Interviewsand Articles


A Conversation with Phil Cass: Shifting the Healthcare Paradigm

by Amit Dungarani, Richard Whittaker, Mar 26, 2019



Awakin Calls are a project of ServiceSpace.

For this call the host was Amit Dungarani and the moderator was Richard Whittaker

Amit:  Good morning, good afternoon and good evening. I’m Amit Dungarani and I'm excited to be your host for our weekly Global Awakin Call. Behind each of these calls is an entire team of Service Space volunteers whose invisible work allows us to hold this space.
     Today our guest is Phil Cass and our moderator is Richard Whittaker who will engage in an initial dialogue with Phil. By the top of the hour, we’ll roll into a Q&A for your reflections and questions. So I'm turning it over to, Richard. Thank you for being here.  

Richard:  Thank you, Amit. I think you’ve all read the wonderful bio on Phil. So here’s a condensed version. For the past two decades, Phil Cass has put into practice methods of leadership in his community of Columbus, Ohio that enable people to come up with something they could not have done alone. He's moved beyond a top-down model of leading in favor of creating a conversational space in which collective intelligence can emerge, leading to wiser and more effective action. During Phil's 16-year tenure as CEO of four affiliated not-for-profit health corporations, he implemented this model of leadership. His experiments later led to the creation of a countywide multi-stakeholder initiative aimed at enabling the current health system to function more effectively. This transformational form of leadership under Phil's influence has continued to spread into other institutions in Columbus and even to a federal initiative on homelessness. Dr. Cass's shift in how he engages as a leader was inspired by his experiences at the Shambhala Institute during a conference he attended in 2002. At that conference, a process called The Art of Hosting was being demonstrated.
     So Phil, we're going to want to learn about all of this. I know a shift took place in your life after a long process of work and evolution. So would you share something of the story of how you got to the point where this pivotal shift took place in your life?

Phil:  Thank you Richard, and thanks for the privilege to be on this call and to have the opportunity to tell a story. It's a quite an honoring thing to have your story asked about.
     I’ll just say something simple about my upbringing. I think you'd find it hard to find a more average Midwestern, white guy. I was born in St. Louis and moved around a bit as a kid with parents who were wonderful. I want to paint a picture of having just a regular Midwestern upbringing; that was me.
     Fast forward. I think one of the things about me is that my career and my work has always been pretty instinctual. I don't think I ever really formally applied for a job until I was in my early 50s. I started out as a high school basketball coach and a high school guidance counselor at an inner city parochial High School in New Haven, Connecticut. And I had a critical decision to make, to either remain in a high school coaching role, which I loved, or go back to school and further my education.  
     So, in 1977 I left New Haven, and went to Columbus, Ohio where I did my PhD in counseling. I finished that in 1981. Significant things during that time were my marriage and the birth of my two daughters who were then, and remain, very core in my life. It's also significant that while I was finishing my PhD I was working in a professional role as a therapist in a Mental Health Center.
     Then, in 1981, literally, on the day I graduated—in the morning in September with my PhD from Ohio State—that afternoon I was on the operating table having been diagnosed with testicular cancer.

Richard: Oh my gosh!

Phil:  I tell that simply because probably the birth of my children and the fact that I was diagnosed at 32 with cancer, were quite formative to the rest of my life. I quickly understood life is impermanent. I quickly understood that whatever was going to happen needed to happen. I made choices to live fully. At 32, when you're diagnosed with cancer, you know?
     I meet people now who are diagnosed with cancer later in life and they have a more reflective view. For me, it meant turn the throttle up, and doing as much as I could do before it might end.

Richard:  At that point, what exactly were your first engagements with the world, so to speak?

Phil:  It's a great question. My doctoral dissertation was on burnout and stress, ironically. While I was in the hospital, they did an eight-hour surgery, and the nurses on that oncology floor were so sensitive to the fact that I was 32. And they knew that I’d just finished my PhD. At that time this cancer was more lethal, and they were sensitive to the fact that I was experiencing a complete lack of a sense of meaning. I mean my life had been devastated.
     They began to ask me questions, while I was lying in bed, about stress, about burnout, about what they could do about it. In a lot of ways, I'm sure they were probably trying to humor me. So I talked to them. I’d done a lot of stress workshops. And they asked me if I’d be willing to speak to the nurses on the oncology floor. 
     So, to answer your question, this gig was probably two weeks after I was diagnosed; I did it standing in my hospital gown, hopefully without my butt hanging out [laughs]. I did stress workshops for three shifts of oncology nurses at Riverside Hospital in Columbus, Ohio.

