I started this series by discussing the attitudes or perspectives that physician leaders should understand and adopt. I would like to complete it with a description of some practical skills that you should seek to learn or enhance. If you are early in the journey, you can try to observe these skills in others as you're preparing to be a better physician leader.

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.

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

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Thanks so much and see you in the next post!