This is in follow-up to Episode #52, in which I talked about the skills and experiences needed to become a physician executive. You’ll recall that there were five major domains, beyond character and medical knowledge, that recruiters and CEOs consider when filling an executive position:

• Data Management
• Financial Management
• Business Practices
• Leadership Skills, and
• Talent Management

Powerful Tool

Today I want to describe a powerful tool that managers and leaders use to set goals. The ability to properly identify, describe and measure goals is important to all managers, directors, executives, and leaders in any organization.

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Writing proper goals falls into the Business Practices domain of my model. And, I’ll talk about that briefly today. Sometimes goals are self-evident, driven by universal business needs, such as growing volumes or improving profits.

But sometimes a good leader needs a tool to help her team surface new initiatives, based on a more thoughtful consideration of internal and external factors. That’s where the SWOT Analysis can be an extremely powerful tool. In my model, a SWOT Analysis falls under the Leadership Domain.

For those of you who haven’t heard that term before, I didn’t say “swat” analysis, like swatting flies. No, SWOT is an acronym that stands for Strengths, Weaknesses, Opportunities and Threats.

The  development of the SWOT Analysis (or Matrix) has been attributed to Albert S. Humphrey, although he disavowed having invented it. Countless business leaders have used this tool to assist in planning. As a physician manager, director, or leader, you should become very comfortable using it.

What Are the Components?

The strengths and weaknesses generally refer to internal characteristics of an organization. This includes financial resources and performance, human resources, branding, and customer loyalty. It also might include cultural issues, such as whether your organization is nimble or slow-moving.

The opportunities and threats describe external considerations. How is the local economy doing? Is the market growing or shrinking? What are the demographics of your clients or patients? Is your competition strong or weak? What is the regulatory environment like? Are there major hurdles to entering a new market?

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From SWOT Analysis to Goal Setting

To use a SWOT Analysis, goals can be developed from the intersection of Strengths and Weaknesses with Opportunities and Threats from the SWOT Analysis. The following table shows this:

During this episode, I go into great detail on how to use the information in the table to create SMART goals, using examples from an imaginary team considering the opening of an urgent care center.

If you’d like more help in pursuing a CMO job or any other executive healthcare position, I’ve developed a new mentoring program for you that I rolled out in Episode 52.

It’s called Become CMO in a Year.

It’s designed for board certified physicians who work at least part-time in a hospital setting, who want to move into hospital or medical group management. Through the mentoring program, you will identify and fill the gaps in your resume that you need to be irresistible to recruiters and CEOs.

You can learn more by heading over to vitalpe.net/cmomentor

Thanks again for listening today.

Please join me again next week for an exciting interview with a previous guest on the podcast who has a fantastic new program that I'm sure you'll want to hear about.

As always, I welcome your comments and feedback.

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

Disclaimer:

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

The opinions are my own, and my guest's, and not those of any organization(s) that I'm a member of, or affiliated with. The information presented is for entertainment and/or informational purposes only. It 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.

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The post How to Deploy a Powerful Tool to Identify Goals – 054 appeared first on NonClinical Physicians.

Today’s episode will be a short one, just hitting on a few issues related to nonclinical career transition. That’s because I’m leaving for a 7-day fishing trip in northern Minnesota and I’m a bit short on time.

Vermilion River flowing into Crane Lake in Minnesota

I want to provide you a little more incentive for taking action on your career pivot. For those that are new to the podcast, I'd like to provide suggestions for blog posts and podcasts to “consume.”

This episode will have a lot of links to follow.

My Primary Goal Today

Today I’m attempting to encourage action. If you’ve been unhappy and unfulfilled in your career but you’ve been struggling to take that first one or two steps, here are some ideas to get things rolling.

Nonclinical Careers

First read these blog posts. All of them can be found on Vital Physician Executive (vitalpe.net}:

• Is It Time for a Nonclinical Career?
• Options for a Nonclinical Career
• Unorthodox Career Advice

That last one, in particular, will help you to understand how to stack new skills. Those skills will then help you develop your unique skills profile.

Then listen to these podcast episodes that address mindset and other foundational issues:

• The Proper Way to Pivot
• Engage a Mentor
• Create Your LinkedIn Profile
• Address Your Mindset

Rainbow on Crane Lake

Management Careers

For those of you considering a hospital or medical group management career, start with these blog posts:

• Five Steps for the Budding Physician Executive
• The Three Domains of the Physician Executive

Then check out these podcast episodes:

• 10 Reasons to Pursue a Hospital Management Career (020)
• The Ultimate Resource for the Physician Leader (024)

Once you’ve read or listened to that articles posts and podcast episodes, you’ll find even more information about specific careers among the interviews. You can scan through quickly by going to PNC Podcasts for a complete list that you can pick and choose from.

At that point, you should be feeling fairly optimistic. You should accept that you deserve a career that brings you joy. And you will begin to understand that there are thousands of potential jobs out there for you.

But you need to take those first few steps.

Inspiration and Support

Unless you've already gotten deep into your career search, here are some things you can do to stimulate movement and get some inspiration.

1. Read Michael McLaughlin's book Do You Feel Like You Wasted All That Training?: Answers About Transitioning to Non-Clinical Careers for Physicians. It describes Michael’s journey. It's in Q & A format, so it's a quick read.
2. If you're not already a member, join the Physician Nonclinical Career Hunters Facebook Group. This is a closed group, so you will need to ask to join AND you will be asked to answer three questions to verify that you're a physician. After applying, drop me a note in the Comments Section of the show notes at Episode 42 and let me know you applied. That way, I can be looking for your request.
3. Set up a free LinkedIn Account if you don't already have one. Then do the following:
   • Request to connect with me – I'm at John V. Jurica, MD, MPH, CPE – and mention that you're a podcast listener.
   • Join the following LinkedIn Groups: Non-Clinical Careers for Physicians, and Doxodus – A Social Network of Doctors with Nonclinical Careers.

Unfortunately, many of us don't know exactly what career we want to pursue. We're not sure about our strengths and weaknesses, and we don't know the full universe of possible careers to consider.

Let’s do some more foundational work.

Quiet evening on Crane Lake

Next Address Your Mindset

First, it's best that you address burnout and other issues pushing you away from clinical medicine. Many of us feel trapped in our jobs. We don't think that we can change our environment, so we seek something “better.”

It's best to address those feelings before you leave your current job. The grass always looks greener, but it almost never is. And you run the risk of bringing that baggage and bad attitude to any new job you pursue.

You can get some useful advice on this issue from two of the coaches I’ve interviewed by listening to the following podcast episodes.

1. The first is with Dike Drummond in Episode 028. He is the guru of physician burnout. He has coached many burned out physicians. And the vast majority (over 90%?) decide to stay in clinical medicine after completing his program.
2. The second bit of advice comes from Katrina Ubell in Episode 035. She believes it’s important that your burnout be addressed before leaving your current job/career. And you should make the move primarily to pursue a higher calling.

Personality Inventory

Once that's settled, you should spend some time thinking about your own strengths, weaknesses, and personality, and the kind of job you might be suited for.

You might take an on-line personality inventory such as 16Personalities. It looks like it’s based on the Myers Briggs Inventory. It will provoke some ideas around the type of job you might like. Are you an introvert or extrovert? Feeling or thinking? Analytical or creative? Then match those traits to a career after using the resources that follow.

The next step is to create a list of possible career options.

Free Lists of Career Options

I know of two blogs that provide specific nonclinical career descriptions.

The most recent one I've read is on the blog Look for Zebras. This post links to descriptions of 19 specific nonclinical careers. It can be found at lookforzebras.com/nonclinical-careers.

If you find them to be useful, do me a favor and please leave a comment stating something like this: “I'm so glad that John Jurica at PNC Podcast told me about your blog. This information is awesome!”

Another site that lists possible career choices is Nonclinical Doctors by Heidi Moawad, MD. There is a page that lists dozens of nonclinical careers. She provides specific details and physician success stories for many of the career options that she lists.