Richard:  That’s a beautiful story, and it's a brilliant intervention by the nurses.  

Phil:  It was a brilliant intervention by the nurses and I was very grateful for it. They were so generous that way and, obviously, I took doing a good job for them very seriously. So, how did I get active? I literally was so weak that I can remember standing up in the nurse's area pretty much shaking on my feet. But it was such a generous offer, I was just determined that I was going to do the best I could, and getting though the third shift was a little hairy!

Richard:  Well, that's quite wonderful. Now you mentioned that you didn't apply for a job or even try to get a job until you're in your 50s. Did I hear that correctly?

Phil:  That's probably a bit of an overstatement. When I got the job at the Mental-Health Center, I did go undergo an interview and was accepted. But I proceeded in that role from being a therapist and a mental-health educator, into Associate Director. Then I actually became the Executive Director. In those cases, I did not interview for the positions. I was promoted because things were opening and people thought that I would fill that that role well.
     Part of the reason I got the opportunity to be the Executive Director is because there was someone before me who was quite fraudulent in his work, and even in the placement of the Mental-Health Center.  This is back in the Mental-Health Center Act days, where we were supposed to be serving people who were the most vulnerable, and they’d set the Mental-Health Center in one of the wealthier parts of town.  
     So one of the first things I did was to tell the Board that we needed to sell that building and move the Center into the middle of town where people with need could access us. That was one of my first acts as Executive Director.

Richard:  That's impressive. We had a brief conversation yesterday, and you told me that Ohio State was home base to Carl Rogers. Somehow this story makes me think of Carl Rogers and his principle of unconditional, positive regard.

Phil:  Carl Rogers wasn’t there when I was, but he’d been on the faculty at Ohio State University, and it did have quite a bit of an influence on the department, and his books really did have an impact on me. As time has gone on, what I realized is that his philosophy had kind of lost its conscious presence for me, but had been really rooted in my soul—in terms of the belief in people and their possibility. So yes, Carl Rogers did influence how I viewed people, and that has stood the test of time for me. It's been important.

Richard:  I really did get that feeling in talking with you earlier. So, what happened when you left eventually your role as Director of the Mental-Health Center?

Phil:  I was the director there for five years and in Ohio, we have these things called "Alcohol Drug and Mental Health Boards." I was asked by the then-president of the Franklin County Alcohol, Drug and Mental Health Board if I would be willing to join him as vice-president of the Board. That role involves funding, evaluating and contracting for all of the publicly supported Alcohol, Drug and Mental-Health Services in the county. It's the coordinating body and involves over 50 agencies that deliver services. It was a great opportunity, so I said "yes" and left the Mental-Health Center. I was in that new role a year when the president left and I was asked if I’d consider being president of that organization. So, for twelve and half years, I headed up the organization that oversaw all the planning, funding and evaluation of publicly-supported mental health services and alcohol and drug services for Columbus, Ohio and Franklin County, Ohio. We had a hundred and six million dollar budget, tax-supported with federal and state resources.
     Then, in Ohio, these organizations can ask for local taxpayers to tax themselves for those services, and that is germane. I will get to that in a minute. But, in the time that I was in that role, the services for people with serious mental illness were pretty much still operating out of a 1960s model of care for people. One of the things I undertook was to rethink care for people with serious mental illness and basically reinvent services for these people. I did that successfully, applying for a grant from the Robert Wood Johnson Foundation. Over those years, we literally moved millions of dollars around to create a more responsive system of care for people with serious mental illness. We also got a three-year grant to address issues of cultural competency.
     One of the things that became clear to me was that we also needed to reinvent how, culturally, we were looking at under-served people and people of color. And I also got a three-year grant to undertake a massive training on cultural competency reusing an Afro-centric model.

Richard:  This is just so interesting to hear about, Phil. I was reading in some of our notes that there was a pivotal moment when you lost an election and, therefore $40 million in potential funding. How does that fit into this story?

Phil:  So in 1995, I was in that role. I’d been part of successful levies—that's what we call these elections. I was part of three successful levy attempts before that. So I was feeling pretty confident about myself in terms of how those got done. In 1995, we were on the ballot for some additional money, and things were changing. I recognized that things were changing, and I’d pushed the envelope with a lot of the changes we had made in the system.
     But I didn't recognize the level of push-back from some traditional folks about what we’d been doing. In 1995 I was pretty hell-bent on conducting that levy my way—the way I thought I knew how these things went. And we lost. Literally, on the first Tuesday of November, with an election you could be $40 Million richer or $40 million poorer.

Richard:  Wow.

