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.

Photo by rawpixel on Unsplash

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.

First, I had to create an outline of my presentation and complete some background research. Then, I would design my slides and organize and rehearse the presentation. Because I had not even formulated the overall message of the presentation, I was getting really anxious about it.

I had little uninterrupted time at the office to prepare because I had double-booked my usual meetings in anticipation of attending the retreat. At home, I was similarly unable to extract myself from the usual interruptions of phone calls, texts and other urgent problems.

Enabling Deep Work

I decided to use one of my time-tested tactics to help me focus and create some dedicated thinking time for this problem. On the following Saturday, my wife was planning to run a short errand. I informed her that when she left, I was going to go on a brisk walk, so not to worry if I wasn't home when she returned.

I followed the plan and walked for about 45 minutes around our neighborhood. During that time, I was able to focus and mentally review the pros and cons that I wanted to present. I fashioned a short list of steps for the proposed project and a timeline in my mind. When I thought about a couple of background items that I needed to follow-up on, I dictated a reminder into my cell phone voice recording app.

By the time my walk was completed, I had a pretty good idea of the outline for the presentation. The approach I would take to present it and the final recommendation I would be making were much clearer. After dinner that day, I began creating the PowerPoint presentation based on the ideas I fleshed out during that walk.

Cal Newport Sheds Light on Deep Work

Since reading Cal Newport's book, Deep Work: Rules For Focused Success In A Distracted World, I have struggled with the best way to present my review of the book to my readers.

I could do a simple book review, but my conclusions could be easily summed up in a single sentence. It's an important book about a very important topic that every physician leader should read.

I could spend several thousand words summarizing the book. But I doubt I could do a better job than the analysis presented by The Productive Physician: Do You Want An Extraordinary Life? Choose Deep Work.

I've come to the conclusion that the best approach is to highlight some of the important concepts, and some examples of deep and shallow work as physicians, leaders and executives.

Intense concentration!

Definition of Deep Work

Let me start by defining what deep work is. According to Newport, it is: “Professional activities performed in the state of distraction-free concentration that push your cognitive capabilities to their limits. These efforts create new value, improve your skill, and are hard to replicate.”

It's counterpart, shallow work, he defines as: “Non-cognitively demanding logistical-style tasks, often performed while distracted. These efforts tend to not create much new value in the world and are easy to replicate.”

Some examples of deep work that involve intense concentration could be:

• research for a book or article,
• writing a comic strip, a book, a journal article, a serious blog post or even a script for a movie or a play,
• creating a new course to teach,
• preparing for an important planning meeting,
• spending time analyzing quality improvement data, or
• preparing a 30 minute board report.

Examples of shallow work include:

• running a meeting,
• processing work emails,
• scanning the literature,
• meeting with direct reports, and
• other day-to-day routine tasks that could potentially be delegated to others.

Value of Deep Work vs. Shallow Work

Although there are great benefits to the outputs derived from deep work, it doesn't mean that shallow work is unimportant. Or that all deep work is valuable. Spending hours focused on a new video game will result in output of little value, as intense and focused as it may be.

Without shallow work, much of the deep work cannot be pursued. The operation of families, businesses and communities require shallow work.

CEO Example

For example, much of the work of the CEO of a hospital or other business is shallow work. The CEO is often a political animal (no insult intended) who spends a great deal of time interacting with his/her employees and community. Coordinating and running executive meetings, interacting with the board, and attending fundraisers are not deep work (according to my understanding of Newport's definition). But these activities are integral to leading a large organization.

There might be time devoted to intense concentration, such as digesting new research or envisioning strategic options. But even these activities can be done in a group setting in which the CEO is facilitating a review and discussion rather than personally engaging in deep work.

Sometimes, the CEO’s primary responsibility is in support of deep work by others. It's critical that there is sufficient time for deep work by those who lead the divisions and departments of the organization.

I'm not clear on whether certain other activities that require intense concentration constitute deep work. Surgical procedures might be a form of deep work. Pharmacists reviewing and processing medication orders might fit the definition. Does a nurse cross-checking an order and retrieving medications at a dispensing cabinet qualify, since it requires intense focus, at least for a few minutes?