There is also  a free guide that you may already have received if you signed up for my newsletter. It's called 5 Nonclinical Careers You Can Pursue Today that has information about five nonclinical careers. If you don't already have the guide, you can go to Free 5 Career Guide to download it.

Don't forget to network widely and develop mentors.

Deer outside our cabin door each morning.

Paid Help for Career Change

Sometimes, however, it's necessary to invest a little money to overcome the inertia in your career pursuit.

A Very Useful Book

The first suggestion is very reasonably priced. It's the book Physicians’ Pathways to Non-Traditional Careers and Leadership Opportunities.

It sells for about $60.00 new, but you can find a used copy in good shape for about $28.00 on Amazon.com. At 385 pages, it's a very comprehensive look at “non-traditional” careers. It describes dozens of career options in 25 chapters categorized by broad career types.

It also addresses other topics related to physician career transition.

Physician Career Coaching

But probably the most proactive way to expedite your career pivot is to engage a physician career coach. Many such coaches are physicians who have completed their own coaching, then trained to become coaches themselves.

The costs vary. I don't have scientific survey results to reference. Anecdotally, I expect costs to range from $150 to $400 per hour, depending on the experience and training of the coach. For comparison, executive coaching for C-Suite executives generally runs $250 to $500 per hour or more.

But everyone I’ve ever talked to has found coaching to be well worth the cost, whether its executive, life or career coaching.

The benefits of coaching are numerous. Coaching opens our minds to new possibilities, helps us overcome self-limiting beliefs, maintains accountability, and accelerates progress towards progressive positive goals.

Coaches I've Interviewed

I've had the pleasure of interviewing the following life and/or career coaches: Kernan Manion, Charlotte Weeks, Michelle Mudge-Riley, Heather Fork, Dike Drummond, Katrina Ubell and Maiysha Clairborne.

They’ve all had great success with their clients and high demand for their services. Some of them may not be taking new clients, but will generally refer you to an alternate if you reach out to them.

Michelle Mudge-Riley has created a site called Physicians Helping Physicians that has three levels of paid services. I have not used them personally, but I'm a big fan of coaching.

There are hundreds of trained physician career coaches out there. With the proper vetting, usually with a free consultation and speaking with references, coaching may be the best way to jump-start your career search.

Take Action and Overcome the Inertia

I think I’ll end it there.

To Summarize

Start by addressing your attitude. Then discover as many career options as you can. Reflect and assess your personality, strengths and weaknesses.

If you’re stuck, check out one of the listed coaches, or do your own coaching research. Then start with a few sessions. The coach may be able to provide insights into your personality, strengths and weaknesses, and help you to identify a career or two that’ll be a good fit.

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

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.

The easiest ways to listen:  vitalpe.net/itunes or vitalpe.net/stitcher

The post How to Overcome the Inertia in Your Career Search – 042 appeared first on NonClinical Physicians.

Obviously when you're working clinically, you need to communicate with patients, as well as with colleagues and other persons. If you're doing a nonclinical job, you'll be doing the same thing. But you might also be doing presentations, and something that's also very common and somewhat annoying at times, and that is: going to a number of meetings.

In fact, you might be going to a lot of meetings. Perhaps a meeting like this one…

Typical Meeting

I enter the conference room and take a seat. Four other committee members have already arrived. The meeting is scheduled to begin in about four minutes. As part-time medical director, I'm representing the interests of the occupational medical clinic. At five minutes after the hour, three more committee members have drifted in, but the chair has still not arrived. I'm a bit frustrated because I have lots of other work to do. And we're already running late. On top of that, I don't even have the agenda or the minutes from the previous meeting to look over.

The chair, William, walks in and hurriedly arranges some papers and hands out today's materials. He calls the meeting to order and accepts a motion to approve the minutes, which is quickly seconded and approved. We begin our discussion of the next agenda item. One of the other physician members, Dr. Milton, strolls in, followed by Maggie, the director of one of the clinical departments. Dr. Milton is the associate program director of the internal medicine residency program. Once he and Maggie are seated, William pauses the meeting while bringing them up to speed on what we've discussed thus far.

Photo by ål nik on Unsplash

We continue to move down the agenda. Maggie has opened her phone and is furiously responding to text messages. One of the other committee members provides an update on an action item from the previous meeting. A motion is made and quickly approved. We're now 30 minutes into the one hour meeting, and we've barely made it through the first few items on the agenda. For the next topic, Dr. Milton is clearly not in agreement with a proposal that may affect his residents. I cringe inside as he begins his attack on the proposal with, “I've been practicing at this institution for 30 years. When I was chair of internal medicine, we tried to adopt this approach and it never worked.”

He speaks for another 10 minutes reiterating the same argument at least three more times. At one point, he takes a verbal detour to a totally unrelated, but potentially important topic. Then he suddenly returns to his initial argument, repeating it a fifth time for good measure. As usual, William seems incapable of keeping the group on track. I jump in from time to time to help refocus the committee's efforts. But in spite of that, we fall hopelessly behind.

After grinding our way through about half the agenda items, William suddenly remembers that he's already five minutes late for his next meeting. He abruptly adjourns the meeting, stands, and exits the room. We didn't even get to the issue that I was hoping to speak to. And I'm left thinking that another hour of my valuable time has been wasted.

Learning Bad Habits

This meeting was fictional, but I've witnessed every bad behavior described in this story and many more. Unfortunately, for most physicians, the types of meetings we're used to going to are typically meetings like those at the hospital where we're part of the medical staff. Now, I understand, not all of you are on medical staffs. But for those that are, we go to meetings. The attendance is often poor partly because they're mandatory meetings and they're designed to meet regulatory requirements. And sometimes they get some good work done, but not always. And learning how to run meetings in that environment probably isn't the most conducive to learning good practices or good habits when it comes to meetings.

Today I'm going to talk about an important topic, which can be very helpful for both nonclinical and clinical careers. But if you're in a nonclinical career, you may be spending a lot of time in these meetings. You may be part of a hospital management team. Or even if you're doing some other nonclinical job, such as chart reviews or working for an insurance company of some sort, or working for pharma, you're going to find yourself in a lot of meetings, generally. And you may be ultimately running some meetings.

Again, getting back to my contention that physicians are natural leaders, we're going to want to do a really good job when we start leading those meetings because that's going to be a crucial element of our leadership, and believe it or not, meetings can be a very effective tool that can help us to get to know our teams better, to accomplish important projects and goals, and to make important decisions, so I'm going to talk today about the 10 ways or practices that you can adopt to become a master or a maestro of meetings.

Meetings Are a Communication Tool

Meetings are a fairly unique method of communication. Most of the communicating that we do are usually face to face with patients or with direct reports or other individuals, or we're used to doing presentations and teaching, but a meeting combines features of multiple types of communication in which the chair is in charge, but which sparks conversation and discussion within the meeting in a controlled manner, and so by following certain practices, you can get the most out of your meetings and make sure they're not a big waste of time for those participating including yourself.

Remember that a badly planned and run meeting can be worse than just wasting time or being ineffective. It can be costly and it can leave the participants more confused and frustrated than if they had never attended the meeting. Some of us come to actually hate meetings because we attend so many that are ineffective. They seem to be too numerous in number. They take too long. They waste our time. They take us away from doing the real work that we're paid to do.

Let's face it. If we're paid to do chart reviews or analyze the medical literature or write some kind of promotional material, sitting in a meeting is not generating income. And at the same time, it's costing the organization money because each of the attendees is being paid to be there, essentially.

Photo by Sharon McCutcheon on Unsplash

Let's take an example. What would the cost be? If you take 10 or 12 people away from the duties that they're normally doing to get together, and, let's say, you're paying these professionals $30 to $50 per hour, then each meeting of 10 to 12 or 15 people is going to be creating about $500 or more in uncompensated expense, not counting any preparation time for the meeting. Imagine a larger organization with 50 persons attending just four to five meetings a week. The cost just for the meeting attendance can run into tens of thousands of dollars each month. And this is time that the participants are not actually generating billable hours, if that's the type of work that they're doing.

