Before getting into the interview, I present another podcast by one of our physician colleagues.

First – A Podcast Review

This one is called The Happy Doc. Here is how the Happy Doc describes his mission: “The Happy Doc is about bringing joy to the work that you do. It’s about understanding how to work on personal and systemic levels to make lasting change in the lives of healing professionals. While the focus has been mainly on physicians, the principles we learn in our podcast, blog posts, reading materials, and group sessions, apply to nearly all professionals.” He goes on to say: “Our website brings inspirational, creative, and happy health professionals to you, get ready to learn how you can be a happy doctor too!”

Taylor Brana, D.O., produces the podcast. He is an intern, just starting his postgraduate education in Philadelphia.

He mostly publishes interviews. But sometimes he presents a shorter episode about his experiences as an intern, or snippets of information gathered from other sources.  I really enjoyed his conversation with Pamela Wible, the founder of Ideal Medical Care, and author of Physician Suicide Letters Answered(this is an affiliate link*).

His other guests are equally unique and inspirational. You can find his podcast by searching for The Happy Doc on the Apple Podcast App or Stitcher, or by going to his website at thehappydoc.com.

Before You Quit Medicine

I first met Bob Gleeson at an American Association for Physician Leadership meeting. He is an internist, author, physician executive and leadership coach. He has a unique experience in the corporate world, having worked for 27 years for Northwestern Mutual Life Insurance.

After leaving that role, he worked in preventive cardiology and hospital patient safety. He also published a book – Lipidology a Primer: The What, Why, and How of Better Lipid Management 2nd Edition (this is an affiliate link*).

Photo by Abigail Keenan on Unsplash

He is now focused on coaching and consulting through his company MD2Leader. His latest book. Effective Physician Leadership: The What, the Why, and the How, will be released in early 2018.

I believe coaching can be very helpful in developing our leadership skills, as I discussed in Unlock Leadership Through Coaching. Coaching is a good tool to enhance personal and professional development.

During the interview, Bob describes coaching sessions with physicians who are unhappy with clinical practice. He notes that most of the frustrations physicians experience come from working in dysfunctional, poorly designed systems. He describes questions we can ask ourselves to identify the root causes of, and potential solutions to, our frustrations. We can then avoid futile attempts to find that elusive perfect career. And rekindle the joy in our medical careers.

Questions to Ask Before You Quit Medicine

Here are some of the questions he recommends we ask ourselves, if we are unhappy in our current circumstances:

• Why am I here? What originally gave me joy and satisfaction?
• What is my current problem?
• Why has it shown up?
• What have I tried, so far, that has not worked to address this problem?
• How might I resolve the cause of my current frustrations?

We talk about some of the common attributes that physicians share. These traits often lead to a sense of hopelessness in these situations. We tend to be overly independent and self-reliant. We would be better served by seeking out help, by collaborating more. Our lack of collaboration, together with our need for perfection, can be very draining. This contributes to our desire to quit medicine.

He discusses how we can use mentors to help identify solutions to our problems. He also describes other questions that a coach might use to discover solutions to the problems causing these frustrations. Examples include:

• If money was not an issue, what would I do?
• If I were queen or king, what would I do to solve this problem?

Coaching Follow-up

Most coaching encounters end with a commitment to implement new ideas. These commitments are in writing, and will be followed-up at subsequent meetings. Accountability is a big part of the coaching experience. Then repeating this process over time results in gradual progress toward the resolution of our frustrations.

Bob has seen many examples of physicians, by creating solutions to practice frustrations, re-discovering the joy of practice:

• Developing a culture in which medical assistants, nurses and advanced practitioners are all functioning at the top of their license, leaving physicians to spend more time on direct patient care;
• Creating teams to improve patient flow and eliminate bottlenecks;
• Helping other teams within the organization solve their practice problems, taking on a leadership role in process and quality improvement.

Photo by Ben White on Unsplash

In Closing

At the end of our conversation, we spent a bit of time discussing Bob's soon-to-be-released book Effective Physician Leadership: The What, the Why and the How. As I explained during the interview, Bob provided an advance copy to me. And I really enjoyed reading it.

It addressed all of the important issues that physician leaders face, including a list of the essential skills of an effective leader and the common mistakes young leaders make. He provides practical advice about managing change, thinking strategically, leading process improvement, building strong teams, giving feedback and dozens of other important skills.

As soon as it is available for purchase, I will add a link to these notes and add it to my Resources Page.

Next Time

In my next podcast episode, I will describe How to Quietly Build Leadership Skills Serving a Nonprofit. Be sure to subscribe to the podcast on the Apple Podcast App and sign up for my newsletter so you don't miss it, using the form below.

[embed_popupally_pro popup_id=”3″]

Here is today's quote:

Please, join me next time on Physician Nonclinical Careers.

Here is a list of resources mentioned in this episode:

[table id=15 /]

If you liked today’s episode please tell your friends about it and SHARE it on Facebook, Twitter and LinkedIn.

Right click here and “Save As” to download this podcast episode to your computer.

[*Affiliate link: I make a small commission when you buy a product/book through my blog, but this does NOT affect the price that you pay. It will be exactly the same price as if you went to the web site directly to purchase the item. I only recommend products that I have used myself and can attest to their entertainment value, usefulness and/or quality.]

The post Answer These Questions Before You Quit Medicine – Interview with Dr. Robert Gleeson – 015 appeared first on NonClinical Physicians.

In an article for my blog a few months ago, what I wrote was perceived as critical of certain physician leaders. I linked to examples of their writing that were popular with physician readers. They pertained to issues that physicians find very intrusive, that promote burnout, and often interfere with the practice of medicine. 

In quoting their articles, I made it look like I was critical of their writing, rather than simply pointing out the popularity of such topics with their audiences. I received several critical comments from my readers.

After trying to defend myself, I finally came to the realization that I was wrong and needed to apologize to the authors of those articles. But I made a major blunder, forgetting the proper way to apologize that I previously described, or the way that Michael Hyatt recommends when admitting a mistake.

Here is what I wrote:

“…In closing, let me apologize if I somehow seemed critical of your efforts.”

Do you see the blunder? I should have written this:

“…In closing, let me apologize for being critical of your efforts.”

A reader pointed out my mistake, and further stated that an appropriate apology does not include the word “if” but simply accepts responsibility and asks for forgiveness.

I was clearly not communicating as a leader, because what a leader does is own up to a mistake, apologize, and make a commitment to fix things going forward. On the contrary, I was approaching it with a victim's mentality.

In writing this post, I started by writing about the difference between leaders and victims. But I feared that my intentions might be misinterpreted. I am not writing about true victims, who have been bullied, or harmed by their coworkers or mistreated by their supervisors.

No, I’m talking about our colleagues, associates and employees with the victim mentality. They may seek leadership positions based on seniority and want the recognition of being a director, vice president, or CEO. But, rather than thinking and acting like a true leader, they fall prey to the victim mentality.

Definition

The victim mentality can be described as the tendency to believe we're the victim of the negative actions of others, even in the absence of clear evidence to support such a belief. This tendency then colors how we think and behave.

It's a particularly destructive belief system because it prevents us from taking responsibility, or accepting even reasonable risks. This stunts personal growth and causes others to avoid engaging with us as teammates. Harboring a victim mentality is antithetical to becoming an effective leader.  Abandoning the victim mentality is vital to being successful as a leader.

However, when subtle, this mindset can be difficult to recognize.

So, I thought that would be useful to review the “tells” that reveal the victim mentality, and contrast them with the behaviors of the real leaders in our midst.

Why Bother?

Why should we learn to distinguish leaders from victims? There are several reasons:

1. Challenging problems are better solved by true leaders.
2. Organizations with good leaders are more successful and enduring.
3. Our own personal and professional growth is accelerated when working for great leaders.
4. Our teams will be more successful if we avoid hiring those with the victim mentality, because they need to be constantly supervised, their productivity is low, and they hurt morale.

On the other hand, a good leader will inspire and motivate employees, volunteers, and members of an organization.

