This week, I present my interview with Dr. Harvey Castro in which we discuss the attributes of the best healthcare leaders. 

Our Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. 

By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

Healthcare Leaders Never Give Up and Never Stop Learning

Along the way, he completed his MBA and took on leadership and business roles. He started as a medical director. Then he devoted his energies as a smartphone medical app developer. However, he hit his stride as a freestanding emergency room founder and CEO. That business has now grown into a network of freestanding ERs and other healthcare facilities.

Harvey is the first in a series of guests who completed the UT Physician Executive MBA Program at the University of Tennessee.

Leveraging Medical Training and Entrepreneurial Skills

We covered a lot of ground. Harvey has effectively leveraged his emergency medicine training and entrepreneurial skills to build a remarkable business. And it has happened because of a desire to serve patients better. But it requires the ability to take more risk than the average physician does.

I sincerely think being an ER doctor… you tend to be a risk taker, and that kind of evolves into the business world.

He also believes that the best healthcare leaders never give up, but continuously strive for better quality, safety, and service to patients.

Summary

You can find Dr. Castro on LinkedIn. And if you want to check out his business, go to trustedmedicalcenters.com. You can contact Harvey through LinkedIn or using his email address at harveycastro4@gmail.com.

And don’t forget that Harvey is looking for franchisees to start freestanding emergency rooms in other states. And he has also developed an investment fund for those interested in investing in his growing network.

NOTE: Look below for a transcript of today's episode that you can download or read.

Links for Today's Episode:

• Dr. Harvey Castro's LinkedIn Profile
• Trusted Medical Centers Website
• Trusted Talks Podcast

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Today's PNC Podcast Transcript

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Transcription - PNC Episode 196

The Best Healthcare Leaders Never Give Up and Never Stop Learning

John: I was recently talking with the executive director at the University of Tennessee physician executive MBA program Kate Atchley, and of course they're a big longtime supporter of the podcast. And I asked if she had any suggestions for guests since obviously the physicians involved in their program are trying new things, advancing their careers, and many of them are doing nonclinical things or combinations. So, she introduced me to today's guest who is an emergency medicine physician, businessman and entrepreneur from Texas. Welcome to the podcast, Dr. Harvey Castro.

Dr. Harvey Castro: Thank you so much.

John: Hey man, it's good to see you live. We're looking at video today, even though this is a podcast, but it's good to see you and finally get a chance to spend a few minutes here and what you've been up to.

Dr. Harvey Castro: Yeah, I'm excited to be on the show and I'm excited to finally get to see you in person.

John: This is how we usually start. Just tell us a little bit about your background as far as your education, past clinical practice, and then we'll get into some of the nonclinical activities.

Dr. Harvey Castro: Well, I'm going to go way back. Literally, I couldn't afford college. So, I had to join the army to help fund college. I went to Texas A&M. I received two degrees there, a bachelor's of science and bachelors of art and political science and biomedical science. Because back in the day, I had this big aspiration of becoming a lawyer, a doctor, and a businessman. And so, I marched on and got into medical school and went to UTMB in Galveston, Texas.

Then I went to emergency medicine in Pennsylvania and started practicing medicine as a board-certified emergency physician. Loved it. But I always had this almost like a tickling to do something else. During residency, I was selling books that I wrote in med school. And then in residency, I started my heart vitamin company that I sold.

And then when I graduated, I started this thing called iPhone app. It was a new thing out there and I started trading apps. And so, I started combining medicine and whatever else I wanted to do with it. And at that time, I was combining technology with medicine. And so that was my educational background.

And then having all those accolades and things that I was doing, I started thinking, "Well, heck what if somebody taught me the business side of things? What if I actually got a degree in business?" Because all the things that I know of business, it's kind of like the streets of business. Like the street accolades is what I was learning and doing, but I thought if I had formal education, maybe I would be a better provider/business person in healthcare.

John: All right. But I know for a fact, just looking at your background that you are doing a lot of management before you decided to get the MBA, for sure. So, what kind of roles were you doing? We use this term commonly "medical director". That can mean a lot of things, but I kind of got the sense that there you, yourself or others were putting you in positions of helping them manage things. So, give us a little bit more detail on some of those positions you held.

Dr. Harvey Castro: Yeah. Excellent question. Early on, thank God, I was identified as the future leader. So, at the time the organization I was working with said, "Hey, we'd like you to go to the ACEF academy of leaders and go through all the phases. Phase one, phase two, phase three. And that leadership, learning that training, learning how to even talk to people. They put me as the assistant medical director, and then later I became the actual medical director of a free-standing ER in Dallas.

And that position helped me so much because I have had the leadership training. And so, then I was able to start free-standing. And within the first month I turned it around and made it profitable. It was literally from zero patients to profitable. And those leadership skills, going out to the community, talking to doctors, telling them about our business, looking at the different things.

And then later, I became a consultant in Texas. I literally would drive around or fly around the state of Texas and different companies would hire me to come and help them start their free-standing. And then after a while I thought, "I've been doing this so long. Why not start my own brand?" So, my business partner and I, we were in the business of rehabbing ERs that were failing. And so, we did one, within three months we rehabbed it, we had it profitable. It went very well. We were returning money back to our investors that have helped to start it. And then I said, "Why don't we start a company?" And we just came up with Trusted ER. And literally this was about three years ago. And in over three years, we've expanded to eight locations.

John: That's pretty rapid growth right there.

Dr. Harvey Castro: Yeah. It's crazy to turn around and see. We have about 350 employees, doctors, non-doctors, front office, different branches of the business. And to your point, you're right. We did all of this and then last year I went to school to get my MBA.

John: Okay. So now let's go back a little bit again. I want to kind of get the idea when you were doing the consulting and teaching others like how to improve their ERs? How long ago was that?

Dr. Harvey Castro: That was probably about seven years ago and it probably stopped about three years ago in the sense that I was just working for myself and just helping my own brand.

John: Now, at what point, have you stopped practicing? Or do you do the occasional shifts? How does that work for you and what was that transition, if there was one?

Dr. Harvey Castro: Yeah. That's an excellent question. I can honestly say I was working too much. I was working as an ER doctor. I was working in three different cities plus consulting. And literally I felt like I wasn't resting. Literally, I remember getting off at seven in the morning and then driving two hours and then going to a board meeting because there was this company, I started calling Trusted ER.

And I remember thinking "I can do this". And finally, after a year of doing that, I said, "You know what? This is not life. I'm just burning it on both ends". Then I took the leap of faith of saying, "You know what? I'm saying no to emergency medicine as far as a paycheck. And I'm going to put all my eggs into this Trusted ER and this'll be my daily bread". And it's really tough. Especially as other doctors know that it took so hard to get here. And then to say, "You know what? I'm going to stop practicing medicine and do more on the business side".

And so, now as far as clinical, the only way I would come into cover shift is if the medical director can't and then the chief medical officer can't and the regional can't. And then at that point it's me. But then at that point they usually fill up shifts. I really don't get to practice unless I want to go in and work a few hours.

But I'm more involved in teaching medicine and teaching the concierge portion of how we do emergency medicine, looking at the business side, looking at locations. And interesting enough over the years, especially with COVID, NBCUniversal, all the major networks have been calling me to do medical segments. And so, through peer reviews and looking at different cases in my experience in emergency medicine, which is over 20 years, I'm able to go in and talk about X and Y subjects. And so, last year I actually did about a hundred interviews on TV.

John: Really? Okay. I was wondering about that like, "Oh, maybe one a month for a few months", but a hundred interviews. I mean, that's actually something where that could be a whole career itself in terms of just being seen as the expert and promoting yourself and doing those kinds of interviews on a regular basis. But I see that it feeds into what you're doing from an ER standpoint, of course, and a business standpoint to promote what you're doing in Texas. That's awesome.

Dr. Harvey Castro: And it's fun. I feel like I can get back and it's a different medicine. When COVID hit and everybody was freaking out and scared, I hit the TV station up and said, "Hey, can we do a hotline? A free hotline, just call this number and we'll answer all your COVID questions". And we did this in March and we were on NBC and Telemundo. And I didn't realize that their outreach was all the way out to El Paso. So, we were getting thousands of calls and I had it literally on a list of doctors in the room together just calling and returning calls and just going through all their COVID questions.

But this was the fun part of medicine. When everybody's freaking out, I was able to get on TV and say, "Hey, let's look at X, Y, and Z. Let's talk about this". And it was actually a fun way of practicing medicine. Way different, but it's medicine.

