Mindfulness and MCH: Cultivating the Art and Science of Inside-Out Leadership

By Christina Bethell
Professor of Pediatrics, OHSU School of Medicine and Director, The Child and Adolescent Health Measurement Initiative

Mindfulness is defined as the four-pronged capacity to 1) pay attention 2) on purpose 3) in the present moment 4) without judgment. Developing and practicing mindfulness is often referred to as "fitness for the mind" and has taken center stage in leadership training programs across the United States. As reflected in Congressman Tim Ryan’s recently released book "Mindful Nation", the simple-sounding ability to be fully present and mindful in any moment is consistently associated with the cultivation of essential leadership skills – literally rewiring our brains and biochemistry to promote clear thinking, relaxed responses and effective communication. In fact, a mapping of national MCH Leadership Competencies and Training Goals to empirical evidence on the benefits of practicing mindfulness reveals its cross-cutting relevance to these competencies, especially self-reflection, communication, negotiation and conflict resolution, and developing others. This mapping was done as part of a new "Mindfulness and MCH" collaboration, initiated by The Child and Adolescent Health Measurement Initiative (CAHMI) in 2011. "Mindfulness and MCH" includes the convening of a national dialogue group to discuss the evidence, opportunities and methods for mindfulness training to advance national MCH health goals and includes a core group of family, clinician, program and research leaders as well as identification and development of MCH relevant mindfulness training protocols, resources and research needs and opportunities.

Consistent with the strong association between mindfulness research and MCH Leadership Competencies are findings from the Institute for Mindful Leadership, which reports that 93 percent of participants in a mindfulness training program reported improvements in taking time to reflect and creating space for discovery and innovation, as well as substantial improvements in being able to notice when they are not present and to redirect attention when it is inevitably pulled away during tasks or interactions along with improvements in being able to say no and/or set boundaries with less harshness and sense of guilt. Nearly 90 percent reported improved listening to self and others and greater patience with self and others during stressful situations. Four out of five participants reported that they felt a greater sense of mental clarity and felt that they made better decisions.

Practices to develop mindfulness were first popularized in 1990 through the bestselling Jon Kabat-Zinn book "Full Catastrophe Living" and the development of his Mindfulness Based Stress Reduction (MBSR) eight-week training program. Since then, neuroscience and clinical research supporting mindfulness has exploded and mindfulness entered the realm of leadership and organizational effectiveness. Perhaps most unexpectedly, mindfulness (and "collective mindfulness") has been found to be the common skill and capacity most essential to achieving High Reliability Organizations (HROs) – the leadership and management model recently adopted by The Joint Commission for improving the quality and safety of health care in the United States.

A stillness and silence practice – or simple mindfulness meditation – is the most important practice to the cultivation of mindfulness. As illustrated in the figure here, mindfulness meditation involves sitting silently with the purposeful intention to train your attention on what is happening in the present moment – which when you are still is mostly your breathing and your body and more subtle feeling sensations. A flowing stream of thoughts and mind chatter is to be expected and should be gently observed with curiosity and allowing what emerges to be as it is and move like clouds in the sky. The neuroscience and clinical research supporting mindfulness meditation is extensive. Mindfulness micro-practices, such as mindful driving, cooking, eating, walking, listening and breathing during daily activities, including practices as simple as pausing and taking one breath before answering the phone or before entering a room, further developing the capacity for mindfulness.

While developing and maintaining mindfulness skills requires some time, its effect to improve the ability to be consciously present moment-by-moment to one’s multi-dimensional inner mental, emotional and physical experience – as well as to outer and interpersonal experiences – actually leads to greater focus, productivity and a more effective use of time. Mindfulness moves us out of an autopilot, habit-driven mode and into an intentional mode where we notice non-judgmentally and choose versus simply react – especially as it relates to responses to perceived and internal stress, difficult communications and even to pleasure seeking instincts to grab for that one more cup of coffee or donut or to delay bedtime for TV.

If you are interested in how mindfulness can advance MCH leadership and health goals for the nation’s women, infants and children or to participate in the Mindfulness and MCH dialogue group, please contact Christina Bethell. A starter resource reading packet, including a self-assessment questionnaire, mindfulness meditation guidelines and micro-practices ideas and personal planning and relational mindfulness worksheets (called the Wheel of Awareness) can be accessed here.


The MCH Leadership Competencies

Twelve MCH leadership competencies are organized into the three categories described in the conceptual framework. These categories include:

I. Self

  1. MCH Knowledge Base
  2. Self-reflection
  3. Ethics and Professionalism
  4. Critical Thinking

II. Others

  1. Communication
  2. Negotiation and Conflict Resolution
  3. Cultural Competency
  4. Family-centered Care
  5. Developing Others through Teaching and Mentoring
  6. Interdisciplinary Team Building

III. Wider Community

  1. Working with Communities and Systems
  2. Policy and Advocacy

Each of the 12 competencies includes a definition of the competency, knowledge areas, and basic and advanced skills for that competency. For more information, visit the MCH Leadership Competencies website.