Important Shallow Work

Other extremely important functions, including bedside nursing care, the activities in the laboratory, physical therapy, and other ancillary services of the hospital, housekeeping, etc., often don't involve deep work. However, they're all necessary for the running of an effective health care organization.

When shallow work becomes too pervasive and distracting, however, it will interfere with deep work. Without an appropriate balance between the two, intellectual progress and creation of new value will suffer.

Effective Leaders Use Deep Work

After reading through the book twice, I've concluded that deep work is an important part of the physician leader’s life. I've also realized that the ability to engage in meaningful deep work depends on two primary factors:

• developing the ability to focus intensely on important work for extended periods, and
• consistently avoiding the distraction of shallow work.

Without accomplishing both of these aspects of deep work, it’s benefits will be elusive.

For example, you might be really good at achieving a state of intense concentration. But if you allow 100% of your time to be spent in shallow work, then that ability is of little use.

On the other hand, you might avoid all distractions (television, social media, email, etc.). But if you don't cultivate the ability to achieve a state of intense concentration, it does no good to set aside a specific time to do so.

Luckily, Newport’s book helps us to address both issues.

Routines for Developing a Deep Work Habit

Deep work usually requires quiet time alone so that our attention can be focused on a specific problem or task. And because such intense mental work can be exhausting, it is usual for it to last no more than a few hours at a time .

Because of this intensity, Newport has found that there are four distinct ways to approach deep work that he calls your “depth philosophy.” Integrating depth into your life serves two purposes. It enables you to improve your ability to concentrate, and it provides some assurance that you will have the time to do so.

Monastic Philosophy

The Monastic Philosophy may not work for most physicians. It involves drastically reducing shallow work by avoiding almost all distractions, including email and social media. This would be akin to locking yourself in your office and only engaging occasionally in conversations with your colleagues. Distractions are avoided at all costs.

Bimodal Philosophy

In the Bimodal Philosophy, you split your time between intense mental work and shallow endeavors. Each period may last a day or longer. During quiet time, it's as though you are practicing the monastic philosophy, but there are frequent extended periods when shallow work dominates. This approach probably does not fit the lifestyle of most leaders (except, perhaps, for those that work primarily as researchers or writers).

Rhythmic Philosophy

The Rhythmic Philosophy for deep work might be a better approach for physician leaders. Simply set aside time each day or two to do deep work. It might be possible in a corporate setting to block out two hours of uninterrupted time on Mondays, Wednesdays and Fridays to devote to tasks such as analyzing quality data, writing a white paper, or preparing a board presentation.

Journalistic Philosophy

Finally, you might consider the Journalist Philosophy as a viable approach to supporting your deep work. In this method, you switch into deep mode whenever there is down time or an open slot in your schedule. This approach can be effective. But it depends on the discipline of moving into deep work frequently, and the ability to shift from shallow activities to deep thinking quickly. This ability requires practice because most of us are easily drawn back into shallow work.

Develop a Routine to Use Deep Work

One common theme made evident by Newport and other authors concerns writing: it is important to develop a routine around writing (and other deep work). Do not leave it to chance or “feeling inspired” to do the work. It is necessary to schedule specific time and use deep work regularly.

Newport also recommends several practices to adopt as a way to develop the intense concentration and energy needed to focus. These methods include:

• walking in nature, thereby enabling “focused-attention mechanisms to replenish,”
• scheduling specific Internet time, and avoiding it at all other times,
• setting very short deadlines for deep work, forcing yourself to work with great intensity,
• practicing productive meditation, in which you focus attention on one well-defined problem while walking, jogging or driving, and
• memorizing a deck of cards (using a specific method that he describes).

Drastically Reduce Time Spent in Shallow Work

Newport also alludes to various methods to reduce the time in unnecessary shallow work, thereby increasing the opportunities to practice and engage in deep work.

