Leading in Wisdom

I began my professional career as an analyst – my goal was to elevate the quality of strategic thinking about a variety of issues. I came to realize that most complex problems certainly benefit from and may actually require collective intelligence. But some questions, particularly those that are fundamentally choices, require more than analytical intelligence – a list of pros and cons for example does not necessarily lead to a wise decision. This recognition has led me to actively explore how we can create the opportunity for collective wisdom to emerge. I shared the following practices recently at the In2:In Thinking conference on the Art of Reflection in a workshop on leading and acting with wisdom.

Recognizing the truth of Bill O’Brien’s observation that the quality of an intervention is a function of the internal condition of the intervener, we used dialogue walks to consider our own sources of wisdom, how we know when we’re centered in such wisdom, when we’re not, and how to return to this center.

We spent the next part of the day applying the Theory U Case Clinic tool (developed by Otto Scharmer) More resources are available at www.presencing.com

We spent the remainder applying the Seeing Things Whole round table process to a leadership challenge being faced by one of the participants. The other participants served as “temporary trustees” to support her in seeing her challenge from a variety of perspectives, while also offering some wise counsel. The first step was to clarify the challenge, using the STW workbook. She presented the challenge. The group set aside the challenge and used the following as catalysts for reflection:

I have heard that in a former time the gods
Used to come from heaven to earth
Out of love for womankind. That time has gone.
By the dried-up, burnt-up river and fields
Of this Baiśākh day, a peasant-girl
Pitifully entreats, ‘Come, send rain!’
She keeps on looking at the sky
With sad eyes, in pathetic expectation.
But rain does not come; the deaf wind
Impatiently drives away all clouds;
The sun licks up all moisture from the sky
With his fierce tongue. In the age of Kali,
Alas the gods have grown old. A girl’s
Plea can only be directed, now, at man.
“The Drought” by Rabindranath Tagore


Henri Nouwen in Bread for the Journey:

To listen is very hard, because it asks of us so much interior stability that we no longer need to prove ourselves by speeches, arguments, statements or declarations. True listeners no longer have an inner need to make their presence known. They are free to receive, welcome, to accept.

Listening is much more than allowing another to talk while waiting for a chance to respond. Listening is paying full attention to others and welcoming them into our very beings. The beauty of listening is that those who are listened to start feeling accepted, start taking our words more seriously and discovering their true selves. Listening is a form of spiritual hospitality by which you invite strangers to become friends, to get to know their inner selves more fully, and even to dare to be silent with you.

Kahlil Gibran, “On Children” (as sung by Sweet Honey in the Rock from their album, Breath.)

Your children are not your children.
They are the sons and daughters of Life’s longing for itself.
They come through you but not from you,
And though they are with you yet they belong not to you.

You may give them your love but not your thoughts,
For they have their own thoughts.
You may house their bodies but not their souls,
For their souls dwell in the house of tomorrow,
which you cannot visit, not even in your dreams.
You may strive to be like them,
but seek not to make them like you.
For life goes not backward nor tarries with yesterday.

You are the bows from which your children
as living arrows are sent forth.
The archer sees the mark upon the path of the infinite,
and He bends you with His might
that His arrows may go swift and far.
Let your bending in the archer’s hand be for gladness;
For even as He loves the arrow that flies,
so He loves also the bow that is stable.

The group made personal connections to the meaning these selections had in in their own lives, and then added connections that might be relevent to the person with the focus challenge question.

Finally, the group of trustees offered nine different reframes of the challenge based on the lenses in the Three-Fold Model of Organizational Life.

It was hard to escape the day without a definition of wisdom. Most conventional definitions refer to the accumulation of knowledge, and most do tie it to good judgement and action. But we all know that just getting old(er), doesn’t necessarily produce what we recognize as wisdom. Here’s one I like from Jack Kornfield in After the Ecstasy, the Laundry.

Wisdom is not information, but an abiding presence, an intuitive, sensing opening of the body and heart. In wisdom the body of fear drops away and our heart comes to rest. Like love, wisdom needs no explanation. Like the Tao, it brings harmony and ease.

In the secular world, my hope, particularly around tough issues and choices, is to create a container for an opening of the body, mind, heart and will, for not knowing, so that intelligent people can learn to act in service of a greater good that is only discovered by at least momentarily, humbly, letting go.