John: Yeah. I think as physicians, we have no inkling of what things could be like if we kind of just open up to the possibility of whether it's expanding your own practice or creating something that has multiple sites or even opening a small hospital. I think you mentioned it is now part of this network.

Dr. Harvey Castro: Yes, sir. We opened our first hospital in Mansfield, Texas. And that was great because now we have the license to do other things. And so, for example, when COVID hit, we were able to start doing mobile testing. So, we were going to the employers. We were the first in Dallas to go out to the employers and test everybody at their location.

And then we were lucky enough to get the first PCR tests and antibodies tests and everything that one was coming out in Dallas. And we were able to show that on TV and have people come to our locations and get these tests and having that outpatient clinical license to be able to do these things. It was perfect timing. So, we actually started our own testing center. But again, I love being able to combine medicine and business and then trying to do something different.

I think it's hard and it's hard almost for us doctors to respect non-doctors in the business world, because they tell us to practice medicine in a certain way and we're like, well, you never help us at the scope and you never talked to a patient, you've never been in those situations. But when another fellow doctor is like I've been there, we've done this, I get that issue. And as the business side, these are the reasons why we want to fix it. And these are the things. So, it's actually been a different medicine that I feel honored and blessed to be able to do every day now. It's just different. No red tape.

John: Yeah, right. When you make a decision, I guess it's going to be implemented pretty quick if you're the CEO. But I do think there is a big need for more physician leaders. There was a time when more than half the hospitals in the country were actually owned by physicians. That's way back in the old days in the 50s. But now I think it's less than 5% or 6% that are led by physicians. And I think we do a whole lot better in medicine and in healthcare as an industry, if we had more physicians in charge of more things.

So, I think physicians should not shy away from that. Especially if they're interested, if they have an aptitude for it, like you've done, then just keep moving forward and you can contribute so much more doing that. I mean, in terms of the numbers of people you're affecting, I would think.

Dr. Harvey Castro: Yeah, it's been fun. I would encourage everybody to do that. Whatever you're good at and whatever medicine you're practicing, take it to the next level.

John: Absolutely. Now you talked about getting a little bit maybe burnt out while you're doing all these things and you say, "Well, maybe I got to cut the practice back at some point, if I'm doing all these business things", but then you decided, "Well, I'm going to go ahead and get this MBA". So, I want to hear what it's like from a student. I don't know that I've actually spoken directly to a graduate of the UT PEMBA before. I mean, I've talked to people and it's a common question I get about advanced degrees.

So, tell me what that was like and how did you carve out the time to do it? Because it's a pretty intense program. Go ahead and just run with that. Tell us about it, what your experience was and how you were able to manage that.

Dr. Harvey Castro: Honestly, I felt like I was going back to med school in that here's all this information being taught to you. I'm going to date myself. I'm going to school and being there and seeing just all the technology and laptops and plugins. I was like, "Whoa, this is so much more fun going to school now than back in the day when I went to school".

And the information was actually fun because we were given PowerPoints, we were given summaries, the books we were told to read. It was even more fun for me because it's like, "Wow, here's medicine and here's business. This is what I've been doing." So, I felt like I was able to get so much more out of it because now I was like, "Okay, now that makes sense".

And it's funny, it's kind of like riding a bike. It's hard to describe how to ride a bike, but once you start doing it, you do it, but then you don't really know why. Going to school was like finding out the "why". Why was I making these decisions? Why was I negotiating in a certain way? Why was I doing things? And it was great to get the Booksmart.

So having these professors talking to me about accounting and one-on-one and entrepreneurship, it was great hearing. Marketing was awesome, listening to different marketing ideas and theories and why things are done in a certain way. And then it's like, "Wow, that's just reinforcing some of the things I'm doing". And now I can actually improve my practice or running my business by using these tools.

As far as the time demands, oh my gosh. It was hard, because running a practice, running eight businesses, having the employees, being the leader, I would literally make time. So, every time I'd come home, I'd say, "Okay, I got to read this book. I got to summarize. I got to think about this". Or working on projects was really hard. Because imagine getting three busy physicians all together on a Zoom saying, "Okay, we are working on this project", it was hard. And then going to class every Saturday and then having a life for the Saturdays. I remember saying, okay, I want to go on vacation, but technically I have classes on Saturdays. So, it's going to be tough.

With that said, I'm glad I did it. Back in the day when I was in the army, I thought I really wanted my MBA one day and my MD. So, that was part of my goal and I wanted to get that. I'm glad I got it because I felt like I had the street-smart, but not the book-smart. And having both just gave me an extra layer of knowledge. And I was able to talk to my classmates and say, "Hey, the reason the professor is pointing X, Y, and Z is because this is how you'll see it in the real world. These are the accolades. These are the things that you need to focus on".

So, I can't say enough about the experience. I thought it was great. I think one of the things about me, I feel like I'm a lifetime learner so I'm all about going back. And today after this podcast, we are having a talk at the University and I'm going to be on it, just listening as a participant to learn more from the University. So, it's fun.

John: Yeah. We're going to try and actually put some of the things that they're presenting there. Dr. Kate Atchley said that we could actually promote that on the podcast. So, I'm going to be putting notices for some of those business-related courses for physicians or just the seminars because they are CME accredited. So, it sounds like it's a really good opportunity for those that are outside to kind of let them get familiar with the program.

But I know this is kind of a leading question. I kind of know the answer, but some physicians are like, "Well, I should've gotten my MBA back when, because then I would know how to run my practice better or run this group better". But I get the feeling that the virtue of an executive MBA is you're coming in when you've already had enough exposure to something that you actually know what you're looking for, when you hear it, it makes sense. I mean, you were talking about marketing before you did the MBA for your organization. And so, I guess my question is, would you agree with that? That there is some advantage to that?

Dr. Harvey Castro: There's a lot of advantages to having the experience of having a business. With that said I wouldn't preclude it as a prereq to go into getting your MBA. I always feel like it's important to have an end in line. If you're getting an MBA just to get an MBA, if that's your goal, that's fine. But if you're getting an MBA because there's X, Y, and Z, that you're wanting to get out of it, then you're going to get that out of the MBA. If you decide I just want to go through it and just see the bigger picture, then you'll get the bigger picture.

But I went into this very razor focus, like, "Okay, these are the things that I need to work on. These are the things I needed to do better on. These are the things that I should be open-minded to". So, every time certain lectures came, I was just taking it all in or pre-reading or trying to get the most or reading the notes. Actually, yesterday I spent some time looking at some of the old notes from our marketing professor and just reading through them I'm like, "Man, this is really good stuff that I need to apply". And so, I think it's important to have an end in mind. Why do you want the MBA? What are you going to get out of it? And then you'll get even more out of it.

John: Yeah, I think you could do either. I get that question all the time. Should I do this MBA or MHA and some other degree? It's a personal decision, but there's nothing wrong with trying to dabble in it a little bit in terms of the business side and then if you feel like you really want to pull the trigger. The other thing is if you can get an employer who will pay for part of it, that can be helpful.

Dr. Harvey Castro: Yes. Yeah, for sure.

John: The other thing I was going to mention is I'm assuming you had a pretty decent team that could at least free you up a few hours when you need to be freed up. It sounds like you have a pretty extensive well-run organization. So, I'm sure that helped.

Dr. Harvey Castro: It does. It does help. I felt bad for some of my classmates that said, "Hey, I just got off a shift and I'm here. I'm in a small group". And I'm like, "Oh my God, bless your heart. I can't complain. I was in bed last night. I slept in my own bed". And interestingly enough, I would say at least 40% of the class was emergency room. And so, that just tells me, I think there is a lot of burnout out there. A lot of doctors are like, "Man, holidays, weekends, I can't do this". And I think early in life, it's fun. And then later you're like, "Whoa, I have kids, I have this and that. It's not as easy to work a midnight shift as it used to be". So, I think doctors are looking to do something else.

John: Well, I've had a lot of guests on here who are ER docs. There seems to be something about the ER docs. I mean even urgent care, right? That's what I do very part time now. Half of them are either owned by ER docs or family docs. I mean, you got to have that broadest exposure to clinically. And of course, the ER docs usually have the more aggressive urgent cares where they do an IVs and things and do more procedures. But even beyond that, I can't tell you how many ER docs have been in start-ups or investing in some new company. So, I know there's something about the excitement I think of ER work and maybe the business excitement.