Phil:  So we lost. And at that point, I hired a person who is now one of my very best friends. I hired him to help me think through going back to the electorate in 1996, and he said to me, very candidly, "If your ego is as involved in this levy in '96 as it is now, it will lose again."
     I said to him, "You've got to be kidding me. You want me to give up control on this next levy and I've got $40 million on the line again?"
     He said, "Yeah. If you don't, it's going to go down again."
     Well, I trusted him and said, "Okay. Let's go." We didn't really have skillful means, but we tried everything we could in terms of involving people.

Richard:  Can you give a couple of examples?

Phil:  Yeah. In 1995 when we’d made the commercials for TV, it was me and two other people sitting in the TV studio making the commercials. In 1996 when we made the commercials, we had 25 people from all walks of the community sitting in the studio and giving guidance on how those commercials were made and what they needed to say. That's one example.

Richard:  That must have been a pretty striking experience for you, the difference between those two examples.

Phil:  Oh it was. I was pulling my hair out, thinking, “I'm going to have to completely trust that there's wisdom here.” And that wasn't easy for me then. This ties back to Carl Rogers in a lot of ways, believing the outcome of this was going to be better because there was more intelligence in the room. I could do it a therapeutic context, but when I was working with an entire community and that kind of money, that was a leap of faith for me. That was not easy. But we won.

Richard.  Wow!

Phil:  In a lot of ways, Richard, where I am today is still an inquiry from what happened in 1996.

Richard:  I love that you said that! It's encouraging to know there's still an inquiry. In a way, once we have the answers, we're pretty close to getting in trouble, wouldn't you say?

Phil:  Why, I think that's exactly right. If there's one of many things I think I've learned over my lifetime, it's the question not the answer.

Richard:  What’s the time spread between this story to your experience at the Shambala Institute?

Phil:  So this is 1996. After that levy in '96, I knew that I had to completely rethink my leadership style. I had to learn more about participatory ways of operating. So between '96 and '99, I tried, within the context of the mental health system, to reinvent myself. I found that very difficult for lots of reasons.
     By 1999, I decided that the system probably needed me to be gone and I needed to be gone. So I looked around and, literally, in the building next-door to us they were looking for a new CEO. So I talked to people on that Board. They were interested in what I had to offer and after going through the proper process, I was offered the job of CEO. So I left the Alcohol, Drug and Mental Health Board in 1999 and moved over.
     Between 1999 and 2001, I was still experimenting, but I had a new place to experiment now. I had new staff to experiment with, and I was very candid. I said the folks from the get-go, "I have a sense of what this is about. I understand its essence, which is about confidence and people—it's confidence and people's intelligence. I'm confident that everyone can participate, but I have no clue how to do this."

Richard:  When you were approaching this new position, did the people already there have this view about bringing people together and making them part of decisions, and all that?

Phil:  Actually, I was entering an organization that had been run by somebody who was a virtual dictator. And they knew they needed something different. So I absolutely believe it was because of that dichotomy that they were open to taking that risk with me.

Richard:  I see. That's fascinating.  

Phil:  Yes. So between 1999 and 2001, we’d read some of Margaret Wheatley's work on self-organizing systems together. And I had some of her tapes. We were also reading other authors. Together, we were trying to understand what self-organizing meant, and what “being a collective” meant. But, again, I really didn't have good, skillful means. Then it was in 2001 that I went to the Shambhala Institute. I went there because Margaret Wheatley was going to be speaking and I’d have a chance to spend a week with her.
      So I went and Meg is now a dear friend. In fact, I've been the chair of the Berkana Board for several years with her. And while I was there, I met Juanita Brown who is the founder of the World Cafe. Then I started thinking, “Oh my God! There are actually skills here that I don't know anything about!” And I saw the potential for using them in context of what we're trying to do with the medical association.
     I came back in 2002 thinking I'd spend time with Juanita, but she was doing something else. And there was an Art-of-Hosting training, one of the first. So 2002 was the beginning of my experience with the Art of Hosting.

Richard:  And this was pivotal, right?

Phil:  It was absolutely pivotal in that I finally started to see skillful means that could be used and that were in sync with my underlying sense—both old, and emerging, of people's potential.  It's through all of that that I really worked with staff at remaking the culture of the medical association, and their affiliate corporations, into a highly participatory culture. Our leadership team, eight of us, met in circle every week for 16 years.

Richard:  Okay, so as this shift goes back 16 years?

Phil:  Yeah. It goes back to 2003.

Richard:  Okay. So the circle you're talking about is made up of the responsible people in these organizations?

Phil:   That is what it is, yes. But the circle is also itself, the form, is a social technology.