So how does this happen? Nobody goes into a meeting or an organization that has meetings thinking, “Well, I'm just going to try and waste everybody's time by getting them together and hanging out and talking about things that seem like they're important,” but basically the intentions are good. But there's three primary reasons that they're a waste of time.

Root Causes of Poor Meetings

The first is that they're often poorly planned. Perhaps they're a regular meeting that's scheduled weekly or monthly, and they just keep going in spite of the fact that there may not be important topics to address, or there's insufficient planning for them.

The second big reason is because they're poorly run. You can have all of the best intentions and have everything planned well, but if the meeting isn't run properly, and in a way that I'll describe in a moment, then it becomes fairly ineffective.

Finally, it includes the wrong people.  Either because the wrong people have been invited, or because the invitee list is too large and people that don't need to be at every meeting are coming, or the people that really need to present something don't show up, often, times without knowing in advance. And therefore the agenda for the meeting really can't be addressed.

So in a few minutes, I'm going to give you some pointers on how to avoid these missteps and others, but let's step back for a minute and let's talk in more detail about the purpose of a meeting.

Why Meet?

There isn't that much that you would do in a meeting, really. You're either getting people together to:

• provide them information,
• brainstorm or come up with a creative solution for a problem,
• discuss an issue and actually make a decision, possibly even by taking a vote, or,
• address a project, either move it along, or complete it.

Information

Now, if we step back to the issue of providing information, this is an important thing to keep in mind. There are obviously many ways to provide information. So unless the people need to get together face to face or online, and need to have a conversation, it might be best to provide that information in another format, possibly a written format, or you could even do a webinar or a recorded video.

The reason to have a meeting to provide information is that it gives you an opportunity to answer questions in real-time, which then often save time in the long run in terms of having to go back and forth in an asynchronous way.

Photo by Patrick Perkins on Unsplash

Brainstorming

Now, the meeting that includes creative discussion or coming up with creative solutions can be a little out of the ordinary. In this type of meeting, we're just getting together and brainstorming. We're trying to come up with “out of the box” thinking for different problem. And this can be a great reason for a meeting. The importance of this is to be sure that you're taking notes and capturing all of the ideas. These are the kind of meetings that sometimes go into strategic planning or goal setting for their annual planning process.

Decision-Making

As far as the typical meeting where you're making a decision, these are often the types of meetings where we're at a committee or a board, whether it's part of your organization or part of a nonprofit or what have you. And information has to be presented and then a vote is typically taken and a decision is made.

Project Planning

Finally, there are some meetings that are part of a project planning process, and I'll probably give an example of this a little later on. But it's not unusual in a large project to have multiple types of teams. Each team meets on a regular basis, depending on what it's addressing, and follows a project plan, completing steps along the way. And then ultimately, each of those teams reports to the steering committee, which is responsible for getting the project completed.

Characteristics of Well Run Meetings

Hopefully, many of us have been to very effective meetings and would recognize when we're part of one. And very well-run meetings seem to share a number of characteristics.

They generally have well-defined goals that answer the questions, “Why are we meeting? What will be true following the meeting that was not true when it started? What decisions will be made? What information will be delivered?”

And these questions need to be answered before the meeting so that the meeting can be focused. The meetings are well-run, which I'm going to talk a little bit further down, and ideally they should be parsimonious.

What does parsimonious mean? I guess technically it means frugal. But the way that I use parsimonious means something that has everything that it needs and nothing that it doesn't need. It's effective. It's getting the job done with minimal or no waste. And that waste could be in terms of time and in terms of involving persons that really don't need to be involved.

It may be hard to believe, but it is possible to use meetings effectively to generate results that are more than offset by their costs, and meetings that people actually look forward to attending. So what are those 10 practices that the meeting maestro uses to create a great meeting?

The 10 Practices of the Meeting Maestro

Well, in my opinion, these are the 10 features that those meetings should have, and the components that should be included in planning a meeting.

Practice No. 1

Number one is the goal of the meeting should be explicitly stated. Now, this can be in the charter for the team that was created and that is now meeting, it could be in a mission for a team, or it could just be stated as the goal of the individual meeting for that day.

Practice No. 2

The second thing is that the agenda, the minutes from the previous meeting if there was one, and other meeting materials should be sent out before the meeting, because that is the only way that participants can prepare for the upcoming meeting so that the meeting can start and end on time, and can address all of the issues that are being listed on the agenda.

Click here to get the CHECKLIST

Practice No. 3

As I said just a second ago, starting on time, which is the third item. We're going to start all of our meetings on time because that's the only way to honor those who are responsible enough to actually show at the start of the meeting.

Practice No. 4

Number four is the chair is running the meeting, but often talks the least. In most types of meetings, the chair doesn't make motions and the chair doesn't vote. The chair is there to coordinate the meeting, facilitate the meeting, make sure we stay on time, and address the other issues that I'm going to talk about in a minute.

Practice No. 5

Practice number five is to follow the agenda. I'm not saying necessarily that it has to be followed exactly in the order in which it's listed. Shortly before the meeting, the chair should look over the agenda. And if there are three or four out of, let's say, seven or eight topics that are critically important, it might make sense to prioritize those and then table anything at the end if they're not all addressed by the time of the close of the meeting. But again, the point is that we should stick with the agenda and not get sidetracked into issues that, while they may be interesting, really aren't part of the reason for today's meeting.

Practice No. 6

Now, practice number six may be the most important part of this whole meeting process. And that is that the chair controls the meeting, starting by limiting the discussion. There are certain types of meeting attendees who try to derail the meeting or otherwise interfere with it accomplishing its goals, and I'm going to address several of those right now even though they don't all necessarily relate to having to limit discussion.

Photo by Fabrizio Verrecchia on Unsplash

Latecomers

But for completeness sake, first I'm going to address the latecomers. I didn't mention that earlier when I said start the meeting on time, but I'm going to reiterate that it's important that you start your meetings when they say they're going to start, so that you respect the people that showed up at the appropriate time. My recommendation for dealing with latecomers is to basically ignore them.

I definitely don't think you should go back and reiterate everything that's happened in the first five or ten minutes of the meeting for those that come late. Because then you're just teaching everyone that comes on time to just come late because they don't want to sit through the reiteration and have to go through everything twice. Probably if this is a recurring pattern, then you should have a conversation off line with the person who consistently comes late, and the conversation may be that “It's fine if you come late. Come in. But we're not going to start over. But I'd really appreciate it if you come on time like everybody else.”

Dominators

Now, the other one that can derail a meeting or make it less than useful and less attractive to attend is the dominators. These are people, and they're very common in a medical staff, but in any type of meeting, these are people who feel they always have an opinion when something is being discussed. Now, it's not always done in a purposeful manner, and I'll give you an example.

When I was on the senior management team at my hospital, we had weekly meetings, and the CEO would typically bring up some new issue for input or discussion, and there were one or two people who always had an opinion. And it was interesting. As we dug into this over time as we were talking about trust and working together as a team, we found that they're just extroverts and creatives who seem to be able to come up with opinions on almost anything in the spur of the moment. If there's a slight pause, they're going to jump in. They're going to start talking.

Now, for those of us who are introverted, more analytical, if that's allowed to go on, then we're not going to really contribute much at all. So the chair needs to deal with the dominators, and I'll talk about how to do that in a moment.

Perseverators

There's also the perseverators. And I don't know if that's really a word. But sometimes people make their point and they keep making their point over and over again. At some point the chair has to step in and say, “Thank you, Dr. Smith. We understand, and let me reframe or summarize your point, and then let's move on and get somebody else's opinion.”

There's also the multi-tasker, and that's just somebody who's being rude. They're in the room, checking their phone, responding to text messages and so forth. And I don't think that should be addressed within the confines of the meeting other than perhaps asking that person to contribute on a specific topic. But that's another issue that should be addressed outside the meeting.

