INTEGRATIVE LEADERSHIP
INFORMED MINDFULNESS AS THE FOUNDATION
FOR LEADERSHIP
| Adam Perlman, MD, MPH, FACP |
In order to transform our healthcare
system through the adoption of an
integrative approach to care, it has
become clear that to make such a shift,
leaders are needed who are not only
dedicated to the values inherent in
integrative medicine but who can also
think critically, create collaborative envi-
ronments, and develop strategic
approaches to change and inspire excel-
lence throughout an organization. A
grant from The Bravewell Collaborative
in 2013 to develop a program that might
train such leadersThe Leadership Pro-
gram in Integrative Healthcare at Duke
afforded me the opportunity to con-
template exactly what core attributes
were needed to effectively lead.
As I thought about the question and
talked with other leaders within integra-
tive medicine, the idea of Informed
Mindfulness began to emerge.
Mindfulness, a concept that is more
than 2500 years old, originally comes to
us from Buddhism. In its simplest
essence, it means paying attention, in a
nonjudgmental way, to what is occurring
in the present moment. Practicing mind-
fulness deepens self-awareness and fos-
ters self-regulation such that our actions
rise from a clear well rather than the
muddy waters of emotional and mental
turmoil.
Jon Kabat-Zinn, PhD, Founder of the
Center for Mindfulness in Medicine,
Health Care and Society at the Univer-
sity of Massachusetts Medical School,
mainstreamed mindfulness into the
healthcare system through his
Mindfulness-Based Stress Reduction
Program. It proved so benecial that it
is now taught widely to both patients
and providers.
But true mindfulness is much more
complex than simple self-awareness.
Scholar R.M.L. Gethin, who analyzed
all the ways in which mindfulness has
been used throughout Buddhist history,
324 Integrative Leadership
summed up the elements of mindfulness
practice as follows:
 Not forgetting, which means not losing
what is before the mind in the present
moment.
 Presence of Mind, which means directly
facing what is arising.
 Remembering, which refers to calling to
mind what is skillful and what is not,
what is benecial and what is harmful.
 Close association with wisdom, which
means innate wakefulness coupled
with clear comprehension or seeing
something precisely and thoroughly
from all sides.1
It was the last two bullets on this list
that intrigued meremembering and close
association with wisdomand I wanted to
nd a way to make those concepts less
esoteric and more accessible. I am not a
regular meditator and not Buddhist, so I
wanted to nd a way to talk about it that
did not require someone to be a 20-year
meditator or even a meditator at all. I
also began to recognize that often,
although being more mindful, more
aware was an important rst step, to
see changes that led to new and extra-
ordinary results, one needed to couple
mindfulness with know-how.
Hence, the concept of Informed
Mindfulness came into being. It con-
nects mindful self-awareness and
self-regulation with educated decision-
making. The mindful person is aware,
non-judgmentally, of what is occurring
in the present moment, and understands
that his or her response is a choice. With
informed mindfulness, as situations arise
and decision points are faced, that same
person is able to place what is happening
in its larger context and, having clear
values and being sufciently educated,
he or she is able to make an informed
choice within that moment. In other
EXPLORE July/August 2015, Vol. 11, No. 4
words, we need our self-awareness to be
coupled with knowledge, skills, values,
and wisdom. We need to know what to
do with our awareness once it is
developed.
Let us say that in practicing mindful-
ness you come to realize that you, as a
leader, are conict adverse. Being aware
of your aversion can help you self-
regulate. Recognizing your own behav-
ior patterns, you can take a step back
from it and stop yourself from running
away from the situation. But in order to
build a new behavior that will yield
more positive results, you need conict
resolution or mediation skills. You need
to be educated about your options so
you can develop an appropriate new way
of being.
Here at Duke Integrative Medicine we
are trying to work on our Press Ganey
patient satisfaction scores. To help us be
mindful, we have buttons that say
Strive for 5. When everyone wears that
button, patients ask us about it and we
see it on others and it reminds us and
keeps us present to the fact that we are
trying to improve our patient experience
and get all 5's on the survey, the top
score. Hence this is a technique to
strengthen our awareness. But if all we
are doing is walking around with but-
tons and we do not understand what it is
going to take to actually improve the
patient experience, then it is unlikely
that we will accomplish our goal in a
sustained and meaningful way.
