EP44 | The Daily Practice of Leadership with Dr. Jessica Bunin - Part 2

If you work in healthcare, you already know this. Conflict is everywhere. In the OR, in labor and delivery, in committee meetings, between physicians, nurses, administrators, and teams that are all trying to do the right thing. But here's the problem. Most of us were never trained to handle conflict well. We learned procedures. We learned Diagnostics, but we didn't learn how to navigate the moments when 2 professionals strongly disagree. That's why I developed the SPARK framework. SPARK stands for stop, pause, ask, don't assume, reflect and respond, and create a path forward. It's a practical system designed specifically for high-stakes healthcare environments. Through keynote talks, residency workshops, and Spark Masterclasses, I teach physicians, nurses, and healthcare teams how to turn destructive conflict into productive conversations that strengthen teams and improve care. If your hospital, residency program, or medical conference is looking for a speaker on conflict communication and leadership in healthcare, I'd love to work with you. You can learn more in the show notes because in medicine, conflict is inevitable, but handled well, it can make teams stronger.

In every operating room, in every ward, in every clinic, and every team meeting, a silent battle brews. Conflict, negotiation, identity. Welcome to the Scalpel and Sword podcast, where I, Dr. Lee Sharma, physician and conflict analyst, Explore the hidden negotiations behind modern medicine. Let's trade burnout for boundaries and learn the art of healing with precision and power.

Hello, my peaceful warriors, and welcome to the Scalpel and Sword podcast. I am your host, Dr. Lee Sharma, physician and conflict analyst. And I'm going to ask you a question. If you're in medicine and you're listening to this podcast, Have you ever had formal leadership training? And if you haven't, did you realize at some point during your education or journey how valuable that would be? And in leadership, being able to handle conflict and communication, being able to talk to the people with whom we work becomes such a vital skill. And I can't think of anybody better for us to have this conversation with today than retired Colonel Jessica Bunnin. Dr. Bunnin is the co-founder and chief architect of All Levels Leadership. She's a certified executive coach and an ICF-associated certified coach. She is passionate about leadership education and coaching, which are passions she's developed over her 23-year Army career, which includes deployments to Iraq and Afghanistan. She is a graduate of the United States Military Academy at West Point, and she did her medical education at Tulane. She is a critical care physician and professor of medicine and health professions education at the Uniformed Services University. She's been involved in academic medicine as a program director for critical care, assistant dean of faculty development, and an associate dean for diversity, equity, and inclusion, and an associate dean for community and educational culture. And I am thrilled to have her on the podcast. Jess, welcome.

Thanks, Lee. It's wonderful to be here.

One of the phrases that you also used in describing this that I think is really powerful is this idea of widening our lens, that we are actively expanding the way we look at a situation. We are inviting new perspectives in. We're willing to see things in a different way, in a different light, which is so much the fertile ground for making peace and for communication. If I'm willing to look at something from your perspective and I've got a framework like CLEAR that actually helps me to do that, then I'm going to be able to sit where you are, walk in your shoes. I'm going to be much more likely to be able to meet you where you are if I'm willing to open my eyes to what you're actually seeing. And creating a process through that, because I think that's something that we talk about. We say, you know, yes, we wanna see things from another person's point of view, especially If we feel like, and I always say feel, because I think you feel conflict before you walk into it. It's very visceral. So if you already feel yourself getting there, but you don't have a process to have this communication, it becomes really hard to kind of walk back. So I love that CLEAR is helping people do that.

Yeah.

One of, I'm gonna give you an example that's actually in your neck of the woods as opposed to mine, but it was one of the first examples I had with a peer. That truly made me believe in the power of civil discourse. And it was a situation where I was discussing abortion with a peer. And at the time, abortion was this visceral issue to me. Like, I couldn't have a rational conversation about it. I had my beliefs, I had my feelings, I had my fears, and I believed in 100% it was wrong.

Yeah.

Pro-choice all the time. There is no reason to ever think differently about it. And I had a peer who I had a conversation with, and we went into it very distinctly. We were going to actively listen to each other first. We were going to meet in the common ground before we started having any further conversation about it. And this was a situation that truly did broaden my lens on the world. I couldn't see going into that conversation A reason why someone would be pro-life, honestly, at that point in my life. And she explained to me that she had gotten pregnant early in life. She had her child, and she knows in her heart of hearts that she would to this day never have been able to forgive herself if she had had an abortion at that time. And it just changed the way I have conversations about abortion. It changed the way I think about choices and I think about lifestyles and I think about family. Like it just broadened my whole perspective and it took away for me this visceral response and let me instead have a rational conversation. So I'm a true believer. Like I really believe that having a framework and starting from an area of common ground can make a huge difference.