Basically inform the person afterwards or at another time that the members of the team really want their input. So we'd prefer they turn their phone off and participate fully in the meeting.

Photo by Sorry imKirk on Unsplash

The PARKING LOT Tactic

Now, before I go into the next type of strategy for running a meeting, I want to mention the use of a very helpful tool, and that's called the PARKING LOT. In fact, the parking lot can be used to deal with the dominators or the perseverators or others who seem to derail a meeting, and that's when somebody brings up a topic that's not particularly germane to the issue at hand, you can stop everything at that point and say, “Hey, this seems to be an important issue and it probably needs to be addressed at a future meeting, so what we're going to do is we're going to write this down on the parking lot list.”

This could be an actual list that's put up on a whiteboard somewhere during the meeting, and as these topics come up, you put them up there to be addressed at a future time. I think it's really helpful to use a parking lot. Sometimes it's just a sheet of paper that you can write things down.

Now, the reality is you may want to address these in the future, but sometimes you just won't. But at least you've stopped the conversation on something that is not to be addressed today on the agenda and get us back on track.

Practice No. 7

Practice number seven that excellent leaders use to run great meetings is to involve everybody, so whether you've got a lot of dominators or you just have people that have more experience, the point is if you're inviting colleagues or employees to a meeting, they should be adding to it unless they're there just to learn as an intern or something like that, so a really good leader will pause every once in a while and we'll say, “Hey, Stephanie, I've not heard from you today. On this topic, I think you'd have some good input. Why don't you tell us what you're thinking?”

That way the introverts or the analyticals, or those that tend to want to think about things more before chiming in will have an opportunity to express their opinions and add to the conversation, and that's what makes some of these meetings really interesting, knowing that you're going to be asked to participate and not just be there as an observer.

Practice No. 8

Now, the eighth practice is to summarize the actions that have been agreed upon at the end of the meeting, so let's say we've made a decision, we've taken a vote, everyone's on board, we're going to proceed with this project or we're going to proceed in this direction, or we've decided we're going to do such and such and bring that back to the next meeting, so it's nice if at the end, the last two to three minutes, we summarize everything that is an action step for the next meeting if there is a next meeting, and that way it's clear, it'll go in the minutes, and then it can be sent out with the other materials before the following meeting.

This is where the accountability can be built in so that these action steps should have one particular person's name next to them as the accountable person, and if they're going to be on the next agenda, that person definitely needs to be there at the next meeting.

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Practice No. 9

The ninth practice is to end on time. In fact, if possible, you should complete your work and end even early. Don't think of those last five to ten minutes of free time as social time. Give the participants a piece of their life back and say, “You know what? We've finished everything. Do we have a motion to adjourn? Let's all go back to our offices or whatever we were doing earlier than expected and get some additional work done if that's what we want to do.”

Practice No. 10

And then the last practice, number 10, is to be certain to follow-up at the next meeting with those items that we agreed to follow-up on during this meeting. It's amazing how many times we come to conclusions or assign tasks or decide to do something, and then the next meeting starts all over again in a different spot and there's no accountability and there's no closure on that loop, which is really the ideal way to keep things moving with meetings and projects and things like that.

Remember that one sign of a great leader is one who runs great meetings, and if given the chance to prepare and contribute to them, attendees will look forward to participating in your meetings.

To Summarize

Okay. Let me go over the 10 practices of the meeting maestro one more time.

1. The goal of the meeting is explicitly stated.
2. The agenda, minutes, and other materials are sent out before the meeting.
3. The meeting is started on time.
4. The chair facilitates the meeting but does not dominate the meeting.
5. The chair follows the agenda.
6. The chair maintains control by limiting discussion when needed, and using the parking lot as a tool to do that.
7. The chair involves everybody in the meeting.
8. The chair summarizes the action steps at the end with accountability attached.
9. The meeting ends on time, or even early.
10. All of the appropriate actions are followed up at subsequent meetings.

I think I'll end it there.

If you'd like to download a checklist to use when planning your next great meeting, go to vitalpe.net/037download, and I'll send you that simple checklist in exchange for your email address.

Thanks again for listening 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.

The easiest ways to listen:  vitalpe.net/itunes – vitalpe.net/stitcher

If you'd like to listen to the premier episode and show notes, you can find it here: Getting Acquainted with Physician NonClinical Careers Podcast – 001

The post Adopt These 10 Practices of the Meeting Maestro – 037 appeared first on NonClinical Physicians.

Today, I'd like to explain what inspires me to bring you new information and new guests, and to keep producing this podcast and other new content. It's going to boil down to two big things that really get me, and keep me, fired up.

Indoctrination

When I started as Chief Medical Officer, or really as VPMA initially, but as I became a hospital executive about 17-18 years ago, one of the things I wanted to work on was becoming a really integral part of the senior executive team.

Photo by rawpixel on Unsplash

So that meant I really wanted to fit in. So I wanted to please the CEO and the other executive team members. But in the process of doing that, I did sort of minimize some of my concerns about the way that the physicians that were my colleagues were working in the organization, particularly the employed physicians.

So, for the first several years, I did a lot of listening, I didn't jump in that often. But over time, I became more and more comfortable. But I also became sort of, I guess you'd call it, indoctrinated into the way things were done as part of that executive team. Now, fast-forward about 15 years, and I began to feel that there were a couple of things that were going on that didn't sit right with me.

Community Needs vs. Bottom Line

One was that it didn't seem that we were really trying to necessarily always focus our efforts on trying to meet the needs of the community as much as we could. It seemed like we always were doing projects that were more focused on increasing the bottom line.

Now, don't get me wrong, we would have projects that were intended to help different populations of patients; and prepare us for working in an ACO; and population health and so forth. But it didn't seem like, if there was a need in the community that was not that much of a profit center, it was given much credence.

Example

I'll give you an example. We had a lot of diabetics in the community, as many communities do. And we had a diabetes center. It was very lightly staffed, and really didn't meet the needs of the county at all. It was expensive to get training, and very few physicians were referring patients. Now, it was a break-even. It didn't add to the bottom line, but it didn't really detract from it.

So I was always pushing to expand the diabetes center because we had such a large population of diabetics in the county. But it was something that never quite made it into the top five or ten strategic goals in any given year, because it just wasn't going to address the bottom line.

Little Physician Input

Now, the other issue that started to annoy me was the way that physicians were being treated, in terms of the amount of input and decision-making that they were allowed to provide. We had set up an informal leadership group, which included an equal number of administrators and physicians.

But it seems as though we only brought topics to that meeting for input from physicians when the strategic decisions were already made at a higher level, either the board or the senior executive team.

And I started to feel as though I really wasn't providing much support for the physicians, that I was oftentimes looking at things from the side of the senior executive team, and I didn't feel good about that.

Now, don't get me wrong. Prior to me coming on as a member of the team, there had never been a physician executive on the senior executive team of the hospital. And so I think it was very good that there was that input over many years. And one of the things that I had done was to try to bring some clarity and some fairness to the compensation plan for our physicians. We were in the process of converting to an RVU-based plan, which is not perfect, but at least it allowed us to recognize that some physicians were more productive than others. Some were seeing more patients than others and doing more procedures than others. And in fact, they should therefore be paid better.

Bringing Fairness to Compensation

So, we made a commitment to use that kind of a salary or income model, but there were several physicians — in particular, I remember a neurologist or two and a geriatrician — who had an enormous number of RVUs. They were seeing many patients, whether in the hospital or on consults in the office, and they were doing certain procedures that generated a lot of RVUs, and they were very, very busy. And yet, they were being paid way below the median salary for their specialty, particularly when you considered the RVUs.

So, over a period of years, I convinced the CFO and others on the senior executive team that we had to make adjustments. And for several of those physicians, they saw their salaries go up quite a bit, probably 50%, 60%, even 100% over a period of several years.

Weak Physician Advocate

So, from that standpoint, I felt like I was an advocate for the physicians. But there were other issues that kept coming up: difficulty with not having enough staff in the office; or struggling with all the paperwork; or having to go home every night and spend two or three hours, and even on the weekend, trying to catch up with their medical records.