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Something small might be the next big thing …

[This was originally posted on http://leading4health.ning.com.  This is an open community – all interested in improving health and well-being are welcome, particularly at the system level, are welcome.]

If you want to read some good news, check out the NYT special section in Tuesday’s edition: The Small Fixes Challenge. There are a series of great examples of elegantly simple solutions to some important health needs.

Because the Fannie E Rippel foundation was a sponsor, I was fortunate to attend the Transform Conference at the Mayo Clinic earlier this month. Here’s the agenda. You can click on the names of speakers to see their bios and get access to videos of their TED-like talks.

I was particularly interested in the “small” innovations coming from parts of the world where resources are scarce and only simple solutions will make a difference. (Probably why I noticed the NYT special section!) One of these featured approaches to getting care to native Americans and others in rural New Mexico was told by Sanjeev Arora. It started with treating HepC patients with the goal of the same outcomes in outlying areas as a patient might receive at a major medical center. The results are astounding – and at a practical level merit attention in terms of the outcomes relative to the healthcare costs. I appreciated Dr. Arora’s examples because they were all about engaging community health workers to leverage very few available physicians. It’s a great example where working within what seems to be an unreasonable constraint produces “impossible” results.

At the same time, in the spirit of The Small Fixes Challenge, there were fabulous examples of technical innovations like the Embrace infant warmer pictured below.

This mini-sleeping bag uses simple technology as a replacement for an unavailable incubator at 1% of the cost.

Similarly, modified CPAP machines (normally prescribed for sleep apena) are being used for infants where ventilators are not available. (See the CPAP solution described in the NYT supplement.)

Finally, compare the Noelle birthing simulator ($37,995) with the MamaNatalie ($150). The latter has virtually eliminated deaths due to maternal hemorrhaging when used to train rural health workers.

This last example is one I find most engaging because it’s both a social and technical innovation – relatively simple technology in the hands of those with a largely natural education supplemented with skilled expertise again produces dramatic increases in health and well-being.

To be a honest, the systems thinker in me is still concerned – the fabulous news for a family who now has an infant child or father who will live to old age also means that society has two more people who are likely to suffer other effects of poverty. I continue to imagine that it is possible to shift the resources that have been saved from healthcare to things like education and other investments. But that will require some political innovation that eludes me – at least today! For now, I will hold the image of the new life safely cocooned as a metaphor for the small fixes that hold enormous promise for all of us.

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Taking short term action and building long term momentum

The tyranny of the urgent produces great pressure to react.  Similarly, fragile groups of diverse stakeholders often feel that they must do something to maintain momentum. The unintended consequence of these impulses can result in a dependence on “the quick fix”, which can also undermine addressing the issue in the long term.  The reasons for this range from the simple release of pressure (“What’s the problem? Things are fine the way they are.”) to a depletion of attention, resources and/or goodwill that make it unlikely or impossible that the fundamental change will happen.

Systems thinking offers some basic resources to think about how to act now while avoiding the seductions of addiction – these are the lessons of the “shifting the burden” archetype.

I used the following attachments recently to speak to participants at the Society for Public Health (SOPHE) midyear meetings about how these ideas might help them in their work.


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How much is that X-ray in the window?

I had extensive back surgery in 1972. One of the things I remember clearly about the experience was the bill. It arrived some weeks later, and seemed to be close to a ream of paper, since everything, and I mean everything down to the sutures, was itemized. I had a visceral sense about what things cost.

Fast forward to today. The Boston Globe recently reported that many consumers are opting to purchase high deductible health care coverage. I’m one of those many consumers.

I funded a health spending account to cover out-of-pocket medical costs, taking the deductible into account.

After some ambivalence and some minor symptoms, one of you persuaded me that it might be time to have some follow-up x-rays taken to document the current state, and help better diagnose any future issues – trend data always gives you more perspective than a single point in time picture.

Megan, my primary care practitioner’s PA, asked me where I wanted to have the x-rays taken. I opted for the most convenient location where I also thought the waiting time would be minimized.

