It was truth and transparency that first attracted the Iranian-born, Harvard-trained physician and healthcare management expert Dr. Khashayar Rafat Zand to the field of radiology. It’s that openness that is pushing “Dr. Khashy” to help move a struggling healthcare system forward with a series of discussions and writings that he calls Uniting Inquiry — a structured approach to healthcare problem-solving through the mutual exploration of shared humanities.
A Harvard Law School Master-Class scholar trained in conflict management and negotiation, Dr. Khashy leverages experience, empiricism and inquisitiveness to encourage conversations that bring people closer together. Collaboration, community and unity are the key to overcoming oppositional relationships that stand in the way of innovation – it requires a catalytic mindset, he explains, while acknowledging one person alone cannot force systemic reform.
Dr. Khashy wears many hats: Chief of Radiology at Lakeshore General Hospital; Director of MRI Value and Quality for the McGill University Department of Radiology (MUHC); Associate Professor in Radiology at the University of Massachusetts; founder and Medical Director of his own clinic, the Institute for Specialized Medicine and Intervention (ISMI) in the Montreal suburb of Kirkland.
The outspoken radiologist explains his three pillars for achieving organizational growth in healthcare, and how encouraging inquiring minds can open doors to understanding and ultimately action.
The Uniting Inquiry principle is a combination of three methods: Socratic Inquiry, Humble Inquiry and Appreciative Inquiry. The first emphasizing science and best practices; the second, questioning over confrontation; and the third, the engagement of all possible stakeholders.
“Socratic Inquiry requires a collaborative conversation,” explained Dr. Khashy. “If there’s conflict, that’s not a good place to start. The goal is asking questions until you reach the truth — a truth that can be agreed upon by all stakeholders involved. And in doing so, you expose contradictions. And that leads to a constant search for the truth in a very systematic way.”
But in this paradigm, truth is not the goal but rather a means to an end: bringing people closer together to push past our differences and focus on what matters most. In this case, the healthcare system itself.
This first challenge is daunting at the national level as Canada’s healthcare system is in reality at least 13 distinct regional systems, each often with dozens of local networks and hundreds of institutions under its jurisdiction. The first objective: to make local networks within provinces more seamlessly connected, sharing resources, data and best practices.
Dr. Khashy’s vision of Uniting Inquiry challenges healthcare practitioners to accept a fundamental truth: doctors don’t know everything.
Having the confidence to say “I don’t know” opens up the possibility of community and shared learning in healthcare management. Especially in times of crisis, multi-institution healthcare communities can come together to reveal powerful new insights and balance increasingly thin resources.
The method of Humble Inquiry, so important to building medical communities in particular, gets its name from the book by author Edgar Schein, subtitled “The Gentle Art of Asking Instead of Telling”. Schein defines Humble Inquiry as, “the fine art of drawing someone out, of asking questions to which you do not know the answer, of building a relationship based on curiosity and interest in the other person.”
Dr. Khashy says it’s about drilling deep to mine shared values and create the most optimal conditions for mutual understanding and cooperation.
“It uses a methodology that requires the inquirer to make themself vulnerable in order to gain trust. This allows the conversation and the relationship to proceed because it acknowledges that without trust, words and conversation ring hollow.”
In order to achieve unity in an eventual network of Canadian healthcare institutions, Dr. Khashy looks to Appreciative Inquiry as the last piece of the puzzle. Managers in particular would be wise to adopt this inquiry-based strategy for identifying strengths in any environment.
“It’s not deficit-based, e.g. we don’t have this so we don’t do this,” he explained. “In fact, it’s completely the opposite.”
In his experience, Appreciative Inquiry is one of the strongest and most effective tools for affecting organizational change. Sometimes difficult to implement, it requires training, patience and mindfulness to transform consensus into collective action.
“You can appreciate someone if you hate them,” said Dr. Khashy. “This pillar incorporates aspects of wholesome thinking, which is the essence of Appreciative Inquiry: a change management tool that asks, what is working well? Then you analyze why it’s working well and how that can be duplicated across any number of platforms.”
It also considers basics in behavioural psychology, notably positive reinforcement which is seen to have a productive effect on most workforces.
The real beauty of Uniting Inquiry, concludes Dr. Khashy, is how there is no right or wrong way to solve the problem so long as you remain focused on results; “there is no change without collaboration; no collaboration without community, and no community without unity.”
With collaboration, humility and a framework for sharing information, all the ingredients will be in place to create a truly national healthcare community.
“You may use Socratic Inquiry and end up divided,” said Dr. Khashy. “So ask yourself, is it the method that matters, or is it or is it the outcome? Is it the path or the destination? In this case, the path is three methods of inquiry. When we say ‘don’t miss the forest for the trees,’ think of the forest as healthcare and the trees as positive dialogue — when you bring people closer, the rest has a way of falling into place.”