And we would talk about that, and we would tend to minimize that and say, “well, that was just the way it was,” that was something physicians had to do, they had to document. No one could document for them, and it's just … it would get better once they learned how to use the systems better.

I also felt that there was a sense that the executive team didn't really understand how much focus and intensity it took for a physician to do their job. Now, you and I know that you need to be very focused. And you need to avoid distractions when you're taking care of patients. You need to be focused while you're interviewing them and examining them. But you also need to be focused when you're deciding what treatment plan to outline and ordering things, whether it's electronically or in writing.

Poor Understanding

And I didn't get the sense that the executive team really understood this kind of intensity. Sure, the CFO, he would go in his office, close his door for a couple of hours if he had something really deep that he had to work on. And he could get that work done without any interruptions. But physicians are constantly being interrupted. And it's difficult to just say we're going to do our charts at the end of the day, because then we're taking time away from our families. And I don't think that the executive team understood the kind of energy that that kind of work requires.

What I'm saying is, basically, this all resulted in an ever-increasing amount of burnout, which we've seen across the country, and there didn't seem to be a consideration of the fact that our physicians were getting more and more burnt out. I think this failure to fully recognize the demands placed on us by clinical activities wasn't recognized, whether it was for physicians, nurses, and other clinicians.

Photo by Joshua Newton on Unsplash

Another Example

I'll give you another example. We all know that medication errors are an important issue in hospitals, and we put in place many tools and many processes to try to reduce the incidence of medication errors. One of the things we did was install very sophisticated dispensing machines on each unit.

Well, the pharmacists and the nurses found that putting the dispensing machines in the middle of a busy unit would lead to distractions, which would impair the nurse's ability to consistently get her work done and do it in a way that was likely to minimize errors.

Photo by rawpixel on Unsplash

It had been recommended by other outside entities that we should be putting the machines in a quiet area, so that nursing staff could enter the important information and obtain the medications in a completely non-distracted way. But this never happened, because it was costly to either take a room out of service for a patient or to find a small area — or build a small area — for the machines to be placed in. And so, really, it was just discarded out of hand. Even the Chief Nursing Officer couldn't really convince the other senior members of the team the importance of doing this kind of work in a quiet, non-distracted environment.

Mistakes Have Consequences

So, what happens when the CEO or the COO doesn't return a phone call, or misspells something on a contract, or puts in the wrong number somewhere? Well, generally, not something life-threatening. On the other hand, if a physician puts the decimal place in the wrong spot, or gives a verbal order that is misinterpreted or misunderstood, or forgets to follow-up on a phone call to a patient with some important findings?

Not only does it lead to potential harm to the patient, but it leads to some potential litigation and years of mental anguish for the physician. So again, these sorts of things are not really appreciated by the senior executive team of many hospitals and health systems.

I also remember other times when there'd be a conversation about a physician who, well, the satisfaction scores weren't all that good, or the physician had a history of complaining. And the senior team members would typically just out of hand say that, “Well, that doctor's a complainer, and you can't take everything he or she says to heart. We should probably just start looking for a replacement.”

So, rather than spend a lot of time and energy trying to get to the root causes of the issues, there were always just simple solutions that were sought, and it was often at the expense of the physician.

Regrets

And after leaving that organization, I began to think more and more about how I could have done more to represent the physicians in those meetings, and during those strategic discussions. And it's one of the things that ultimately drove me to do what I'm doing now. So I left that environment, I partnered with some people and started an urgent care center, and now serve as Medical Director, and I'm doing some clinical work, as I've talked about previously.

But I've also gotten more and more committed to addressing this kind of issue. And finding ways to address the burnout and the lack of engagement that physicians seem to be feeling more and more every day. It's a way that I can help to maybe make a difference now that I'm no longer in the environment that I'm talking about today.

And as I looked at the root causes of these issues affecting physicians, I began to see a trend. Now, granted, some of the root causes involve regulations that are put on us without our input, and insurance companies adding more and more layers of bureaucracy. But it has occurred to me that there are some root causes that can be addressed, and I want to talk a little bit about how I came to this conclusion.

Physician Engagement

Sort of the other side of physician burnout is the issue of physician engagement. It's become very important. It's not a well-understood concept, but basically, if a physician is engaged, that means they're proud of where they're working. They feel like they want to contribute. They like the people that they're working with. They feel that they're making a contribution. And so, it's basically a positive feeling as opposed to the negative feelings of burnout.

And a lot has been written about engagement of physicians — books have been written, articles have been written. And there are some tricks, and there are some things that you can do to help improve physician engagement, which also helps improve interaction with patients, and even patient outcomes, and employee satisfaction in the organizations where physicians are fully engaged. And there is one factor that I've tended to focus on more so, that does help to improve engagement and reduce burnout.

Possible Solution

And that is: working for an organization that has physician leaders.

So, that could be physician CEO, physician COO. The more physician leadership in an organization, the better the physician engagement, and the less likely to have burnout. It won't necessarily eliminate it completely, but definitely, my feeling is that the more physician leaders we have in those important positions, the more engaged the physicians, the better care that will be provided, and overall employee satisfaction will improve, and the organizations will be more successful.

So that's why I've devoted my podcast and the blog basically to two aspects that might serve as solutions to this problem, both at a global level and at an individual level. The first is to provide information, support, and inspiration for physicians to take on those leadership roles. My experience has been mostly in a hospital setting, and so that's the area where I focus quite a bit. But I also talk to other physicians who have taken on leadership roles in the interviews that I do, to try and help you to get inspired and get motivated to take on some of these leadership roles yourselves.

Nonclinical Careers and More Leaders

And I don't believe it needs to stop at the level of Medical Director, or Chief Medical Officer, or Chief Information Officer. I think physicians need to become COOs and need to be leading organizations as CEOs and chairmen of boards and other roles. Because, number one, I think they have many of the leadership skills, and those they don't have, number two, they can get those. And ultimately, we'll all benefit as more and more physicians step into those roles and begin leading these health care organizations.

But then the second part is this. Let's say you don't want to jump into a leadership role. But if you're burnt out, if you're not fulfilled, if your job isn't satisfying, then you need to get out. You might do some coaching, you might even see a psychologist, but at the end of the day, if it's not for you, and you can't find some clinical alternative, then you should get out.

But probably your best opportunity for making a decent living and finding a fulfilling career will be a career that builds on your medical knowledge. So while it's fine for someone to go into real estate or open a new franchise, it probably makes more sense to build on all of that clinical knowledge that you have, and pursue a career that incorporates that knowledge, but in a way that doesn't put you in the middle of the same factors that are causing the burnout and the frustration that you've experienced so far.

2 Big Things That Get Me Fired Up

So, the two big things that get me, and keep me, fired up are my desire to inspire physicians to seek a fulfilling nonclinical career if they're not loving their current career, and to encourage physicians to become better leaders in whatever career they are engaged in.

I strongly encourage physicians to pursue a hospital or health system leadership career, because those are one of the biggest and most expensive parts of the health care system. And the more physician input we have into that, the better off we'll all be. So that's what I'm going to be doing over the next few years, is creating more content and more resources to help you do either of those two things.

Helpful Resources

One of the resources that's out there right now are Facebook groups. I happen to be an administrator, along with Laura McKain, who is the founder, creator, and also an administrator for Physician Nonclinical Career Hunters Facebook group. I would advise you to check that out.

Most of my listeners, I believe, are already members, but if you're not a member and you're on Facebook, check that out. We've had some really interesting conversations on there. There are some resources, people ask for advice; there's many people on the Facebook group that can provide great advice because they've already done some of the things that other members are thinking about doing.

And if I can help you in any other way, you know that's really what I want to do, so feel free to email me at johnjurica@nonclinical.buzzmybrand.net with any questions, concerns, or suggestions. And I'll do what I can to get to those quickly and help you out.