It wasn’t until I was pulling into the Mt Auburn Hospital parking lot that it occurred to me that the cost might be different at the different locations. Even though I was fully aware that I would really have to pay for these pictures, it hadn’t occurred to me to ask how much they would cost. And Megan only offered that she might get the results faster from Mt Auburn. Hmmm. Hard to believe that I would discover a cost difference worth the time I’d spent so far, but now having made the decision to consciously buy x-rays, I wanted to do so intelligently relative to my policy and about-to-expire savings account.

I began my quest at the registration office. They had no idea what things cost – nothing in my file indicated the need to make a payment in advance – as far as they were concerned, this was covered by my policy. I was insistent that I was buying the x-rays and they suggested I ask about their cost at the radiology desk.

I surrendered to my fate, and headed to the basement, also noting that my enthusiastic (and inexperienced) PA had ordered lots of x-rays. I asked the person at the desk if a) I really needed all these x-rays and b) what they would cost. The head x-ray technician was summoned. The good news was that Maggie was a pro and reduced the 6 plus requests to a single scoliosis series. The bad news was that no one had the faintest idea about what things cost and suggested that I call my insurance company.

I called the insurance company. Maria reported that the hospital had up to 90 days to bill them for the service. They would then bill me for what I can only assume is 100% of the cost from the fine print of my policy. That’s when we would all know what the x-rays cost. When pressed on the likely charge, she confessed to having no idea and suggested that I contact the hospital billing office.

I called the hospital billing office and the first person told me that it would be impossible to tell me what it would cost. I asked her if she routinely ordered food at restaurants off a menu with no prices. (These are not the circles in which I travel, but I do remember having someone take me to one once. In this particular case, I think it was because guests and/or women shouldn’t concern themselves with the prices. However there are such places in the world where this is the logic: if you have to ask how much it costs, you can’t afford it. It’s a sign of having money to burn that you find out what things cost only after consuming them.) She thought this was a great question and transferred me to head billing manager, Rick. Rick spent a little time investigating and said that if I walked in off the street, the series I had would cost $250. HOWEVER, Tufts health plan has a GREAT deal with Mt Auburn Hospital. He couldn’t tell me what it was, but he doubted the bill from the hospital would be more than $200. Oh, and there will be another bill from the physician group that reads the x-rays – he had no idea what that costs, but gave me their number.

I called the reading service and got voicemail. I gave them full permission to talk to my voicemail with an estimate of their bill. No message yet.

My health spending account will only cover expenses incurred through next week. Then a new year begins. Any balance remaining is forfeited. Because of the timing, I have until July 31 to submit expenses for reimbursement. This is an anomaly of changing jobs – I could have ended up with about 8 weeks to submit expenses – over 30 days less than the maximum amount of time it might take for me to find out what the services really cost with the arrival of the bill from my insurance company. After all this, I’m still not sure how anyone can plan and make good economic decisions working under these well-intentioned but flawed structures.

High deductible plans and health spending accounts should be a great way to get everyone to stay healthy and save insurance for the catastrophic events and unavoidable illness we all would wish to avoid; it should help us all think twice about what things cost, relative to their likely value. Instead, I can only tell you my experience of living a fix that backfired.

Unfortunately, high deductible plans are most used by those who can easily absorb the risk and are relatively healthy, and those who can least afford the risk. This latter group is the cause for the biggest concern. What seems to be happening is that they are opting to avoid “routine” preventive health care, EVEN WHEN IT’S FULLY COVERED by their policy. Presumably this is because they can’t figure out what is covered and what’s not, and certainly can’t a afford to order from a menu without prices. The consequence is that the very disasters they are conscientiously insuring against may ultimately come to pass due to the behavior their policy is inspiring.

Given some of the symptoms I’ve had, Megan couldn’t believe that I didn’t have any neck pain. If only metaphorically, I certainly have a pain in my neck now.

And by the way – if I was looking for a community organizing campaign to launch, I think I’d seek to imitate our public health colleagues. I’ve been making different choices at Panera, Starbucks, etc as their menus display calorie content as prominently as the price. Wouldn’t it be interesting to see what would happen, if we all knew what things cost?