When I became associate vice presi-
dent for Duke Health and Wellness, I
inherited many teams in diverse settings,
each operating as small satellites. My
job, as a leader, was to bring cohesion,
to get everyone rowing in the same
direction, as it were. But if I had not
understood how I could help my organ-
ization develop a shared sense of com-
mitment to our values and goals then I
would never have been able to achieve
that goal. It would just have been a game
of chance as to whether I succeeded or
not. I needed to be fully aware of self
and others, build trust and rapport, but I
also needed to know what to do with
that trust and rapport.
DEVELOPING SELF-AWARENESS
Even though I named it informed
mindfulness, there are many ways to
develop self-awareness and gain a deeper
understanding of your own self. A struc-
tured practice like mindfulness or med-
itation might be the most direct, but it is
not for everyone. You can build that
awareness in other ways. For instance, it
can come through self-exploration and
reection, through reading and study-
ing, through Jungian analysis or depth
psychology sessions, through contem-
plative practices, and even through dis-
cussions with mentors, advisors, or an
executive coach.
Personally, I do not have a formal
mindfulness practice but I spend a lot of
time thinking about who I am and who I
want to be and how I show up in this
world. I would describe my practice as
both reective and contemplative. I also
use an executive coach to help develop
and rene my knowledge and skills.
Along the way I have looked for tools
and resources to help me in my journey.
For instance, a while back I bought The
Power of Now by Eckhart Tolle. I only
read about 100 pages but his concept of
not listening to this voice in your head
that is talking about the past or babbling
about the future but instead being
present in the moment really struck me.
Tolle said: identication with
thoughts and the emotions that go with
those thoughts creates a false mind-
made sense of self, conditioned by the
pastthe little me and its story. This
false self lives mainly through memory
and anticipation. Past and future are its
main preoccupation. The present
moment, at best, is a means to an end,
Integrative Leadership
a stepping stone to the future, because
the future promises fulllment, the
future promises salvation in one form
or another. The only problem is the
future never comes. Life is always now.
Whatever happens, whatever you expe-
rience, feel, think, doit is always now.
It is all there is. And if you continuously
miss the nowresist it, dislike it, try to
get away from it, reduce it to a means to
an end, then you miss the essence of
your life, and you are stuck in a dream
world of images, concepts, labels, inter-
pretations, judgmentsthe conditioned
content of your mind that you take to
be yourself. And so you are discon-
nected from the fullness of life that is
the suchness of this moment.2
I could see that it was something that
I was doing. I spent a lot of time either
thinking about the past or dreaming
about the future. And that single idea
was enough to propel me on a better
course and I began to practice not
listening the voice inside my mind.
Another book that helped me was
The Four Agreements by Don Miguel
Ruiz. The second agreement is don't
take it personally. Ruiz said: Whatever
happens around you, don't take it per-
sonally Nothing other people do is
because of you. It is because of
themselves.
When I read it, I thought, wait a
minute, I can see how I have been
making things personal and reacting to
other people's judgments and negative
emotions. It resonated with me so I
began working with it and as I did, I
rescued myself from a lot of turmoil.
Here is the conceptthese nuggets of
wisdom are like food. You need to take
that food in and digest it. You need to
assimilate it into your body and mind
until it becomes your own.
WHY IT MATTERS
You can see, from the above examples,
how self-awareness and reection often
EXPLORE July/August 2015, Vol. 11, No. 4 325
lead naturally into a more informed state
an idea triggers reection and that
reection leads to a new way of being.
I think you can also see how developing
informed mindfulness makes a big dif-
ference in one's ability to lead.
Who would be the better leaderthe
person who is always worrying about the
mistakes of the past and fantasizing
about the future, or the person who is
deeply rooted in the now, seeing and
responding to things as they truly are?
Who would be the better leaderthe
person who constantly worries what
other people think and is always trying
to change himself or herself in response,
or the person who knows who he or she
is and always acts in accordance with his
or her values?
Who would be the better leaderthe
person who is aware of what was hap-
pening but does not know how to
resolve the situation or the person who
is aware of what was happening and
understands which path leads them out
of the forest?
Let us all become better leaders by
becoming mindful and informed.
REFERENCES
1. Gethin Robert Mark Lovell. The Buddhist
Path to Awakening. Oxford, England: One
World; 2001.
2. http://www.eckharttolle.com/article/The-
Power-Of-Now-Spirituality-And-The-En
d-Of-Suffering. Accessed March 12, 2015.
Adam Perlman, MD, MPH, is an
Associate Professor of Medicine and works
within the Duke University Health System
as Executive Director of Duke Integrative
Medicine and Associate Vice President
for Health and Wellness. In addition,
he is the Director of The Leadership
Program in Integrative Healthcare at Duke.
(integrativehealthleaders.org)