Some are addressed in his description of the four depth philosophies. But he also provides advice on other ways to reduce distractions. Some of the methods that the physician leader might apply include:

• schedule every minute of each day,
• reduce interaction with email, similar to what I described in my September Monthly Leadership Favorites,
• limit engagement with social media to only those that add value,
• delegate as many tasks as possible,
• say “no” to requests for your time that are not highly valuable and pertinent to your goals,
• eliminate meetings without a specific goal, and end them early when possible, and
• reduce distractions by disabling notifications from emails, texts and social media accounts.

What I Do to Get to Deep Work

In order to reduce the amount of shallow work, I use all of the approaches listed above. But I must admit that I'm still trying to learn how to say “no” and protect my discretionary time.

When I was working as Chief Medical Officer, I routinely had my assistant block out time for an hour or two several times a week. This allowed me to work uninterrupted on important projects that required intense thought and creativity (Rhythmic Philosophy).

At home, I squeeze in uninterrupted blocks of time to read, write blog posts, work on an eBook, or prepare for my new podcast (applying the Journalist Philosophy). This works for me because I developed an ability to shift quickly into intense concentration as a child.

When I grew up, I was the oldest of ten children. My family of twelve lived in a three bedroom bungalow. I generally studied in the middle of the dining room, surrounded by my siblings and their friends while they ran around playing tag and other games. This taught me to focus intently, ignoring the chaos that surrounded me. I continued this practice regularly through high school and college.

And I still do deep mental work while on 30- to 60-minute walks. These are mostly devoted to creative thinking, like developing new ideas and outlines for articles.

I haven't tried to enhance my attention skills by learning to memorize a deck of cards, but I'm thinking of giving it a try later this year.

In Closing

In conclusion, as a physician leader, and especially a healthcare executive, I believe it's important to devote a sufficient amount of time to deep work. It will enhance our effectiveness and productivity, allowing us to create more and lead better.

Please list more examples of shallow and deep work for the physician executive. Or answer the following question:

Which of these activities do you think use deep work, and which demonstrate shallow work? Please list your answers in the Comments.

1. Performing 3-vessel coronary artery bypass grafting (CABG): deep or shallow?
2. Bathing a bed bound patient: deep or shallow?
3. Preparing an employment contract for a newly recruited general surgeon: deep or shallow?
4. Writing an annual report summarizing the quarterly quality and satisfaction measures for a multispecialty medical group: deep or shallow?
5. Running a quarterly medical staff meeting at a large medical center: deep or shallow?

[embed_popupally_pro popup_id=”3″]

Next Steps

If you think a friend or colleague might enjoy reading this post, please SHARE it using the links below.

Thanks for joining me.

Until next time.

The post Effective Leaders Use Deep Work Wisely 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.

Don't forget to Subscribe.

Take my Survey.

The post Create a Wildly Effective Annual Management Plan appeared first on NonClinical Physicians.

Leadership Favorites – April 2017 Edition

This month's favorites follow…

United Airlines Faux Pas

United Airlines provided some obvious examples recently of how NOT to treat your customers (a.k.a. patients). Without getting into the weeds, here is what was reported:

• United Airlines overbooked a flight;
• UAL subsequently found that it needed four of the seats for its own employees to travel;
• The discovery did not happen until after the paying passengers were already seated;
• Four passengers were reportedly selected, using an unclear algorithm, to leave the plane to accommodate the employees;
• Three of them left quietly, but one passenger refused to exit;
• The passenger that refused to give up his seat was confronted and forcibly removed by airport security personnel;
• Much of the altercation was videotaped by other passengers and has been extensively shared on YouTube and other social media;
• The initial responses to the incident by the CEO of UAL was less than stellar.

There are several lessons to learn here, for sure. I think two of the best analyses that I have seen, especially regarding the importance of leadership in the face of a public relations nightmare, are provided by Skip Prichard and Michael Hyatt.

