How to Adapt to Change

SUMMARY

How do you stay relevant in a world of continuous change and uncertainty? Although everyone reacts to change differently, those who achieve success have particular mindsets, adaptability skills and attitudes. Our guest Arlene Gotera has been in many changes throughout her career. She has gone from practicing as pediatrician to nurse to case manager, then to holding leadership positions in health care management. She has also been adapting to different cultures as a Filipina in the US and in Saudi Arabia. Her experiences in adapting to change include:
1. For any big change, do a SWOT analysis (strengths-weaknesses-opportunities-threats).

2. Step back to leap forward.

3. Have a goal in mind and stick to the plan. Be guided by your mission and purpose.

4. Don't expect people to adjust to you, adjust to the situation.

5. Let go of titles. Don't get stuck to the titles. Any profession as long as it is a decent and honorable profession is worth doing.

6. Get out of your comfort zone, it might just be making you resistant to change.

7. Deny yourself in little sacrifices every day and you will build your stamina to face any change of circumstance.

8. Focus on the positives and see on you can mitigate the negatives.

9. Be humble to accept that not everything is in your control.

INSPIRATIONAL QUOTES

TRANSCRIPT

[Please note that the first the intro from the end of the countdown to around 16:00 has the noise of my electric fan as I had forgotten to turn on Krisp which is the noise cancelling app that I use in my live streams.)

Avic: How was the change from being a doctor to a nurse?
Arlene: It took a lot  of courage and humility and a lot of analysis. You have to adapt to whatever circumstances you have at the moment. At that time the economy when I finished residency training in 1997 was really in a slump. My husband worked in the  stock market and so we really took a hit. It wasn't the best years for the Philippine economy. Security-wise, there were a lot of kidnappings. There were things happening. My friend who was a physician also at that time almost got  kidnapped and the physician of the clinic next to him got kidnapped and we had friends who had been held up randomly and shot up just at a traffic light. So there was too much happening at that time and I had kids. We had six kids already. Maybe with a smaller family it would have been okay but my family was growing faster than our finances, I have to be honest.

One day one of my friends who actually shared the clinic with me said she was going to university as she would enroll in nursing. I said what's that? They have this program for physicians to become nurses. But the class was already full she said so I said okay and I'd like to find out more  about it because I’m open to any offers. I was doing my own analysis so I went with her and when we were there somebody backed out so there was one slot open. I called my husband and said do you think this is a good idea, I’ve been thinking about it and I said there could be no harm. So I enrolled.

It was I think a miracle because it might have been a sign that of all the days that I would have bumped into her that was the day and there was no opening and all of a sudden there's the slot. I said I've been praying about answers because anytime I have to make a big change I have to sit down, bring it into prayer, think about it, and then do a strength-weakness-opportunity-threat analysis so at that time I said this is an opportunity. Then there is this course which was not going to be open for forever I had to jump the gun, just take the opportunity while it's there. If it's not I can just back out. Fortunately it worked out. The year I left the Philippines was 2006.

Avic: When you left the Philippines, had you finished nursing?

Arlene: I finished nursing, I did my research, I got in touch with the agency and through it all I had my goals in mind. So even when talking to the agency where I wanted to go which state, know what kind of working situation I'm amenable to. But like I said it was the first time for me to take a sign, from getting married this is the next big step. Yeah it's a total pain just like a turnaround, I had to step back to leap forward.  At that time I thought I might be stepping back. I'm a doctor now I'm becoming a nurse, where am I going to? I didn't have the framework. That was the hardest change I think because the changes after that I had the formula already on what to do when this thing happened. Then it's smoother. It's not easy but it's smoother. It was the biggest move because I was used to giving orders and now I am taking orders. And when I see and I feel that this order doesn't seem right it feels like you really have to hold to the goal in mind and you have to stick to that plan. Don't expect people to adjust to you, you have to adjust to the situation.

Avic: As you said, that's really already the biggest change after getting married, and starting a family.

Arlene: Yes, because I was moving, changing careers and changing countries.  I went to the US having six children in tow. It was a big decision, we did research of course before we did. We found out the cost of living. My mother in law was with us so she helped us. It was hard because I worked night shift. By then I was the only one working. It took six months for my husband to find a job so I worked night shift and overnight. The thing about change is you have to believe that you need to make that change. What is your mission, what is your purpose of making that change. The all your decisions after that would be based on that one. And every time you get confused you have to look back and ask why am I making this change. what must I do I have to re-assess my situation?

