5 agile lessons from the doctor’s office to help you change lives for the better
Warning: this post is heavily biased by love
One of the blessings of being in Portugal during the pandemic this past summer is that I got to do one of my favorite things: hang out with my mom at the beach café, catching up on life over espresso. Through one of those conversations I learned something new about my childhood: I was never potty-trained (bear with me, I promise there is a point to this). My mother described how I, as a two year-old, decided from one day to the next to stop wearing diapers and graduate to the next level- without any nudging, cajoling, or training. This is still a scientific curiosity to my mother, a pediatric nephrologist with a 35-year career in all things kidney, bladder and… bed-wetting.
Nocturnal enuresis (science’s name for bed-wetting) affects 5–10% of 7-year-old children in the US, and about 5% of children over 10 years old. Some wet their bed well into their teenage years. This is a hardship for families. It’s not just that the body is not behaving as expected. Everyone’s sleep is affected. There is stigma and shame. The good news is that there is a pretty good drug to manage enuresis which many physicians (including mom) prescribe. The bad news is that the drug alone doesn‘t work for many kids. So my mother developed her own method, and her success rate is so high that most of her colleagues refer their patients to her. Her secret sauce? Agile coaching. She never learned how to do it, never even heard of it — she just naturally good at it. Here is how my mother changes kids’ lives:
[But wait. A proper introduction before we move on. Meet my mother, Helena.
When she was 8 months old, she sailed from Portugal to Mozambique with her three brothers and my grandmother to join my grandfather, a carpenter and one of the many poor and politically “inconvenient” people working in the Portuguese colonies. At age 10, she enrolled in a catholic boarding school in Maputo (then LourençoMarques), a precious opportunity for education but a lonely and strict existence. She was the first in her family to graduate from high school and college. When the Portuguese dictatorship ended in the 1970s, chaos ensued. She and another 1.5 million people were displaced and sought safety and a future in Portugal. She became a physician. She was the first woman in her department to do research abroad, while her husband stayed in Portugal working full time and caring for nine year-old moi. Helena helped thousands of children with chronic illness grow up and thrive, and trained hundreds of doctors to do the same. She is published internationally. She ran a hospital, and built one, too. She is an advisor for the government. And she bakes a kickass chocolate chiffon.]
Above: Mom as a medical student doing field work in Mozambique. She was one of the rare white people who spoke native languages because she had grown up and gone to school with native Mozambicans.
I believe that my mother’s ability to thrive in the face of adversity taught her how to help others do the same. Here is her simple and powerful approach.
1. Empathize, empathize, empathize
The first thing my mom does when a new enuresis family walks into her office is to reassure them. “This is not a disease. This is a solvable problem”. Meaning, there is nothing wrong with you. By relaxing the grip of fear and shame, she creates a safe environment for healing to begin (something I am learning more about through Dr. Stephen Porges’s polyvagal theory).
She spends a full hour in that first appointment vs. the typical 15 minutes. With no off-the-shelf solution and no way to predict the outcome, Helena knows that this is a complex problem with a unique solution that will emerge as the treatment unfolds. She’s never heard of the Cynefin framework, but she sure knows how to apply it.
Finally, most of her time is spent talking with the child. It’s not uncommon for pediatricians to examine a child and then turn around to explain things to parents. My mother uses dialogue to get to know the child and their experience, beyond what’s going on with the body. Like a good agile coach, Helena values kids and interactions over protocols and pills.
2. Paint a picture of the future that matters to them.
More often than not it’s the parents who seek help, exhausted from sleepless nights and piles of laundry. Their kids don’t see a problem at all. In those cases, mom brings things into a new perspective. “You like sleepovers, right? What would it be like to go on a sleepovers without being afraid of having an accident?”; or, “what is something you wish you could do that you can’t because you wet your bed?” And so on. Kids catch on real quick.
What I like about this approach is that it calls on their creative self, what they love to do and who they really are, rather than speaking to their fear and need for approval from parents, friends. Helena is not only helping kids to stop wetting their bed- she is helping them develop as human beings.
3. Make people accountable for their own journey.
Before any treatment begins, there is an agreement. Helena asks every child who they think is going to solve the problem. Every one of them invariably responds “I am”. She defines her role, too: “you know best what works for you, and I’m just here to guide you”.
One cool tool she offers is a booklet for tracking bed-wetting events. Parents are not allowed to touch said booklet. It’s the child’s job to fill it in every day and tally the numbers weekly. Kids love it. They create their own tracking systems, like using the logo of their favorite football club to mark dry nights and the one of their archrival for wet ones. Others use their smartphones, and even start water intake journals. They quickly start noticing patterns and come up with their own explanations for what’s happening. They are learning to learn, a critical competency any good coach wants to transfer to their client.
A success case: This child stopped wetting their bed after just one consult. Sometimes, having a sincere conversation and helping kids understand why it’s happening and what they can do about it is enough to motivate them to change their behavior.
This story reminded me of what my mentor and expert agile coach Len Lagestee once taught me: never touch the work of the team you are coaching. Give them tools, frameworks, encouragement, but hands off their slides, prototypes, etc. In my pre-agile days, I used to focus on getting the team “there” as fast as possible. I avoided tangents at all costs. And if a helping hand would move things along, then so be it. But when I decided to surrender to the wisdom of a team’s own process, magic happened. Tangents became rainbows leading to learning and innovation treasures. That simple principle of not touching a team’s work brought to life one of my favorite coaching adages: I am your sherpa, but this is your mountain to climb.
4. Start simple, iterate over time.
Back when Helena was a PhD student and computers had floppy disk drives, she learned to code so that she could run statistical models for research. Maybe that’s where her talent for “debugging” comes from. In her treatment method, mom helps kids replace unhelpful habits with new ones that support their goals. First order of business is to ask a child to walk her through a typical day to uncover areas for intervention (a pediatrician’s version of user journey mapping.).
Helena: “What is the first thing you do in the morning?”
Patient: “I eat breakfast.”
Helena: “From now on, the first thing you’ll do is pee. Then eat breakfast.”
She meets them where they are by giving them a simple practice to start strengthening bladder self-control. As this habit sinks in, she releases version 1.1: now pee at least 5 times per day. And so on. (Early and continuous delivery! Yes!)
5. Celebrate progress, not victory
Every week, parents are supposed to reward kids for progress made. As soon as they start seeing positive results, many parents think they’re done and stop rewarding. “This is a big no-no”, mom explains, and shares stories of kids complaining to her that their parents are not playing by the rules.
I smile as I remember a questions I frequently hear in organizational transformation: how long do we need to keep rewarding people for just doing their job?! Here’s how my mother knows her job is done: when kids forget to take their pills and the next day they wake up to a dry bed. That’s when the new way is in their DNA. And the kids are smiling, victorious.
My pediatrician mother opened my eyes to the fact that coaching is not a profession. It’s a human skill. All of us, in some way or at some point in our lives, need to help a fellow human get unstuck and emerge stronger. It’s a hard job, but there is really just one thing you need to do. As Helena summed up nicely, “you just have to engage the kids”. I couldn’t have said it better.
What is your secret sauce for coaching others? Is there something that comes naturally to you that helps bring others closer to their best self? Please share in the comments, I’d love to learn about it!
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