That's incredible. And I'm sure as you've worked with people that you coach and as you've worked with academic learners, this is something you've also showed them that they've been able to use in real time too. Yes.

Well, so interestingly, I became really passionate about this recently because I became aware of a lot of student conflict and the students weren't able to bridge the divide between them in a lot of different situations. Most notably, there was a situation where we had our LGBTQ student group and our Christian student group, and those 2 groups would not communicate even in a professional setting. And so in my mind, wow, these students needed work, right? They needed help. It was their fault. They learned behind screens during COVID and it was all about them. And I took this to a dean staff meeting to talk about it. And really quickly everyone corrected me and they're like, this isn't a student issue. Our staff aren't doing good at this. Our faculty aren't doing good at this. We're not doing a good job of communicating. Our basic scientists to our clinicians, our military folks to our civilian folks. Like, there's 100 layers of conflict where we are not doing a good job. So we actually felt like it was really important to start with the staff and faculty education and learning this language and learning these skills before we brought it to students so that we had folks in place who knew how to have these conversations effectively. And actually, we started at the very top with our deans and chairs to make sure that right from the top down, everyone was sort of in lockstep about the importance of civil discourse and productive conversation across difference at all levels.

Oh my gosh. And I can't even imagine as you're seeing these people, like you said, the deans and the chairs who are actively buying into this, who are actually saying, we are going to use civil discourse is a method of communication on the daily. We're not just going to limit it. And then you start to see that permeate throughout the entire culture. Did you get feedback from your colleagues or from the learners as they were able to incorporate this into their daily life?

Yeah, it's really fascinating. So as a result of doing a lot of workshops in this, we saw that people had an increased sense of belonging at the institution. They had increased hope for the future of the institution. But there were actually specific incidents that happened that made me more hopeful and more excited about the actual productivity of this. And that is that I would have people come into my office regularly and say, I just had a conversation and it didn't go well. Can we talk through the steps and see where I missed and how I might have approached it differently? Like the fact that people were willing to reflect on situations after the fact and want to do it better next time. That was a win to me, right?

Yes.

So those folks coming and being willing to say that. Another area that I saw as a huge win, I had someone who came to the workshop, was not initially convinced that it was going to be worth his time, and actually thought that it was going to be a very adversarial situation based on the title of the workshop, based on this topic of civil discourse that was unclearly defined for this individual beforehand. They attended a whole day workshop, and at the end of the day, this person who I didn't know approached me really rapidly, and I was getting a little nervous and I didn't know where it was gonna go. And he came up to me with a straight face and stood in front of me and said, I'm gonna hug you. And I was like, okay, what just happened? And he said, I didn't sleep a wink last night because I was coming to a civil discourse workshop today, and I was afraid it was going to be really adversarial and frightening. And I enjoyed every moment of widening my lens and learning about other people today and practicing these skills. And I'd love to help you market this so that we can get everyone to come to this because I think it's that important. And he's become a friend and we do book clubs together and we share information and it's someone I didn't know before at all. And so it's really been wonderful in seeing those sorts of changes happen, whether it's The commitment to wanting to make it move forward effectively for everyone, or the commitment to want to get better each time you do it.

Absolutely. And I love the story so much that you just told because I think it speaks to something that's so prevalent and it's not just in medicine. The idea that we are so afraid of confrontation and conflict that literally he didn't sleep. And it wasn't that he was necessarily walking into a conflict.

He was walking into a class. Yeah.

That was talking about it. And he was so terrified that when he realized, number one, that this was a safe space that he was going to grow and it was going to be challenging, but he was going to learn some very valuable skills, but that he saw how awesome that could be and put him at ease that he literally walked up to you and he didn't know you at all and said, can I give you a hug? That just makes me want to jump up and down. Because you really hit upon something that I think so many people are afraid to talk about. They don't know how to approach it. And you give them a path. You gave them with CLEAR, you gave them a path with civil discourse. You gave them something that they could truly understand. And all of a sudden they start to lose their fear.

Yes.

