The Serenity Prayer Mindset: Finding Peace and Purpose amid the Complexity of Accreditation
Lois Margaret Nora, MD, JD, MBA
God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.
While I doubt theologian Reinhold Niebuhr ever spent time thinking about LCME accreditation, his words come to mind when I work with accreditation professionals. The Serenity Prayer, often attributed to St. Francis but widely believed to be the work of Niebuhr, has been adapted and popularized across many facets of our culture, from literature to politics to recovery programs, where it serves as a reminder of life’s realities and offers a grounding perspective during times of difficulty.
For those tasked with managing medical education program accreditation, a Serenity Prayer mindset can help cultivate peace of mind amid challenging work and illuminate a constructive path forward on even the thorniest of issues.
Accreditation: An Emerging Profession
Medical education program accreditation has been around for many years, but it has evolved substantially since my days as the faculty accreditation lead at the University of Kentucky College of Medicine. The increasingly distributed nature of and changing leadership roles within the academic medical enterprise, larger medical school classes, and external influences on the educational process (e.g., changing the USMLE Step 1 scoring to a pass/fail framework, competitive residency selection processes in certain specialties) have collectively made accreditation far more complex than ever before.
Schools have adapted by adopting continuous quality improvement (CQI) approaches to what used to be a periodic undertaking and investing in dedicated offices to manage accreditation on an ongoing basis. This expanded scope of work has contributed to the rise of a new type of medical education leader, the executive accreditation professional (EAP). While these skilled individuals bring critical project management, quality assurance (QA), and CQI expertise to their schools, their work can be as difficult as it is important.
Accepting What Cannot Be Changed
Through accreditation and CQI processes, much of what EAPs manage through accreditation self-study processes can’t be changed. Data is data, faculty numbers are faculty numbers, dollars are dollars, and physical resources are what they are.
In my experience, EAPs often take substantial ownership for accreditation metrics—even though compliance with accreditation requirements often depends on activities and resources that lay outside of an EAP’s direct control. Consider the common problem of inadequate relaxation and storage space in affiliate hospitals. Addressing this challenge is well beyond the ability of the medical education office, let alone the EAP.
However tempting it may be, it is unwise for EAPs to take undue ownership of these things. Doing so creates unnecessary stress for these individuals and their teams and draws their attention away from what they can—and should—be doing instead.
Courage to Change What Can Be
Stephen Covey, author of 7 Habits of Highly Effective People, reminds us that while circumstances are often beyond our control, our response to those circumstances is within our control. A productive response includes making progress toward common goals by working within our areas of responsibility and spheres of influence. EAPs have a skill set that can be particularly effective for instigating such progress—including strong communication skills, creative problem-solving, and an ability to work across boundaries—especially as it relates to creating structures and processes for acknowledging and addressing issues.
Consider findings related to the success of medical schools’ programs and services. While EAPs themselves may not work closely with students or curriculum, they are often responsible for crafting a framework that ensures findings are treated as an opportunity to learn and improve, rather than something to be dismissed. For example, EAPs can foster an approach that uses appreciative inquiry to ensure successes are both celebrated and maximized to generate further progress. Alternatively, they can use negative data to drive constructive action and improvement. Regardless of the issue, EAPs can facilitate real change by establishing and supporting mechanisms that enable the right stakeholders to fearlessly acknowledge data, explore underlying factors, take actions to address problems, and assess the results of those actions.
There’s no guarantee this framework will solve issues, but it often does (though it can take a frustratingly long time). And even in those instances where it isn’t enough, it still offers tangible benefits. Modeling a true CQI process sends a powerful message to teams across the school that leaders can acknowledge and work to address tough problems.
Additionally, EAPs have an ability to help colleagues across the institution see the benefit of working together to achieve compliance. Collaborating in this way often builds a sense of buy-in and demonstrates to stakeholders that internal accreditation professionals are on their side, which can spark meaningful cultural changes within teams and across the institution.
The Wisdom to Know the Difference
Working with dozens of accreditation teams has allowed me to meet deeply committed professionals who take their work in QA and CQI seriously. They believe in the power of accreditation to make education, medical practice, and ultimately, patient care better. And they work tirelessly to deliver. This level of commitment is inspiring, yet it can take a toll. This is why I remind them of the Serenity Prayer mindset: acknowledge and accept what you don’t control, maximize your input and influence where it can make a difference, and recognize the difference so you can sleep better at night.
Thinking in this way can help EAPs and all of us who care deeply about medical education work more effectively toward our goals while allowing the peace of mind that comes with accepting what is beyond our control.