Phil:  You can learn how to host a circle as a methodology for hosting the intelligence of a group of people. So when I talk about circle, I'm actually talking to you about a form that has methodology to it, that has a practice to it. This is just like the World Cafe. Just like Open Space. Just like a lot of social technologies that are participatory. We incorporated all of those, but we were small enough that the circle and the methodology of the circle became the operating system of our organization for those years.

Richard:  Are you still the CEO of four health-related corporations?

Phil:  In 2016, I decided—as I’m going on 70—I decided it was time for somebody else to come in; it was time for me to free myself of some of the things I was doing there and move on.
     While I was at the Medical Association I also spent two years with Otto Scharmer. I spent two years with him at Cambridge in a Master Class learning a lot about Theory U. One of the things we did was we undertook to understand the soul of physicians at a level that I don't think has ever been done before. We did very deep, two-hour interviews with 50 physicians across the community and came away from that pretty shocked.

Richard:  What was shocking?

Phil:  Physicians have become the #1 group of people who commit suicide in the United States. Up to 60%, and some studies showing up to 69%, of physicians are depressed. We had people tell us more than once that they’d attempted suicide. So we decided then that there were things we needed to do as an organization to change it. But what we did—I didn't think was sufficient. So at the end of my time there, with the help and support of the boards, we founded a mindfulness-based physician leadership program. Today I'm the co-director of that. We’re at our fifth year, our fifth cohort.  When this group graduates at the end of the ten-month program we will have 80 meditating physicians in Columbus.

Richard:  As I'm listening to you, I'm feeling some real hope. I’m not a student of healthcare in the U.S. but I think it’s just in a terrible shape. Would you care to reflect about the general state of our health care in the US?

Phil:  Well, there's a big project, Richard, that we've left out—one that reflects on that. We got invested in the issue of health care for the uninsured and created a literal, and virtual, free clinic for people in town. We have over 5,000 Physicians who volunteer in it.

Richard:  Five thousand? Oh my goodness. And that reflects some of the deep reasons why people become doctors.

Phil:  It does. And that's part of the reason we did it. It was for people who are uninsured, but it was also for physicians. We also launched a community initiative to try to understand what the community wanted from healthcare. Nobody had asked the community. The healthcare system has grown up topsy-turvy.
     So we again went out and conducted interviews with business CEOs, with insurance companies, with citizens and tried to ascertain whether this community was ready to do something. We came back saying we think so.
     So then we sponsored 10 community assemblies using a lot of this art of hosting methodology that I just spoke of, to engage over thousand citizens in what the purpose of healthcare is in our community. It was from those 10 assemblies that we learned that the citizens did not want just a “sick-care” system. They wanted a health-care system. So one of the outcomes of that work was that a good friend of mine (who also is an art of hosting practitioner and was the CEO of a not-for-profit organization) took it on to see if they could shift how health care was being delivered in Columbus. So with no authority—this is not a government entity; they are a not-for-profit—using the hosting methodologies, they brought together insurers, providers, hospitals and what have you. Today, there are over half a million people in Columbus, Ohio (population 1.1 million) who are getting their primary care in something called patient-centered medical homes.

Richard:  Tell us about what a patient-centered medical home is. What does it look like? How does it work?

Phil:  A patient-centered medical home is oriented toward making sure that it’s organized in a way that it has all the services it needs. So for instance, one will typically have a personal relationship with a psychologist, personal relationships with social workers, personal relationships with local food banks and personal relationships with community resources. When the patient comes in, it's not just about the fever and the cold, but are you eating right? Are you depressed? So it's a comprehensive approach to healthcare, and there’s the expectation that the patient-centered medical home will have gathered the resources together so it can easily both make referrals, but more importantly, identify the fact that health care is multi-factorial. And, in bringing the resources together, it’s understood that there has to be access to these resources if people are going to really be healthy.
     It's more complicated than that, Richard, but that's kind of the basics of a patient-centered medical home.

Richard:  Okay. Now when I read that phrase, I imagined a 3-bedroom house [laughs].

Phil:  It's not an accident that it's called a “medical home.” It is really the intention that people will see that medical access point as a home for getting healthy.

Richard:  Do people live there while they're sick?

Phil:  No, it's not a physical living space. I go to a patient-centered medical home. I'll get emails from the doctor saying, "It's time for this; it's time for that. You need to have this check up. You need to have that blood work." They're just proactive about my health. They will ask me things. Physician practices are well known for not dealing with the obvious like being overweight, not exercising. They address that kind of stuff.
     I'm privileged. I don't have the disadvantages that many people have in terms of economics and so on. These clinics in the city look at all of the things around food, around housing, around domestic violence and so on. “Do do you feel safe at home?” That's addressed no matter where you are.