I believe that physicians are natural leaders, but we sometimes fail, as I did, to demonstrate our leadership skills and attitudes.

Top Clues Reveal the Victim Mentality

Here are examples of words and deeds that expose this way of thinking.

A victim…

needs to be told what to do.

By following specific instructions, the victim avoids the possibility of being blamed for a poor outcome. They don’t want to improvise or be put in a position of finding a creative solution. A leader wants to be given a goal and left to decide on her own how to achieve it.

is quick to assign blame to others.

When a project falters, victims point out that they did what they were told to do, and someone else failed to deliver. Leaders strive for 100% accountability. They will support others to accomplish their parts in a project, while also completing theirs.

fails to seek help when struggling.

They can’t admit that they don’t have the knowledge or skills to accomplish their assignments. They blame someone else for giving them too much responsibility. Leaders admit their shortcomings and seek expert mentors and coaches to help them learn how to finish their tasks.

hates to be seen as a failure.

A victim avoids failing by taking little or no risk. Leaders understand that growth comes from taking on challenges and being uncomfortable. Consequently, leaders admit their mistakes, and welcome failures, as long as they lead to learning and eventual success.

complains more, and takes action less, than a leader.

Leaders will identify a problem, and whine about it briefly, but then dedicate themselves to identifying and enacting solutions. The victim identifies problems but offers no solutions.

is a downer to be around.

The victim is focused on how hopeless circumstances are. Pessimism and resignation are central to the victim mentality. Leaders are optimistic, hopeful and encouraging.

is motivated to achieve by the accolades they'll receive.

Leaders achieve because they find it fulfilling, and are interested in overcoming important challenges. The victim often reminds us of their accomplishments and constantly seeks affirmation.

projects their own weaknesses, shortcomings and insecurities onto others.

When a person with the victim mentality says “I know that they don’t respect me and they want me to fail,” it’s because they're projecting their own attitudes and thought patterns onto others. Leaders don’t spend much time thinking or talking about others' negative thoughts. They focus on getting results.

expresses feelings of entitlement.

Victims expect promotions due to seniority and “time served.” A leader wants to be judged based on performance and results.

is complacent about learning.

If his skills are lacking, someone else should help the victim out. A leader is committed to lifelong learning.

focuses on what’s wrong.

She dwells on the circumstances that are beyond her control. The leader acknowledges reality, but is focused on problems that can be controlled or influenced.

does not apologize sincerely.

They will use a statement such as: “I’m sorry if what I said…” A leader expresses a real apology and owns the mistake and its resolution.

Statements that reveal the victim mentality vs. leadership mentality:

Final Thoughts

I may have just scratched the surface with this list. But you get the idea.

Now listen carefully to the conversations around you, when interviewing a potential new hire, or sitting in a meeting. And watch the behaviors of others.

Are they expressing the leadership mentality, or do they reveal the victim mentality?

Do the questions on the left side of the table seem more comfortable to you? Or do you speak using the language on the right? Be honest with yourself. Do a little introspection. Have you used the language of the victim or the language of the leader more?

We all fall prey to feeling like victims at times. But the quicker we can catch ourselves and switch back into the leadership mode, the better for us and our organization.

[embed_popupally_pro popup_id=”3″]

Next Steps

Please add your thoughts and questions in the Comments.

Don't forget to SHARE this post.

Thanks for joining me.

Until next time.

The post Top Clues Reveal the Victim Mentality appeared first on NonClinical Physicians.

What Is Dyad Leadership?

As described in a 2015 Advisory Board Article, dyad leadership is “…a partnership where an administrative or nurse leader is paired with a physician leader, bringing together ‘the best of both worlds' of skills and expertise.” According to that report, the use of dyads in health care has become more common over the past decade.

The purported benefits of a leadership dyad include:

• Two leaders with complementary skills can be more effective than any one leader;
• The dyad ensures optimal use of each leader's time and effort; and,
• It improves engagement and reduces stress.

I don't agree with all of these assumptions. Yes, complimentary skills are useful. But there is an equal risk that two leaders attending the same meetings and duplicating their work could result in wasting valuable resources.

Enhanced engagement of physicians seems more likely. But whose stress level is going to be reduced when working on these high priority projects under the usual budgetary constraints and tight deadlines?

Leadership Dyads Would Have Been Useful When…

I can understand how dyads can be beneficial. I've witnessed major initiatives that could have used additional physician leadership at my hospital and others. Some of the more classic examples of projects that met physician resistance and often needed the help of a physician executive included projects such as:

Utilization management.

After DRG payments were instituted by CMS (then called the Health Care Financing Administration, or HCFA) it became clear that UM nurses alone were unable to fully engage physicians. Medical advisors were added to the mix. Many programs did not become truly effective until a high-level physician executive, such as a Vice President for Medical Affairs or Chief Medical Officer, was made administratively responsible for the UM Department.

Clinical documentation programs.

As it became clear that appropriate documentation and coding were essential to ensure that hospitals were reimbursed properly, cajoling physicians to follow documentation requirements produced little results. The next step was to hire medical advisors to intervene with and motivate their colleagues. But at many institutions, until an administrator such as the CMO became involved, medical staffs did not embrace the programs.

Hospitalist programs.

After the initial growth of “organic” hospitalist services (in the sense that they were developed by the physicians themselves), hospital leaders took notice of the increased efficiency and improved outcomes and decided to adopt the model. As they did so, intense resistance by the independent medical staff was often encountered. The hospital administrators then recruited physicians to serve as champions to help educate the medical staff and push the programs through.

Sometimes a “dyad leadership team” of a nursing executive and a respected physician (often the newly appointed medical director) was created to promote the initiative. At many facilities, unless a physician COO or CMO was involved, the hospital-driven programs took off slowly and often remained a financial burden to the organization for years.

Length of stay initiatives.

Like these other programs, effective implementation was often difficult to establish until meaningful executive physician leadership was involved.

Observation units.

This is another important strategic initiative, designed to address requirements imposed by CMS, that was typically met with physician resistance. At our organization, it took a very lengthy planning process involving the CMO and the nursing director to operationalize the unit. It required several concessions to the medical staff, including the ability of the private physicians to manage their patients in the unit, rather than use hospitalists or emergency medicine physicians, which would have been much more efficient.

Lean initiatives.

Pharmacy, emergency department, laboratory and nursing unit Lean Projects can be very difficult to work through without significant physician input and leadership.

Strategic Plans Falter

These and other hospital programs often became strategic initiatives based on presentations at national conferences to senior hospital executives and board members. The executive teams would identify the new initiative that appeared likely to benefit its organization, assign the initiative to one of the team (COO, CNO, VP for Strategic Initiatives, etc.) and flesh out a plan.

Early in the process, resistance by the medical staff would appear. A physician champion would be recruited to help interact with the medical staff. This tactic sometimes reduced the intensity of physician resistance. But the effectiveness of this approach depended on the skills and gravitas of the champion.

In the Advisory Board article, the authors recommend that the partners in this process have the following characteristics:

Physician:

• Sterling clinical credentials
• Excellent relationship and influence skills with physician peers
• Systems thinker

Administrative Leader:

• Management skills: finance, staff, operations
• Clinical credentials
• Persistent, organized and detail oriented
• Relates well to leaders of shared services and relevant functional areas across the organization

There is fairly broad consensus that using the new dyad model (i.e., bringing more physician leaders into the early planning stages) provides for better execution, with less resistance and dysfunction, than when traditional leadership is used.

Still, looking at the above desired skill sets, in my opinion, the experienced physician executive may well have the skills of the administrative leader, but the converse is generally not true.

Two Kinds of Dyads

I fear that healthcare systems are attempting to use the old style of leadership teams, rather than adopt the modern ones described above and in books like Dyad Leadership in Healthcare: When One Plus One is Greater than Two.  My sense is that many hospitals have misconstrued the true nature of effective dyad leadership teams. Simply recruiting a respected physician to help support and promote a new initiative, while still carrying her usual clinical load, is not sufficient.