And when they start to lose their fear, when we start to understand that there are ways we can approach conflict. That aren't necessarily scary. It's always going to be frightening. I think that's just who we are as human beings. But then as we develop these skills, we can learn how to build something. I do love the fact that C stands for create, that you're creating an environment that's fertile for this, and that's your first step. I think that's beautiful. But also too, one of the things that you talked about that I think is really important to bring up as a success point, because I agree with you on that. Is the fact that people recognize as they're going through this, that maybe it doesn't always work the first time, the second time, the 10th time, but actively trying to practice it so that they do get better at it. What kind of things do you help them with as they're coming in, they're sitting in your office and they're saying, okay, Dr. Budan, this didn't go the way I envisioned it. What kind of things can I do next time to actually help me adopt this better?

Yeah, well, I'm a huge believer in reflection at any level. And I think often it's one or two good questions that can allow someone to truly reflect on the whole situation to see where it went awry, where you might not have seen that upfront, which I guess is partially my coaching background makes me very interested in doing that. But I'm just a believer that you cannot improve anything that you do. You can't improve how you do procedures. You can't improve how you do rounds in the morning if you don't reflect on how things went and focus on some things to get better next time. And so I always just ask them like, tell me exactly your experience of the conversation. How did it feel when it started? When do you feel like it went awry? And how did you handle it when you felt like it went awry? And often people don't realize that in real time, and it takes reflecting on it and talking about it. To understand where those friction points happened, to understand what area is going to be most effective to work on to get better next time. And I think there are specific areas where we note where you feel like you got defensive. And instead of saying, huh, I just felt defensive and uncomfortable for a moment, can we just take a timeout real quick? So just doing a timeout just to catch your breath. Or using a phrase for you that allows you to calm down. Whenever I get constructive feedback and I'm caught off guard by it and I get a little defensive, my reaction every time is, wow, thank you for saying that. I hadn't thought about it that way. And I don't even know what that means anymore, but that's my phrase that rolls off my tongue to give me a second to calm down, to deescalate the situation. And so Sometimes it's just you didn't realize in real time that you were getting defensive. Now that you know that that was the moment when you started getting defensive, what might you do differently there next time? And just asking that one question can change it for the next encounter. Often we'll note that you didn't start on common ground. You were having a conversation, but you both started on opposite ends of the spectrum. When in reality you had experiences that were the same, you had values that were the same. If you had started the conversation there and then moved to your different perspectives, it would've been a lot more effective. So having people think through what that could be like is very different, but it's often a teeny tiny thing that can change how the whole conversation can go. Taking a moment, taking a breath. Using a comfortable phrase, making an effort to not shame someone or not talk about someone, but to make sure you focus on the issue. Any of those things can make it go more productively next time.

There are so many things that I want to talk about and emphasize from what you just said, because it's so powerful. The first one is the absolute strength of taking a pause. The absolute, almost necessity of taking that pause, especially when you feel yourself reacting or when you are tempted to react. Being able to do that and not feel like you have to respond. I think sometimes there is that pressure. People feel like I have to say something.

No, you don't.

You really don't. And I love how you have this phrase that is, thank you so much for saying that. You know, now this is sort of inbuilt, but it's the inbuilt that gives you the pause.

Yeah.

And that is power right there. So number one, I love that. Number two, I completely 100% applaud and agree with you on the idea of a reflective practice.

Yeah.

Whatever that reflective practice looks like for you. My husband is also critical care pulmonary, so he very often, I think early on when I started really working on conflict resolution and understanding that I did not have a reflective process, that I needed that in my life, that he and I became sort of each other's reflective process. And part of that reflection is like, okay, X happened and I will talk through it. And then as I'm talking through it to him, He doesn't really have to say anything. As I'm talking, I'm, okay, I see what happened.

Okay.

I see what I did. Okay. I see that this did not work as well for me. And I see how I can improve this process next time I'm going to do X. And so we became each other's reflection, but also too, I've developed a really, really awesome journaling practice. And that journaling practice in real time, like I keep my journal, like if this is my workspace, my journal is right here on my desk. And so during the day, if I have things come up, I can sit there and I can write notes to myself of, wow, I'm really happy with how that went, or, ooh, I need to really look at that process and how I responded. And next time I really need to consider doing X. And I can do that in real time. And I think that helps me because it's not just a thought in my head that I lose.

Yeah.

