Power of Perspective

Benjamin Zander is the conductor of the Boston Philharmonic orchestra. I must say that despite an upbringing with a father who blasted classical music at us at every opportunity, prior to reading the book the Art of Possibility I had no appreciation for what a conductor of an orchestra did beyond showmanship. This talk given at Google Zeitgeist not only brought my reading of that book to life, it illustrates a few lessons that I think apply well to healthcare. At 26 minutes it is on the longer side so I’ll give you a bit of a summary and interpretation and you can see if you think it’s worth watching it for yourself.

The traditional culture of an orchestra is top down, hierarchical leadership where the conductor is all powerful and sets the parameters for acceptable behaviour. Sometimes this means the standards of civility aren’t very high. Zander shares that for many years he was this kind of leader. But as years went on he found he “paid a high price in terms of the energy, well being and self-expression” of the people around him.

One day he had a realisation that forever changed his life.

The conductor of the orchestra doesn’t make a sound…he depends for his power on his ability to make other people powerful…I realised that my job was to awaken possibility in other people

Following this, Zander changed the way he behaved as a leader. He started to explore a new kind of leadership to that of what he refers to as the downward spiral; the world of measurement and comparisons that generate competition fear and pressure. He shifted his world view to one of radiating possibility; of shared commitments, open mindedness and contribution. (Note the similarity to Healthcare as an infinite game)

At this point Zander points out how some may liken this to positive thinking, to which he makes this comment

Positive thinking is the way of saying something’s great when you know it’s shitty. And it’s stupid and it belongs in the downward spiral.

Around the 14 minute mark Zander moves to a more practical demonstration of what he’s been talking about. His domain of expertise - classical music. It’s no secret that classical music isn’t exactly a growth industry. When talking about the future of classical music, those living in the downward spiral would tell you that only three percent of the population loves classical music and the goal is to lift that number to four percent. Zander’s preferred perspective is that everybody likes classical music, they just don’t know it yet.

At this point he invites a pianist to play a well known piece of music - Beethoven’s Moonlight Sonata. It starts off familiar and emotive, but to be hones it kind of drags on and had me looking for the fast forward button. And this is exactly the point Zander was trying to make. Following the conclusion of the piece, he thanks the pianist and lets her know that she did a wonderful job, but unfortunately she failed to keep the audiences attention “not because you’re not a great pianist, but because you misinterpreted what Beethoven was intending to say”.

He goes on to explain that “Moonlight” sonata was popularised by the publishers following Beethoven’s death. It led to a perpetual interpretation of that piece of music as slow and romantic, which works for the first section of music but gets to be a bit dreary later on. Beethoven in fact named the ‘Piese Quasi una Fantasia’…a fantasy. The melody is not found in the right hand, but the left.

Zander then guides the pianist to play the piece again with the new interpretation. It is heard as an entirely different piece. My attention is maintained and I’m rethinking the role of classical music in my life.

My mind goes to a few different places when I watched this, but primarily it made me think about my role as a Pharmacist within the broader context of health.

Our culture in healthcare is very much top-down and hierarchical. Whether the hierarchy be within an organisation, a pecking order or the power differential between care provider and patient, for a very long time medicine has been paternalistic. In terms of medicine use, this results in a culture of compliance, with those who are non-compliant seen as either ignorant or deviant. Given the high rate of medication related harm and the fact that only 50% of people take their medicines as prescribed (two thirds being intentional), as well as the high rates of disillusionment and burnout amongst the healthcare providers themselves, I think we can say that this type of approach isn’t exactly serving us well.

Like Zander, I had a moment of realisation a few years ago…as a Pharmacist, I don’t prescribe/administer/use the medicines…my effectiveness depends on my ability to support other people in making good decisions about how they use medicines. Having knowledge and expertise in medicines means bugger all if I can’t build trusting relationships and communicate with people in a way that resonates with them.

This realisation shifted me from the world of compliance to the world of service and contribution. My interpretation of my professional role shifted from that of instructing people on how to use medicine correctly, to discovering how I can support them in making informed decisions and implement positive behaviours relating to medicines.

What does this make you think about with your professional work? Have you had any shifts in perspective throughout your career that have had an impact on you?