Another Example

The importance of executive level physician leadership is most evident in the implementation of Electronic Health Records. As it became clear that EHRs would need to be implemented at every health system in the U.S., the common response was to put the onus for implementation on the I.T. Department and engage physician super-users as medical advisors to help communicate and educate physicians. But two realities became obvious as implementations failed:

1. Clinical informatics specialists would be needed (including physician, nursing, pharmacy, etc.);
2. High level physician engagement and leadership would be required, and the growth of Chief Medical Information Officers took off.

Such CMIOs were often partnered with I.T. VPs or Directors to co-manage implementations and lead the informatics, while the nonclinical partner handled the technical issues. Such leadership dyads are generally very effective.

Real Leadership Dyads

Carle Foundation Hospital and Physician Group in Urbana, Illinois has been using leadership dyads extensively. It is an organization that has embraced the model. By several measures, Carle is a very successful organization and has utilized dyads to great effect.

The Studor Group has noted that “Carle has one of the “purest” and most successful dyad models in healthcare today.”

What are the features of the Carle Leadership Dyad model?

• In its model, the physician leader and administrative leader are equal co-managers. For example, at the most senior level, the COO and system CMO work as a team. Part-time super-users, champions and medical advisors do NOT meet this requirement.

• Even their medical directors, assistant medical directors and associate medical directors are at least 50% administrative, leaving less than 50% of their time dedicated to clinical endeavors.

• There is extensive ongoing leadership education and training for its physician managers and executives.

Another critical feature of modern dyads is described in Dyad Leadership in Healthcare: When One Plus One is Greater than Two:

• This type of dyad is often a permanent part of the organizational structure, not a temporary implementation strategy.

In Summary, Don't Kid Yourself

1. Assigning a physician “champion” or “medical advisor” to a help promote and plan a new service line does not meet the definition of the modern Leadership Dyad and will not produce the results obtained by systems such as Mayo and Carle.
2. Using the modern Leadership Dyad model will NOT reduce the need for physician executives; in fact, it will increase the demand.
3. This model will require ongoing education and training of physicians.
4. Therefore, financial resources will be needed to recruit and train more physician leaders. But the result should be faster, more effective implementation of important strategic initiatives and better overall quality of care and patient outcomes.

[embed_popupally_pro popup_id=”3″]

Has your organization successfully implemented co-management using leadership dyads?

Next Steps

Please add you're thoughts and questions in the Comments. I'll respond to them all.

Don't forget to SHARE this post, SUBSCRIBE Here and complete a SURVEY .

Email me: johnjurica@nonclinical.buzzmybrand.net or leave me a Voice Message.

Thanks for joining me.

Until next time.

The post Not All Leadership Dyads Are Created Equal appeared first on NonClinical Physicians.

If you stop in any hospital doctor's lounge, you will certainly hear a lot more complaining. We complain about electronic medical records, complicated billing requirements, regulations, lawsuits, the difficulties of running a medical practice or working for a large institution.

Much of the complaining is warranted. But complaining without taking action is the characteristic of a victim. What we need in healthcare is leadership, not victimhood. And true leaders jump into action and skip the whining part completely.

Complaining Is Not Leading

What does complaining accomplish? For years, I've read surveys showing that physicians are unhappy. They're planning to retire early. Physician numbers should be declining. They won't recommend a career in medicine to their students or family. Fewer students will choose the medical profession.

But, I don't see increasing numbers of physicians quitting. Retirement rates have not gone up. The number of medical schools has grown. So has the number of students applying to medical schools.

I'll admit that physicians are unhappy. If you ask any physician what they don't like, you'll get a list of 10 or 20 things that are wrong with “medicine.”

My question is this: What are we going to do about it?

I recently listened to a podcast in which Tim Ferris interviewed Blake Mycoskie. Mycoskie is one of the founders of TOMS, the shoe manufacturer. TOMS is known for donating a pair of shoes to a needy child for each pair that it sells. It has reportedly donated over 75 million pairs since the company was started about eleven years ago.

During the interview, Ferris and Mycoskie discussed their definition of an entrepreneur. Their assessment: A true entrepreneur cannot be made. An entrepreneur is born when she is consumed by a burning desire to solve a problem. All of the entrepreneurial studies courses at ivy league business schools won't create an entrepreneur without a problem begging to be solved.

[embed_popupally_pro popup_id=”3″]

Physicians Who Identified a Problem and Solved It

The same can be said for physicians and leadership. There is no shortage of possible problems for physician leaders to solve. And rather than complaining, we should step up and fix the problems that are plaguing us. Nothing could be more motivating to an emerging physician leader.

There are many examples of physicians who have done just that:

• Pamela Wible, a family physician, has taken on the issue of physician depression and suicide. She couldn't stand by and watch as physician suicides grew to double the rate in non-physicians.
• Atul Gawande, a surgeon, has taken on the issue of patient safety. As a public health journalist and author, having witnessed all of the preventable medical errors around him, he was inspired to speak and write about the issue.
• Serafino Garella, a nephrologist, founded the largest free medical clinic in the U.S. He was compelled to address the intense need for care of the poor in Chicago, Illinois.
• Robert Wachter, an internist, started the hospitalist movement in the United States. He recognized the negative effects of trying to balance an outpatient practice with the increasingly complex care of hospitalized patients and created a solution.
• Howard Maron, a former Seattle SuperSonics team physician, founded a clinic that introduced what became known as concierge medicine. He was responding to the overwhelming paperwork, lack of control, rushed visits, and unhappy patients he and his colleagues were encountering.

All of these innovations resulted from physicians identifying a problem, becoming obsessed with solving it, and creating a solution. It took leadership.

Four Reasons to Stop Complaining and Start Leading

I can think of four good reasons why physicians should stop complaining and start leading today:

1. Eliminate negative self-talk. Complaining is a form of negative self-talk. It only leads to deeper frustration and despair. We think of complaining as the result of unhappy circumstances. But the field of positive psychology has demonstrated that negative self talk increases unhappiness, poor health and anxiety. By eliminating complaining and replacing it with positive self talk and taking action, our optimism and vitality improve.
2. Improve physician engagement. Physician engagement is at an all time low in many institutions. Stepping up to solve problems will help improve engagement and ultimately the lives of our colleagues and our profession.
3. Elevate our teams. Taking action will improve our standing, and our work environment. The nurses, radiology technicians, pharmacists and other team members will be inspired by our efforts. Then hospital and medical group executives will welcome our input into solving problems, rather than seeing us as whiners.
4. Promote healthy communities. Developing a meaningful calling, and devoting ourselves to servant leadership, will improve the health of our communities. How many free medical clinics have been started by courageous physicians taking a leadership role?

Think about the problems that can be overcome if we devote ourselves to addressing them.

The next time you hear yourself complaining to your colleagues, step back for a moment and reflect. Make a commitment to address the issues you're complaining about. Begin a journey to take control of the situation. Stop complaining and start leading.

Question: What causes would you be excited about? Answer in the Comments below.

Next Steps

Don't forget to SHARE, SUBSCRIBE Here and complete a SURVEY .

Until next time.

The post Physicians: Stop Complaining and Start Leading appeared first on NonClinical Physicians.

It's a poor management technique that wastes time, fails to utilize our staff’s full potential, and causes resentment and frustration in those being controlled.

… the highway!

It is one of the 4 things that drive employees crazy, according to Dan Rockwell.

Micromanagement is Not Inherent

One afternoon I was having an informal conversation with one of my colleagues, Dennis (a pseudonym for this story). He was lamenting the fact that our CEO was such a micromanager. According to him, the CEO displayed a need to be involved in every decision. He never seemed to trust Dennis to pursue his job independently. And the CEO seemed compelled to instruct Dennis how to do his job.

I listened quietly to Dennis' complaints. But I was thinking that the CEO did not come across as a micromanager to me.

Weekly Operations Meeting

A few days later, on a Wednesday morning, ten of us were attending our weekly planning meeting with the CEO. I was sitting at my usual spot at the south end of the boardroom table. The VP for Senior Services was seated to my right. The CEO was next to her, leading the meeting.