Dr. Harvey Castro: Yeah. I agree. I sincerely think being an ER doctor and I love all the professions, but being here, I think you tend to be a risk taker and that kind of evolves into the business world. And then you're more likely to say, "You know what? I'm going to jump in and start my own urgent care, even though I don't know anything about urgent care", because you're that risk taker. And sometimes to be successful, sometimes you need to take risks, calculated risks. And I think you see that in ER doctors.

John: Okay. Now I got to segue us into another business topic related to what you're doing. From what you told me before we got started today, you are in the process of franchising, what you're doing and maybe even looking for investors. So, explain that to us in some detail because I think we've talked about franchises, like being a franchisee and just signing on with somebody. But if somebody has a practice, a group practice, ER practice, something like that and what you're doing, how could you possibly consider franchising? Explain that to us.

Dr. Harvey Castro: Yeah. Well, it all comes down to what we're talking about today - Business. We all are healthcare providers. We spent hours and hours of taking care of patients. We know how to take care of patients, but do we know how to buy a business? Do we know how to negotiate a business? Unfortunately, when people see MD/DO behind your name, they're like, "Oh, that's a premium. We're going to charge you a little extra here".

So, what we decided is why not create a product that we can franchise and create that business. And in that way, we are negotiating, we know what the prices are. We already have the vendors. We have the system in place. Every organization that we've started, every ER, is very meticulous how we do procedures. We have a handbook. We have HR, accounting. We spend a lot of time making sure that when we opened and we grew so fast, we had to create these folders and processes.

And so, we've got it down to a science. And now we have our own HR, accounting, billing company, our own physician company, our own staffing company. So, we thought, why not create a franchise so that if another doctor wants to do the same thing, but do it in their community, here we go. We can support you. Not to promote myself or our company, but it's really hard to start a business, especially if you're going to make a lot of mistakes. And those mistakes sometimes cost a lot of money.

So, to me, it makes sense. And I'm personally looking actually at other franchises out there to say, "How can I invest in franchise X and Y?" Because they've already fine-tuned this. They've already fixed all the issues. They already know what issues are coming and how to avoid them. So, I would gladly pay a company to say, "Hey, come in and help me". I'm looking at some food industry places. And I'm like, I don't know anything about food, but this franchise is known. And that's why I thought, why not do the same thing?

On the Dallas side, we have eight locations. And we're about to launch basically a fund that if someone outside of Dallas wants to invest in Trusted ER, they can buy a share of the ADRs. And we're selling that. We have two parts of our business. One is an investor side and one is a doctor side. We're consolidating basically all the doctors into one fund and then letting other people come in and buy into that fund that is representative of all the eight locations. So, we're doing that and we're doing the franchise separately. So, it's been fun. I think it's a good tool. And I think as a physician, I wish I had that tool early in my career to be able to say, "Hey, I want to invest in X and Y. And this is run by another doctor or a nurse or someone that knows the business".

John: We'll have to have you come back on in a couple of years and see how things are going. But I did want to say the following. As my listeners know, my wife owns a franchise for a home helpers' business and she's been doing it for 12 years now. And we're thinking of semi retiring to another state. And I asked her, I said, well, if we move somewhere, you could easily open your own in-home care business, you know how to do it. Would you bother with the franchise? And she said, I wouldn't do it unless I was part of a franchise. Because there's so much support and it's not just the protocols and the procedures and things they've worked out. It's the ongoing support. You've got people that you're in touch with on a regular basis, you can ask questions, they have quarterly meetings, they have annual meetings.

So, I think a franchise really simplifies the process of getting into that business. Yes, you have to pay a fee for it. It's not free, but, boy, I'm going to be really interested in seeing how this works out over the next few years.

Dr. Harvey Castro: Yeah. Thanks. And I'm excited. I'm really excited.

John: You're going to be a busy man for a while I think probably for the next couple of decades, the way things are going. But it does keep you young, huh?

Dr. Harvey Castro: It does, it does. I do want to shed some light. No matter what you're doing, I think it's important to just have fun. I love medicine. I love practicing. I loved the business side of it. So, I'm having fun. I love being on TV and just doing it. It's not for everybody. But once you find something that you love, I would just say, take off with it.

I have a big heart for single parents out there with kids, single kids out there that are just teenage kids, teenagers having kids. My mom had me at an early age. And so, I literally wrote a book called "Success Reinvention" to kind of help others out there. I'm in the process of writing my own course. I'm hoping in the next two months that course will be out to just help other parents that are out there trying to struggle, but trying to improve themselves.

And in November, we're doing a video tape with Amazon. Basically, I'll be on TV on Earth Day next year. For the pandemics, I'll be on an Amazon TV series called The Social Movement. So, I'm kind of excited.

But whatever it is, I'm sharing these things, not to brag at all. It's just to say, "Hey, you can use your MD, but do it with different things". Here I am, I wrote a book. I'm doing a course. I'm going to be on a TV series next year. It's just about wanting it and then whatever it is that you enjoy, just go with it.

John: Yeah. It's so much easier to create things these days. Imagine going back 30, 40 years before the internet. I mean you can create courses, you can get online, you can collaborate, podcasts weren't even a possibility. I guess it could be on the radio. But yeah, that's good. That's absolutely true.

Well, before we go. We're going to run out of time, a couple of things. To get a hold of you, probably a simple way might be through LinkedIn. Would that be appropriate?

Dr. Harvey Castro: Yes, sir. I'm on all the social networks, Facebook, Instagram, but LinkedIn, I check a lot. And so, if you don't mind, LinkedIn me, and if you don't have LinkedIn, then my email is harveycastro4@gmail.com. And I answer all my emails myself. So, feel free to contact me about anything.

John: That sounds good. And they can see what the company's up to at trustedmedicalcenters.com.

Dr. Harvey Castro: Trustedmedicalcenters.com. It has all our locations. It got some great blogs. We started our own podcast actually called Trusted Talks. It just talks about health care specific to Trusted ER, and we have our own marketing media. You'll see lots of videos that we do in house. It's actually pretty progressive.

John: All right, trustedmedicalcenters.com. And the podcast is sort of geared for patients?

Dr. Harvey Castro: Yeah, it's for patients. Exactly. Trusted Talks.

John: Okay. I'll get that down and I'll put that in the show notes as well and send that out. All right, I'm going to give you a chance to just give a little advice to a physician. A lot of the listeners are sort of like struggling. They're obviously listening to this podcast because we're talking to people that have done new things and they haven't all left medicine, but they've started something maybe with medicine or built on their background in medicine, but they're scared sometimes of fear of failure, all kinds of things. So, any last words of advice for people that are thinking about trying something new like that?

Dr. Harvey Castro: Yeah, so much to say. I think at the end of that, I want to make sure everyone knows that you need to just stop and smell the roses. Take time for yourself, take time for you because if you're running, running, running, you're not going to be able to build anything.

But if you have time for yourself, even if it's simple, like I know I sound like I'm crazy busy and I am, but at the end of the day, I make sure I do something for me. It may be calling my kids and maybe going for a walk. It's important for you to just take time.

Sometimes I literally turn off everything when I'm driving to work and I just enjoy the solitude and quietness. That's something that helps me get the energy. And then when I'm at work, I'm ready to go or whatever task I need to do, I have full of energy and get to do that.

Make sure you take time for yourself so that you can make it sure that you have the energy to do whatever it is that you're trying to do. And don't be scared. It's all about calculated risks. So just take time and research, whatever it is that you're trying to do and then do it.

One other quick advice is, look at life like a ladder. It doesn't matter about you getting there quickly. It's about you going up that run. And it can take you 10 years, 20 years. Here I am, I'm in my late 40s. I'm 47, I just got my MBA. And so, I always wanted to do that. I thought that back when I was 18 and I personally want to get my JD and I'm pretty sure I'm going to go get it when I'm 65. So, I'm still going to go up on that ladder.

John: All right, we're going to hold you to that now. You put that date out there. All right. Well, I really appreciate those comments and I think we've had a fun talk today and very motivational, inspirational. I appreciate that. We'll be in touch again in the future, I am sure, Harvey. So, thanks a lot for being here today.

Dr. Harvey Castro: I'm honored to be here. Thank you, sir.

John: You're welcome. Bye-bye.

