Mark Briesacher, MD: I'm Dr. Mark Briesacher, the Chief Physician Executive at Intermountain Healthcare. Today we have a guest host, Dr. Anne Pendo, who is interviewing one of Utah's healthcare heroes.

Anne Pendo, MD: Welcome, my name is Anne Pendo, and I am an internist by training, and currently the Medical Director in the office of Patient Experience, and welcome to another Intermountain Healthcare podcast. I am thrilled today to be talking with Terri Flint, who's been one of my mentors and friends at Intermountain for the last 20 plus years, and have so appreciated our work friendship, and friendship, friendship.

Terri Flint: Thanks, Anne.

Anne Pendo, MD: Today we're going to talk about growth mindset, and this is particularly meaningful for me both personally and professionally. The more I have read about growth mindset and interacted with Terri in teaching this concept, what I've recognized is that the way we approach things, and in the world of healthcare today, there's certainly a lot of change, but also in personal lives and our relationship with our spouses and friends and family and children.

Having a growth mindset has allowed me to be more curious about things, deepen my relationships with both my family and people at work, and really has created a new way of approaching change. With a lot of change in healthcare, and hopefully someone who's going to continue with relationships in the future outside of my work, we wanted to spend a little bit of time today sharing what growth mindset is, and how you can apply it in multiple aspects of your life.

I'd like Terri to get us started with talking about what growth mindset is, and then we'll have a discussion, so take it away.

Terri Flint: Thanks, so I want to share two stories to start with to help make this applicable, I think, to people's lives. For years when I was young, I wanted to learn to play the piano, and life happened and I didn't get that opportunity when I was young. When I grew as an adult, as I finished my college and my PhD, the time was right to say, "Okay, now I'm going to go buy the piano, find the teacher, and begin to learn piano lessons."

This was something that I really did want, and I bought the piano, it sounded amazing. It's a gorgeous piano, it sounded great in the store. I brought it home and said, "Now I need to go find a teacher," and found a teacher who was willing to teach an adult and started with her. If you've ever played piano, or had your kids play piano, you know that the test of how good you are is by the number on the book.

You start at 1A, go up to 1B, 2A, 2B, up until 5 or 6, and then you start sheet music. Having just finished my PhD, I was feeling pretty darn smart, and really believed unconsciously probably that what I had learned in my PhD would apply over to the piano. That as a, "Smart adult," I should quickly move into those 3s or 4s.

I had a fair amount of bewilderment when in fact I started with 1A.

Anne Pendo, MD: You were disappointed.

Terri Flint: I was disappointed, and I thought she had misjudged, that's what I really thought is, you just don't know how smart I am. As I took the book and started to play at home and really the natural consequences unfolded, which was I couldn't play the blue canoe, it was not going well. My dog wanted immediately to go out of the room, actually outside, when I sat down at the piano.

My family wanted to know when are you practicing? We have errands to run, and all of this reality that I was really a beginner. That as a beginner you are not good, and that was an amazing aha. It was like, "Oh, so I'm really good at this, but I'm not so good at that." I persisted and the months went along, and I began to crave the stars that you receive every week, or the treat, because it meant I could turn the page.

About three months in, this was the real conversation we had. "Barbara, I'm not very good at this," and she said, "You're right, you're not." I laugh at that today, but that was the poignant truth. She then added a phrase that I don't think I realized how big it was, because she then said, "That just means you need to practice more."

How easy it would've been for her to say, "Yeah, you're wasting your time, my time, and we should both quit," but she gave the obvious answer, is if you're not very good at something, because you're a beginner, and you really want it, it means you just need to practice more. That's truly been a life-changing experience.

I don't think I knew the name of what that meant, or what it was about, but about two years ago I was on vacation and I stumbled across a book by Carol Dweck called, "Mindset." When I read it, I knew that I now had a name for my piano experience. She, Carol, is a PhD professor at Stanford who's worked a lot with children in the education system, and she really began to see two differences in these children about how they looked at failure.

For me that's what the book is really about, is what do you do when you fail, or you're not as good, or you're a beginner? What she saw is that there were people who took that, and they moved to a fixed mindset, or others who take failure and perceive it very differently in a growth mindset.

Let me just really quick describe the differences, and then maybe we can talk about some examples that are happening within both of our jobs. Fixed mindset are when we've had experiences in our life, and others around us perhaps gave the message that, "Gee, you failed, that means you're not very good, and you probably should quit."

Inadvertently, or maybe purposely some people have said failure is a bad thing, it's shameful, it's embarrassing. When you experience it, there's someone to blame, either yourself, or another person, or something in the environment you should blame. Above all, you probably should quit, it's not worth doing, it's too hard, it didn't happen quick enough, and so you should quit.

Failure in a fixed mindset just really means that if it doesn't come quick and easy, or fixed mindset means if it doesn't come quick and easy just let it go, right? I think we can all think of times when we've been told something, we've took that label and have kept it with us for years. An art teacher who said you can't draw, and here I am at my age thinking I still can't draw, because of one sentence a person told me so many years ago.