The CEO was expressing his frustration that there were several projects that seemed to be “stuck.” And he didn't understand why.

During the discussion, he also mentioned that one of the hospital board members had called him. The board member asked why we had stopped sending one of our medical specialists to an outlying clinic near her home.

The CEO was unable to answer the question for the board member. He was not aware that this staffing change had been made. And he was angry that he had not been notified so that he could reasonably respond to a question like this. He felt he appeared uninformed to the board member.

I thought about those comments later, and about my colleague's complaint about being micromanaged. The CEO had not called Dennis out during the discussion. But Dennis was the involved VP in some of the struggling projects and the staffing change at the clinic.

It became clear to me that the need to micromanage may not be inherent in a leader, but a result of our own behaviors and attitudes.

Causes of Micromanagement

Granted, some micromanagement comes from the insecurity of the micromanager. It is often driven by fear: of making a mistake, or of failing to complete an important project. The micromanager then responds by trying to escalate his control.

Some micromanagement is a result of inexperience, and tends to be temporary. Managers are promoted by being successful at what they do. They may have achieved success by being meticulous about what they do and how they do it.

Then they think they should teach former peers to do things their way so they can also be successful.

Shift in Mindset

What these new leaders must learn is that there is a new set of skills that need to be applied. These skills involve granting more responsibility to team members, and allowing them to fail and learn. And they must learn to trust their teams to accomplish goals in their own ways.

Later, experienced leaders may revert to micromanagement to obtain better performance from a direct report who under-delivers.

In my world as senior VP, I observed that micromanagement often resulted when a direct report lost the trust of her boss by:

• Under-communicating;
• Underperforming (under-delivering); and,
• Making excuses.

So, that leads me to my list of tactics that can reduce or eliminate micromanagement.

Stop Your Boss' Micromanagement

If you feel that you're being micromanaged, try to determine whether you have contributed to the situation. And, by following these simple steps, prevent it from continuing.

1. Be consistently and totally accountable.

I describe the four step process for demonstrating accountability in Preparing to Be a Better Physician Leader.

Being totally accountable means understanding and demonstrating that you hold yourself responsible for the things that you control, and the much larger domain of things that you can influence.

In a recent post on Medium, author Nick Caldwell writes about the day he learned what separates managers from leaders. In the article he does a good job of describing the “aha moment” when he recognized the difference between identifying problems (as a manager) and taking on responsibility for solving problems (as a leader).

2. Keep your boss informed.

This doesn't mean to ask permission for every move you make. But when a significant change is being made, especially those that might leave a stakeholder (board member, physician, patient or employee) unhappy, let your boss know what's going on. That way, she will be prepared for questions or blow-back from the decision.

3. Build deeper trust.

This is a different kind of trust than the trust developed within a team.

I’m talking about the trust of a boss in a team member to follow-through. The deeper the trust, the less need to micromanage. This gets back to being 100% accountable. And it only occurs with persistently demonstrating that you can deliver results without being micromanaged.

4. Write things down.

One of the reasons our bosses micromanage us is because we forget to follow-up on some things.

We forget about specific problems we promised to address. Or we remember to address the problem, but forget that we promised it would be done by noon today.

By being compulsive about following up on our promises, the need to micromanage will dissipate. This compulsiveness will come from taking notes, writing down deadlines, and putting things in writing so our boss can review them later.

5. Be honest and timely in communication.

When things go bad, be the first to let your boss know. Ignoring failures or trying to cover up missteps will only increase the boss' need to micromanage.

Then circle back to Step 1., apply the four-step accountability process, and get back on track.

One Tool I Use to Eliminate Micromanagement

I was being a little dishonest when I made it sound like I never experienced micromanagement by my CEO. As I described in Four New Skills Physician Executives Must Learn, there were many lessons I needed to learn as a new hospital executive.

Some of those lessons involved meeting my CEO's needs, and communicating completely and proactively.

So, I developed a process and tool that enabled me to combine written and verbal communication with being accountable. Using this tool, I virtually eliminated micromanagement by my CEO.

We met once every week or two. So, I created a checklist that served as an agenda for our meetings. On it, I included every topic that I knew or suspected my CEO would be interested in.

I maintained a working copy of the list of issues in a shared electronic folder that I created. It was in a location on our shared drive that anyone on the senior team could access. I named the folder “CEO Meeting Agendas.” And, I updated the list as things changed, in real-time as much as possible.

On the afternoon before our next one-on-one, I updated the list and reordered and highlighted the topics according to what I thought was important. Then, I saved the file using the date of the meeting in the file name.

I would generally email the file, or a link to the file, to the CEO asking if he wanted to discuss anything else during our one-on-one.

Posting this series of documents enabled the CEO to quickly review the list of ongoing goals and activities at will. The folder contained all of the previous lists, so he could look back and follow the progress on any job or goal.

The Tool in Action

An image of a sample list is shown below. This example reflects the kind of topics that I generally included. They originated in specific departmental duties, from my management goals, or from other challenges that I was addressing, such as personnel (HR) issues.

Some things to note about the tool:

• The list for a busy VP can get very long, so not everything can be addressed during the one-on-one;
• The level of detail can be adjusted to the desire and needs of your boss;
• Important (urgent or contentious) items should be highlighted – I am using an asterisk on this list; and,
• The highlighted items will be discussed first, then the remaining items as time allows.

In this example, I know that the CEO is likely to be concerned with:

• Acquisition of Dr. XXXXX's practice, one of the oldest and largest practices in the county (3.);
• Unusual demands by Dr. C. S. during his contract review with potentially significant cost ramifications (4.i.);
• Completing the revision of the compensation plan for the medical group (5.b.);
• Providing a review of the quality reports for the CEO prior to my presentation at the next board meeting (6.);
• The resignation of one of our top directors (14.); and,
• The progress on the opening of a new urgent care clinic (15).

As you can see, using this virtual agenda and keeping it up to date will enable you to demonstrate ongoing accountability, maintain a written record, and avoid under-communicating important information.

Next Steps

Try creating a written agenda for every one-on-one meeting with your boss. Post each one where it can be reviewed easily, yet securely. After using it for a while, ask if the tool needs to be tweaked in some way.

Let me know if it reduces micromanagment. Happily, it should also reduce phone calls and emails for updates between meetings.

Don't forget to COMMENT below, SHARE this post, SUBSCRIBE Here and complete a SURVEY .

Thanks for joining me here on Vital Physician Executive.

Until next time.

The post How to Stop Your Boss’ Micromanagement Today appeared first on NonClinical Physicians.

My usual optimism was gone. I did not become overtly suicidal, but I began to have thoughts about what it would be like if I was no longer “around.”

After wallowing around in that state for a while, I took some steps to extricate myself…

• Engaged a psychotherapist and began weekly counselling;
• Started a regular practice of mindfulness;
• Spent more time with some of my closest friends, parents and siblings;
• Began exercising regularly;
• Took up some new hobbies: rock climbing, downhill skiing, and scuba diving.

Gradually, I was able to claw my way back to a life with passion, energy and hope.

I was reminded of those times during a conversation about resiliency at the recent American Association for Physician Leadership Spring Institute in New York City.

Welcome Back

It has been about four years since I last attended a formal AAPL conference. Hence, I was really looking forward to this one.

Being in Manhattan with my wife, just a short walk from Times Square, was a great start. We enjoy being in a diverse, exciting city that never sleeps, even though my wife and I were back to our room by 9:00 PM most nights.

Home to the future stars of stage and screen at Ellen's Stardust Diner

Since we were staying at the Sheraton Times Square, it was a short walk to Ellen's Stardust Diner, where your servers and the entertainment are one and the same. There was some great talent there!

My wife enjoys the attention of a very talented crooner.

Pursuing Resilient Physician Leadership

The conference started April 19 with an all day workshop on Resilient Physician Leadership. This workshop was led by Rebeka Apple and Mamta Gautam.