And let's end today with a quote from Lao Tzu:

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.

The easiest ways to listen:  vitalpe.net/itunes or vitalpe.net/stitcher

If you'd like to listen to the premier episode and show notes, you can find it here: Getting Acquainted with Physician NonClinical Careers Podcast – 001

The post 2 Big Things That Get Me Fired Up – 036 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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This is a process. Like any new realm of learning, we follow a path from awareness, to understanding, knowledge, competence, and eventually, mastery. This process may take years to complete.

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

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

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

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

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

Seeking a Solution

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

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

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

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

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

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

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

Preparing to Be a Better Physician Leader

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

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

Project Planning

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

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

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

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

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

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

Communication

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

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

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

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

• Listening
• Asking questions

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

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

Planning and Running Meetings

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

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

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

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

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

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

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

Measurement

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

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

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

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

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

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

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

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

Teamwork

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

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

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

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

Management

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

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

In Closing

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

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

Next Steps

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

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

I welcome your comments and questions.

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It was early August, and Julie and Pat had already received the most recent update on Julie’s balanced scorecard. The scorecard listed four key responsibilities as well as the three goals she and Janice had agreed upon at the beginning of the year. The scorecard contained data through the second quarter, ending June 30.

After some small talk, and briefly discussing a new manager on one of Julie’s units, they shifted their conversation to Julie’s scorecard. During the previous year the entire organization had implement this formal, objective evaluation process as a pilot. It had worked well, so it had been officially implemented in January.

Reviewing The Scorecard

Pat commented, “I’ve had a chance to look over your scorecard. It looks like almost everything is on track. The performance of your department in the financial, growth and patient satisfaction areas is at the above average level. The second quarter performance in quality was better than the first quarter. So, I want to commend you for that.”

“I notice that you had an uptick in turnover of your staff in the second quarter. It looks like that will push your overall score for Employee Engagement below the minimum threshold. We should probably talk about that one. Is there something I can do to help support you in this area?”

Julie responded. “Yes, I saw the spike in turnover. So, I worked with HR and reviewed the turnover for the past five years. This issue seems to be related specifically to CNA turnover. Nursing turnover actually looks very good. Looking back, there always seems to be a peak in turnover in the second quarter.”

“I worked with my managers to identify any employee concerns. But the increase this quarter is actually smaller than the average second quarter increase for the past five years. I'm confident that the third quarter numbers will be quite low and our performance for the year will be very good.”

Pat responded, “That's good to hear. I think it was great that you took the time to look into this before our meeting today. Your explanation makes sense. Now let's look at where you stand on your three goals for this year…”

How to Evaluate Direct Reports

As a physician executive, you will be blessed with the opportunity to work with some great directors and managers. They are called your “direct reports.” You will be held responsible for their performance as well as your own.

In your executive role, you will use your management skills to identify goals and ongoing performance measures to demonstrate the success of your division. The performance of your directors’ departments and their employees will be key to your division performance.

As a wise administrator, you will have neither the interest nor the time to micro-manage your direct reports. However, you will tools that allow you to monitor their performance and alignment with the rest of your division and with the organization as a whole.

You will have limited time each month in which to do this. Frequently, you will spend significant amounts of time meeting with other senior executives, including the CEO. You will be presenting updates on your division's performance, writing proposals, negotiating contracts and providing coaching and mentoring to other team members.

Competing Responsibilities

If you are a hospital chief medical officer, you will be preparing presentations about quality, patient safety, infection control, length of stay, and performance by contracted specialty groups, as outlined in the Eight Essentials Abilities.

Therefore, you need a system for motivating and supporting your direct reports. You’ll require a tool that lists their core responsibilities, and monitors their success in achieving them.

If your organization still uses an annual evaluation based on each director’s job description, the evaluation will be subjective and not very useful. It won't do much to align your direct reports’ daily and weekly efforts with your division goals.

An annual evaluation is basically useless with respect to day-to-day management. What you really need is a tool that will provide clarity for your direct reports and enable them to focus on important goals, and maintain accountability throughout the year.

The best way to do so is to use a balanced scorecard and key performance indicators (KPIs). By agreeing on a set of ongoing performance expectations and tracking them over time, you will be able to encourage and support your team. This tool will also enable them to make course corrections during the year.

Backbone of the Scorecard: KPIs

For each director you will need to identify the primary performance measures. These are often called the Key Performance Indicators (KPIs). I will provide an outline of a general scorecard below, and then a specific example of a scorecard for one hospital department.

Many large organizations, including hospitals and health systems, design their strategic plans and management goals around so-called Pillars. These pillars represent fundamental areas that must be addressed by any organization to be successful.

Generally, these pillars will include domains such as:

• Growth
• Financial Stability
• Customer Service
• Excellence or Quality
• Employee Satisfaction

The organizational pillars can be spun off into individual department pillars that parallel them. For hospital-based departments, they should align with the pillars above:

• Growth
• Financial Performance
• Patient Satisfaction
• Quality and Patient Safety
• Employee Engagement
• Physician Engagement

To implement this process, at the beginning of each year we create a balanced scorecard that identifies KPIs that align with each pillar and then determine levels of performance for each metric. Some departments may not create a KPI for every pillar. For example, if a department does not interact with physicians, then it will not have a KPI for Physician Engagement.

Some pillars might have more than one important KPI. A department that produces revenues and has expenses (e.g., outpatient laboratory) might need a KPI related to both increasing revenues and reducing expenses. A non-revenue producing/support department such as human resources, quality improvement or risk management may have one KPI related to reducing expenses.

Some of the measures remain the same from year to year, but the threshold goals for each may change over time. The goal for each metric may be dichotomous (pass/fail) or tiered to three or more levels.

Avoid Subjective Measures

My preference is that the measures be completely objective and easily measurable. I prefer not to use subjective evaluations.

For example, I would rather not use an evaluation with measures such as these:

Instead, I prefer evaluations based on achieving measurable agreed-upon thresholds that have been discussed and clearly articulated by the supervisor. This means that staff are assessed based on results, or what they accomplish, and not on how it is accomplished.

A criticism of such a process is that if the focus is on one or two parameters, short-term gains will be sought rather than long-term success. For example, financial performance could be improved by terminating highly compensated employees and replacing them with lower paid inexperienced staff.

Balance is Critical

But that is avoided by using a balanced scorecard in which all of the important measures are addressed simultaneously, thereby avoiding the short-sighted focus on only one or two measures.

A decent balanced scorecard for the evaluation of a director over an imaginary hospital department based on the pillars above might include KPIs that look like this:

[Note that more detail would need to be provided – this is for illustration only. – VPE]

For the director of such an imaginary department, these measures would be measured, reported and discussed monthly by the VP or CMO and the director. The director would be encouraged to perform at the above average or superior range.

The VP would provide support and encouragement to achieve better results in any area in which acceptable or less than acceptable performance was being achieved. The support of the VP might be to intervene with other departments, or deploy resources (staff or budget dollars) from another department to help meet important goals.

Incentives

There are two primary incentives working to improve performance. The first is simply the recognition that comes from achieving the proposed goals. This recognition can be enhanced when the results for all of the directors and executives are shared across the organization.

This scorecard will be even more powerful if annual salary bonuses are tied to the outcomes. In such a scenario, the KPIs are reviewed and discussed with the director monthly or quarterly. Estimated bonuses, based on the most recent scores, are discussed at least quarterly. Then later, the bonus amounts (or lack thereof) will not come as a shock to the director.

The CEO and CFO will generally determine the amount of financial incentive that is potentially available, because it needs to be budgeted. The board may also need to approve the plan.

The total available for bonuses  may be a set dollar figure, or it may be set as a percentage of salary (e.g, 20% maximum potential bonus). The bonus payments may be canceled if the organization experiences a major financial decline in any given year.

Once a potential bonus is determined, you must create a formula for a partial payout because it is likely that KPI thresholds will only be partially met. The formula is based on the number performance measures and the importance of each.