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The post The Best Healthcare Leaders Never Give Up and Never Stop Learning – 196 appeared first on NonClinical Physicians.

I have a very interesting interview this week with an entrepreneur who has spent the last 4-½ years developing his international start-up company. He is not a physician, but his story is so compelling, and the technology solution so important, that I had to interview this guy.

I met Matt McGuire at the Physicians Helping Physicians Conference in Austin, Texas. He was a fellow presenter, discussing the subject of entrepreneurship and his start-up.

He's the classic Silicon Valley entrepreneur: outgoing, totally committed to his company, sleeping only about 30 hours per week. Yet, his company is not based in Silicon Valley. It’s a health care technology start-up with a product designed to save lives and improve health care for millions of patients around the globe, by making medications safer.

Anti-Counterfeit Technology

However, it's not a pharmaceutical company. It's a company that sells an anticounterfeit technology called SafeStamp that can help reduce or eliminate the sales of counterfeit medications. Medications that are responsible for hurting millions of patients around the world.

So, who is Matt McGuire? Well, before he entered the Wharton Business School, he was a soldier deployed to Iraq for four years. While there, he discovered that terrorist groups were generating millions of dollars in cash to support their operations by selling fake medications.

Counterfeit Medications Kill Millions

With a little research, he learned that AROUND THE WORLD, fake drugs were a MASSIVE problem. Globally, 15% of medication are fake, and even poisonous, resulting in over 1 million deaths.

In some countries, 50% of the medications being dispensed are counterfeit. That means they are at best placebos, and at worst deadly poisons.

So, when Matt was looking for a business to start while at Wharton, it became obvious to him that developing a technology to eliminate counterfeit medications could be a HUGE opportunity. And his start-up was born.

He told us that the market for anti-counterfeit packaging technologies for pharmaceuticals alone is something like $100 billion. And there are whole markets beyond drugs where the anti-counterfeit technology can be applied.

During our conversation, Matt mentions SafeStamp – the name of the technology and the company. It's basically a sticker or label that incorporates nanotechnology that cannot be copied. His patented nanotechnology produces a unique reaction and color change – an orange or blue glow – by blowing on or touching the label that cannot be duplicated by counterfeiters

Our Sponsor

The University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, is the proud sponsor of this podcast. You’ll remember that I interviewed Dr. Kate Atchley, the Executive Director of the program, in Episode #25 of this podcast.

The UT PEMBA is the longest running, and most highly respected physician-only MBA in the country. It has over 650 graduates. Unlike most other ranked programs, which typically have a duration of 18 to 24 months, this program only takes a year to complete. And Economist Magazine recently ranked the business school #1 in the world for the Most Relevant Executive MBA.

University of Tennessee PEMBA students bring exceptional value to their organizations. The curriculum includes a number of major assignments and a company project. Hence, students immediately contribute to their organizations while in the program.

Graduates have taken leadership positions at major healthcare organizations. And they have become start-up entrepreneurs and business owners. If you want to acquire the business and management skills you need to advance your career, contact Dr. Kate Atchley’s office by calling (865) 974-6526 or going to vitalpe.net/physicianmba.

Five Start-Up Secrets

So, here are Matt's 5 big start-up tips. They are:

1. Do Not Neglect Proper Pricing. This should be addressed scientifically. Matt recommends reading Smart Pricing by Jagmohan Raju.
2. Pay Attention to Design Principles. For insights into this topic, Matt recommends books by Donald Norman such as The Design of Everyday Things and Living with Complexity.
3. Understand Your Customers. Matt says you must talk to your customers while developing your product. He recommends two books by Giff Constable: Talking to Humans and Testing with Humans.
4. Select Great Partners. Go it alone if you can. But if you need a partner to bring critical skills to the company, be very selective. And use a vesting schedule for ownership in the company. That way, if a partner walks away in a few months, they don’t already control a large piece of your start-up.
5. Don’t Pursue Investors Too Soon. Be scrappy. Don't take money unless you really, really need it. And never take more than you need to, any sooner than you need to. That will dilute your ownership more than necessary.

One More Source for Ideas

Matt also mentioned that if you’re interested in starting your own company, but don’t yet have a great idea, you might try checking the Technology Transfer Offices of large universities.

They're really good at developing creative ideas and potentially valuable intellectual property. But they aren’t so good at bringing them to market.

That’s where you can step in, partner with them and build a company around the idea. The databases can often be searched on line. But you’ll need to share a good deal of the profits with them.

Links for today's episode:

• SafeStamp
• Smart Pricing by Jagmohan Raju
• The Design of Everyday Things by Donald Norman
• Living with Complexity by Donald Norman
• Talking to Humans by Giff Constable
• Testing with Humans by Giff Constable
• The Milken Institute Ranks the Best U.S. Universities for Technology Transfer
• To inquire about investment opportunities and other questions, you can contact Matt McGuire via email at: matt@safestamp.com

Thanks to our sponsor…

Thanks to the UT Physician Executive MBA program for sponsoring the show. It’s an outstanding, highly rated, MBA program designed for working physicians. It might be just what you need to prepare for that joyful, well-paying career. You can find out more at vitalpe.net/physicianmba.

I hope to see you next time on the PNC Podcast.

If you enjoyed today’s episode, share it on Twitter and Facebook, and leave a review on iTunes.

Disclaimers:

The opinions expressed here are mine and my guest’s. While the information provided on the podcast is true and accurate to the best of my knowledge, there is no express or implied guarantee that using the methods discussed here will lead to success in your career, life or business. 

Many of the links that I refer you to, and that you’ll find in the show notes, are affiliate links. That means that I receive a payment from the seller if you purchase the affiliate item using my link. Doing so has no effect on the price you are charged. And I only promote products and services that I believe are of high quality and will be useful to you, that I have personally used or am very familiar with.

The information presented on this blog and related podcast is for entertainment and/or informational purposes only. It should not be construed as medical, legal, tax, or emotional advice. If you take action on the information provided on the blog or podcast, it is at your own risk. Always consult an attorney, accountant, career counsellor, or other professional before making any major decisions about your career. 

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

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The post Top Five Start-Up Secrets for the Physician Entrepreneur – 087 appeared first on NonClinical Physicians.

For this interview, I found an expert at a firm that’s focused on recruiting physician managers, directors and executives for hospitals, medical groups, health systems and managed care companies. In the future, I hope to talk to someone who is focused on other fields, such as utilization management firms and pharmaceutical companies.

An Expert Physician Recruiter

Paul Esselman has spent more than two decades helping to recruit physician leaders.

Paul is Senior Executive Vice President and Managing Director of Cejka Executive Search, a nationwide leader in executive search, specializing exclusively in the health care industry for over 35 years.

Photo by rawpixel on Unsplash

As Managing Director, Paul provides strategic oversight and operational direction for the Cejka Executive Search team. He provides client consultation for senior-level executive search engagements focused on C-suite positions, and organization development, and succession planning strategies.

For our purposes, Paul is an expert recruiter of physician leaders in a variety of healthcare settings.

Paul Esselman Did A Great Job Answering My Questions

Paul describes his role at Cejka Search. Then he explains that Cejka recruits both clinical physicians AND physician executives. He provides an overview of the types of organizations he works with, and the positions to which he is likely to be recruiting.

I heard some interesting insights into the way the demand for certain types of positions, such as Chief Medical Officer, Chief Clinical Officer or Chief Strategy Officer have changed over recent years.

According to Paul, many organizations are beginning to devote more resources to developing leadership talent within their organizations.

We spent time digging into the topic of physician salaries, and Paul was fairly forthcoming about that. Most of you will see an increase in your overall salary and benefits, unless you’re in a procedural or surgical specialty and are very busy.

Photo by Jens Johnsson on Unsplash

He explained his opinion about advanced business degrees and the potential benefit of completing the CPE (Certified Physician Executive) designation. These topics have been discussed previously in My Interview with Dr. Kate Atchley and 3 Reasons to Pursue the CPE.

We spent a few minutes talking about the need for good references, and the appropriate references to solicit. And he emphasized the importance of working with a mentor and developing a 3- to 5-year career plan.

Contact Mr. Esselman

You can reach Mr. Esselman via email at pesselman@cejkasearch.com. And you can find current positions posted at the web site at cejkaexecutivesearch.com.

It’s a good idea to check there every couple of weeks to see how the job postings change.

And DON’T FORGET – you can begin your journey by following this podcast on iTunes. Please take a minute to leave a rating and review.