This seems to be a very popular general business topic. Resilience has been taken up by the AAPL as an important subject for physician leaders themselves and for the physicians in their organizations.

This may be in response to the apparent increase in physician burnout. Burnout is an issue that threatens many health systems and, while not a disease per se, has been associated with depression and suicide.

All of the registrants for the course completed the CPI 260 prior to arriving. This tool is one of several California Psychological Inventory instruments that can “help people gain a clearer picture of their personal and work-related characteristics, motivations, and thinking styles.”

Dr. Apple brought the Client Feedback Reports for each of us to review. So we spent time talking about the sections of the report that related to resiliency.

And we discussed useful skills needed to maintain resiliency:

• coping strategies for stress;
• the ability to maintain focus, optimism and composure; and,
• strategies for recovery when excess stress or burnout occur.

An awesome musical five minutes from our hotel. Highly recommended!

Enhancing Resilience

The second part of the workshop was led by Dr. Gautam. She started with a story.

As a young psychiatrist, she was asked to assist a few struggling physicians early in her career. This rapidly became a large part of her practice as she assisted professionals distressed by the circumstances of their challenging lives.

She came to devote much of her time to improving physician wellness. She spent years increasing awareness of physician health issues, treating colleagues, and creating a network of resources for physicians in distress. Now she devotes time to coaching physicians to learn strategies to keep well. Many can be used to enhance resilient physician leadership.

Here are the danger signs of increasing stress that she described:

• More frequent physical ailments and illness
• More problems in relationships
• Increasing frequency of negative thoughts
• Accumulation of bad habits
• Exhaustion

Additional Skills

She presented her approach to enhancing personal and professional resilience and described the FIVE C’s of RESILIENCE:

• Control – not of our circumstances, but of our perceptions about our circumstances
• Commitment – remembering our values and prioritizing them
• Connections – using our personal and workplace support systems
• Calmness –  self-regulation, meditation, and mindfulness
• Care for Self – through exercise, nutrition, sleep and time alone

I found the workshop to be quite interesting and applicable to my life. Fortunately, I had already implemented many of the suggestions, but there are several that I don't use as much as I should:

• I spend less time with my parents and extended family than I would like.
• Time with close friends is very limited. For example, I recently wrote about a friend that passed away, and my regret for not having spent more time with him.

Finally, in addition to time for learning, there was plenty of time to network and meet new colleagues. I was impressed again by the breadth of backgrounds of the participants. Hearing about their varied experiences was very inspiring.

My Conclusions

I have been severely stressed at certain times in my life. And I wish that I had a better mastery of the skills presented in this workshop earlier in my career.

Resiliency is a leadership topic that will be increasingly important, and one that should be taught to our physician colleagues.

Next Steps

• Read more about resilient leadership. You can start by reviewing Harvard Business Review the article mentioned above, and this interview with Eric Greitans.
• Join the AAPL if you're not already a member and attend a live course or access one of its online courses.
• Subscribe here.
• Take a short survey:  Survey Page

Recent Interview by Future Proof MD

FPMD was kind enough to post a written interview with me at Future Proof Docs – The Vital Physician Executive. Check it out and look around his site for useful financial information.

Feel free to email me directly at john.jurica.md@gmail.com

If you like this post, please share on your social media using the SHARE buttons below.

See you in the next post!

The post Pursuing Resilient Physician Leadership appeared first on NonClinical Physicians.

This is a process. Like any new realm of learning, we follow a path from awareness, to understanding, knowledge, competence, and eventually, mastery. This process may take years to complete.

The Chief Operating Officer and I asked the Director of the Laboratory, Sheila, to join us to discuss a challenge she was experiencing with her staff. I was still learning the ropes about working with directors of hospital departments like the Lab. The COO was quite good at sorting through difficult issues and building strong teams.

The director was very frustrated. She spoke about a particularly difficult employee. Peter had been working as a laboratory technician for many years. Every few months he would become the center of some drama in the department. He would be “written up” and then not be heard from for several months.

The employee had certain skills and certifications that made him difficult to replace. In spite of repeated involvement in various kerfuffles that impaired the morale of the department, he never received more than a slap on the wrist for his transgressions.

Sheila described her frustrations in detail. Several technologists and laboratory assistants had come to her with complaints about Peter’s behavior. They felt that Peter was repeatedly allowed to skirt the rules without serious consequences. The staff resented what was happening.

As Sheila described the situation to us, we mostly just listened. The COO occasionally encouraged her: “Go on, tell us more.”

Seeking a Solution

At one point he asked, “How is this behavior affecting the performance of the department?”

Sheila replied, “The turn-around times have gone up because the staff aren't working well together. And one of our new technologists resigned 2 weeks ago, probably because of Peter.”

“How is this affecting your work?” he asked.

“I'm spending much of my time putting out fires and trying to convince the other employees not to quit.”

“What have you tried so far to resolve the situation?”

She described various attempts she had made to work with Peter to improve his accountability and address his behaviors. As she paused during her description, we listened without comment. After a few moments, she continued.

“You know, it's going to be difficult to replace Peter, but I think I have to do it. For the department, and the organization. His presence is too toxic. If you agree, I'll meet with HR later this week to review the process. Then I'll meet with Peter and let him go.”

Preparing to Be a Better Physician Leader

In Part 1 of this series, I wrote about the attitudes and approaches that physician leaders should reflect upon.

In the following paragraphs, I discuss important skills we should hone if we want to be truly effective.

Project Planning

The ability to take on ever more complex projects is an important skill for the physician manager and executive. All physicians have some experience in creating plans to achieve important goals.

After all, we were able to effectively plan the process of admission to, and completion of medical school and residency, and becoming board certified.

In its simplest terms, project planning consists of starting with the desired result in mind, and working backwards, addressing each discrete step as a sub-project along the way. The planner then pieces together the steps, assigning work to involved participates and deadlines to each step.

Below is a very simple Gantt Chart that displays the process for preparing a lecture. A similar process could be used for preparing an article for publication.

On the other hand, the process for opening a 5,000 square foot physical therapy facility would be much more complex, and include dozens of separate sub-projects. Each piece of the planning puzzle would come together, ultimately resulting in the opening of the facility at some future date.

If you are just getting started in management and leadership, the best way to learn this skill is to be part of the planning of a big project and observe how all the moving pieces are coordinated.

Communication

Physicians generally excel at one-on-one communication with peers, patients and teachers and mentors.

Physician leaders must expand those skills to verbal and nonverbal communication, including lectures, group discussions, meetings, presentations and negotiations. Each of these has its own demands.

Often the best way to learn these skills is to just start doing them. Practice is the best teacher.

There are two specific communication practices that really serve leaders well:

• Listening
• Asking questions

The best leaders I have known spent much more time listening and asking questions, than making declarative statements or offering opinions.

Like the COO who allowed my laboratory director to come to her own conclusion concerning her employee, sometimes just asking questions is the best form of communication a leader can use.

Planning and Running Meetings

Meetings can be the bane of a leader's existence: too many meetings; boring meetings; meetings that take too much time and accomplish too little.

Leaders must employ several of the leadership skills already discussed to use meetings as intended: to obtain input, create action; move a project along and achieve important goals for the organization.

While many meetings are dreaded by invitees, it is possible to plan and manage a series of meetings that participants WANT to be invited to.

Such meetings are seen as exciting, challenging, inspiring and productive.

The chair of the meeting is responsible for achieving these outcomes, by following the process that I outlined in an earlier post. But it basically boils down to these steps:

1. Create an agenda that is designed to achieve the charge of the committee as quickly as possible, sharing it prior to the meeting so that everyone can come prepared;
2. Maintain control of the meeting so that EVERYONE contributes and there is respect for the participants’ time (start on time, and end early if possible);
3. End the meeting by clearly stating the next steps for the team;
4. Cancel any meeting that is not likely to produce results.

If you are not the organizer, in your next few meetings observe whether these steps have been taken. Gently encourage the team to adopt these recommendations.

Measurement

The best leaders become experts at measurement. It is only by using meaningful metrics that performance can be improved.