Avic: Tell us about the formula.

Arlene: We do a lot of research as the pre-work for the change. You can apply the principles of change management like what we do in business. Have an assessment. You have your mission, your purpose. You look at the means on how to get to that. And now when you've  weighed the pros and cons and decided on what you want to do then you have to go through the stages of change management, so to speak.

1. You have to unfreeze. That means you have to communicate to everybody what change is going to be done. So that involves your friends, your family, employers. And you set whatever needs to be ready before you make the move.
2. Then you make the move and you adjust to whatever is an unknown situation. You have to keep your eyes for opportunities and threats and see how can I use my strengths to go to pursue that opportunity and to minimize the threats. And then while you are at this moving stage you're constantly looking around and reassessing and seeing if this is working or not and then after that if you find what's working for you then you stick to that plan.
3. Then you freeze it. That's the third step of change management. You freeze whatever is working and then even after you freeze of course if circumstances will change you have to learn how to readjust as long as possible. If you know what your goal is then even if it changes you will just change how you approach things and then get to the same goal.

Avic: How do you face being open to new changes and setting new goals in your life?

Arlene: You have to let go of titles, you have to accept that any profession for as long as it’s a decent and honorable profession, it is worth doing. Don't get stuck to all the titles. If it’s like I'm a doctor I shouldn't be doing this or that, then you're being a slave to your title. You have respect from the janitor to the CEO. Each person has its own dignity. If you don't believe that every person has the same dignity whatever your title is then you will have a hard time changing from one title to the next, from one role to another  because you're stuck with that role. And you have to be ready to get out of your comfort zone. Anytime there's a change, people  are resistant to change. It's because it's going to take them out of their comfort zone so you have to be ready to get out of your comfort zone  and how do you do that? Through little things of every day. If you know how to deny yourself of little things every day then it builds up that stamina that a time will come circumstances will change and not everything will be in your favor. How do you face that if you have not built that stamina of taking things that you don't like. So make little sacrifices each day so you don't get  blasted when something bad happens. It's like you're already built up the muscle to face that.

Avic: You seem like a superwoman, you know it can overwhelm people. Wow really, you have to do everything! Can you tell us how did you rest? How do you rest?

Arlene: I spent time each day to sit down and meditate a little time with just silence and thinking about things that I have to do. It's hard not to worry because I'm a worrier too, because I want to plan ahead. I'm the type a personality I have to  admit things have to be planned. Things have to be in place but that doesn't always happen so you have to set time away from everything every day even just a few minutes be it you want to pray, you want to meditate, do something, be alone, go outside, take a walk. It’s a breather - whatever makes you breathe. And then you look back at things objectively because sometimes when we put emotions in it it’s hard. You have to learn to separate the emotion and once the emotion is out of the picture, you can think of it more objectively. It's a hard thing to do. I have a hard time taking emotion out of things. I think my husband's better at that than me. But it's it is a struggle and if you have that mindset that this is your goal, always look at your purpose. If you have a purpose everywhere you move you will be motivated.  

When I moved to Saudi Arabia and I'm like oh I can't even drive here (at that time now women can drive there but at that time) I'm so used to just jumping in the car go wherever I want, I don't have to wait for anything and then now I'm like okay now I have to call a cab or wait for my husband.  So it's a totally different culture than like I mean moving from the Philippines to the US it's more or less similar. I mean there are minor differences. Practically everything from education and everything else we do what's in the US. It's similar.

Avic:  Tell us a little bit about that shift, that change that you did again from the US moving to Saudi Arabia. What were your considerations for that other major change?

Arlene: Economics because my husband had a hard time. In the Philippines, he was like at the peak of his career, getting interviews for news channels for his opinion on stocks. He was doing research for the stock market. And then coming here it's hard for people in finance when you don't  have the network and you were not educated here. So it would be harder for him to find a career path that's his level as well. He got the opportunity to work in Saudi  Arabia and it was a lot economically, a lot more attractive than the package that he was  getting here. And at that time there was  a recession in the US too, so he was  the last in, first out kind of thing. Then this opportunity meant an advancement in career. It was a big difference in pace and the opportunities  for him was very good.