It became cemented or fixed, that's very different then growth mindset, who really believes I can change anything. I can do hard things, but in a growth mindset you remind yourself the fun of being a beginner. It's both fun and hard, but realizing that if you want something, you've got to be humble and teachable. That you have to view failure as just part of the process.

Rather than it being bad, it's evidence that you're trying, and that you're going to learn and take that learning and keep moving. It's just what Barbara my piano teacher said, "Yeah, you're not very good yet." Carol Dweck loves the word yet, but you just need to keep practicing. As I've lived with this concept, I've really seen how fixed mindset doesn't problem solve.

You just want to quit, growth mindset loves to problem solve, and you'll all of a sudden open up your mind to, "Wow, I haven't thought about that, or that," and fixed mindset is I don't need any help, and growth mindset is, where can I get some help like a piano teacher to help me get better and better?

Anne Pendo, MD: When I think about fixed mindset, I feel that it's a really personal failure, like I'm a loser, there's something intrinsically wrong with me. That's so different from the growth mindset, who's like, "Oh, what did I just learn today about this because I failed?" Just that shift, that reframing ...

Terri Flint: It's an instant boost in your mood, and I think it gives instant oxygen to your mind that allows you to go, "Well, wait a minute, but I haven't thought about this, or this, or this."

Anne Pendo, MD: Exactly, exactly.

Terri Flint: Just to go on to that, I've become interested in this notion of self-compassion. I've just seen that when we have a fixed mindset and we fail, we move to that self-criticism, really beating ourselves up, again that shame, whereas growth mindset is optimistic and is filled with self-compassion. We forgive ourselves for failing, and we then say, "Look at you, you were still trying, so what can you learn? Let's move on."

It just is aligned with so many characteristics of resilience and optimism, and the ability to do hard things.

Anne Pendo, MD: Yeah, I have a photo of some daisies, well it's a painting of some daisies, and underneath it says, " Forgive me, me."

Terri Flint: Love it.

Anne Pendo, MD: I just am realizing at this moment that, that's exactly what that is.

Terri Flint: You know what? What I've begun to discover, we're drawn, I think, to movies and books and people, role models who have a growth mindset.

Anne Pendo, MD: Yeah.

Terri Flint: I asked a group of people what movie have you seen that makes you feel good? Most of them have characters or stories about people overcoming hard things, and succeeding. I'm thinking we love growth mindset when we see it, now we just have to put it more in our lives.

Anne Pendo, MD: Yeah, and as I think about what you've said, what I found happening for me, is I'm paying attention to when I'm in a situation where I start with the, you're not good at this, you should be rethinking X, Y, or Z, and reminding myself to pause, stop, reset, and reframe, and think about it in a different way.

Terri Flint: That's a wonderful process that you're practicing to get better at this. I think that's it, we have to start being self-aware, and then find our way. Carol and her book would talk about maybe finding a mantra that says, "Oh, wait a minute, I can do this." For me it's being patient, wait a minute, be patient, you're gonna learn this, you can do this, stop being judgmental, open your mind, and maybe finding some fun phrase, even your daisy phrase is an amazing mantra that helps you then move over to that growth, open mindset.

Anne Pendo, MD: Yeah, and I think about well two particularly points of change in healthcare have been for a lot of our clinicians and caregivers, is a new EMR. I didn't really think about this until of course now the implementation is complete, but we're still learning. You've taken many people who are experts in their field, and they’re now beginners trying to learn a new EMR, and feeling frustrated in either something's wrong with the EMR, or something's wrong with them.

I'm never going to get this, and you shared with our medical group not too long ago this growth mindset idea. As I was listening to you speak, I was thinking about our transparency data around experience of care and the patient experience. That has been a particularly challenging piece of data to share. It's very personal, it's like being rated as how am I doing as a wife and mother? Then sharing it on the Internet.

What I realized is, is that we look at those scores, and we then start grading ourselves in a very personal way, instead of so now what I'm trying to do is, "Okay, reset, take a deep breath, pause, and think about okay, I can do a little bit better."

Terri Flint: Yeah, where can I?

Anne Pendo, MD: Where can I, and so it might be thinking about with my team what can we do a little bit better? It's not a big change, it's really a small little change that we can all get behind. Even as I'm thinking about it now, I'm feeling okay, we can do this, we can do this, and that's such a great way to think about it, instead of being defeated, or you used the word ashamed, then just saying you know what? I give up, I'm not even going to try.

Terri Flint: Right, I want to just hide and close up.

Anne Pendo, MD: Yeah.

Terri Flint: Yeah, I love those two examples, because in some ways it's about very smart people who are competent and confident. They've gone through years of schooling, have this amazing experience of being providers, but they've been challenged. There's two opportunities that is like, but you don't know this skill of an electronic EMR, and/or being transparent and having to focus on customer service and communication.