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And join me next week for another episode of Physician Nonclinical Careers.

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

Disclaimer:

The opinions expressed herein are those of me and my guest, where applicable. While the information published in written form and in audio form on the podcast are true and accurate, to the best of my knowledge, there is no express or implied guarantee that using the methods discussed herein will lead to success in your career, life or business.

The opinions are my own, and my guest's, and not those of any organizations that I'm a member of, or affiliated with. The information presented on this blog and related podcast is for entertainment and/or informational purposes only and should not be construed as advice, such a medical, legal, tax, emotional or other types of advice.

If you take action on any information provided on the blog or podcast, it is at your own risk. Always consult a professional, e.g., attorney, accountant, career counsellor, etc., before making any major decisions related to the subject matter of the blog and podcast.

Affiliate Links:

Where noted in parentheses, I receive a small stipend for referring you to a site, such as Amazon, where you may purchase a product discussed in a podcast, show notes or blog post. This does not affect your cost for the product. I only promote products that I have purchased, or used myself, or that respected colleagues have recommended.

The post What Do Recruiters Look For In a Physician Leader? with Paul Esselman – 041 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.

After considering the purchase, we decided to proceed. We signed a loan agreement and purchased the device. It would take 5 years to pay back the loan. We were convinced the device would generate procedures that would easily cover the loan payments.

Eighteen months later, we had only used the device about a dozen times, and we were stuck making that monthly payment with little revenue to offset the cost.

We had been overly optimistic in our assessment of the need for the device. And we had not considered what we would do if it failed to match the salesperson's inflated return on investment.

As a former small business owner, I have been guilty of the sin of failing to perform a basic financial analysis prior to purchasing new equipment. Furthermore, my partner and I never took the time to budget appropriately or formally plan for each coming year.

Later in my career, as I studied hospital finances and participated in regular strategic and management planning meetings, I came to appreciate their importance. In hospital management, it is expected that annual goals and budgets will be developed. And executives and their direct reports will be held accountable to them.

The earlier in its development that a healthcare organization adopts a formal budgeting and management planning process, the more likely it is to meet and exceed its goals. The old adage is true: you cannot manage what you don't measure.

The Annual Management Plan

Many hospital systems, including ours, went though a major strategic planning process every 3 to 5 years. But we found that such a plan became outdated very quickly. So we began to focus our efforts on creating an annual management plan that was strategic in nature.

This process dovetailed with the annual budget process. We could therefore push the organization to identify and pursue big goals on a regular basis.

For this post, I would like to outline a fairly straightforward, though somewhat time-consuming, process that any business can follow. This process can be adopted to medical groups, hospice organizations, nursing homes and hospitals.

When applied appropriately, it will help such organizations to optimize their performance, and drive growth and improvements in satisfaction, quality and financial performance.

I'll start by providing an outline of the process that you can follow. The goal of this planning process is to review what has happened in the recent past, analyze the current situation, and then plan for the coming year.

It’s been demonstrated many times that those with a plan are much more likely to make progress toward important goals.

So, here are the general steps to follow when creating a new management plan for the upcoming year.

Assumptions

In creating this plan, I'm starting with two assumptions. You may need to pause the management planning process and address these foundational steps first, if these assumptions are not true.

Assumption #1 – Mission, Values and Vision

Your organization has a mission, values and vision that have been articulated clearly and are understood by everyone. The goals that will be chosen for the coming year must be aligned with these fundamental concepts.

Keep the vision in mind.

The one item that could be rolled into the planning process could be updating the vision. The vision is not as fixed as the mission, so it can change from time to time. It is therefore possible to start the management planning process by updating the vision.

Then the new management goals can be selected to start to achieve the new vision. It is rare that a one year is enough to completely achieve the vision.

Here's why.

The definition of vision is as follows (from businessdictionary.com): “An aspirational description of what an organization would like to achieve or accomplish in the mid-term or long-term future.”

So, a statement such as “improve sales by 10%,” or “increase revenues and earnings by 5% next year,” are not what I consider meaningful vision statements.

A vision statement is more profound and long-term: “Our organization will become the premier provider of in-home care in our county,” or “We will be the number one orthopedic group in the state, as measured by surgical volume.”

These are big audacious goals that qualify to be part of a vision statement.

Our annual management goals are going to help us move toward the fulfilment of the vision.

Assumption #2 – Pillars

At my hospital, we identified major domains or pillars that serve as the foundation for the success of the organization. These were fairly stable, but occasionally changed. For us, they generally included the following domains:

1. Financial
2. Growth
3. People
4. Customer satisfaction
5. Quality
6. Physicians

Pillars serve as the foundation.

Some organizations include employees and physicians under the People pillar. Academic organizations might have a pillar for Research or Technology.

A Word About the Budget

Sometimes the question comes up: should we complete the budget first or the management plan first?

To some extent the processes are done in tandem. However, it is impossible to complete the budget without knowing what new initiatives, service lines or technologies are going to be developed. If a new unit is to be opened or a management firm consulted, there will be new expenses generated.

And new revenues must be added to the budget if these new services are designed to generate additional income.

The final budget can, therefore, only be completed after the management goals have been approved for the new year.

Creating the Annual Management Plan

I divide the process into six phases, each of which will be described in more detail:

1. Preparation
2. Review of previous budget, previous management plan, prior results and market analysis.
3. Analyze and discuss, including a SWOT Analysis
4. Brainstorm preliminary goals
5. Draft the list of general goals
6. Finalize plan by creating SMART goals with assigned accountability and milestones to achieve

The Annual Management Planning Process

1. Preparation

The team will need to have a basis from which to make recommendations and select meaningful goals. That will require information to set the stage for analysis and brainstorming.

A set of documents will need to be prepared prior to the first meeting. The reports that will need to be reviewed prior to, and discussed during, first planning meeting will include the following:

• Financial Statements. The Profit and Loss Statement (also called an Income and Expense Statement). You probably want to look at 3 to 5 years of annual reports, if possible, and 12 months of monthly data. These will also include a comparison of the budget created last year to the actual financial performance.
• Volumes. Is the number of clients, patients, residents, etc. increasing or decreasing? What are the trends? Depending on the business, it could be the number of widgets sold, tests completed, or treatments delivered.
• Market Analysis. To the extent possible, bring in an analysis of what has happened over the past year or so with respect to the market. How many competitors are there? What is the market share of each? Is your share going up or down (you may be growing but still losing market share if others are growing faster).

Other Considerations

The Preparation Phase also includes determining the following:

• Who will be attending? Just the executive team (CEO, COO, etc.), or directors or managers? Who will be presenting the reports and leading the sessions? Who will take notes?
• Where will the review, brainstorming and selection of goals take place? Will some sessions be held at an offsite location (at a so-called retreat)? This tends to help avoid interruptions and distractions more than holding all of the meetings at the main office location.
• Will an outside speaker be needed to help set the stage with a broad market overview, or a review of the regulatory environment for your business? Perhaps a speaker with a legal or risk management perspective is needed. Or you might ask someone from one of your professional associations to provide a summary of recent trends in the field (like the American Hospital Association, the American Medical Group Association or the Ambulatory Surgery Center Association, or similar national or state associations).

Someone will need to be assigned to make the arrangements (reserve meeting space, hotel, meals, etc.).

Conference room for discussing and debating new goals.

2. Review and Market Update

This phase will take from one-half to one full day to complete.

At the beginning of this review, there should be an effort made to do some team building. This is something that should be done all year long, but at this meeting it will be helpful if the participants feel comfortable openly discussing issues with one another.

Team Building

You might simply have each person describe their background and their families. Or you can go further by sharing little known facts, and getting into hobbies and interests outside of work.

You can use specific techniques to break the ice and generate rapport among the participants, such as:

• Two Truths and a Lie. This is one of my favorites. In groups of 4 to 10, each member identifies three “facts” about themselves, two of which are true and one of which is completely made up. The others attempt to guess which item is false. Then the speaker explains which is false and expounds on the others. Each takes a turn doing the same.
• The Observation Game. Everyone is paired up with a partner. Then you both stand facing each other for about a minute, observing the appearance of their partner. The moderator has everyone turn away from their partners. One partner changes something about their appearance, such as removing eyeglasses or a bracelet, placing a pen in their shirt pocket, etc. Then the partners are asked to turn towards each other and the observer is given 30 seconds to determine what is different. Then the partners switch roles.