When I started as the Chair of the Quality Committee at the local hospice organization, I was impressed with the work that was being done. The Quality Director and her team were following infection rates, falls, and other meaningful quality indicators.

In addition to providing input and direction to the process, my role was to present updates to the Board of Trustees of this organization.

But I found that quality data were being presented as a written description of the monthly findings, with steps taken and planned improvements interspersed with the actual measurements.

Such a document would take the board hours to go through, since there were similar reports for all of the other major departments.

I asked the director if she could present the data in a way that was more concise and easy to understand. Ultimately, she was able to summarize the performance in a small number of easily understood graphs that displayed the trends in the outcomes.

Great leaders are able to identify good measures and communicate them to other stakeholders. They also use them to continually drive improvement in the performance of the department, committee or organization being led.

Measurement is key to driving improvements in quality, patient safety, employee performance, patient and employee satisfaction, and financial performance.

Teamwork

Creating effective teams is a critical skill. Like organizational culture, a strong team does not just develop by chance. I have discussed this issue before and have pointed to Peter Lencioni's book, The Five Dysfunctions of a Team,  as a good starting point to address trust and conflict.

According to Lencioni, leaders should reach of these stages in order to create a highly functioning team:

1. The members know each other at a personal level and they trust each other to NOT be judgemental or overly critical when expressing an opinion. Such team members have learned to listen carefully and provide honest, constructive comments.
2. The team engages in appropriate conflict in the form of full expression of opinions. A leader does not want a team of “yes-men.” Rather, all points of view must be freely expressed before a fully informed course of action can be developed.
3. Consensus almost never occurs. But once an issue has been discussed and debated, and a path chosen, everyone commits to supporting that decision, in spite of personal reservations. Team members will NOT undermine the plan once it is put in motion by second guessing or failing to support it.
4. Each member is accountable to the organization and its plan and holds each other accountable.
5. The team remains focused on achieving results. Each team member supports other departments and divisions, even if it means forgoing some of its own resources to achieve the overall goals of the team.

As you participate in different teams, try to observe whether the members are participating at this level. Or are they protecting their silos of responsibility and undermining others to achieve their own personal goals?

Management

To some extent, managing others involves using all of these skills to bring out the best in those that report to you. Communicating with clarity, listening well, planning well, building teams and measuring and reporting the right metrics enables us to support and encourage highly productive direct reports, committee members and colleagues.

The best CMOs, CMIOs, CQOs and medical group administrators have spent a good deal of time preparing to be a better physician leader. And, as with clinical care, such leaders are committed to lifelong learning.

In Closing

In presenting this and the previous post about preparing to be a better physician leader, I have attempted to demonstrate that:

• Physicians are natural leaders.
• The medical profession needs more leaders.
• Many of you will be drawn into leadership roles.
• You need to learn new skills to be an effective leader.

Next Steps

Observe these skills in others. See what works well and what does not.

Informally approach those with the best leadership skills for advice and counsel. Use them as mentors, as I described in Why Both a Coach and Mentor Are Vital.

I welcome your comments and questions.

Subscribe here.

Provide feedback:  Survey Page

Contact me at john.jurica.md@gmail.com

If you like this post, please share on your social media using the SHARE buttons below.

Thanks so much and see you in the next post!

The post Preparing to Be a Better Physician Leader – Part 2 appeared first on NonClinical Physicians.

A colleague reminded me about the upcoming Spring Institute and Annual Meeting of the American Association for Physician Leadership. I had just completed registering myself. And I volunteered to act as an ambassador, assisting with introducing speakers and helping to support the meeting.

Networking with colleagues and old friends will be fun. And I look forward to spending time in New York City with my wife, Kay, when I am not attending educational sessions.

As vice president of the local nonprofit hospice board, I had the privilege of chairing the board meeting because the president was out-of-town. It was interesting to observe how the board members, many of them leaders in their own organizations, communicate with one another and run some of the subcommittees to which they are assigned. It is a very effective team.

I also had the opportunity to present a lecture to the internal medicine residents at the hospital where I previously worked as chief medical officer.

When choosing the topic for the lecture, I consulted with the residency leadership but also reflected on the topics I had written about on this blog for the past nine months.

As I did so, two revelations occurred to me:

• Physicians are natural leaders.
• Most physicians will assume formal leadership roles during their careers.

I thought about all of the physicians I have known over the years. Very few spent 20 or 30 years practicing without assuming some management or leadership role.

They have been hospital committee or department chairs or president of the medical staff, medical directors, nonprofit board members or former hospital or medical group executives. Or they have become involved in their specialty society. I have other colleagues that serve as county and state medical society trustees or committee chairs.

Given this likelihood, it make sense that physicians, even those still in training, begin to think about the gaps that exist in their abilities as they learn to be a better physician leader.

So this post and the next are based on the lecture I gave to the residents this week.

Physicians Are Natural Leaders

You have met the challenges of a rigorous and challenging process. Many of the traits that have allowed you to complete your training successfully are those needed by leaders:

• Intellect
• Focus
• Accountability
• Ability to handle complexity
• Good communication skills
• Perseverance
• Commitment
• Altruism
• Desire to work with people

Most of these traits will serve you well as a future leader. Some, like accountability and communication skills, will need to be enhanced.

Most Physicians Will Lead

There is an ongoing and increasing demand for physician leaders. Physicians prefer to be led by other physicians. Engagement of physicians improves when physicians lead their organizations.

Better engagement creates better quality outcomes and patient satisfaction. Other team members are inspired when the physicians are passionate and engaged.

Hospitals are seeking more chief quality officers, chief medical officers and other physician executives with management training and experience.

Value based care, pay for performance and population health initiatives require the input of physician leaders that can integrate the clinical with the business aspects for large organizations.

This recognition has led to an explosion in need for physician executives.

But there are new attitudes and skills that must be improved or developed in order to be a better physician leader.

Preparing to Be a Better Physician Leader

Existing leadership characteristics and abilities must be enhanced and new ones must be learned. In Part 1 of this series, I am going to focus on just a few of the attitudes or perspectives that emerging physician leaders should adopt.

In Part 2, I will discuss some specific skills that should be learned or honed as these new roles are assumed.

Physician leaders, to be most effective, must evolve to being:

• Proactive rather than reactive;
• Planners rather than performers;
• Strategic rather than tactical;
• Delegators rather than deciders;
• Participative rather than independent; and,
• Organization focused rather than practice focused.

And  I believe that there are three special areas that we should try to enhance as leaders.

Accountability

The accountability inherent in individual patient care should evolve into accountability for the team or the organization. One sign that accountability is in place is the ability to admit mistakes. The young physician leader must be willing to own up to mistakes.

No one is infallible. We all make mistakes. But the sign of leadership is our ability to admit our mistakes, regroup and move on.

There is a process that leaders use to address individual accountability in an organization. I saw this most clearly described by Michael Hyatt. The process follows these steps:

• Admit that you did not prepare, communicate or manage properly to achieve the desired result;
• Restate your understanding of your responsibility;
• Explain how you’re going to rectify the problem;
• Commit to resolve the issue by a specific deadline.

Optimism

Healthcare can be challenging and frustrating. Payments are declining. Patients can be demanding. Personnel issues make us crazy.

Too many times I have been in conversations with physicians that are negative and defeatist. Apathy and resignation are rampant.

But leaders cannot withdraw. As a leader, you must inspire and encourage your team and remind them of the shared mission and vision, even when things are not going so well.

Humility

I can't count the number of times I heard one of my physician colleagues offer an opinion on a topic about which he knew very little. Some of my colleagues seem to think that their medical degree grants them insights into every field of endeavor.

Leaders are not self-righteous, or condescending. They're able to admit that they’re not the experts in every field. They hire and defer to people who are smarter than they are and welcome input and allow associates to accomplish goals in their own ways, without micro-managing.

Nobody wants to follow a leader that's a know-it-all.

In Summary

Observing attitudes in ourselves and our colleagues is a start to understanding how they affect managing and leading.

