As January comes to a chilly close, I hope you all are faring well, wearing lots of layers, and tapping into self-care habits that make these winter days bearable. If winter gets you down, take heart that every day we get a little more daylight than the last one, that Groundhog Day is next week, and that February is a much shorter month than January. If the dark and cold of winter does not get you down, teach me your ways! In either case, I continue to believe our strength is in our community and that support nourishes both the giver and the receiver. I know for me, my husband helps keep me grounded. He often sends me links to articles he finds interesting that might otherwise slip past me. Not only does he know what I will find useful, but I appreciate the gesture too.
One recent article he sent me published last month was on how to make durable change. The author, a psychologist at Penn named Angela Duckworth, cites studies showing that willpower is one of the least effective ingredients when it comes to reform. Not only are very few of us likely to cite willpower as one of our strengths, but it also feels really bad to have to rely on it for forcing change. Don’t eat that cookie! Put your phone down and get back to charting! Instead, Dr. Duckworth cites the effectiveness of controlling your environment. Students keeping their phones far away from their desks while they study got better grades. If you pack the healthy lunch the night before, because you will be in a rush the next morning, you are less likely to default to the fast burger and fries the next day. Instead of feeling like a failure when willpower alone does not stop you from making the less desirable choice, exercise “situational agency” over problem areas. “Be the sovereign ruler,” she writes, “of what enters your personal space.”
What could that mean for us here in Internal Medicine? I think our friends in health services research or other areas of quality improvement are already nodding their heads at Dr. Duckworth’s advice above. Introducing changes to a new unit inevitably contains an element of understanding, through qualitative research and motivational interviewing, first what people tend to want to already do and how a new process should dovetail with existing practice. We heard a similar message last week in Dr. Martha Carvour’s excellent Grand Rounds presentation: how can we simplify instead of overcomplicating? What are the areas we already have control over? The effective and lasting change most likely lies in the answer to those questions.
Photo for reflection 
The Norwegian town of Ålesund stretches across three islands at the entrance of one of the nation’s many fjords. It’s become a home to medieval artifacts like Viking ship replicas and ancient homes, but the distinctive architecture along the harbor is its primary draw. In 1904, a fire broke out and, with the help of a stiff sea wind, the blaze consumed all of the small wooden village’s structures. Over the next few years, the town’s inhabitants rebuilt entirely using imported stone and brick, expanding even beyond its original borders. Today, more than 120 years later almost all of those original buildings still stand today. When we think about what we build here, whether a structure or a process, or when we think about change in general, as important as it is to focus on what will be effective, we should also think about what will last. Next year the University of Iowa will turn 180 years old. The building my office is in is almost as old as those that still stand in Ålesund. Thinking about the next quarter or fiscal year matters, but institutions like ours should also think about the next century. What do we want our successors to still have in 2126?
Upi’s “Oh, WOW” moment
In the last quarterly update, I shared the good news that the number of grant applications submitted was up. I want to thank Vice Chair for Research Dr. Chad Grueter, Lori Bassler, and her impressive research administration team for helping guide our researchers through an often-arduous process. Shots on goal, as they say. The more we take, the more we score. As we near the end of this current round of NIH grant submissions, I want to congratulate everyone assembling applications and wish you well in the scoring rounds. In the meantime we can also celebrate the wins of some applications to the American Heart Association and the American Diabetes Association. Postdoctoral trainees Dr. Amira Zaher, Dr. Ivan Budnik, and Dr. Abhishek Jha, and PhD candidate Kayla Henry are the most recent four in what’s become an annual tradition for these awards. Congrats to these four and to their faculty mentors!