Pharmacy Director

Let’s create a balanced scorecard for the (inpatient) Pharmacy Director, using the rules we set above.

Based on the CEO’s recommendation and board approval, all directors will be eligible for a bonus of 20% of gross salary if all KPIs are met at the Superior level (maximum threshold). The total potential bonus is being split equally among each director's five KPIs (possible $6,000 for each).

If the performance falls between Above Average and Superior, 80% of the bonus will be paid. When it falls between the Average and the Above Average, then 50% of the potential bonus is added. If a KPI ends the year below the lowest (Average) threshold, then the director is not eligible for a bonus on that item.

If the Pharmacy Director receives a salary of $150,000 per year, she is eligible for a maximum bonus of $30,000 at the end of the year, to be paid in March following the calendar year. The reason for the delay in payment is the processing time required to collect, tabulate, and review the data being used to calculate the measures.

Here is how the year-end analysis might look, assuming the performance listed in the 6th column:

Under this scenario, with a potential $30,000 bonus, the Pharmacy Director would receive $21,600 in March, based on relatively good performance compared to the annual goals.

In this example, just the basic outline is provided. In a real implementation, each goal and threshold would be clearly defined, and a determination made that the measure could be reported in a timely fashion.

Carefully Select KPIs

For the HCAHPS metric (patient satisfaction that is based on a mailed survey, collected and reported by a third-party), there is a significant time delay. So, the organization might need to use internally tracked measures that mirror the publicly reported measures.

It is best to use a monthly or quarterly scorecard that looks like this at each meeting with the Pharmacy Director:

Each month or quarter, you and the director will look over the current trends and develop plans together to improve performance for those areas not meeting the stretch goals.

The design of the KPIs and specific goals will need to be carefully considered. Looking over historical averages and trends can help to determine appropriate thresholds. It is also helpful to consider the variability of the measures. If there are wide swings in annual expenses in a given department, setting a goal may be more difficult than setting one for a department that performs within a tight range.

Wrap Up

The performance of your direct reports will sky-rocket if they transition from old style subjective evaluations to a balanced scorecard using Key Performance Indicators. Whether through peer pressure or financial incentives, measurement and reporting are the keys to improved performance.

An optimal scorecard will include KPIs that represent the major pillars defining the performance of the department. The KPIs must be designed with care, however. The metrics must be measurable and timely and meet the same guidelines as a SMART Goal. And they must be balanced, so that one area does not dominate the focus of the director and department.

Next Steps

If you are not using a balanced scorecard to provide ongoing objective evaluation of your direct reports, then commit to the following process over the next month or two:

1. Choose a director with whom to explore the use of a balanced scorecard;
2. Identify the major pillars of the organization and of the department;
3. Select 4 or 5 Key Performance Indicators based on their importance and measurability;
4. Begin a pilot beginning next quarter in which you measure, report and discuss the KPIs with your direct report;
5. If the process results in improved performance, then expand to other departments;
6. Share with your COO and CEO and the rest of the organization.

Then watch as the organization's performance really blossoms!

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Pharmacy

Medication administration is one of the most important functions of a hospital. Safe, effective and timely administration of medications requires coordination of multiple hospital staff departments, integration of electronic medical records, implementation of pharmacy automation, and monitoring and managing drug costs.

The triad of professionals responsible for the selection and delivery of medications consists of the physician, nurse and pharmacist. These highly educated professionals each contributes critical expertise to medication delivery. The integration of the physician/nurse/pharmacist triad is the secret to safe medication delivery.

Those three professionals each work in domains with unique challenges and cultures. Thus, when they bring to bear their particular skills and tools, they optimize the patient's outcome.

Value of the Physician Executive

The physician is an expert in selecting the medication needed to treat a given patient. The nurse is the expert in safely administering the medication and monitoring the patient for intended benefits and adverse effects. The pharmacist is the expert at monitoring the process, delivering the medication to the bedside and providing needed support and advice, especially when polypharmacy is involved.

The Physician Executive is in the best position to understand the process and facilitate coordination of the stakeholders. Some of the critical aspects that must be led are:

• Developing guidelines and protocols that drive medication selection.
• Facilitating discussions needed to create a formulary that is appropriate, yet manageable in size, cost and complexity.
• Mediating between physicians and pharmacists when constraints are placed on the use of high cost medications.
• Advising about which functions can be delegated to technicians and which require direct doctorate-level pharmacists.
• Promoting the collaboration between the pharmacy and quality improvement departments.
• Balancing the costs and benefits of new pharmacy-led initiatives such as:
  • Deployment of clinical pharmacists to the emergency department and other units such as intensive care;
  • Diabetes management services to adjust insulin doses for inpatients; and
  • Anticoagulation clinics to adjust warfarin dosing.

Practical Considerations

How can the VPMA or CMO best help the pharmacy to deliver on its mission? Here are a few suggestions to consider.

1. Promote a culture of accountability, teamwork and safety within the department. This will require the selection and nurturing of a very skilled pharmacy director.
2. Lead your physician and nursing colleagues by example. Commit time and resources to measuring outcomes, participating in teams, and presenting pharmacy concerns to medical staff and executive leadership.
3. Remain current with important medication safety issues by monitoring publications from:
   • Institute for Safe Medication Practices
   • American Society of Hospital Pharmacists
   • American Hospital Association (see Quality Advisory on Medication Safety)

One-on-Ones

Finally, as with all of your direct reports, you will meet with your pharmacy director on a weekly or biweekly basis. During those meetings, the following topics should be addressed (not necessarily at every meeting):

1. Review of goals for the year. Are milestones being met? How can you facilitate them?
2. Review staffing. Is the pharmacy fully staffed? Are there open positions? How are those being addressed?
3. Budget updates. How are expenses running compared to budget, especially staffing and drug costs?
4. Medication safety reporting. What are the number and nature of medication errors for the past reporting period? Were they preventable?
5. Formulary requests. Are any pending? Review the agenda for the next Pharmacy and Therapeutics meeting. Do physicians need to be contacted prior to the next meeting?
6. Summary of cost reductions resulting from clinical pharmacy interventions.
7. Director’s performance review (at least quarterly).

Conclusion

The physician executive can have a positive impact on patient care. This will be achieved by enabling the pharmacists to fully apply their expertise and by promoting the physician/nurse/pharmacist triad.

Next Steps

If you are a VPMA or CMO and do not currently oversee the pharmacy functions, become more involved in the department.

• Attend P and T Committee meetings.
• Support the efforts of the Pharmacy Department to engage physicians.
• Promote new clinical pharmacy initiatives that will enhance medication safety.

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My partners and I had started a pension plan and we were making regular contributions. But none of us really knew how we should invest our contributions. I realized that I needed to learn about investing.

I needed to go through a crash course on mutual funds, stocks, bonds and asset allocation. And the Internet did not exist, so there were obviously no blogs like White Coat Investor, Physician on Fire or Future Proof MD to read.

So, what did I do?

Like many medical colleagues who seem to be afflicted with (blessed with?) hypomania and obsessive compulsive disorder, it was time for my first round of post-medical education TOTAL IMMERSION!

I’m sure you have seen this in some of your physician friends, if not yourself. You get into something and it becomes an all-consuming obsession. You need to find and devour every possible resource on a topic – written, audio or video. First, you start with the free and easily available, then move to low-cost, and then high cost, sources of information. I've done this with investing, bluegrass guitar playing, rock-climbing, rollerblading, blogging and other subjects.

For this first obsession resources included:

• Reading articles in Smart Money, Forbes, Fortune, etc.
• Requesting free financial newsletters
• Listening to financial radio personalities like Bob Brinker and Dave Ramsey
• Subscribing to one or two newsletters, like Bob Brinker’s Marketimer and The Kiplinger Letter
• Watching CNBC day and night
• Reading the latest books on investing (too numerous to list – and out of date now!)
• Starting an investment club (see Better Investing)

You get the idea.

So, how does this apply to the physician intrigued by a career in management?