Next Steps

Watch how others lead. See how they express their accountability, optimism and humility through their body language, and verbal and written communication. Observe how others respond to their leadership style and personality.

Then reflect on your own approach to these issues. Ask a few close friends how your own personality and leadership style are perceived. You may receive some interesting insights.

I encourage you to attend the upcoming meeting of the American Association for Physician Leadership. The speakers are excellent, the content is very useful, and the conference offers great value to the new or established physician leader.

In the next post, I will continue with a discussion of the skills new physician leaders should begin to understand and acquire.

For more of my thoughts on leadership Subscribe here.

Take a short survey here:  Survey Page

Contact me at john.jurica.md@gmail.com with any questions about anything.

If you like this post, please share on your social media using the SHARE buttons below.

Thanks so much and see you in the next post!

The post Preparing to Be a Better Physician Leader – Part 1 appeared first on NonClinical Physicians.

There is no one set of skills or abilities, of course. Each organization and CEO will be looking for a set of skills to meet its unique needs. But there are some common themes.

After the hospitalist movement began, it wasn’t on the radar at our 300-bed hospital for many years. Robert Wachter and Lee Goldman made the case for dedicated hospital-based physicians years earlier. And as DRG payments failed to keep up with inflation, and inpatient care became more complicated and costly, it seemed our medical staff was not becoming any more efficient with inpatient care.

Our CEO and other executives began to read more in their professional journals about hospitalists. Hospitalists had the ability to provide more timely, evidence-based care. Community-based internists and family physicians were working in both inpatient and outpatient settings. Therefore, they had limited time to devote to hospital rounds.

And it was clear that a hospitalist service could provide better patient satisfaction, shorter lengths of stay and better documentation. The last issue resulted in better payments from Medicare. Such benefits could produce $1 million or more to our bottom line. And externally reported quality metrics would improve.

In spite of being patient-centered and quality-driven, physicians are also resistant to change, especially when the proposed change appears to threaten their autonomy. Our physicians were no different. As a result, the slightest hint of starting a hospitalist program was met with intense resistance.

There were some good arguments against adopting this new approach that might fragment a patient’s care:

• Without the PCP involved, knowledge of the patient's history and previous response to treatments might be lost.
• With handoffs on admission and discharge, there could be an increase in the risk of medication errors.
• The PCPs did not know the new hospitalists, so how could they recommend referral to them in good faith?
• Patients might be upset because they were expecting to see their own PCP when admitted to the hospital.

This situation is a good example of the type of new service line that the chief medical officer is expected to lead. In our case, the CEO asked that I develop and implement a plan to establish an effective hospitalist program. The process did not proceed quickly or easily.

Here are the steps that we followed to establish a full-time hospitalist service. The long-term goal was to staff with two daytime hospitalists and one “nocturnist,” all of whom rotated day and night shifts. The service we started was not mandated, but would be used by those physicians wishing to focus on their outpatient practices. The implementation team:

• Educated the medical staff using memos, and discussion at department and quarterly medical staff meetings; presented the supporting evidence from the literature; and, demonstrated examples from other hospitals that showed that care was measurably better and that the potential handoff problems could be prevented with good planning and communication.
• Identified several physicians who wanted (in some cases, demanded) the hospital provide such a service to free them up to focus on outpatient care ( I had already cut back my care, so I was one of the physicians seeking such a service for my patients as I transitioned into full-time administrative medicine).
• Started with a part-time service with two providers who covered the evening admissions from home, coming in as needed, until the volumes justified a full-time service.
• Interviewed several national and regional hospitalist groups in preparation for starting a full-time service with six new internists to cover the hospital as outlined above.
• Selected the best of the new programs and entered into contract negotiations.
• Executed an agreement and began interviewing candidates.
• Went live about six months later, with six newly credentialed, board-certified internists.

This process is similar to many that the hospital executive must lead. The process took years to complete. It met a strategic need, and involved staff at all levels of the organization. We worked with the formal medical staff leadership and multiple individual medical staff members. Good communication, project planning skills and patience were required.

As the CMO, I was administratively responsible for the implementation. This meant that I:

• dealt with the concerns of the medical staff by listening to them in every venue conceivable;
• developed the structure of the program, and the timeline for implementation, with input from other senior executives;
• worked with the facilities department to identify office space for the hospitalists;
• made initial inquiries with hospitalist groups and arranged their presentations to our senior staff;
• reviewed the proposed contracts, involved our attorney and negotiated changes that we needed;
• executed the agreement and worked with the new group on implementation;
• interviewed every new candidate (as did other members of our team); and,
• approached members of our medical staff to personally invite them to use the service.

My involvement in this process is an example of what your CEO will expect of you, whether it is starting a new hospitalist program, a wound management service, or a new patient safety initiative.

Reflecting on my own experiences, speaking with hospital CEOs and CMOs, reviewing published accounts, and looking at dozens of job descriptions, I believe that there are eight primary abilities the CEO wants in a chief medical officer.

The Eight Essential Abilities

1. Patient Safety and Quality

This is the most often cited skill set. The CMO should have an excellent knowledge of healthcare quality and safety and be able to lead quality initiatives. The director(s) of quality and patient safety often report to the CMO. Hence, familiarity with these specific issues will be important:

• Sentinel Events, Never Events, Patient Safety Indicators, and Root Cause Analysis;
• Measurement of risk-adjusted mortality, complications, and readmission rates;
• National and regional quality collaboratives;
• Patient Safety Organizations, the National Quality Forum, the Institute for Healthcare Improvement and the Leapfrog Group;
• Infection control initiatives and reducing hospital-acquired infections; and,
• Pharmaceutical safety and the Institute for Safe Medical Practices best practices.

2. Medical Staff Affairs

This includes the areas of medical staff structure and governance, bylaws, and medical staff meetings. The Director of Physician Services/Medical Staff Office often reports to the CMO. Medical Staff restructuring efforts fall under this skill set.

And it is not uncommon to find the Continuing Medical Education enterprise to be housed in this area, so an understanding of CME planning and accreditation may be needed.

3. Clinical Service Line Development

This is one practical way in which the CMO contributes to the strategic initiatives of the organization. The CMO should be able to identify possible new service lines, evaluate them, present them to the senior management team and then accept accountability for successfully operationalizing them.

These new service lines could be as simple as an inpatient wound care program involving one or two wound care nurses and a medical director, to a brand new open-heart surgical program or neurosurgical service line. Or, it might be more unit based, like starting an observation unit or an inpatient dementia unit.

4. Resource Utilization and Standardized Care Processes

This requires an understanding of care management, evidence-based protocols, and nurse case management. The CMO may be administrator assigned to direct the activities of the Length of Stay Team. Measurement of the length of stay is dependant on accurate documentation and coding. Therefore, it is common for the director or manager of clinical documentation and coding to report to the CMO.

As CMO, I brought in outside documentation and coding experts to educate our staff. To do so, I executed agreements with two different consulting firms over 10 years to help us optimize our documentation and coding practices.

5. New Payment Models

The CMO will be valuable as changes in payment models drive changes in care delivery. It takes a sophisticated understanding of new care models, including inpatient and outpatient support systems, and the ability to educate and engage physicians to adopt the new models of care.

There have been many such changes over the years that have required the expertise of the physician executive. These changes have included:

• Moving from fee for service to DRG payments in the 1980s, which required physicians to think about discharging patients earlier rather than when they had reached “maximum hospital benefits” or had returned to “pre-illness level of function.”
• Helping physician colleagues to balance a shrinking length of stay with the need to reduce readmission rates in order to avoid Medicare penalties.
• Engaging care teams in new population health initiatives, such as palliative care, diabetes and other chronic care management programs.
• Creating collaborative relationships in order to implement bundled payments for elective surgical procedures such as total joint, cardiac valve, and spinal fusion or medical conditions such as congestive heart failure and acute pneumonia.