These games tend to help participants loosen up and feel comfortable with the group. When appropriate, more sophisticated team building methods can be employed.

Review of Reports with Discussion

Once the team building is done, a review of the prior year updates on financial, HR and satisfaction data are completed. This should be sufficient to prime a smaller organization and might take 2 to 4 hours to complete.

For a large organization, this might be an all day retreat with the hospital board, CEO, CFO, CMO and other senior executives, that includes a review of all of the above issues. It might include other presentations, such as:

• an overview of national trends in your business by a professional society representative as noted above,
• a lecture by a futurist about innovations in healthcare that might impact your organization,
• new healthcare delivery models, and
• changes coming to Medicare and Medicaid reimbursement.

This time is spent learning, digesting and internalizing new information in preparation for the next stage of the process. Discussion should be encouraged, but it is a bit early to start talking about specific goals or new initiatives.

Be sure that these reports are distributed PRIOR to the meeting so participants can come prepared to discuss them.

3. Analysis and Discussion

Components of the SWOT Analysis

At this point, the information reviewed needs to be put into context and analyzed. Probably the best way to accomplish this is to do a SWOT analysis. I have described this process in some detail at From SWOT Analysis to Inspired Goal Setting.

Briefly, a moderator is going to lead a discussion encouraging participants to identify the Strengths, Weaknesses, Opportunities and Threats that exist for the organization. These observations need to be captured in written form during an unbridled brainstorming session without regard to the relative importance or magnitude of the strength, weakness, opportunity or threat.

During a break, someone will then combine and categorize the results of the SWOT Analysis. The break for this can be as brief as a lunch or overnight break, or over a period of days back at the office.

4. Brainstorming Preliminary Goals

Following the collation and categorization of the items identified during the SWOT analysis, a separate meeting will be held to write out goals based on the analysis.

This SWOT analysis can drive the process by creating goals that:

• Capitalize on the Strengths of the organization,
• Address the Weaknesses of the organization,
• Take advantage of Opportunities open to the organization,
• Minimize Threats to the organization, and,
• Address combinations of the above factors.

When the team is together again, everyone takes turns articulating goals that follow the above outline. At this point, the goals do not need to be written in final form – just a form that is easy to understand and categorize under a given pillar.

Each goal is assigned to one of the Pillars. To facilitate the prioritization process, each goal can be listed on a document under the appropriate pillar. Then each team member assigns a number to the goal indicating the relative importance of each, and the name of a team member that should have accountability for the goal if it is adopted.

Ranking the proposed goals.

It is probably best to use three levels of importance:

1. Most critical and important – to be addressed quickly
2. Secondary importance – address if resources allow after goals rated #1 have been addressed
3. Least important – possibly to be considered at next year’s planning process, if ever

Someone must then calculate the average ranking of each goal. The list of goals and rankings must be distributed and discussed at a subsequent planning meeting.

5. Goal Selection

The CEO or other leader presents the list of draft goals and rankings at a subsequent meeting.

The team will look at the importance and balance of each of the goals. It will also consider the budgetary implications of the proposed goals. If not presented previously, estimated expenses and/or potential income associated with each goal will be listed parenthetically.

The team will select goals with the highest rankings, and confirm that the “owner” of each goal is appropriate and that it is assigned to the correct Pillar.

By the end of the meeting, each team member will have a list of goals which he/she will be responsible for during the coming year.

6. Write Finalized Goals and Management Plan

Each leader is asked to rework his or her goals offline such that the statement of the goal includes ALL of the following components (as discussed in How I'm Using Smart Goals). Each goal will be:

• Specific. It states a change that is clear to anyone reading the goal. It is not general in nature like “improve safety” or “reduce employee issues.”
• Measurable. The goal itself states or implies the change in the measure, such as “increase revenues by 10%,” or “reduce nursing turnover in the ICU from 10% to 6%.” Or it will describe a clear endpoint, such as “opening of the new unit.”
• Attainable. The goal should be a stretch to accomplish, but still possible.
• Relevant. It addresses an important issue that will support the previously described vision and make a significant contribution to the organization's finances, quality, community standing or similar aspect.
• Time-specific with a deadline. You should at least define the quarter when it will be completed. In addition, separate from the deadline, a series of milestones should be included as a footnote, or separately in another document, in order to support the next step of the process.

Following some “wordsmithing,” the team and/or the board or CEO finalizes and approves the plan.

Using the information within the document, a dashboard is created for each of the accountable parties that lists each goal, the milestones for the goal, and a place to write final grade for the goal.

Dashboard for the new goals.

The management team will review this document quarterly in order to maintain accountability AND to identify when assistance or resources are needed.

Conclusion

I've tried to provide a brief overview of a management planning process that any organization can follow. It can be adapted based on the resources available to organize the planning process.

Once the goals have been selected, budget aspects applied and accountable parties assigned, the hard work of implementation follows. However, following this process on an annual basis will greatly improve an organization's chances of continuing to grow and succeed.

Next Steps

If you're part of an executive team, pull out your annual management plan and see if it follows the guidelines presented here. Is there a dashboard that can be used to track implementation of the goals for each VP or Director?

If you are just getting into management, ask the CEO or Executive Director if a Management Plan exists, and look it over.

Check to see if SMART Goals are being used and if there is a single accountable owner of each goal.

If you're the leader of a small to medium-sized medical group or similar organization and you don't have an annual management plan process, start to develop one using these suggestions.

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The post Create a Wildly Effective Annual Management Plan 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.

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

The CEO and the Board of Trustees (or Directors) definitely want to see meaningful reports about hospital performance. They truly want to see that performance is improving. Along with positive financial results, nothing will make the CEO and board happier than seeing that quality can be measured, is at an acceptable level, and is improving.

There are many ways to collect, analyze and present such data. I am going to show you how to prepare quality reports that my board found useful and interesting. Several of my board members told me that they really looked forward to seeing these reports.

First, Some Basics

Anyone who works in the quality arena will take the following caveats as a “given.” But for those who are just starting, here are some things to keep in mind.

It is not easy to reliably measure quality. And for hospitals, we generally do not measure “chart-level” outcomes. Our quality measurements are limited by the fact that we use billing data to collect mortality, complications, length of stay and other quality outcome measures.

UB-04 Billing Form

However, there is more than two decades of work by universities and quality vendors validating the use of billing information to measure outcomes. These researchers have produced an approach to quantify outcomes and apply statistical methods to the process. This enables us to compare the performance of facilities across the country. These methodologies are the same as those used by CMS and private quality reporting organizations such as Truven Health Analytics and HealthGrades.

You should verify that the following requirements are in place before you try to create reports like the ones I describe:

1. Your organization has a quality measurement tool that is interfaced to all of the necessary hospital systems.
2. The tool accurately draws data such as date of admission, date of discharge or death, source of the patient, destination on discharge, length of stay, etc.
3. The system(s) have the ability to distinguish between medical conditions that were present on admission (POA) from those that arose during a hospital stay.
4. Your hospital has robust medical records, coding and billing departments that accurately assign CPT codes, ICD-10 codes, and DRGs. You must be confident that those codes comply with the definitions from CMS and other quality agencies.
5. You have staff in the quality department that is knowledgable and can pull the outcome reports you need.

Other Considerations

The systems that I’m describing perform risk-adjustment of the data. It is therefore valid to compare outcomes to other organizations. In addition to reporting risk-adjusted rates, the outcomes are also expressed in one of two ways:

1. As an index, defined as the ratio of the observed rate over expected rate. If the observed and expected rates are the same, then this ratio is 1.0. A higher ratio indicates a rate worse than expected. A lower ratio than 1.0 indicates a better than expected rate.
2. As the difference between the actual and expected rates. If the difference is a positive number, the actual rate is worse than expected. If it is less that zero (a negative number) the rate is lower/better than expected.

Finally, most systems will also indicate whether the difference or ratio is statistically significant, and at what level of significance. When considering quality comparisons, we want to know differences at the 75th and 90th percentile. In research studies a significance level of 95% is desired. But we want to err on the side of identifying opportunities for improving quality. And we ignore opportunities with a significance of less than the 75th percentile, because they are more likely a result of chance alone.

Bringing It All Together to Prepare Quality Reports

As complicated as all of that sounds, the majority of hospitals have systems that meet those requirements. They can produce risk-adjusted outcomes and deviations from expected. And they can apply statistical testing for any of the high volume diagnoses. This allows us to prepare quality reports for our medical staff, our executive team and our board.