A Sincere Apology is a Must

Skip Prichard presents several very astute observations, and offers suggestions for dealing with a situation like this:

“United apparently chose policy over principle, chose employees over customers, chose to save a few dollars only to lose millions.” – Skip Prichard

His advice for addressing an incident such as this:

• Avoid it in the first place by establishing protocols and giving employees freedom to do the right thing.
• Admit your mistake and don't trivialize it.
• Apologize sincerely for the mistake.
• Assess the situation thoroughly before it spirals out of control.
• Acknowledge what went wrong.
• Act to resolve the issue and take steps to prevent future occurrences.

The first rule of holes: When you’re in one, stop digging. – Molly Ivins

Next is some sage advice from Michael Hyatt: Why United’s PR Disaster Didn’t Fly.

He notes that Oscar Munoz initially gave a “defensive, legalistic apology” and then tried to blame the customer. He recommends that leaders display “extreme ownership” when attempting to control the narrative in a situation like this.

Making Excuses

One of the traps that Munoz fell into was making excuses for the failures at UAL that led to the PR embarrassment. It is unusual for a seasoned leader to fall into that trap.

But our teammates and direct reports can easily forget the difference between the cause of a failure and an excuse. In How to Confront Excuse Makers, Leadership Freak Dan Rockwell provides specific responses for the four most common excuses leaders hear:

• “I didn't have time.”
• “I'm not ready.”
• “It's just the way I am.”
• “I'm afraid I might fail.”

Have these responses ready the next time of your direct reports tries to lower your expectation of him/her using one of these excuses.

Reverse Delegation

There is another maneuver that employees sometimes use to avoid accountability. Dan Rockwell calls this reverse delegation and provides some advice for combatting it in 12 Sentences That Prevent Reverse Delegation.

He explains what reverse delegation is:

Reverse delegation happens when delegated tasks end up back in your bucket.

A couple of examples of statements that can be used to deflect reverse delegation follow:

• “What’s the next step you can take?” Use “You,” not “we.”
• “No. It’s better for your career for you to grab this opportunity.”

You can find the full discussion by Rockwell in his recent article.

More on Powerful Language for Leaders

As leaders, we need to use language to inspire and motivate others. This is not manipulation. This is using our words to bring out the best in those that we influence.

Skip Prichard provides a list of Powerful Phrases that every leader should use regularly. The first one brings us back to the UAL debacle that I started this post with:

I'm sorry.

Prichard goes on to explain that this short phrase demonstrates self-awareness and personal responsibility, and is very powerful.

Moving away from accountability, his list of powerful phrases includes:

Tell me more.

What's working?

I'm proud of you.

I think you'll appreciate the other 8 phrases and Prichard's explanation of why these work so well.

Tools for Quality

On a more practical note, Becker's brought together a list of 19 Quality Improvement and Patient Safety Toolkits. Several come from the AHRQ, an organization whose tools I described in Six Steps for Delivering Outstanding Patient Safety and Addressing Disruptive Behavior.

These toolkits can help to address quality and safety issues in ambulatory, hospital and nursing home settings. I recommend that you or your quality staff check them out and use the ones that can help in your QI efforts.

In Closing

Those are some of the articles I found inspiring and educational this month.

I will be attending the AAPL Spring Institute and Annual Meeting in New York City in a few days. My plan is to write a couple of posts with fresh information and/or news from the meeting.

To keep this content coming Subscribe here.

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

Contact me: john.jurica.md@gmail.com.

And if you enjoyed this, then share it using the links below!!

See you in the next post.

The post Monthly Leadership Favorites – April 2017 Edition appeared first on NonClinical Physicians.

It also required a thorough review of workers compensation and occupational medicine. And I needed to take a mandatory course and exam by the National Registry of Certified Medical Examiners in order to conduct physical examinations for interstate commercial motor vehicle drivers.

As a result, I was not able to attend any recent American Association for Physician Leadership Annual Conference or Institute.

However, I am now registered to attend the 2017 Spring Institute and Annual Meeting! They run back to back from April 18 through April 23, in New York City. And my wife will be attending with me because she loves New York.

As the name implies, the event is actually two meetings in one.

The AAPL Spring Institute

This part runs from April 19 through April 21.