 6. Clinical IT and the Electronic Health Record

It is not surprising to find that physicians helping to implement electronic health records stay on to run the clinical informatics efforts as Chief Medical Information Officers. Often, the CMIOs progress to a broader role as CMO in many institutions.

The CMO must again demonstrate the ability to engage physicians and solve safety and quality problems, in this case with evidence-based order sets and IT solutions.

7. Communication Expert

When trying to describe important new technologies or recent quality efforts, the CMO is often chosen to deliver the message. Hence, the CMO must have the ability to take complicated topics involving epidemiology, statistics, population and public health, and quality improvement initiatives and convey them for the board and other lay audiences.

He or she also needs to be able to recruit team members to support initiatives that may not be profitable but will create better patient care and improved health outcomes.

8. Liaison to Contracted Hospital-Based Groups

Many health systems rely on the use of independent medical groups to provide certain specialty services. The most well-known specialties contracted in general medical hospitals are anesthesia, emergency medicine, and radiology. It is also common to use contracted groups for hospital medicine and pathology.

Each hospital must have a liaison who will meet regularly with the group's leadership and monitor the following issues:

• Patient satisfaction;
• Quality, safety, length of stay;
• Utilization of resources;
• Relationship with nursing, pharmacy and other professional staff;
• Maintaining regulatory compliance and being “survey-ready” at all times;
• Addressing complaints from patients, physicians and other stakeholders;
• Monitoring any financial performance measures; and,
• Soliciting feedback and input from the contracted group

The CMO is in a very good position to apply the other abilities (safety, quality, resource utilization) to the relationship with these independent hospital-based groups. The CMO can monitor performance and ensure that there is a partnership that benefits both parties. As a physician, the CMO can understand the practice challenges and empathize with issues important to physicians, further enhancing the relationship.

Wrap Up

In reality, no CMO is an expert in all of these areas. And in specific situations, some very different skills may be needed. For example, with the increasing employment of physicians as I have previously described, knowledge of physician employment, contracting and compensation design can be very helpful.

CMOs need to be adaptable and committed to life-long learning. And by developing in the eight areas described above, they will become a valued member of the senior executive team at any healthcare organization.

Next Steps

If you are serious about continuing your growth as a CMO or moving into a CMO role, spend some time reviewing job descriptions at LinkedIn or the AAPL.

If you want to receive my weekly newsletter and a reminder of recent posts Subscribe here.

Tell me what you'd like me to write about:  Survey Page

Email me directly at john.jurica.md@gmail.com.

If you like this post, please share on your social media using the SHARE buttons below.

Thanks so much!

The post The Eight Essential Abilities The CEO Wants In A Chief Medical Officer appeared first on NonClinical Physicians.

I was still learning the ropes about working with directors for critical hospital departments like the Laboratory. The COO was quite adept at sorting through difficult issues and building strong teams.

The lab director was very frustrated. She began talking about a particularly difficult employee who had repeatedly stirred up trouble in the department. Peter had been working as a laboratory technician for many years. Every few months it seemed he would be the center of some drama in the department. He would be “written up” and then not be heard from for several months until the next issue.

The employee had certain skills and certifications that would make him difficult to replace. So, in spite of his repeated involvement in various kerfuffles that impaired the morale of the department, he never received more than a slap on the wrist for his transgressions.

Sheila described her frustrations in detail. Several technologists and laboratory assistants had come to her with complaints about his behavior. They felt that they always had to make adjustments to avoid upsetting him, and it had created a very tense atmosphere in the department.

They complained that there was a lack of consistency in the way the work rules were applied in the department. Peter was repeatedly allowed to skirt the rules without serious consequences. There was a great deal of resentment among the staff members.

As Sheila described the situation to us, we mostly just listened. The COO occasionally encouraged her to “go on, tell us more,” and then we waited for her to go on.

Seeking a Solution

At one point he asked, “How is this behavior affecting the performance of the department?”

She replied, “The turn-around times have gone up because the staff aren't working well together. And one of our new technologists resigned 2 weeks ago, probably because of Peter.”

“How is this affecting your effectiveness?” he asked.

“I'm spending all my time putting out fires and trying to convince the other employees not to quit.”

“What have you tried so far to resolve the situation?”

She described various attempts she had made to work with Peter to improve his accountability and encourage him to address his behaviors. As she paused during her description, we listened without comment. After a few moments, she would continue.

Finally, Sheila said, “You know, it's going to be difficult to replace Peter, but I think I have to do it. For the department, and the organization. His presence is too toxic. If you agree, I'll meet with HR later this week to review the process. Then I'll meet with Peter and let him go.”

What I Learned

In the situation that I describe, as a physician and new hospital executive, my tendency was to jump in after about one minute and advise Sheila to fire Peter, and ask her why she was putting up with his nonsense.

But that would have been shortsighted and counterproductive. What the COO demonstrated was how to lead by asking questions and listening. He built trust with Sheila and helped her grow as a leader. He strengthened his position as COO by not allowing Sheila to put the monkey of the termination decision on his back. Rather, he deftly led her to the right decision by asking a series of questions, rather pushing her with declarative statements.

The Top Skills Leaders Employ

I believe there are many skills a leader needs to develop. These skills include the ability to:

• Act decisively
• Embrace change
• Delegate generously
• Continually learn
• Challenge others
• Build trust in teammates
• Be authentic
• Communicate with clarity
• Inspire others

There are many others I'm sure you can think of. In my opinion, however, there are two critical skills that I see frequently forgotten or overlooked; two that I sometimes fail to employ.

A Leader's Two Most Important Skills

I believe that a leader's two most important skills are these:

1. Listen (or I could say –  shut up and listen!).

2. Ask questions.

We worked on these two issue a lot when I was the hospital VP and CMO. When one of the executive team had a particularly challenging issue, the CEO would set aside time in our weekly strategic planning meetings to take the “hot seat.”

Taking The Hot Seat

This meant that one of us would spend a few minutes describing our challenge in detail to the rest of the team. During this part, nobody was allowed to interrupt. Once finished, the CEO would remind us that the rest of us could now ask questions, and ONLY ask questions, with no debating, no discussion, and expressing no opinions.

The person would then summarize what he or she learned from the questioning, and the possible next steps to resolving the conundrum.

This really helped to clarify important issues and allowed us and the presenter to recognize the important aspects of a new project  that needed additional fleshing out.

Now Let Me Try It

I would like to use these two behaviors to finish out this post. Allow me to set the stage a bit, ask a couple of questions and then Shut Up And Listen.

Here's the setup…

You’re reading this, so you have at least some idea about the goals and intended audience of this blog. Over the past eight months, I have posted about 70 articles.

The articles have mostly been about three or four subjects:

• Leadership
• Management
• Non-clinical careers
• Quality and patient safety

My intended audience is physicians and other healthcare professionals interested in management and leadership, provided from my perspective as a former hospital executive.

But I am not sure if I am hitting my mark. I wonder if  my posts are resonating with you. I wonder how I can serve you better.

Please Help Me Improve

So, I am going to end this post with a series of questions for you, my reader. I ask that you take a minute and share with me the answers to the following questions.

Please respond in the Comments Section that follows.

Or email me directly at john.jurica.md@gmail.com.

Or take this short survey (use the last option and free text as much as you like to provide me candid feedback – it is totally anonymous!) .

Here are the questions I’d like you to respond to (answer as many as you like):

1. What, if anything, do you like best about what you have read and would like more of?
2. Knowing me (check out my About Page or about.me/johnjurica site if you need to), what additional information, advice, resources, ebooks, tools, interviews, etc. can I provide to help you?
3. What is your biggest challenge with respect to career, management, and leadership?
4. What parts of the site are really annoying or broken?
5. Would more stories that weave in my personal experiences (travel to Israel, Uganda, Nepal; eldest of 10 children; bluegrass guitar playing; competing as a sprinter in the USATF Masters events) be of any interest?

I really appreciate any direction you can give me. Be brutally honest.

I’ve asked a few questions. Now, I'm going to listen.

The post Today I Try to Use A Leader’s Two Most Important Skills appeared first on NonClinical Physicians.