Using these systems, the quality department can create a report for the high volume diagnoses that lists the mortality, morbidity (complications), readmissions and length of stay.

I usually break these reports into two main categories. I produce one report that focuses on the mortality and length of stay for serious medical conditions. In this way, I can show the CEO and board a report that addresses pure quality (mortality) and a combination of quality and utilization (LOS).

For the high volume surgical or procedural admissions, since the mortality rates are very low, I find it more useful to present the morbidity (complication) rates and LOS data.

Start With a Spreadsheet

I use Microsoft Excel to create the data table and the graphs. But most spreadsheet software should work as well. I copy them to Microsoft PowerPoint for my presentation. I keep the slides as simple as possible. Usually, I include a minimum of labels so the information is clear. Yet I try to be parsimonious: showing everything that is needed, but nothing that is not needed.

Creating the bar graphs is simple: just highlight two columns (the list of diagnoses and the outcomes) and select the type of bar graph from the drop down menu. I generally use 2-D graphs for simplicity. Then, I save the charts on a separate page so that I can easily copy them to my slides.

The “bubble graph” is created by highlighting the three columns to be included (LOS, mortality and volume columns in this case), then choosing the prefered style from the “Scatter or Bubble Chart” option.

An example of a table that includes all of the information needed for these graphs follows. Note that these are completely fictional data that I generated for demonstration purposes only. But the information I present will look very much like this table, but for a larger number of conditions (20 or 25).

Using the information from the table, I create a bar graph to show the spread of outcomes from best to worst (in this case, lowest to highest mortality and LOS indexes). To do so requires sorting the data (lowest to highest) before creating each chart. Here is how those graphs would look:

Preparing the Bubble Graph

Finally, in order to bring it all together when I prepare quality reports, I combine all of the information into a single graph. This graph displays a grid showing the mortality index, the LOS index and the volume of cases. That graph is shown below.

I usually add small labels for each bubble indicating which diagnosis it represents. [Those must be added manually using individual text boxes. I did not do it for this post to save time. – VPE] I should also note that most of this work was delegated to a capable quality improvement nurse once I had created the first few iterations of these reports.

When I was presenting these data regularly for our board (twice a year), I would show the previous results and the current results. And I would skip through the bar graphs quickly, since all of that information was also incorporated into the bubble graph. But I wanted the board to understand where the bubble graph information came from.

Then I would just leave that bubble graph up on the screen while I discussed the great results of conditions sitting in the bottom left quadrant. And I would point out that it is possible to have great outcomes and a short length of stay (contrary to the opinions of some of my medical staff colleagues).

I would then describe the challenges of the conditions in the top right quadrant. And I would outline the procedures we had instituted to address the excess mortality and/or LOS. I might also comment on how we would prioritize working on the largest bubbles in the top right quadrant because they represented more cases.

Other Steps

It is best to preview these presentations with your CEO and senior executive team. That way, you can better anticipate questions the board may ask. And it gives you an opportunity to engage other team members in your quality improvement efforts.

You can combine any two variables (plus the volumes) to create similar slides. In addition to mortality and LOS, I would present a bubble graph of morbidity and LOS as noted above, or incorporate readmission rates. You may want to apply this method of analysis to metrics from patient safety or infection control. Even the finance team can find a use for these types of graphics.

Next Steps

Get creative and come up with some other combinations. Once you create some charts, why don’t you include a picture in the COMMENTS below, or just describe what you have created.

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The post How to Prepare Quality Reports Your Board is Begging to See appeared first on NonClinical Physicians.

I was the newly appointed vice president for medical affairs (VPMA). I had convinced our CEO that is was time to add a formal physician leader to the executive team. It was 1999, and most hospitals of similar size and scope had a full-time VPMA or CMO (chief medical officer).

There were several members of the executive team that had never worked with a physician executive. And that was not the only reason that trust was a bit of a challenge. Each of the executives in the room were focused more on their own division and its performance than on the performance of the executive team as a whole. Adding a physician to the mix added a whole new level of discomfort.

Over time, mostly through gentle encouragement by the CEO and his astute way of pulling all of the team members into the important strategic decisions, we began to work as a team. Part of that working together involved building a high level of trust.

I don't think we fully developed that trust, however, until later in my career. The CEO that hired me moved on to another, bigger challenge. And our COO had taken the reins, first as interim, and then as permanent CEO.

He was very interested in creating a strong, highly functioning team. So we spent time in retreats, and during weekly meetings, discussing and discovering how to develop a more cohesive and effective team. We spent much of that time on developing trust.

I wrote previously about the importance of trust in a team, and how to identify a lack of trust in this post: Six Signs of a Lack of Trust in the C-Suite. The foundation of an effective team that confronts challenges, engages in fierce conversations and gets results, is a culture of trust.

I'm not talking about the kind of trust in which you trust your colleague to do her job, or you trust that your staff will complete their projects. Building trust that I'm referring to is the trust that I can speak my truth and that my colleagues will listen and engage honestly with me.

It is trust that I can be vulnerable in a meeting or in my interactions with co-workers, that I can admit my mistakes and that I can disagree without being criticized. It is trust that politics and game-playing will not be tolerated.

So, why bother developing THAT kind of trust in a team?

Because those are the teams that are really effective. Teams with that kind of trust will express themselves without holding back, and have the kind of conversations that generate great ideas and solutions. Those teams work together to solve organizational problems rather than focus on their silos (divisions or departments). They care less about how they look and more about how successful the whole enterprise becomes.

Who is Responsible for Building Trust in Their Team?

The primary responsibility for fostering an environment in which trust can grow falls to the leader, of course. Some of the mechanisms for effectively building trust can only be done by the leader.

But every member of the team can encourage and promote attitudes and behaviors that promote trust. Members can also participate in being vulnerable within the group, which is one of the hallmarks of a team infused with mutual trust.

Still, the leader must inspire the team to build trust. The leader should talk about the value of trust, vulnerability, and teamwork. He or she should clearly work to limit political agendas and encourge transparency within the executive team. And the leader should acknowledge team members that demonstrate and support trust as an organizational principle.

What Tactics Are Effective for Building Trust?

I think there are at least four major behaviors that must be encouraged and embraced in order to fully develop trust in all members of the team.

1. Encourage Personal Relationships

Some might call this team building. But it is more specific. This component of building a team is dependant on developing personal relationships with others on the team. This does not mean becoming best friends with them, or spending every Saturday at their home.

Each person should develop knowledge of the teammates' families, interests, hobbies and personal backgrounds. This will need to be led by the CEO/team leader and actively supported by the team members. There are specific exercises that can be done to improve this aspect of fostering trust. The following are a few that I have participated in myself.

1. Start by simply spending a few minutes at the beginning of a regular team meeting with each member talking about their personal background. Talk about your family growing up, your hobbies, your interests and your family now. How did you come to work in healthcare?
2. During a retreat or strategic planning meeting, try some exercises to enhance this process. One I liked was this:  Each participant writes down three things about themself that nobody else knows. But one of them is NOT true. Then each person takes a turn describing these three “fun facts” and another participant has to guess which of the three is not true. It works best when participants write things down that seem very out of character, making it more difficult to distinguish the false from the true facts.
3. In subsequent meetings, try this exercise: Have each member in turn tell the group the characteristic that they most appreciate about the member sitting next to them (pick one side!). Then spend a few minutes discussing how the person came to display that characteristic.

2. Promote Individual Commitment to Being Vulnerable

This is where the CEO/team leader really needs to take the lead. He or she must take opportunities to be vulnerable, admit to needing help and soliciting input. In fact, the leader should refuse to provide an opinion on an important strategic issue until all other sides have been heard.

The CEO might ask the COO to present an overview of a new project that is being planned, and then solicit input from everyone before offering his or her thoughts. Also, the CEO might admit that there is no clear answer, that he or she has not led such a project before, and is depending on all of the insight of the team before making a final decision to proceed.

Team members should then offer their opinions and themselves demonstrate their vulnerability. The CEO can then acknowledge when one of the team members is demonstrating vulnerability.

The CEO might also try to “come clean” with examples where he or she failed to follow the commitment to vulnerability and renew the commitment to follow the principles outlined above.