Note: After writing this I discovered that the “menu with prices” metaphor appears in:

“A Menu without Prices” (editorial), Alan M. Garber, MD, PhD Annals of Internal Medicine: June 17, 2008 vol. 148 no. 12 964-966

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Breakfast is the most important meal of the day – in more ways than one

Today I had blueberries for breakfast. What’s significant is that I had the conscious experience of having blueberries for breakfast. This was not my intention, but the blueberries demanded my full attention and I answered their call. I had rinsed the blueberries, destined for cereal, and they sat waiting in the bowl. While I was making other preparations, hunger and impulse overcame me, and I popped a single blueberry into my mouth. Something caused me to savor it. There are many subtle things about blueberries – the relatively thick tart skin, the juicy sweet-tart pulp, the smallest of seeds inside, the sturdiness of this fragile thing that had traveled thousands of miles to my door and already endured a week in the refrigerator. There was nothing subtle about the experience – it became a blueberry moment. I changed my plans. Did I just happen upon the most exceptional blueberry ever made? I had to have another. It was similarly exceptional in its own way. I reveled in each berry in the bowl in its turn until they were gone.

There are many health practitioners who encourage us to eat more mindfully. They recommend practice exercises where you simply eat a grape or raisin, or blueberry! They note that our failure to pay attention certainly contributes to eating that damages our health.

More importantly though, people like Thich Nhat Hanh remind us that eating is an example of an ordinary activity that is an opportunity to practice the attentiveness that is beneficial more generally in life.

There is a zen story that’s a favorite of mine from a parable attributed to Buddha that this morning calls to mind. It’s usually referred to as the “Tigers and the Strawberry” and is the extreme case of mindful eating (and living):

One day while walking across a field a man encountered a vicious tiger. He fled, the tiger after him. Coming to a precipice, he caught hold of the root of a wild vine and swung himself down over the edge. The tiger sniffed at him from above. Trembling the man looked down to where, far below, another tiger was waiting to eat him.

Only the vine sustained him. Two mice, one white and one black, little by little started to gnaw away the vine. The man saw a luscious strawberry near him. Grasping the vine with one hand, he picked the strawberry with the other. How sweet it tasted.
From Zen Flesh, Zen Bones: A Collection of Zen and Pre-Zen Writings compiled by Paul Reps

Today, the simple experience of being unusually present to my breakfast brought new meaning to the aphorism that “breakfast is the most important meal of the day”. Sure, it might make us smarter, slimmer, more energetic, more productive, as the data suggests. I’m wondering if all these results might pale in comparison to the opportunity to embody doing one thing at a time, and knowing that I am doing it, even when, or perhaps especially when my mind is sending the message that I’m starting the day surrounded by tigers! Hmm. While I don’t think I’m going to start eating frosted flakes, I think I might give a nod to Tony the Tiger when I eat my next blueberries – to put tigers in perspective at the start of the day as well.

With thanks to the humble blueberry and from whence it comes.


Eating Mindfully

Savor – Mindful Eating, Mindful Life

Myths & Realities: Is Breakfast the Most Important Meal of the Day?

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Miles to go before I sleep

Taxi to the Airport - Oct 15, 2010

From this point forward, October 15th will be a phoenix celebration for me. On Friday, the taxi taking me to the airport on a dark rainy windy morning spun out of control, slammed into the abutment of an overpass facing on-coming traffic, caught fire and then exploded. The picture to the right shows the taxi (ball of fire) and the Mass Turnpike vehicle directing traffic away from what would shortly be a cloud of acrid smoke. There wasn’t much to do but stand in the downpour beside my driver, Lee, and thank God that we were alive. When I took out my phone to call the cab company, I decided instead that I would capture a reminder about how lucky I am to be here.

Both the taxi driver and state trouper were concerned that I was going to be late getting to the airport, offering to find a way to get me there. The state trouper, a woman about my age, was great. While I had no intention of proceeding as if nothing has happened, I remained practical – “I have no clothes – my suitcase was in the trunk.” Also pragmatic, she replied, “That’s what credit cards are for!” But of course, I had no credit cards either. So home I went to check-in and regroup.

This isn’t the first time life has spun me around – literally – including 3 other snow-related spin-outs over the years and a forward somersault over my bicycle handlebars last summer. I’m not taking this wake-up call lightly – my inventory of nine lives is seriously depleted.

