Lastly, imagine that last shift of your career. When you walk out of the ambulance bay for the final time, what is it that people felt working with you? Perhaps they remember how you treasured community, coordinating ED fishbowl baby showers or buying Tuesday pizza and paging overhead, “Attention, stat gastric resuscitation in break room.” Or perhaps they remember you for unwavering duty — during the height of the COVID-19 pandemic, you stayed hours after your shift in powered air-purifying respirators to cover for a COVID-afflicted colleague.

Select or create those three to five core values that speak to you from reflection.

Evoke a “Totem”

Create a tangible representation — or “totem” — that embodies your core values. You could define it further, as if from a dictionary. For example, a totem for candor can be defined by, “I speak my truth clearly and directly, with respect and integrity.” Another totem may be a personal statement or essay as suggested by Burnett and Evans or Covey. Others may find their totem in creative outlets as an artistic piece, imagery, lines of poetry, mantras, or musical lyrics that capture the essence of their core values.⁵ Some of us may already do this in part without knowing it. Clothing choices, as is shoe choice on shift, may be a totem of your underlying values — running shoes, clogs, or riding boots.

The totem is a grounding element. It is not just a starting point for executing behaviors, but also an endpoint to come to when situations become difficult. Thus, deliberately creating a totem that is memorable and simple for you allows easy accessibility. When we are faced with particularly challenging situations, evoking this totem can remind us of what is important to us.

Execute with Intention

Sustain and develop behaviors that align with those values. In Dare to Lead, Brown describes “operationalizing” values into discrete behaviors for which we are held accountable.² For example, behavioral execution of the inclusion for an ED or educational leader could manifest as:

1. Providing space for follow-up and input after a meeting,
2. Calling out those that are interrupting others, and
3. Asking specific people for their valuable input that may not be shared otherwise.
4. Leveraging heuristics to engrain value-based behaviors can be empowering. Building heuristics as, “For every patient with an upper extremity injury, I ask about hand dominance and occupation,” or “Every patient with falls, I ask about their living situation and mobility,” or “For every parent, I ask if they need a school/daycare note,” may “automate” an underlying value of understanding. An interval feedback mechanism could be internal or external, such as checking in with oneself or a trusted peer on a weekly basis to see if those value-driven behaviors are executed.

In Atomic Habits, Clear describes fostering an environment (“Make it Easy”) conducive for desired behaviors.⁴ That environment can be as concrete as your ED workstation to the patients or colleagues. Perhaps you have your Dragon PowerMic Command of “Open Websites” to auto-open UpToDate or OpenEvidence to foster curiosity when a clinical question comes up. Or you create a gratitude form or template for deserving colleagues that takes only a minute and a few clicks to fill out. Or you simply schedule monthly coffee or walks with a peer whose values align with yours. Make the environment work for your values.