The AAPL lists the following benefits of attending:

• Live interaction with world-class faculty
• Learning with peers
• Opportunities for networking
• Concentrated learning (time efficient)
• Fun group activities
• Personal education advising sessions

The Spring Institute focuses on in-depth study of topics from its Physician in Management Series. I have participated in several of these educational activities that in the past. They address management topics such as:

• Quality Improvement
• Negotiation
• Finance
• Marketing
• Teamwork

Physician leader Atul Gawande

The presenters are always polished and very knowledgeable. For this meeting, I heartily recommend sessions presented by:

• David Nash
• William “Marty” Martin
• Kevin O’Connor

Each of them is very engaging and effective in meeting the objectives of the presentations.

For the beginner physician leader, it is probably best to start with Managing Physician Performance or Three Faces of Quality.

As a more seasoned participant, I have decided to attend the sessions devoted to Resilient Leadership and Coaching and Mentoring Physicians to Higher Performance.

The American Association for Physician Leadership Annual Conference

This year’s Annual Meeting officially runs from April 21 through April 23. The educational sessions don’t begin until Saturday morning, April 22.

It is designed differently from the Institute. There are two keynote presentations, and two workshops. The rest of the educational material is presented in the form of Peer-Led Learning Labs.

What is a Peer-Led Learning Lab?

It is one of forty-seven 20-minute presentations covering the following categories:

• Leadership
• Healthcare Organizations
• Finance
• Communication
• Careers
• Management
• Patient Care/Quality
• Health Care Professionals
• Innovation and Technology
• Health Law and Policy

As I look at the list of topics, several appear quite interesting. I recognize several of the presenters. They all currently hold leadership positions in many different types of organizations.

I can also recommend the session by Jeremy Blanchard. He will be discussing Language, A Fulcrum for Physician Engagement and Culture Transformation on Saturday, April 22nd, between 10:30 and 11:30 AM in the Madison Square Room (according to the schedule I have been provided). I interviewed him for this blog back in January.

There will also be opportunities for networking, and other formal and informal events.

I will be helping out as an “Ambassador” for the meetings. That means I will be introducing Edward A. Walker at the start of Coaching and Mentoring Physicians to Higher Performance on Thursday and Friday, and helping to manage the peer presentations Saturday morning in the Bowery Room (three presentations each for Lab 1 and Lab 2).

I would love if any of my readers stopped by and said hello.

How I'm Preparing for This Conference

There are some things can be done to help maximize the value of this or any other conference. I’ll admit that I have not always followed my plan for this meeting.

That's in part because I am an introvert and find it difficult to strike up conversations with strangers. But networking is probably as important as the content I will be trying to learn during the meeting.

Attitude

• I want to be intentional with this conference; to participate with curiosity and a willingness to meet other participants.
• As a committed introvert, I will overcome my hesitance to engage with others.
• I will strive to remain coachable.
• I commit to speaking up and contributing verbally when asked to do so.

Goals

I am approaching the conference with specific goals in mind. My primary goals are to:

• Learn new ways to be a more resilient leader;
• Achieve a deep understanding of coaching and how to effectively coach others to achieve their personal and career goals;
• Meet at least five new colleagues from the AAPL that might consider being interviewed for this blog in the near future;
• Pick up some practical tips from the Peer-Led Learning Lab in the Leadership and Management content areas;
• Get to know more of the AAPL staff by working as an Ambassador; and,
• Promote this blog to at least one hundred conference participants, in networking events, before and after presentations, and at any exhibits that may be held at the meetings.

Recent business card to bring to the meeting.

Further Preparation

One of my Institute sessions requires completing pre-conference work (a personality inventory), so I have already completed that .

I have taken a closer look at the faculty for my sessions and have looked them up in more detail on LinkedIn, as a way to better engage with them during the meetings.

My Advice

I recommend that you seriously consider attending this meeting if you are in a leadership position or thinking about moving into one.

Next Steps

My next steps are to:

1. Check that my flights and hotel room are confirmed;
2. Get all my work (including blog posts) caught up, prior to departing on April 18;
3. Review any instructions from the AAPL regarding my role as an Ambassador;
4. Take copious notes at the meeting;
5. Write a blog post or two based on inspiration from the meeting.