We tried it out for two years. He  was on bachelor status that means he was going  back and forth, maybe three times four times  a year to the US and I go there maybe once  a year. We tried it for two years and said this is not going to work for the family. I mean it's a temporary solution  just to get things ready. So we moved to Saudi Arabia.

Avic: Were you prepared for your career to move  to Saudi even if it really was for your husband's career?

Arlene: You have to work as a team when you're married.  You could do whatever you want but  when you're married you work as a team. So when I said okay now I'm not going  to be working I mean I can work as a physician  there but I have to go back to the Philippines  for a year to have my experience updated.I can't do that really because I have to  stay in Saudi Arabia six months in a year  for family status, to get the benefits  for the family with my husband's job. So I said okay we made everything. It was still  a plus to go there so we all went kids in tow  

I wasn't working for I think three years.  I didn't work full-time. I was working part- going back and forth the US and Saudi Arabia  just to keep my license up and my experience up.  But it was really culture  there that was a sort of a shock  because at that time it was totally different. It feel like you're not  part of that country but as years go by and with  the progression of things in Saudi Arabia  I actually miss my friends from  there, the relationships I developed. At  first I was very negative, don't get me wrong, it  wasn't all a pleasant experience at the start but  as I said it needs to be done so when you're in that  situation in anything in life there's a positive and a negative, pros and  cons. Why focus on the negative  things? Focus on the positives because there  are positives the culture: there it’s very family  oriented. When people need to get out of work for a family reason even like a PTA parent-teacher  meeting for the kids it's not a problem it's  like they force you. They even tell my  husband it's a parent meeting you have to go you don't need to be in the office kind of thing. And the people there are warm. At first I was  I was saying oh people here are cold. They think all Filipinas are maids and I said nothing bad about being a maid. It's just that they will cut you in line. 

That was my first exposure there but as time went by and I knew more people and I kept my eyes  open I said yeah there's a lot of nice people here. And the people I've worked with are one of the  nicest people too. And the community spirit there- I've never had that community spirit anywhere  else I've lived where you know your  neighbors, your kids play together. We lived in an expat compound. The kids can go around and you feel safe, you don't feel scared like oh if  they don't go home at this time where are they,  what happened. No. They go out with their friends, they ride their bikes, they play sports and it's all contained in that community. Before when I first came there I felt like I am  trapped in this community. I can't go out. Then as I reached out, I think that's the key you don't wait for people to reach out to you.  

You reach out to people and then you find out oh  they're just waiting for people to reach out to them as well. And before you know it you have  your own group, you know a lot of people you have  a lot of activities. And it gave me the one thing I  really cherish most. It gave me the chance to help  less fortunate people while I was there because I had the time, I had the resources and I had a group of friends who were doing  the same thing.

Avic: Tell me more about that. What do you mean by community  work? How did you help less fortunate people?

Arlene:  At that time there were helpers who are mistreated. Don't get me wrong, not all not all  employers there for the maids are bad. A lot of them are good but the thing is  the bad ones are the ones that get to the tabloids. So those people we hooked up with the  the Philippine embassy  representative. We gather stuff for them. If there's people who need a safe place and they  need supplies we give them supplies and we try to  raise funds. If they need a plane ticket  home we get them a plane ticket home. And during the Covid I would say it  wasn't the best because some of the laborers didn't get their pay so they  needed food. Some of them were  thrown out of their employers because they tested  positive for Covid so we had to gather funds to  buy food for them and give it to them like on  a regular basis when they didn't get their pay.

I was gloomy  at first that's because all my friends are there so now I have to make new friends. But that's what I mean by you have to  step back and look at this situation and look  at your opportunities and threats. And I said  there's a very big opportunity to help. I mean I  was in the health field because I wanted to help  people so I said I may not be working now in the  health field but I am still fulfilling my purpose. I can still help I'm not useless. So always find that mission moment.

Avic: Yeah and it has never changed for you. It's  really giving yourself as a mother, as a neighbor, as a daughter of  God. In Saudi after how many months of adjustment did you get?