Rick Redpath at Derek Lowe's no-hitter - 27 April 2002 - with my sister, niece and nephew. Rick succumbed to brain cancer on 26 April 2003.

A few weeks ago, I participated in a fundraising walk for the Brain Tumor Society with my family. A young couple ahead of us asked me to take their picture. It was a beautiful fall day and I was completely delighted. As I stepped back to get a better shot, I found myself head over heels down a small embankment, miraculously landing on the grass rather than the pavement. As I emerged from my somersault (camera in hand!) the young couple looked at me the way a fallen toddler seeks a signal from its mother about whether to laugh or cry. In fairness, I was bent over – because I was laughing so hard – and ultimately saying that I was very glad they didn’t make their request at the Grand Canyon.  Presumably, the universe has some other message for me that I did not quite hear then.

What could it be? Slow down, you’re moving too fast. Be here now. Your work here isn’t done. There’s someone to watch over me. Miracles happen every day. Life provides plenty of warning signs – pay attention! Speak now, or forever hold your peace. Live every moment as if it’s your last.

Maybe it’s all of them, or something else that comes from realizing my days are numbered and I’m blessed with a second chance  – I still have some serious reflecting to do! I‘m always grateful to be reminded of the present, fragile moment though. I had gone to sleep the night before tossing and turning about a message I’d received and responded to somewhat abruptly. That, and not patting the dog before I left the house could have become eternal regrets. I hope I’ll pay more attention to these hesitations and omissions going forward, remembering that forgiveness is a powerful ingredient for resting in peace. On the other hand, I did kiss my mother goodbye, as well as my other family members (as much as they tolerate being kissed). I had rewritten and sent another message originally composed in haste to a dear colleague about something that ultimately felt like an appreciative pause in the conversation. I had put the trash out. I had completed all my urgent promises.

Years ago, I participated in a week-long retreat and was assigned a spiritual director. I don’t remember the particular questions that were on my mind at the time, but I hoped for some clarity and insight during a week of silence. At our last meeting, as he wished me well, he added that “I hope God speaks to you.” I’m quite sure I laughed out loud in response, because I found it very amusing to imagine that the universal divine was somehow the underperforming partner in this relationship! I know I responded that I was quite confident that my only concern was recognizing and then acting on the abundance of messages generously provided by life everyday. It still is.

And at 50-something, I can’t see or hear with quite the same clarity that youth afforded – although I’m often loathe to accept it. I feel fortunate to have so many wonderful companions on life’s journey, of which you are undoubtedly one – known or unknown. Perhaps part of our service to each other is asking about these signs and where they are pointing us. For now, I am clear that my contract has been renewed and there’s something important to learn, experience and do – with miles to go before I sleep.

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I still have more to learn from Ed Schein – a salute

Don’t panic!  Ed is alive and well, although soon to move from the east coast to west – riding off into the sunset as we see it here in Cambridge. I’m not going to try to be comprehensive in acknowledging Ed’s many contributions, particularly to organizational development and organizational learning.

Ed Schein

Ed Schein

For those of you less aware of the role Ed has played in defining what culture means in organizations, and how those of us who attempt to help can best engage in process consultation, I’m providing a link to a piece Ed wrote a few years ago in reflecting on his career for SoL’s journal, Reflections.

From Brainwashing to Organizational Therapy:
A Conceptual and Empirical Journey in Search of “Systemic” Health and a General Model of Change Dynamics – Drama in Five Acts
(click to download)

The title captures so much of what I appreciate about Ed which I’ll summarize in few key guiding ideas:

