma. (n.d.). Retrieved March 30, 2019, from https://www.hopkinsmedicine.org/healthlibrary/conditions/adult/bone_disorders/enchondroma_85,P00115

Women's Health Care Physicians. (2017, August). Retrieved March 30, 2019, from https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Antenatal-Corticosteroid-Therapy-for-Fetal-Maturation?IsMobileSet=false