For more of my thoughts on healthcare and leadership Subscribe here.

Please help me out by taking a short survey:  Survey Page

Feel free to email me directly at john.jurica.md@gmail.com with any questions about anything. I am here to help you excel as a physician leader.

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

Thanks so much and see you in the next post!

The post The Looming American Association for Physician Leadership Annual Conference appeared first on NonClinical Physicians.

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

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

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

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

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

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

Seeking a Solution

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

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

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

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

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

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

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

Preparing to Be a Better Physician Leader

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

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

Project Planning

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

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

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

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

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

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

Communication

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

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

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

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

• Listening
• Asking questions

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

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

Planning and Running Meetings

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

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

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

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

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

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

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

Measurement

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

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

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

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

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

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

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

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

Teamwork

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

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

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

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

Management

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

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

In Closing

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

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

Next Steps

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

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

I welcome your comments and questions.

Subscribe here.

Provide feedback:  Survey Page

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

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

Thanks so much and see you in the next post!

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

March Favorites

This month's favorites follow…

Productivity Pointers

Create a Personal Mission Statement for the Life YOU Want by the Productive Physician should inspire us to become more intentional

This is the first time I am offering content from The Productive Physician. I have been following him for about 6 months.

I found his post about creating a personal mission statement very intriguing. He is one of the physician bloggers that I failed to include in my last update on physician authored blogs.

My bad.

His blog will definitely be on the next update. In any event, if you like his Personal Mission Statement post, I think you'll really enjoy his 4,000+ word article Achieve Your Big Hairy Audacious Goals in a 12 Week Year. Have fun!

Inspiration

See Skip Prichard's Great Basketball Quotes To Up Your Game

The author collects and publishes inspirational quotes. His most recent list is inspired by March Madness.

It makes sense, because of the season and because successful teams always seem to have great leaders. John Wooden was the coach for the legendary UCLA team. Skip includes several quotes from him.

My favorite quote from the list is one of Wooden's:

When opportunity comes, it’s too late to prepare. – John Wooden

Accountability and Teams

Here is Leadership Freak's Over-Engaged Leaders Produce Disengaged Teams

Dan Rockwell, the Leadership Freak, has some really sound advice in this post. He reminds us that the best leaders step back, loosen their grip and ask questions rather than provide answers.

Another gem from Dan Rockwell: Two Questions That Crackdown On Excuse Making

As leaders, we must demonstrate consistent accountability in order to maintain trust and engagement. But we also have a responsibility to nurture and demand accountability in others.

Rockwell provides more insight on accountability and he notes that In nearly 25% of Businesses, Leaders Believe 30%-50% of Employees Avoid Responsibility

In addition to trust and engagement, Rockwell talks about the importance of clarity and follow-up in maintaining accountability in team members.

Be Prepared

Mo Kasti lists 8 major trends in Top Trends in 2017 for Physicians and Healthcare Administrators

Kasti leads CTI and its Physician Leadership Institute. In this short post, he highlights eight trends that are likely to continue well into 2017 and beyond. We should contemplate these trends and reflect on how they might affect our organization.

Recognizing Our Suffering Colleagues

Take a look at Dike Drummond's advice in Stop Physician Burnout – how to reach out to a colleague in distress.

There are two uncommon and challenging issues that physician leaders need to address: the so-called disruptive physician, and the impaired physician. Both problems can arise from a common malady that seems to be growing in frequency: Physician Burn Out.

The Happy MD author, Dike Drummond, has produced a very helpful blog post and video that can teach us how to recognize the symptoms of burnout and begin a conversation that might prevent its most deadly consequence, suicide.

Watch the video and rehearse the questions. And the next time you're alone with a potentially burned out colleague, give it a try.

Another Opinion on The Value of an MBA

Finally, here is The Path to MD/MBA

This is an article posted on The White Coat Investor about why, when and how to pursue an MBA. It's a guest post by an anonymous writer. It presents some arguments that go beyond getting the degree to become a physician manager or executive, which was my focus in a previous post.