Arlene: The first six months of adjustment was the toughest because I didn't know anybody there and I wasn't working. I had to build a network connection. Going back and forth to the US was three years until I got a full-time job in Saudi Arabia in 2015 because being an expat wife it's  hard to get a work. Technically I'm  a dependent and it goes to a separate bucket  of work visas. It's easier for somebody there to be hired from outside than be hired as  a dependent of my husband. We can't  work for the same company. The only time I got a break was when  the hospital became a joint venture  with the hospital here in the US so that opened  up visas. I was able to work but I was doing  volunteer work at that hospital prior to that. So any change like I said you have to plan ahead:  what do you need to do ahead, what can you do ahead because you can't always do things ahead but you  have to look for what you can do to get to your goal.

Avic: And then afterwards, did you specialize  in case management? 

Arlene: I was in case management here in the US. When  I moved to Saudi Arabia case management was  just starting there so I took it as an  opportunity. I said I have experience to share  that nobody else had and I was certified and I was  the only one certified so it gave me a chance to  train people to share what I know and to give them an overview of what it should be.  I've been like a change agent everywhere  I go.  It’s like  okay what can I do and and my mindset is like that. Every time I'm in a new place it's like okay this  looks good I absorb what's there. I'm not there  to change everything but what can I do to make  things better? My goal is always to leave  things better than how I found them objectively  or subjectively. It's the feedback from the  team- we've never had like this, I'm glad  you came along. So that that gives fulfillment and it's like you know I don't have to be a  doctor or whatever title. If you care about  people and improving people and you get there,  that's my reward if somebody becomes better than I  am. That would be the most relief of the  fulfillment that I get from that work.

I've  trained one of my colleagues in Saudi Arabia on  case management. He was the most negative person  in that group. Anything you say anything that's new anything, that deals with change, he didn't like. It's like you run against the wall every  time that there's a change because that means  it makes people unsettled when there's change  and that's a normal reaction. But as I broke the  wall brick by brick he's now leading what I left  there so that for me is the greatest reward of my  work there. It's like you know these people are  going to be better than me I just need to train  them the right way.

Avic: Tell me more about breaking  that wall with this very negative man.

Arlene: You have to be  a friend, you have to gain their trust first  because in that culture he's a man  I'm a woman. It's a woman telling him what to do. That's a first cultural wall right there. It’s hard for some people there to take  orders from women, it's a cultural thing. And two  I was the newest person in that group and then I  have all these ideas that you know it's like we've  been doing this for two years now and it seems to  be working why are you making changes. Aand you're only new so that's the other wall. And I  learned a lesson there you know when you're new  in a place keep your mouth shut, let them talk, let them bring out their ideas and then in the  end you bring yours and that would be a better  way to break a wall because if you come out with  new ideas at the start people will be shocked.  Later I learned okay, it's part  of change management, you don't shock the system  with the changes. You have to initiate changes  slowly. so I became his friend I made sure  that he knows that I'm there for him, that if he  has questions I'm just there to answer questions. I'm not there to force my opinion on him because  it's like you have to care and that relationship develops with time to show  people that you care not just because of the job  but because you care for them as a person. And once you are at that level it's easier  to bring in new ideas because now you have their  trust. Without that trust it's hard to initiate.

Avic: It must be very difficult because  you are as you said a type A personality.

Arlene:Yes and they were very relaxed. It's like you know  we work seven to four. Before  seven I'm there already. By seven I'm starting  to work, I don't dilly dolly around chit chat. I just work and then take a break and then work  again and then I leave. If something's hanging and it's past four I stay behind to make sure that  thing for that day is done. I don't want it to be  there tomorrow. And that the work ethic  is different. I came from the US where everything  is okay do this do that, everything has to be fast  and then there they're more laid  back. I said this is too laid back. And I was saying there's something good too  in being laid back they probably live happier lives because they know how to step back.

And one  thing I admire about this very negative person   he's Muslim  he never misses his prayer time and he would take some other people from the  hospital with him to the mosque in the  hospital. With that discipline I said that's a positive thing he has. If he has that  discipline with his prayer life he can do the same and be disciplined as long  as you give him a purpose on why things  should be done this way. And that worked  because it's like okay at least he has that, he has the drive. I just have to redirect that  drive because I already know he has good habits.  He just doesn't believe that this thing has to  be done that's why he's not working on it.