Richard:  So a patient-centered medical home might look like a hospital?

Phil:  It might look like a doctor's office. They simply added all these components to it. Most patient centered medical homes have same-day access. In Columbus, as I said, half a million people are in patient centered medical homes, and they can typically access healthcare today, if they are sick today—as opposed to having to go to the emergency room.

Richard:  Do the staff doctors in these medical homes, do you think they feel better about their practice? Like are they able to spend more time with the person who comes in? How would you describe that?

Phil:  When patient centered medical practice first gets implemented and practiced, it’s just the opposite. Physicians actually feel fairly overwhelmed by it. But there is now more time for physicians to see patients. And that is very satisfying for physicians. I can tell you from working with physicians for 16 years, one of the biggest things they struggle with is not being able to see the patients for a time that is both good for the patients and good for them. It creates a moral dilemma for them.
     When a physician has to see 35 patients a day, they leave at the end of the day, not only physically exhausted, and mentally exhausted, they are morally exhausted. Because they know in their hearts, they have not been able to do what they are trained in.
     And we’ve also worked on changing the financing for primary care; what we have now termed "value based" as opposed to “event based.”

Richard:  How do you deal with the realities of the insurance industry, in terms of managing the financial end of healthcare?

Phil:  It's been very interesting. We’ve been successful at bringing the major insurers together here. In the beginning we just asked them—this grew over a course of ten years—if they would do pilot projects, with a few practices, and change their funding focus, and see if it actually delivered better for them. And it did.
     So here in Columbus, we’ve had some major shifts. Health insurers are now paying for primary care more along this value-based measure I’m talking about, rather than fee-for-service.
     We’re getting into some complicated financial stuff here. But insurers were willing to experiment, and that was the beauty of the participatory process. There was no government forcing them into it. They sat with hospitals. They sat with primary care physicians. They sat with patients. And together, they talked through what it might look like based on these experiments.

Richard:  I’m assuming you’ve been part of these discussions, so have you been able to integrate any of these principles you’ve learned from the Art of Hosting in them?

Phil:  All those meetings were based on those principles. I wasn’t hosting them. There was another fellow who is a good friend. But I brought this Art of Hosting training back to Columbus.

Richard:  So if you’re dealing with Cigna or Blue Shield or some national insurer, will one of their representatives be part of such a circle?

Phil:  Yes. We’re able to have the national insurers in a conversation.

Richard:  What's your take on the impression that's been made on people so far?

Phil:  At first, insurers were some of the most cynical. And in those meetings, they were also faced with business executives who were confused about what they were buying with the insurance—and even confused about healthcare. But when the executives started to wake up to what was happening in their own world of buying healthcare, they were the ones who began putting pressure on the insurance companies, saying, "Well, we got to try something different here."
     So, it was the combination of citizens, hospitals, providers and businesses together with government. “We’re not going to continue to buy and pay the way we have been. So come to the table and try something different with us.”

Richard:  That’s encouraging. Would you reflect on the difference between not-for- profit organizations and for-profit organizations? It seems like with the bottom-line model of for-profit corporations, it’s all about “serving the shareholders,” and forget the rest of the society.

Phil:  So Richard, I think this is good. When you talk about what this call is supposed to be about, I would like to simply say that, “Yes. For-profit and not-for-profit does have something to do with it.” But what it really has to do with is: what is the heart and soul of the leadership? And that is, in this case, convening these conversations.
     We had a group of people who had absolutely no agenda. And I don't know enough to know whether they were coming from a for-profit standpoint or it happened to be a not-for-profit. In this work with patient-centered medical homes, with shift in healthcare systems, with the work I did within my own organization, I really started to understand at a fundamental level that this is about relationships between people; this is about whether you really care, and whether you’re willing to live that out and push it.

Richard:  That sounds very powerful to me. As I listen to you speak, I feel that in people's heart of hearts, that's what they long for: relationship. And yet, there’s a quote, I think it’s from Margaret Wheatley, something like this: "I used to think that a good idea, well-presented could change the world. I was still innocent.”

Phil:  Yeah! But I do think that a good heart, a strong heart and a real heart, well positioned—I don't know if it can change the world, but I know it can change the world around you. And that was the basis for the founding of the Physicians Leadership Academy in Columbus, Ohio.
     We just recently, Richard, defined for ourselves what leadership is. And the Physicians Leadership Academy’s definition of leadership is: caring deeply about something; deciding to act on that caring; and then acting from that place of caring, in the form of what we do as leadership.
     Then there’s the requirement of skillful means. We teach meditation. The way we defined meditation is as a radical act of self-caring. We have to help physicians rediscover caring for themselves. We have to help physicians rediscover allowing other people to care for them. Because just simply caring for patients and not caring for yourself—and not allowing yourself to be cared for—is sure track for dying in one form or another.