Yeah.

I'm not good at that. I have tried a million different times in my life to journal. I've actually learned ironically. That when I am struggling the most, when I am emotionally depressed or having a hard time in life in general, I'm very good at journaling then. I'm not good at journaling just in general. So that doesn't work for me. But how I've worked this is I have a feedback partner, and this is a point that I will try to sell to everyone for the rest of my life because it has changed everything about my life.

Wow.

So one of my friends who, man, is she good at being direct and honest and telling me what I need to hear no matter what. Whenever either of us have one of those things that you just said, like, that didn't go well, or I'm thinking about this thing too much, or I'm starting to ruminate, we give each other a call and we say, this thing happened to me today. Am I looking at it correctly? Is it relevant? What changes do I need to make as a result of it? All of those things, to have someone who is outside of the specific situation who's going to be honest with you is so important. So You are very lucky to have your husband that the two of you can do that together. A lot of folks don't have that sort of a relationship with their spouse where they can, in which case I think finding someone in your professional life who can be a feedback partner, who is not gonna sugarcoat anything, who's not too close so they don't know all the people involved in your realm every day, that you can just have those unbiased conversations with is so important.

Yeah.

That is beautiful. And 100%, I love that you have a partner, someone that you can interact with. And I agree with you that we all need that. And I also have Risa Lewis, who's an emergency medicine physician who's written a book called Microskills, was on the podcast about 6 months ago. And one of the things that she talks about is her personal board of directors.

Yes.

And when I heard her speak and I was in an audience when I heard it, With another friend of mine that we have a group of 8 women doctors that we all socialize and get together and have dinner and things like that. And immediately she texted the group chat and said, thank you for being my personal board of directors. And I'm like, I get that because I'm in this audience, but we have that relationship with each other as well. And that's a bigger pool of people, but the concept and the comfort is still the same in terms of having people who will be honest with you. And as you're asking for that feedback. And think, okay, I had X happen, guys, let me talk through it and give me your honest feedback. And you know that they will. And I think that's the other part of that process is they are going to be honest with you. Yeah, I think you could have done X, or maybe this would be something that you could try that would be a better process. As you have grown as a leader and as you have been so vital and helpful to other people growing their leadership, skills as a coach, as a physician, as an academic. One of the things that was on the All Levels Leadership site that I want to jump into is the idea of followership and how necessary that is for a leader's growth. Like, what is followership?

Yeah. So I think that this is such an interesting topic. So Lauren Weber is one of my partners at All Levels Leadership. I'm going to say probably it was 5 or 10 years ago now, she first came to me and she said, I'm going to give this talk on followership. Will you give it With me. And I said, no, like, I'm a leader. I'm not a follower. What do I wanna go talk about followership for? And we sat down and had a lot of discussions, wrote a lot of articles, did a lot of talking about this idea of what if we could make leadership mean something different than just following the leader, right? Like, I think that leadership and followership are two sides of the same coin. And they go together. Those folks who are great followers become great leaders because you know how to develop partnerships, you know how to make things work, you know how to use your influence. And so when we think of followership now, we think of someone who can use their influence to help their leaders achieve their goals and the mission of the organization. And that's really different. Knowing how to partner with a leader to achieve goals is very different than blindly following a leader. And so I think followership is excruciatingly important. I think the skills are often the same as far as you have to have good communication skills. You have to be able to give and receive feedback. You have to be willing to sacrifice sometimes for the good of the organization or for the achievement of the goal. All of those things are the same for leadership and followership. There are definitely characteristics that make some followers more effective, and really it is that willingness to support your leader and the willingness to challenge your leader, which that can open you up for conflict.

Yeah.

But if we start small and working on conflict resolution at a small scale and build that muscle, we can get better and better and better at it. So that we can keep our leaders on course when they're starting to go off course. And having someone in your life that, as a follower, is willing to be honest with you and redirect you when you need redirecting and let you know what is happening at lower levels, let you know what people are saying and how they're feeling and how they're experiencing your decisions. Having someone that's gonna partner with you to do that is invaluable. And then once you learn how to do that as a follower, you learn how to accept it as a leader, how to admit your fallibilities, how to use your followers effectively. It changes everything. So I, 5, 10 years ago would not have said this, but I think followership may be even more important than leadership.