In Closing

Those are some of the articles I found inspiring and educational. There is at least one nugget of really useful advice in each one.

If you have any favorite blogs or podcasts addressing leadership and related topics (or humorous ones) please share in the Comments.

To keep this content coming Subscribe here.

Tell me what you'd like to read more about here:  Survey Page

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

And if you enjoyed this, then share it using the links below!!

See you in the next post.

The post Monthly Leadership Favorites – March 2017 Edition appeared first on NonClinical Physicians.

This month's favorites follow…

February Favorites

Check out “How to Take Responsiblity After Making a Major Mistake.”

Michael Hyatt gives an excellent 4-step process for acknowledging a mistake and making it right. The ability to take ownership of a mistake is the hallmark of a great leader. The inability to demonstrate this leve of accountability will hamper your ability to move upward in an organization.

See Skip Prichard's “Customer Experience Starts by Ignoring Your Customer.”

The author reminds us that the best approach to achieving high customer (patient) satisfaction is to focus on improving employee satisfaction. I think this is a good reminder for all of us that if our staff is not engaged and satisfied, it will be very difficult to create loyalty in our clients.

Here is Leadership Freak's “3 People to Throw Off the Team.“

I remember discussing the importance of creating and sustaining a powerful team in our senior executive meetings. Our leadership coach would admonish us with simple advice like:

“Keep your “A” players, try to get your “B” players to become “A” players, and free up the “C” players to pursue other opportunities,” or

“If you were to go out and start a brand new company, would you really bring all of your current team members along? If not, you need to think about moving some of them off the team.”

I think that Dan Rockwell, the Leadership Freak has some really sound advice in the post I am highlighting this week. He describes three types of “C” players that need to go, and why they can be so destructive to any team.

Here is another gem from Dan Rockwell: “4 Ways to Lead Action-Taking Meetings.“

He reminds us that meetings should rarely be held simply to share information. And he gives some sound advice about how to make your meetings more “action-taking.”

Finally, here is an entertaining video rant by ZDoggMD (aka Zubin Damania, MD): Antivaccine Cleveland Clinic Doctor Just Made Our Jobs So Much Harder

You might not agree with all of ZDoggMD's points, but he certainly makes them in an enthusiastic (and perhaps condescending) fashion. I think he represents the indignation that many of us feel when so-called experts make proclamations that go unchallenged. ZDoggMD definitely challenges them in this video.

In Closing

Those are the posts that I found worthwhile reading (and watching).

If you have any favorite blogs or podcasts addressing leadership and related topics (or humorous ones) please let me know. I am always looking for new sources of inspiration and wisdom.

For more of my thoughts on healthcare and leadership Subscribe here.

Please help me out by taking a short survey:  Survey Page

And feel free to email me directly at john.jurica.md@gmail.com with any questions about anything.

And if you enjoyed this, then share it or tweet it using the links below!!

See you in the next post.

The post Monthly Leadership Favorites February 2017 Edition appeared first on NonClinical Physicians.

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

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

First, Some Basics

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

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

UB-04 Billing Form

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

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

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

Other Considerations

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

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

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

Bringing It All Together to Prepare Quality Reports

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

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

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

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

Start With a Spreadsheet

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

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

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

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

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

Preparing the Bubble Graph

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

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

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

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

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

Other Steps

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

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

Next Steps

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

If you like this, Subscribe here.

Here is a short survey about your interests:  Survey Page

Email me directly at john.jurica.md@gmail.com with any questions.

If you're a nerd like me and like this post, please SHARE – SHARE – SHARE on social media.

Thanks so much and see you soon!

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

There is more need today than ever for skilled physician leaders. There are several specific steps that hopeful executives can take to enhance their competencies. But each physician will need to determine his or her own path based on his or her circumstances.

When trying to acquire these skills, it is best to follow Steven Covey’s admonition: “Start with the end in mind.”

Resources for the Emerging Physician Leader

Here are some resources that I found very helpful while I pursued my dream to become a physician hospital executive.