Richard:  Yes. I'm interested in this phrase "skillful means" that you're using. I know that when you bring people together, a few are likely to be difficult. Someone will talk too much. Or there's competition, ego issues. Not listening to each other. It can be very difficult when you bring people together. Would you agree?

Phil:  Absolutely, I would absolutely agree. In my experience it has certainly been that. I can't even tell you how many times I've been faced with people who wanted to stop everything I was doing cold in our tracks. Yeah.

Richard:  So what are the skillful means? Can you give some examples or some stories?

Phil:  I was in the midst of trying to change a law in the state of Ohio where physicians have to notify patients if they leave their practice and retire and go out of town. They have to give them a notice. Hospitals had taken on more and more hiring of physicians, but there was nothing in the law that required hospitals to do this notification. In our community, I found out that a hospital had fired 15 physicians and the notice to patients was just tacked on the door.  
     So I went to the legislature (and we’re the capital here) and I got a legislator to draft a bill to change that law so that hospitals would have to conform to giving notice just like physicians do. The hospitals saw it as costly and bureaucratic and they were doing it already, they figured.
     And we were coming down to a vote on the bill. The legislator invited me to a meeting. I thought there would be 2 lobbyists from the hospital association plus myself and the legislator. But when I walked into the room I was faced with 25 lobbyists from all across the state of Ohio. They were all there wanting to hang me up and the legislator. As the conversation went on, I realized was losing and I said to myself “the conversation’s got to drop into another level.”
     I looked at them and said, “Guys, I know what's going on here. I've been around. I'm just going to ask—would any of you here this room be okay if you found that your physician had left town by a note on the door. If that's okay with you, put your hand up.” The room got quiet and then somebody spoke up and said, “Okay, so what do we have to do to get this done?”

Richard:  That's, that's beautiful.

Phil:  It required a different level of conversation. In that moment I thought, “I'm either going to get laughed out of this room or it's going to work.” But I had to take that risk, because I was losing. I tried to figure out how to take the conversation and deepen it, and it worked.

Richard:  It's encouraging because you made an appeal to people's essential humanity.

Phil:  Yeah. Is it okay with you to find that you lost your doctor by a note on the door? So now we have a law that doesn't allow that anymore.

Richard:  This has been a wonderful conversation. Amit, what do you think?

Amit:  This is fantastic. I do want to open it up to the callers. [repeats directions for people on the call] I keep coming back to this concept of skillful means. It can mean a lot of things to different people. So how does one truly develop those skillful means? Skillful means can also be used to how you approach problems within yourself. I'm curious how you came across that and how you’ve developed it with discipline around it?

Phil:  I think I first started to understand about it in the context of truth telling. As a trained therapist we learned, and we understand, that having people speak what's in their mind and in their heart is often a helpful therapeutic process. We also know that when people do that as a way of unloading in a therapeutic process, that's helpful. Unloading in a public process often times is not.
     So how do we skillfully tell our truth? One of the things I began to work with in myself, was not allowing myself to get away with being comfortable in telling my truth in a way that was a battering ram, which is how I led the alcohol and drug addiction system for a number of years. I would tell the truth: “The system stinks, and we’ve got to make a difference, and this is where we're going to go.”
     I went from that to understanding that in fact the people who I'm speaking to have the same truth, the same capacity, to care about people. So how can I tell my truth in a way that becomes an invitation, as opposed to a battering ram, for people to consider thinking about something different? For me this is a question about how to tell my truth skillfully such that it's usable—where someone else can actually hear it, decide whether they want to work with it or not. At least it's come from my heart as a gift as opposed to an attempt to just unload that’s potentially harmful.
     I think, from that basis, you start to talk about how do we collectively tell our truth? How do we collectively engage people in a way that leads to productive truth-telling, that actually gets us some place?—not only in terms of decisions and processes, but gets at what fundamentally these processes can really do, which is build relationships.
     Institutions will come and go. I know that from the years I've spent working with systems change. But what stays are relationships. So in working around systems change, using processes that encourage people to tell their truth in a skillful way creates a long-term possibility that's not built on the impermanence of institutions, but on the backs of real relationships.
     I'm fond of saying that a few years ago I adopted a goal of falling in love with as many people as I can before I die. So I hope that helps answer your question a bit.

