Mindfulness in medicine: Why leadership is crucial for a mindful health care system

Ronald Epstein, MD, FAAHPM, reflects on how his views have evolved, emphasizing that organizational mindfulness depends heavily on leadership alignment and culture rather than individual clinician effort alone. He notes that mindfulness cannot compensate for toxic systems, but in organizations with self-awareness and supportive leadership, collective mindfulness can meaningfully improve staff well-being.

Melissa Lucarelli, M.D., FAAFP: Just last week, a Medical Economics guest article, I think it was a blog, argued that “when the system is broken, no amount of mindfulness can fix it.” Since you wrote about imagining a mindful health care system, would you — how would you respond, and particularly around the idea of organizational mindfulness?

Ronald M. Epstein, M.D., FAAHPM: I would give slightly different answers now than I wrote; it’s now, I actually wrote the book about 10 years ago, and so the landscape has changed, and also I’ve changed. One thing is the role of leaders, and I had really underestimated that for most of my career, until I really started meeting with leaders and also seeing how they work and visiting a lot of different institutions around the world. If leaders are aligned to what really matters in medicine, then that can create an organizational culture that would permit that kind of collective mindfulness to emerge. However, if you’re in a situation — I’ve been in situations where I’ve been asked to give a keynote lecture in a health system that clearly is not only dysfunctional, but toxic, expecting that my whatever hour-long talk would fix things, and it can’t. I mean, it’s just completely impossible. And I think that organizational mindfulness, that if you think of an organization as an organism with the same kind of capacities for self-awareness and repair and self-monitoring, then you can really see how some organizations themselves are more mindful than others. I’m working very closely with some organizations that seem to be more on that more mindful spectrum, and what they can accomplish in terms of staff well-being, I think, is much more meaningful.