If we frame that to say, "Yeah, here're two new skills that you've never been expected to know, but you get now an opportunity to be a beginner and really practice and include these as your new skill set, in addition to providing amazing care." You could have a fixed mindset about that, I hate it, I don't want it, I didn't go to medical school for it, or you say, "Wow, this is going to be hard, I may not be very good at it, but if I keep practicing I can do it."

Anne Pendo, MD: Yeah.

Terri Flint: That's just part of where we're headed, so why not embrace it. We hit on a word, and I thought about it a lot since that training we did together called confident humility. Isn't that just, that almost is my new shorthand for growth mindset now, because you're confident that you can do anything, but you're humble about the process that it takes to become good at anything.

Anne Pendo, MD: You might need some help.

Terri Flint: Always you need help, growth mindset, and it just makes sense that you couldn't do this by yourself. You would want people who are just a little bit better to give you feedback and to help you learn how to tweak it. I just don't know how we do these hard things without a piano teacher.

Anne Pendo, MD: Exactly, and practice.

Terri Flint: Practice, lots of practice.

Anne Pendo, MD: In the last few minutes of our time together today, is there anything that we didn't cover that you think, here's something that our audience would really find valuable and useful?

Terri Flint: Let's just go back to forgiveness. Woven into all of this is that forgiveness, and it really if we don't forgive ourselves or others, we get stuck in a victim place. When change occurs, it's so easy just to become a victim. I can't believe they've done this, why is this happening to me? I don't like it, I don't want it, I'm not very good.

I think if we can move to let it go, forgive, people aren't doing this with bad intent. I'm going to look for good intent, and figure out what part of it I can own, and what part of it I can influence or change. The keyword really ends up to, or the key action is forgiveness, and that really moves us from being fixed at home, at work, at relationships, over to forgiving of ourselves and other people as we keep looking for solutions to be extraordinary.

Anne Pendo, MD: Can you share with our audience what to look for to recognize that they're in that fixed mindset?

Terri Flint: It feels dark, and I think the emotion attached to it, so it's when you're confronted with some change, right? It can be I think a feeling of defeated and helpless and hopeless, because you've moved to a place where you don't see solutions, or you don't see other people as being helpful to you. In some ways it's very isolating, because you are thinking, "Oh, I have to figure this out on my own, and I don't think I can, and I tried, but it didn't work, so it must mean I cannot do it."

Anne Pendo, MD: I'm wondering if I heard myself saying, "They're making me do this ..."

Terri Flint: Excellent.

Anne Pendo, MD: ... Is that an example of what I might hear myself saying in a fixed mindset?

Terri Flint: Yeah.

Anne Pendo, MD: I can't.

Terri Flint: I can't, why are they making me? Why do I have to do this? Now we want to tease that out from having good information exactly will tell me why are we doing this.

Anne Pendo, MD: Right.

Terri Flint: As soon as it moves into this place of I'm being acted upon, rather than I get to respond how I choose. When it's feeling like you're losing your choices, then you know you're moving into this space.

Anne Pendo, MD: Okay, that's really useful.

Terri Flint: Another discovery we've made as we've been teaching this, is that fixed mindset is very tightly aligned with perfectionism. That perfectionists often get stuck here, because they're saying, "I need to do it all at once, it's all or nothing, and if it's not perfect right away, then I'm not even going to try." They don't even make an attempt, because it can't be perfect.

Interesting, that's why we created a live well module on perfectionism, because we saw this coming up over and over again in connection with being a fixed mindset. You can see it makes a lot of sense, if I go back to my piano analogy, as soon as I couldn't play Rachmaninoff, I would have just said, "Well if I can't do that, then why even start?"

It contradicts the whole notion of being a beginner. We want instant mastery, and that's where fixed mindset people go, is again if I can't be perfect at it right away, give me one hour of training on the EMR, and if I don't get it, then something's wrong.

Anne Pendo, MD: Right, and I'm thinking of those of us who've gone to medical school, who needed really high marks to do that.

Terri Flint: Yes.

Anne Pendo, MD: Who there's no room for error if I'm doing a surgery, you forget all the practice you've done before to get there, but I think the idea in our mind, is that we are A+ students, and that's where we should be ...

Terri Flint: Instantly.

Anne Pendo, MD: Yes, and in everything.

Terri Flint: In everything, and I think that's really the disconnect that is happening these days as we're challenged to learn new things where we get the opportunity to be a beginner. Again, back to confident humility, I'm confident because I've done these hard things in my life, I've been to medical school, but I'm now humbled to say, "There're some new things I need to learn to continue to provide this care to my patients."

If we're open to learning new things, it's fun. That's another characteristic, fixed mindset, not so fun, growth mindset, it's a blast, because you're like, "Cool, look at that, I made that mistake, but look how I changed that."

Anne Pendo, MD: Maybe that's ...

Terri Flint: Where we're really, now I'm not even there yet, but I keep looking for it.

Anne Pendo, MD: Yeah, me too, me too. Well, I'm hoping that on our next time together we'll be able to spend some time talking about how to implement growth mindset. I'm looking forward to that conversation and sharing that with all of you. Thank you again for joining us from Intermountain Healthcare.