Amit:  It's a beautiful framing and a wonderful paradigm. Thank you.

Phil:  Along the way there was personal exploration, personal learning, and learning the “art of hosting” really helped. Then came Otto Scharmer. He starts talking about the blind spot of our time. We've spent billions and billions of dollars on reinventing process to get better results, and the blind spot of our times has been what's the interior condition of the intervener? Who's doing the intervention? What place are they coming from?
     If they're coming for system change because they're pissed off and hateful, guess what you're going to get. If you come for systems change from the standpoint of “people are confused, but they're basically good people. We’ve got to engage that goodness,” you get a different result. So the time I spent with Otto , both theoretically and in practice, helped codify my deeper beliefs about how these things work.

Amit:  I'm curious about the impact this leadership style has had on some of your other team members. Have they begun to implement this approach in their own various organizations?

Phil:  So we've trained about twelve hundred leaders in Columbus now, in “art of hosting.” Now I'll go to a church meeting someplace, to a community meeting someplace, I'll walk into a World Cafe or walk into a circle, or what have you. Are we at a Tipping Point? Probably not.
     Have we had an impact in terms of how the dialogue is happening? Yes. There are several departments at Ohio State University that have begun to work this way. There are several corporations in Columbus that have begun to work this way. So it's had an impact. Now part of the training the Physicians who go through our academy get is not only learning meditation, but they learn how to host conversations; they're learning how to host their patients.

Amit:  My father was a physician. My younger brother is a physician, and while they are great at taking care of others, they’re terrible at self-care. And just across the board, I’ve always felt like doctors can sometimes be the worst patients because, while they're first in line to care for others, having them coming back to themselves is another question. So I'm curious, while offering these wonderful programs how do you make that internal shift in them?

Phil:  You know, what's even harder for physicians than caring for themselves, is allowing other people to care for them! That's the hardest lesson for them to learn. But every time they walk into their office, they expect compliance from their patient with allowing themselves to be cared for. Then we ask the doctor, how can that possibly happen if you know nothing about that yourself?
     Then we offer, “Here are some ways of communicating. Here are some ways of being quiet and seeing yourself and starting to really like yourself. Here are some skillful ways of doing that.” And we do it over 10 months. Meditation is a repetitive process. And every time the physicians come together, each month, they sit in circle. They're practicing meditation. They're reminded of the self-care and they're reminded it’s as important as developing the capacity to allow yourself to be cared for. We all have trouble with that one, but it's essential.

Amit:  It's interesting hearing this and I'm curious, if you were to go back to your 32-year-old self after you had just been diagnosed, how would you have coached yourself through hearing that you had cancer?

Phil:  You know, I think that's what I'm doing now. I think it's part of who I am in this phase of my life. I'm spending time with myself now on those very questions, that at 32, I couldn't have. I think that's absolutely part of my path now.

Richard:  I'm heartened to hear that you're very clear about the need for work, so to speak—that these skillful means are not developed over a weekend. This really requires something. So would you say more about that?

Phil:  Yeah. I guess you know, I would just simply say this: there’s something inside of me that's known for a really long time that short-term kind of interventions can have an effect, but they really don't shift the person’s systems.
     When I finished my PhD, there were people who wanted me to go an academic route, who wanted me to do the workshop route; they saw how I could both make money and make impact by teaching classes and that sort of thing. And I said to them at the time, you know, I really need to go work in institutions and organizations over a period of years to understand what the work life is really like for most people in this country. It's not the stuff that we, as academics, think it is. It's tough.
     I worked in factories when I was in high school. I saw what real work was in a lot of ways. I'm sorry to be belaboring this, but for me it goes back to that. It goes back to learning that, in fact, daily lives are lived day and day—and most of the time through monotony. So how do we become what we can potentially become in real life, living in the day-to-day in the monotony of producing? I know that takes time and it takes effort and takes practice. It doesn't happen fast. I hope that was a fair enough answer for you.

Richard:  It has the ring of truth to my ear. I have a thought, and I wonder what your reflections might be around it. The new model of leadership you're talking about, the fostering relationship and getting through assumptions and so forth, it still requires someone who has the skillful means, who knows when it isn't happening and how to keep an eye on where it needs to go. I can't help but think that this is like having a good father or a good mother. Does that make any sense to you?

Phil:  I certainly think those of us who have been fortunate enough to have those experiences growing up, absolutely. But I think the vast majority of people don't have that experience. And so they've got to still learn.