Join Pertinent Associations

Join organizations that provide support, education and networking. While I was actively working as a hospital CMO, I was a member of the American College of Healthcare Executives (ACHE). It provided some very good resources, including an annual conference to attend.

Since my hospital belonged to the American Hospital Association, I had access to its resources.

The dominant physician-led organization is the American Association for Physician Leadership (AAPL). I joined the organization in 1994 and have been a member ever since. In addition to conferences, workshops, and on-line activities, it publishes a monthly journal and hosts a job board.

Consider an Advanced Degree

Obtaining an advanced degree such as an MHA, MMM or MBA is not required. But it can be quite helpful for developing new management and leadership skills. In 1993, I completed a master's degree in public health, with a focus on occupational medicine. At the time, I was working as part-time medical director for an occupational health clinic.

Had I joined the AAPL before starting the MPH, and fully considered my long-term goals, I may have chosen to pursue an executive MBA or MHA. The MPH has been useful, nonetheless, in my work in quality, safety and population health initiatives.

Although it is not an advanced degree, the Certified Physician Executive (CPE) designation is evidence of competence in many physician leadership skills. It can be obtained by those with or without an advanced business degree through the Certifying Commission in Medical Management.

Get Training in Business and Management

Formal training relevant to the physician leader can be obtained through workshops, conferences and on-line programs. The organizations mentioned above all provide extensive education in business and management topics. If you are on staff at a hospital, you should be able to access some of the AHA programs. If employed, even part-time, by a hospital or other healthcare organization, you can probably access the ACHE conferences and workshops.

I attended many conferences organized by the AHA and ACHE over the years.

I also recall attending training provided by the Advisory Board, the Studor Group, Press Ganey, and the Greeley Company. Also, specialty societies, state medical associations and the American Medical Association offer additional learning opportunities for the emerging physician leader.

The additional benefit of attending AAPL courses and workshops, including on-line courses, is that many of them count toward CPE certification.

Read Books, Journals and Blogs

There are many good books to read on the subject. Some are written by physicians such as Atule Gewande, some are about physicians leadership (by Mark Hertling). Most of them address general business and leadership topics (by experts like Jim Collins, Peter Lencioni, Susan Scott and Sean Covey).

The AAPL publishes the Physician Leadership Journal monthly. Modern Healthcare is useful, as is Medical Economics.

There are several blogs devoted to leadership. This is a resource that was not available to me when I began my career journey into the executive realm.

I like blogs because they are contemporaneous, and often more focused and brief than a journal article. Also, they often allow for interaction with the blog author or other readers through the Comments section.

There are some great blogs devoted to leadership that provide free content and engagement with others interested in leadership, like MichaelHyatt.com, JohnMaxwell.com and SkipPrichard.com. I have been unable to find any blogs written for the physician leader that don't require membership in a parent organization like the AHA or ACHE.

Volunteer Your Services

A good way to get experience is to lead hospital based teams, and participate in professional society committees and nonprofit boards. At my hospital, I volunteered to work on the CME Committee. That led to being asked to join the Illinois State Medical Society's Committee on CME Accreditation. I later served as chair for that committee for five years. In that role, I attended the ISMS Board meetings.

Work on the Committee on CME Accreditation led to working as a CME surveyor and appointment to one of the Accreditation Council for CME's subcommittees.

In later years, I joined the local hospice board of directors, where I now serve as Vice President and President Elect. I have also served as a member and chair of our local health department board.

All of these experiences have given me an opportunity to set agendas, lead meetings, participate in strategic planning and review financial statements.

All of these experiences have helped me to hone my business and management skills over the years.

Take the Plunge

Once you have some education and experience, you will be ready to seek that full- or part-time job as a physician executive and leader. You will never be fully prepared. It is like marriage, the only preparation for being a physician leader, is to become a physician leader.

Now, take a deep breath and jump in. Our profession and our patients need you.

Have you found any blogs devoted to physician leadership? If so, please mention them in the Comments Section.

Don't forget to Subscribe to Future Posts.

And feel free to contact me directly at john.jurica.md@gmail.com

The post Resources for the Emerging Physician Leader appeared first on NonClinical Physicians.