3. Encourage Fierce Conversations and Embrace Collegial Conflict

One sign of trust is the ability to engage in serious, difficult conversations. The leader should promote these conversations, and encourage participation:

“I know these conversations can be difficult. It may sound like some of us are attacking other members of the team. But the only way we're going to explore all aspects of this decision is to hear everyone out. As long as we go into the conversation knowing that we're not here to demean or belittle anyone personally, we can work through all of your perspectives.

“We must have a clear understanding of where each of you stand. I want you to vigorously debate the ideas here, yet remain respectful of those expressing them. Our success depends on hearing everone's opinion, as difficult as that may be.”

Then the leader has to listen carefully, and be sure to intervene if there are any personal attacks. For important discussion like these, everyone should be asked to contribute.

4. Admit mistakes

The leader can start the process by admitting prior mistakes. Let's face it, none of us is perfect. We all fail from time to time. If trust is generated through vulnerability, well, vulnerability is demonstrated through admitting mistakes.

Even the best CEO chooses the wrong strategic initiative, hires the wrong associate, or rushes to judgement on an issue from time to time. When encouraging trust, a statement like the following can be helpful:

“Last year, this team had a healthy discussion about starting a new service line. I know several of you had major concerns about proceeding. When I decided to move forward, you all got on board and supported the project. And I appreciate that.

“In retrospect, it was the wrong decision and we are now going to abandon the project. I take full responsibility for making the decision and I appreciate that everyone worked hard to make it work. I will certainly learn from this and take steps to avoid making this mistake in the future.

“This just demonstrates that I am fallible, and that more than ever, I need the expertise of this entire team when making such an important decision in the future. So, I strongly encourage you to continue to share your opinions with me and the team.”

Final Thoughts

The CEO will create the setting where building trust can be achieved. But all of the team members needs to be willing to expose themselves. They must also be sure to avoid the temptation to hold off-line conversations or engage in political maneuvers rather than open discussions.

If you want to use a tool to assess the level of trust in your team, you can down load the 2 page tool here:

Signs of a Lack of Trust Checklist

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The post 4 Tactics for Building Trust and Inspiring Your Team appeared first on NonClinical Physicians.

One of the consequences has been the growing employment of physicians. The expansion of this employment model is having serious negative effects on our profession.

Physicians have become commoditized. Today, we seem to be treated more like run of the mill laborers than highly trained professionals expected to provide ideal patient care.

Historically, the medical staff was an independent, self-governing organization within the hospital. Under this legacy model, a hospital CEO and board had to collaborate with the medical staff to create new service lines and implement new policies and procedures.

Loss of Autonomy

That independence and control have vanished, leaving medical staff members feeling powerless. Whether due to this loss of autonomy, the ever-growing number of regulations, or the relentless need to see more patients, it is easy to feel overwhelmed.

These feelings are magnified when working in environments that lack transparency and shared decision-making. Physicians become resentful and withdrawn in this kind of environment. Trust diminishes. Burn-out follows.

Sociologists call this withdrawal a lack of engagement. Physician engagement sounds like a nebulous term, but it is a very important aspect of our professional lives.

Engagement

Engagement can be thought of as presence. It reflects the degree to which physicians are inspired by their work; how loyal they are to their organizations; and how much pride they have in what they do.

Engagement appears to be at an all time low.

This was confirmed by a recent survey by Athenahealth (Engagement Survey). Only 20% of physicians demonstrated characteristics of engagement.

We’ve all seen, and maybe even felt ourselves, this lack of engagement. When we’re not engaged, we become complacent. We lose our vitality. We just go through the motions. This lack of enthusiasm for our work can affect our relationship with our patients and our co-workers. The quality of our work, patient outcomes and success of our organizations are jeopardized.

Solution: More Physician Leaders

But the same survey also provided insight into improving the level of engagement. Because it  showed that…

• Physicians working in physician-owned, independent medical groups were almost twice as engaged as those in hospital- or health system-owned groups, AND
• Physicians employed by organizations run by a physician leader (even if hospital-owned) showed engagement levels four times the levels reported in non-physician-led organizations (8% vs. 32%).

Working physicians respond better to a physician leader. They share similar backgrounds and experience, which creates more credibility. There is a higher level of trust among such physicians.

Skilled physician leaders can help healthcare organizations to better understand and communicate with their physicians. Such executives can build trust, loyalty and engagement.

Appropriately trained physician executives know how to integrate clinical care, leadership and business skills. Many of the top hospitals in the country, including Mayo Clinic, Mass General, UCLA Medical Center, Johns Hopkins and Cleveland Clinic, are run by physician CEOs. There is evidence that quality metrics are better in health systems led by physician CEOs.

I believe the survival of our profession depends on more of us becoming involved. Physicians should step up to lead our hospitals, medical groups and other healthcare organizations. We’re the best hope for maintaining the focus on the patient, while engaging and motivating our colleagues. By doing so, we can help to ensure the fulfilment of the healthcare industry's promise – and the survival of our profession.

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The post Become a Physician Leader and Save the Medical Profession appeared first on NonClinical Physicians.

A primary skill that a new physician executive needs relates to working in teams: to effectively lead teams and to be an able team member. Lack of trust will kill the effectiveness of an executive team. If team members aren't comfortable with expressing their truths, the team will perform poorly.

The definition of trust that we used in our executive team followed the definition given by Peter Lencioni in The Five Dysfunctions of a Team: A Leadership Fable. It basically centered around developing a team in which each member trusted themselves and each other enough to allow for vulnerability. Our team spent over a year working on trust. Our CEO pushed us to create a team that could fully explore difficult issues and utilize the gifts of each team member.

Why Bother?

As Lencioni argues, trust is the foundation upon which an effective team is built. Without trust, deep conversations and confrontation cannot effectively occur. Without meaningful, often difficult, conversations team members will not feel heard and will not commit to organizational goals. Accountability will be shaky and results will not follow.

Signs of a Lack of Trust

There are generally some fairly obvious indications that trust is lacking. Take a moment to reflect on the following scenarios. Do any of them describe the way your team operates?

Here are some of the behaviors to look for:

1. Members of the team have not built personal relationships.

They are not familiar with the personal lives of other members: their backgrounds, where they grew up and attended school, and what their outside interests and hobbies are. It is difficult to build trust when you do not have a personal connection with other team members.

2. The team always seems to be in consensus on decisions.

This is a bit counter-intuitive at first. But members of a team never agree on everything. If there seems to be a culture of consensus, it means that team members are holding back. Highly effective teams can only achieve commitment to a shared goal after a thorough discussion in which participants feel that they have been heard. At that point, commitment may be possible but 100% consensus will almost never occur.

3. The executive team dreads meetings.

Executive meetings are seen as boring and unimportant, because there is little engagement. Attendees are zoning out or checking emails. When our team was functioning at a high level, I looked forward to our weekly strategy meetings. There would be lively conversations, challenges to each other, and strong opinions expressed. I would come prepared, ready to make my case for, or against, a proposed strategic decision. Nobody wants to miss those kinds of meetings.

4. Team members don't regularly challenge each other and the CEO.

With a culture of trust, the participants feel open to challenging each others' assumptions and conclusions. If the meeting room is filled with yes-men (and woman) always agreeing with the CEO's ideas, it is a sure sign of a lack of trust.

5. Lack of discomfort.

In the absence of trust, conversations tend to be superficial. There is an avoidance of the risk of being wrong, or revealing that a mistake has been made. In an environment of trust, intense probing will occur and there will be times when the questioning becomes uncomfortable. There may be “pregnant pauses” during discussion. More empathetic members may feel the urge to come to a colleague's defense. But this discomfort is a normal occurrence in an effective meeting and will dissipate once the discussion proceeds, as long as each participant can openly express themselves without fear of being attacked or belittled.

6. Participants rarely admit their mistakes.

In a team lacking trust, the usual reaction to being called out is to defend your position or blame someone else for your failure. But when vulnerability is encouraged, and team members trust that they will not be criticized or embarrassed, they will admit mistakes, learn from them and move on.

Next Steps

If you recognize 5 or 6 of the above observations in your team meetings, there is a lot of work to be done. Even if only 2 or 3 are true, there is probably weakness in your team that should be addressed.

If you are the leader of the team or the CEO of the organization, then it is up to you to begin to address these issues. I will provide a list of possible actions you can take to build trust in a future post.

Have you witnessed these behaviors in your team? Does the level of trust tend to shift over time? Let me know in the comments section below.

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