Richard:  In other cultures, it's often part of the culture to address other people as “brother,” “sister,” “uncle” “aunty” “mother,” “father.” It's not just my nuclear family. I think there's a deep wisdom in that. What do you think?

Phil:  I think absolutely that's the case. But I also think that the essence of that is already there. I think that my purpose in life now is really to try to help people remember what is already essentially inside of them.
     I got an email from a young physician who was in our academy last year and who was one of the people I coached. It brings me to tears every time I read it. He talks about a situation in which he had a very complex situation with a patient. He could not figure out the diagnosis and, in fact, missed the diagnosis. He sensed that he might be missing it, so he sent him to a specialist who he thought might nail it ,and they did. The patient came back to him for his follow-up visit and the physician I’d coached was ready to apologize and bare his soul about what he knew and didn't know, which alone is an amazing thing for a physician and so healthy for him. But when he started that, the patient said, "You don't need to do that. I know who you are." And he began to teach the physician about what his experience was.
     The physician said, "We connected as people. He's not my patient anymore. Technically, he is, but that's not our relationship anymore." What the patient connected in him was his essential humanness, his goodness. And what he connected in the patient was the same thing.  When that happens, that's it.

Richard:  This is a key thing, isn't it?

Phil:  It is to me.

Amit:  One thing that struck me earlier was you said you want to fall in love with as many people as you can in your lifetime. I'm just wondering if there was a story or an epiphany around that and why you have that goal.

Phil:  You guys are pretty good at knowing where there are stories, you know that? We'd been working in this circle for probably 10, 12 years, and one of the people who'd been in that circle with us all those years had a chance to take a great new job in the community. As much as she loved working with us, it was her time to go. She needed to do that, and we all knew it. We did our circle goodbyes. Then I happened to be in the office that night, her last night. She was packing up her books and I helped. And as I was driving home that evening, I began to sob so hard that I had to pull off the road because I couldn't see. I realized while I was sitting there in my car that my heart was breaking. By the time I got home, I started to realize that this is exactly why we don't work the way we could. Because inevitably, if you work this way, if you love people that way—and I mean that in the most healthy sense of love—you will get broken-hearted. People die; people leave; things change. That's the other side of loving people that you work with. And I also decided that night that I would never work any other way.

Richard:  That's really living, I think.

Phil:  It's like, I'm not going to live numb. So yes, there's a story behind that.

Amit:  It's truly, truly beautiful. I have a question here from Jay here in Washington DC.: As you've transformed over the years, how has this outlook affected working through things with your own family?

Phil:  That's a good question. I think you'd have to ask them. It's actually probably the hardest, the closer the people are to you. It's one thing to talk about a broken heart with a wonderful person who I care a lot about as an employee. When I start to talk about my children or my wife it gets into a territory where you talk about loss and pain. That's what I learned when I had the cancer. I kind of looked at death and I said, "You know, I don't think that scares me." So my answer to your question is that I’m probably not as skilled with the people I'm closest to. On the other hand, I do the best I can.

Amit:  I'm curious about who's inspiring you today. Where would you like to shine that light?

Phil:  There have certainly been people who I've learned from in a powerful way. Meg Wheatley and Otto Scharmer have had a big influence on me. A friend of mine in Denmark, Mueller is his name, has had a huge influence on me.
     The people having the biggest influence on me now tend to be people like the woman who teaches meditation for us at the leadership academy. Or this physician who sent me that email. There's not a particular person or theoretician that I would say. I'm very fond of the writings of Thomas Merton. I go to the Abbey of Gethsemani in Kentucky on retreat. I'm particularly inspired by a lot of the Shambhala Buddhist teachings.
     Right now I find myself finally taking the time to deepen my own spiritual path. I've become more intentional about it now. And I'm not trying to be cute about this, but I have a six-year-old granddaughter who floors me. I remember the morning she was born and I went to see her. I was like "Oh, there it is! There's nothing I have to do about it.” Honestly, she inspires me.

Richard:  There's something very pure there.  

Phil:  It's a grandparent thing. If you're not in that situation now, look forward to it if you get a chance.

Amit:  As a community, what can we do to be of service to you?

Phil: I guess it's what you're doing—these interviews. When I said at the very beginning that to ask another human being to tell his story, and to do that in a thorough and honorable way, what a gift that is!

Richard:  It's a gift that goes in both directions.

Phil:  It's the only way that real gifts work.



About the Author

Amit Dungarani is one of many volunteers at ServiceSpace supporting the weekly Awakin Calls. Opportunities for service and inner-connection make Amit feel alive the most. What makes you come alive? Richard Whittaker is the founding editor of works & conversations and West Coast editor of Parabola magazine.   


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