Avic: So it's  more intellectual actually he really has to understand case management but he has personal  discipline personal piety yeah he's a good person.

Arlene: He's a good person that's why I was wondering why is he very negative   so I had to really analyze and step back and  say maybe I'm doing changes too fast. Maybe but yes I have to start with  myself and see what can do. Remember I am the new person there, I'm  not there to dictate things I just need to change the approach. And  I realized okay I made a mistake in my approach  I will approach it this other way so it's a  trial and error because it's a totally different  culture that I've never dealt with. It's like  even talking to men I look eye to eye. When  I talk to patients’ relatives I can sense  that they're uncomfortable and sometimes they get  shocked. Who’s this  Filipina? Filipinas are usually subservient and they usually just follow  orders, and here comes me and they're shocked. It's like being educated in a  different culture I just don't take  orders and I just I can't just keep quiet. If I have to talk to you I have  to look in your eye because that's how I was taught to talk. It was funny at the same time and then I didn't realize it until I really reflected on why did he seem shocked. I have to look back- this is not their culture. I said okay, next time I'll be more gentler and if  I see they're uncomfortable I have to do this, I am in a new place, this is their culture, I am not here to change  their country. You have to respect their beliefs  and their culture so that they respect yours.

Avic: Yeah but it seems to me that from the time that you became  a nurse you seem to really be a follower, you should not be as a doctor because now you're a nurse  and then this time in another country  you should not appear like you're  much more better than the men. It's quite a tough for me I mean your career history must have been tough.

Arlene: You have to have an open mind. It was tough I  wouldn't say it's easy but you have to have an  open mind and say what am I really here  for. Am I just stuck with my title? When I moved  there that was the toughest one too, it's like I've never been  a full-time housewife ever since I had kids. This is the first time I'm going to be a full-time housewife. At first I was like oh no I'm a housewife,  I'm just going to be one of those ladies in those reality shows who just  gossip all day. And I said no I have to take  hold of my thoughts. That's a good thing I've attended some of  our sessions in the Philippines on how great it is  to be a housewife, how noble it is to be one. And  I have to attest that it's one of the hardest hats  that I've worn. I'd rather be working than be a housewife full-time. It's so much harder. And if you don't have a system in  place you'll just get lost in all the chores, all the things that you  see. When you're working you don't see as much  because you go out half a half of the  day. If you're in the home the full time you  see every little things and you want to  fix every little detail. I have to hold my hand and stop my hand from saying okay you  need to stop because now if your work is at home  there's no end to it so you have to put your own  limits to your schedule and give yourself a break  time too. People get break times in the office you  should do it at home or else you go crazy. So that was something too. There was a lot of things and a lot of it  you have to have faith that whatever happens  somebody up there a Supreme Being has your back  or otherwise you'll be afraid to move. And when  you afraid to move and you're afraid to fail you  get nowhere. It's better if you fail. That's  fine you just get up but then not to move for me  that would be a failure, not to move and just  sit there and watch things happen.

Avic: Well actually  I cannot imagine you, being a Type A personality  not moving at all. Really somehow the personality,  that temperament really has helped you through  all of these tough changes in your life. And of course as you said faith in God and all of those  lessons that you have been imparting to us. One of the viewers Josephine Co is saying  that this is really very educational you  you've been helping us with a lot of your  wisdom but can you also tell us a little bit about  case management. Very briefly what is that?