And it's so beautiful how you talk about that. They are two sides of the same coin that you have to have that ability to have a common goal. To able to present another perspective, but do so in such a way that you're creating something and not leading yourself into sort of this zero-sum, this, again, a debate rather than a civil discourse. All of these things that are necessary, and I really see that mirrored, and I'm sure as you're seeing this in your residents and as they grow through this process, this is how PGY-1s become good PGY-2s. This is how good PGY-2s become PGY-3s. This is how PGY-3s become chief residents. Is that they literally start as good followers and develop that ability of followership. And then as they become higher in that hierarchy, they naturally pull that skillset and that feeling into being leaders. And it does create culture where they are leaders, but they are humble. They are open. They are willing to engage in conflict and understand that conflict can be productive. Just because you disagree with me doesn't mean that we are going to be at odds. I think it creates a very different way of providing that shared goal.

Yeah. And Lee, like in reality, we've been doing this for decades, right? We still are followers and leaders on any given day. We may be leading one meeting and walk out of the room and then go meet with a dean or a chair or our chief of our department, and now we're a follower and we have to be able to make that shift. And change from like, I'm not the ultimate decision maker here, but I'm gonna help someone make a good decision as a follower versus I'm gonna hear everyone's voice and make a good decision with this team to move forward. So it's a shift we all have to learn to make all day, every day until you are, I don't know, like the ultimate leader in one situation maybe. But I think in reality, most of us are shifting back and forth all the time.

Absolutely. And I think the people who have the ability to walk back and forth, who understand that different days, different roles, different hours, different roles, different minutes, different roles, and seamlessly move between those two are the people who become effective in the organization wherever they are.

Totally agree.

If you could give one piece of encouragement or leadership development advice You know, you're talking to a resident or a young physician and you get to tell them one thing. What one thing would you share with them?

Yeah, I would share feedback is love. I think that the day that I learned to be receptive to constructive feedback is the day my career started taking off. I really struggled prior to that. And I think if any individual is going to continue to learn and grow for the rest of their life, which is what we talk about, right? We want to be lifelong learners. I think a big part of that is hearing feedback for what it is and knowing that no one's gonna waste time giving you feedback if they don't think you can incorporate that feedback, or if they don't think you're worthy of the feedback, right? It's far easier to just go about your day and not give feedback to anyone, particularly constructive feedback, because it is or can be a small source of conflict to give constructive feedback, right? Right. So, We have to think about no one's gonna waste their time generating the energy to give you constructive feedback if they don't believe in you. And so I really do believe that feedback is love. And if we can see it that way, and every time someone gives us some constructive feedback, say, wow, they cared about me to believe that I'm worth this, then I think it changes how we feel it, how we use it, how we— can change our behaviors moving forward and how we seek out that person for help next time. I think it changes the relationship, it changes the conversation, and it changes your growth curve.

That's beautiful. That's absolutely beautiful. Jess, thank you so much for being here on the podcast. This has been an amazing conversation. I have learned so much from you. CLEAR is one of those things that I think is such a great idea and something that's so teachable. So I'm definitely going to hope that people seek you out. I've learned I'm going to start to try to apply it myself. If people are interested in All Levels Leadership or they have questions for you about CLEAR or civil discourse, how would they best find you?

Yeah, so you can always reach me at jess@allevelesleadership.com, and I would love it. Like I mentioned earlier, I'm a believer in this methodology. And if I can help anyone have more effective conversation, if I can help folks communicate better with their chains of command, with their patients, with their kids, whatever it might be, I'm in. I can do workshops at any level. I'm happy to do lectures at any level. I just do believe that this can change the way we feel about our workplaces and the way we feel about each other. And so I'm fully in. So jess@allevelesleadership.com is where you can reach me.

Fantastic. We will put that in the show notes as well. Thank you so much for being here. I really appreciate it. This has been wonderful.

Lee, it's been a pleasure. Thank you.

For all of us who joined the Topliners Corps today, for all of you who are here, my peaceful warriors, thank you so much. And until next time, be at peace.

Peace.

Every episode is an invitation to speak, to negotiate, to choose. I'm Dr. Lee Sharma. Join the dialogue by subscribing to Scalpel and Sword. Until next time, peaceful warriors, may your choices be sharp and your voice be even sharper. This podcast is a reflection of lived experience and research in conflict resolution. The Scalpel and Sword is not intended as medical or legal guidance. For personal matters, please consult a qualified professional.

Thanks.