  1. Get out of your comfort zone – and integrate what you learn. Most of us tend to continue to do what we do well. We tend to associate with others like us.  However, it’s well documented  that using a wholly different lens makes the familiar richer, providing new insights about both theory and action. If one take this interdisciplinary journey, integrating the learning should be seen as part of our new work. Discerning the patterns in the seemingly unrelated and making sense of them requires a commitment to reflect.  (Ed was the advocate behind launching SoL’s journal, Reflections, and served as its editor for the first four volumes. He was a frequent contributor, modeling the way.)
  2. Theory and experience are iterative. Ed refers to his conceptual and empirical journey. If you’ve read this far, you probably have an interest in the theoretical.  Of course the challenge of favoring a theoretical approach is that we can always find plenty of data in support of our ideas. And yet, the world will also easily provide plenty of evidence that our ideas are incomplete at best.  What I love about Ed’s approach is that it always seems systemic without searching for the holy grail of a grand unified theory. I appreciate the encouragement to be perpetually curious about the complexity of human systems, expecting to be amazed but not quenched.
  3. Health is what we want to nurture, addressing pathology is secondary. Some therapists and consultant make their whole practice about identify and fixing what isn’t working.  After all, we usually don’t seek help if everything’s fine.  Still, we are most likely to put the weakness in context by evoking strengths and what is working.  When we can see the diversity in our organizations as a source to draw on, much more is possible.
  4. Bring your whole self to your work and help others do the same. From the standpoint of psychology, I think Ed would make the case that we really do bring the complexity of our history and relationships with us to work anyway!  If we use the premise about learning from outside your comfort zone and integrating these insights from a professional standpoint, why not use it from a personal standpoint as well?  Ed’s choice to tell his story in the form of a play is a small example of using his experience of the arts in reframing his professional work. We have more strengths and passions than we offer or elicit – another source of health and abundance.

I guess it should go without saying, but I’ll just summarize with this: Ed is a great model as life-long learner.  I was prompted to share this with you because Ed will be offering a 4-session on line seminar this fall (Oct 21, Nov 4, 18, Dec 9) hosted by The Presencing Institute.  It’s called: Process Consultation: Leading Change in a Multicultural Networked World.  How timely is that? I’m not going to let this rare opportunity pass by – I still have more to learn from Ed.

Click here for more information on the seminar.

A few of Ed’s classic contributions (in addition to the article above) include:

Schein, Edgar H. (2009) Helping: How to Offer, Give, and Receive Help, Berrett-Koehler, San Francisco, CA.
Schein, Edgar H. (2004): Organizational Culture and Leadership. 3rd Edition. Jossey-Bass, San Francisco, CA.

Schein, Edgar H. (1999/2009): The Corporate Culture Survival Guide. Jossey-Bass, San Francisco, CA.

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In the beginning …

Some would say it’s a gutsy move to call your company Heaven & Earth Incorporated. What’s behind the name? A few things: first, in Chinese philosophy, the human being (literally perched on the horizon) is seen as where heaven and earth meet.

Second, my work for the last 30 years has centered on creative or generative tension, as initially introduced to me by Robert Fritz. The simple model poses that creative energy comes from the discrepancy between vision (what we want) and reality (what we’ve got). As you can imagine, this is easier said than done. I like the phrase “heaven and earth” to capture how we are oriented to our aspirations while also being grounded in reality. I’m also intrigued by the more recent work of colleague Charlie Kiefer in this area, noticing that the most entrepreneurial among us are master creators, not only because they keep their “eyes on the prize” but because they let their definition of the “prize” actively evolve as they create and adjust.

Finally, my Roman Catholic upbringing complemented with the adult exploration of many eastern contemplative traditions causes me to believe that life is fullest when we can integrate the spiritual and the material. I am committed to this integration in my own life, and the company name serves as a daily reminder of my own aspiration.

Since I founded Heaven & Earth Incorporated in 1996, I have been fortunate to vastly expand my network of colleagues who have in turn have helped me develop and expand my thinking and capabilities. I’m particularly grateful to Otto Scharmer and his colleagues (Senge, Jaworski and Flowers) for articulating their model of a deep action learning process in Presence and Theory U. Like many others, I feel they put into more organized concepts what I too had experienced. I’m delighted to have published the first editions of both of these books and marvel at the “presencing” community that has evolved around this reflective/generative model.

Lastly (for now), the opportunities that I’ve had to travel extensively in India as well as my connection with the Seeing Things Whole community have provided wonderful opportunities to explore the “integration of spiritual imagination and organizational life”.

This has all been good for my soul. As my mentor Bill O’Brien said, the effectiveness of a leader, manager, change agent is largely a function of their interior condition. Much of my work holds what I’ve been describing here as tacit. I hope it makes me a good listener and “friendly co-pilot” for those change agents I work with, creating the conditions for greater collective intelligence and wisdom as we take on awesome challenges and wonderful opportunities.

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