Arlene:  Case management is a field in nursing  that specializes in care coordination  transitions. There's four aspects to it, you do  care coordination that means you deal with the  transition of the patient to the whole continuum  of care from inpatient to outpatient to post-acute  services like home health, nursing homes, assisted living, long-term care. You do your assessment,  you do your care planning, you talk with the  team to make up a plan for the patient. It's  utilization management, utilization review,  care coordination, and discharge planning.  With utilization review it's a lot of making sure that the patients, those heads  in those beds in the hospital should be there  otherwise should they should be transitioned to a lower level of care. So it's good for the patient  because you place them at the place where they should  be. Should they be in the hospital? Should they be  at home with home health. The hospital is not always the best place for the patient. You can  get hospital-acquired infections the longer you  stay there and it's a high cost. The highest cost in healthcare is the inpatient so especially in the Philippines where where  most people pay out of pocket their own self pay. It's nice to have somebody guide the patient and  say you don't have to be in the hospital for all these 14 days of antibiotics, some of them you can  do at home. So it saves them money, it saves the  resources too like hospital beds especially with  covid hospital beds which gets scarce. So you want to make sure the people who really  need to be in the hospital are in the hospital  and those who can be treated outside are treated  outside. And then you juggle the quality and the  cost and the benefit to the patient all in all.  So in in a nutshell it's being a patient advocate.

Avic: It would  seem also to me like always a step back  because somehow the patient can be seen by several  doctors. And who is really taking care of the whole? Who's getting the entire perspective for the sake of the patient.

Arlene: Yes and the case manager is the one who brings everybody  together- your physicians, all your physicians, your  specialties, your physical therapists, if you need  one your dietician, everybody that's involved  in the care of the patient. The case manager should  be able to coordinate all of them so that there's  one plan because sometimes what happens is this  physician has a plan, the specialist has a plan, the sub specialist has a plan. Somebody has  to make sure everything is on the same page  so that the patient can progress  more efficiently and safely to home.

Avic: Now are you back in the US but still with the same  specialization?

Arlene: Yes but now from a leadership  perspective.

Avic: How do you see your career from here? Are there major changes coming?

Arlene:  I'm always open to changes and now I'm  like okay I think I want to be what I what  you know being at the forefront. I've been at the bedside I've been a physician a nurse  at the bedside. At a certain point you  realize you can't change anything by  being at the bedside. This is what drove me to take my master’s degrees my MBA and masters in health care management. If I were to initiate change and make things better  I have to be part of the decision makers and  it's going to be tough because I'm like just tell me what I need to do and  I'll finish it. You know being in management  is totally different -it's not just work, you have to look beyond the person doing the work, how it's affecting their family life,  their development. If there's one thing  that irks me it’s when leaders don't  develop their people so that they can be  moved up, they can be better and move up too in the  ladder or be rewarded financially or at least me have a plan for each employee to help  themselves develop. Sometimes they don't even  see the opportunity unless you guide them and bring them to it. And that's one of  the biggest responsibilities I think  of being in leadership and management. Now you don't have to just worry about yourself  you have to worry about your people: are they on track in their personal development and  not just meeting your metrics because at the end  of the day they're people and they have families  and they have friends, they have a life to live too.

Avic: So you're getting towards career  development in leadership, the responsibility to develop the careers  of people under them. You can also think of  succession planning so that when people move up they develop. It’s really a very tough world again in terms  of leadership. And so we're getting  near the end of time and you have shared so much  of your wisdom but still I will ask you to leave  us with three major tips on how to adapt to change.

Arlene: This might sound like cliche but the first  one is be positive. Remember in anything there's pros and cons. In anything you have  to focus on the positive and then see how you can  mitigate the negatives. And you have to be  objective you have to have a plan in place and  you have to look at that your mission.  You have you need to have that in your head  so that if anything changes you stick by your guiding light. That's your compass. And be ready to come out of your comfort zone. No change is successful without sacrifices. The third one is be humble. Accept that not everything is in your control . You don't know everything and you don't know  everything that's going to happen and you  should be open to suggestions and hear what other  people have to say. Keep an open mind  but in all things be humble because you will make  mistakes and if you can't take mistakes  you're not going to move.

Avic:  That's really great!  Thank you very much, Arlene. Really we've known each  other for a long time but I always take live stream  as an opportunity to really get deeper into what  my friends are doing. We have shared so much  of all of your experiences and your learnings. It's really a big help. Don't worry because  if later on in the beginning I will see the sound of the electric fan will bother  the audience I'm encouraging everyone  to wait for the podcast version of this  interview and we will fix that beginning, okay? So have a good breakfast, Arlene. Thank you  very much.

Arlene: It's a pleasure, thank you.

Avic: I hope to see you  again here in the Philippines or wherever. I hope  we meet again in person.

Arlene: I'm planning to be there  in October

Avic: Oh great let me know.