Health Partners Fellowship Program

Gaining Power by Giving it Away
An interview with W. Donald Weston, M.D.

Vice Chancellor of Health Sciences
The University System of West Virginia

Dr. Don Weston talks easily about a great many things, but his leadership is not one of them. "It is awkward for me to talk about leadership," says the man who manages an innovative initiative that is changing rural health care and medical education in West Virginia. "It's easier to talk about what I do," he explains.

"I operate from a perspective -- a belief, a feeling -- that the more I can understand where other people are coming from and what they value, the more I can trust them and they can feel comfortable with me. In essence, the more we mutually trust each other, the more we really understand each other -- that is the key to making things happen."

In a conversation with Weston, other people -- their ideas, decisions, and issues -- surface often. Despite his obvious position of influence in an academic system, Weston is quick to point out his limitations and the important role community voices play in educating health professionals in West Virginia. "I acknowledge that in certain things, I have more power than community members do," Weston agrees. "But they have power, too. There are things I cannot accomplish in the community realm or anywhere outside my organization. And as ideas move toward policy, they are shaped by hearing people out -- by listening.

"You can't worry about staying in control, about being in charge, having your way," says Weston. "With that approach, you can temporarily have your way, but it won't be sustained."

In a culture that traditionally defines leadership as the man on the white horse, the loner who sets things right, or the individual with a plan and the grit to stick to it, Don Weston's take on leadership is an anomaly. Yet his focus on trust and putting power in others' hands is characteristic of his approach. "Power may be the wrong word," he suggests. "I prefer 'sharing perceived position.' Because when we operate at a different level of trust, collectively we have the force to make things change."

Placing Power in Other Hands
Since Don Weston arrived in West Virginia, health professions education statewide has changed significantly. Today, all West Virginia health care students work and learn in rural West Virginia where care is most needed. In 1997, more than 59,000 West Virginians received services through the Rural Health Education Partnerships. But this shift represents a series of evolving relationships and new partnerships that took power from some and placed it in the hands of others, Weston explains.

"The legislature said, 'This is the way we're going to go.' They defined the direction for health professions education. Within one year, we had students learning in rural settings. They were out there. If we'd waited for the perfect plan, we'd still be waiting," he says.

"Historically most decisions concerning educating health professions students were determined solely by academic institutions. Now we have 13 rural consortiums run by independent boards and 180 community sites where West Virginia health sciences students spend a minimum of three months."

Although some in health professions education would resist being pushed by such a directive, Weston had a different reaction. "I accept the premise that professional schools have a moral obligation to be responsible to the needs of people. Lots of money is invested in health sciences in West Virginia. We have three medical schools in our state. But there has been a great deal of frustration because of our poor health statistics.

"My approach has been to acknowledge the frustrations, not to react defensively. I see demands on our system as an opportunity. In my view, the community has every right in the world to expect more from our institutions. They have every right to exercise their power. I have no problem with legislative systems saying: 'Here is an outcome you need to produce.' They don't tell us how to achieve it, but requiring us to work in that direction and report on our progress is OK with me."

Since 1992, Weston has worked with health sciences schools and communities to find the best way to educate developing health professionals and to increase access to needed health care in rural communities.

"West Virginia is a single system that includes institutions from all over the state, each with different identities and some autonomy in the way they work," he explains. "Part of my challenge was to get schools within our organization working together. Establishing community structures that shared power with academe — rural consortiums made up of community members and academic representatives — was an important part of the process. These policy-making structures handle decisions about the education of health sciences students traditionally determined by academic institutions alone."

The transition to a system guided in part by a series of consortiums has not been without its wrinkles, according to Weston. The groups have both the power and responsibility to make decisions, but they also face logistic problems and have differing perspectives on issues. "These groups share a variety of decision making, but they do not always agree," is Weston's matter-of-fact observation. "I see it as an interesting, multi-dimensional problem."

Valuing the Opinionated to
Forge Partnerships
Seeing "an interesting, multi-dimensional problem" in the midst of long-term system changes affecting six academic institutions and many hundreds of faculty and students working statewide is typical of Weston's low-key optimism. As he readily admits, "I enjoy the challenge of chaotic situations." His optimistic approach to challenging situations appears to apply to people as well. States Weston:

"Very few people want to be bad. Most people get up in the morning wanting to do good. I believe that people will make things better if you give them the opportunity. But you need to take them seriously and listen to what they are saying. We all come with ideas.

"Sometimes you hear people in academe say, 'I can't make the legislature understand,' or 'I can't make the community understand.' But I think they do understand, and they don't agree with you. Accepting that they understand and then listening to their ideas is how we become partners," he says.

That is why Weston says he values the involvement of opinionated people. "It's terrible to be afraid of the person who dissents and disagrees," he explains. "If we're all being honest, we cannot always agree. If I have a person in a workgroup who tends to identify issues, I'll say, 'I want you to serve on this committee because I know you will speak up.'"

"We gain the ability to make things happen the more we equally respect other viewpoints," Weston believes. "That is the nature of trust. If the vote is 5-4, nobody wins. You need at least 80 percent agreement, I think. Everybody may not agree, but most do."

Summing up his role at the University System of West Virginia and elsewhere, Weston puts the emphasis on others' contributions and minimizes his own.

"I look at myself as a change agent," he says. "Whatever allows people to put you in a leadership role, building trust and understanding are the most important features of the relationship. If we have a common understanding, we can make a system better."