Well, you need to decide if it is really what you want to pursue before spending potentially large dollars and lots of time on it. Unfortunately, there are not as many readily available resources about physician management. But there are a few that should be explored before jumping in.

Let me list what I think are the bests ways to learn about management before investing too much time and money in the effort.

4 Steps to Learning About Management

Let's look at the four steps you can easily take to get a clear understanding whether this might be the right career for you.

1. Reflect on Your Motives

This step has the advantage of being totally free. You should reflect honestly about why you are thinking about beginning this journey.

Is it because you are burnt out, or overwhelmed by your clinical practice? Does the fantasy of sitting in an office, giving instructions to a direct report seem less frustrating and stress-free? Are you thinking that management is a nice pre-retirement way to slow down?

The fact is, you may get just as stressed and burnt out in a management position as a clinical position. There are budget and staff constraints, difficult decisions, accountability for your performance, and more work than the available time. You're paid well, so you must demonstrate a measurable return on investment for your salary. And you must not be timid about terminating underperforming directors and managers on your team.

Are you attracted to management because you wish to help larger groups of patients and work in a team on big projects? Do you enjoy big challenges? Are you comfortable with more uncertainty than the typical physician?

Do you prefer one-on-one interactions with patients? Or do you feel comfortable in front of a group of peers or board members? Do you enjoy working on quality improvement and patient safety? What do you think about confronting your colleagues about unacceptable behavior or questionable clinical practices?

If you are not running from an old career, but embracing a new one, then you are probably on the right track. But there are other careers to consider (such as those discussed in Options for a Non-Clinical Career).

2. Talk to Physician Leaders

If you are acquainted with a chief medical officer, vice president for medical affairs, chief quality officer or someone in a similar position, ask them to sit down over coffee and answer a few questions. Ask them how and why they went into management. What were the barriers to entry? Where did they learn about management and leadership?

This is also one of the best ways to find a mentor. Talk with several such persons. And make it a point to follow-up with them several months later. You don’t need to ask them to “be your mentor.” That can be scary to a leader. It feels like they need to commit to a formal role with a major time commitment. But just getting together to talk about management issues and career choices three or four times a year is not so threatening.

3. Read Everything You Can About Physician Leadership

You can scour the Internet for articles using Google Alerts. Look for articles that include keywords like physician executive, leader, administrator and manager.

You can pick up books like Growing Physician Leaders: Empowering Doctors to Improve Our Healthcare, The Six P's of Physician Leadership and Essentials of Medical Management.

4. Join the American Association for Physician Leadership

Here is where an investment will be required. Membership in the AAPL currently runs $295.00 per year. This is well below the annual cost for many professional societies. But it is a small investment given the resources that are available to members. (I have no financial incentive to recommend membership, but I have been a member for about 23 years).

Joining the organization will jumpstart the other three steps, because membership includes access to a journal, books, a job board, and online educational materials. There are several live conferences each year where networking can occur and mentorships can be developed.

I believe it is helpful to join even if you have not made a personal commitment to seek a management position, because the available resources will help to inspire you, and to decide whether to proceed or not.

Start the process outlined above and see if a management career is right for you.

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Let’s imagine that your team has selected a WIG. And the goal is written in the format of “from X to Y by when.” According to the authors of 4DX, the next step is to develop lead measures. Lead measures, if implemented, will result in improvements in the lag measure.

Consider an enterprise in which the WIG is “increase our sales of widgets from $50,000 per month to $75,000 per month.” The sales team knows that a certain percentage of calls on customers results in eventual sales. The lead and lag measurements might be written as follows.

• Lag measurement = monthly sales (goal is $75,000)
• Lead measurement = number of monthly sales calls

If chosen correctly, an improvement in the lead measure will result in an improvement in the lag measure. One of the common failings of goal implementation is to track the lag goal, but fail to create measurable lead metrics. It is the lead measures that can be tracked and shared with the team on a regular basis as a way to enhance execution.

However, in order to progress on a goal a team maintain focus on the goal, even as the daily whirlwind continues around us.

In their book, the authors spend a fair amount of time describing the process for maintaining that focus. It includes weekly meetings in which the lead and lag measures are reviewed using a scoreboard. The meetings involve everyone that has an impact on the goals. And it aims to maintain accountability of the team's success by making commitments and reporting on those commitments. This is what a scoreboard might look like:

How the Disciplines of Execution = Quality Improvement

The lead measures and lag measures described by the authors are very similar to what are called process measures and outcome measures in the field of Quality Improvement. The process measures are sometimes called core measures when referring to The Joint Commission-required quality metrics.

Core measures are specific process measures defined by TJC (and CMS) that hospitals must measure and report. They are used to measure compliance with quality monitoring programs, some of which determine adjustments to Medicare payments. Core measures are generally scientifically supported interventions that have been shown to improve outcomes.

When trying to measure and compare outcomes of hospitals, process measures became popular for several reasons:

• They are more timely. Measuring beta blocker or aspirin use for acute myocardial infarction can be measured and tracked in near real-time. Measuring, risk adjusting and reporting mortality or complications for patients with acute MI is slower.
• There is a greater range in performance of process measures. Improvements become obvious more quickly. Tracking compliance rate for a process measure from 60% to 99% seems more meaningful than demonstrating a small reduction in mortality from 3.0% to 2.5%.
• The process or core measures generally correlate well with the outcome measures. Demonstrating higher compliance with process measures usually predicts better results for outcomes.

Example: Ventilator Associated Pneumonia

My primary reason for discussing 4DX is to help physician executive understand how to translate goals into results. But I think it might be helpful to use a clinical example to demonstrate some of these principles. As physicians, we understand these principles pretty well, and they can easily be applied to business examples in the healthcare setting.

Ventilator associated pneumonia (VAP) is a subset of nosocomial or hospital acquired pneumonias. It falls under the general category of healthcare associated infections (HAIs), which is a subset of hospital acquired conditions:

Hierarchy of Hospital Acquired Conditions

If we want to improve this entire cascade of hospital complication, we need a team to address each one. If we focus on VAPs, we can see that the lag measure is the VAP rate, which must be measured reported, discussed and addressed. It is generally measured and calculated as follows:

[# of VAPs (meeting specific criteria)/Ventilator days] X 1,000

It is reported as VAPs per thousand patient days. The numerator can be measured manually via logs, or pulled from an EMR, as long as documentation and coding are consistent and accurate. Tracking ventilator days is generally done manually.

Lead or Process Measures for VAP

The process measures that have been shown to affect VAP outcomes are as follows:

• Elevation of the head of the bed (30 – 45 degrees)
• Daily sedative interruption and assessment for extubation
• Peptic ulcer disease prophylaxis
• Deep venous thrombosis prophylaxis
• Daily oral care with chlorhexidine

These metrics need to be manually observed and recorded in the units where ventilated patients are treated. There are checklists that can be used to help ensure compliance. An intensive educational program will need to be presented to staff to achieve understanding and “buy-in” to the project.

Achieving 100% compliance with the performance of these lead measures results in drastic reduction in the lag measure of VAPs per thousand ventilator days. Below are examples of real trends following the institution of VAP bundles and weekly quality improvement meetings in an anonymous organization.

Percent Patients in ICU with Ventilator Bundle

Average Stay of Patients

VAP in ICU

To achieve these results, however, the same principles that 4DX describes must be followed:

• Create a scorecard with weekly tracking of the process and outcome measures.
• Focus on the process by meeting weekly so that the whirlwind can be shut out – if non-WIG items come up, deal with them in another venue.
• During the weekly meetings
  • Follow-up on the previous meeting’s commitments
  • Review the dashboard
  • Make individual commitments to be reported on at the next meeting.

Final Thoughts

4DX provides much more detail about the process for implementing the 4 Disciplines of Execution. I find it very interesting that effective quality improvement methods closely mirror the detailed approach to executing strategic goals outlined in 4DX.

Physicians involved in QI and Patient Safety Initiatives should feel comfortable translating those skills to selecting and achieving management goals if they chose a career in hospital management.

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