What Is Dyad Leadership?

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

The purported benefits of a leadership dyad include:

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

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

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

Leadership Dyads Would Have Been Useful When…

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

Utilization management.

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

Clinical documentation programs.

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

Hospitalist programs.

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

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

Length of stay initiatives.

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

Observation units.

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

Lean initiatives.

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

Strategic Plans Falter

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

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

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

Physician:

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

Administrative Leader:

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

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

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

Two Kinds of Dyads

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

Another Example

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

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

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

Real Leadership Dyads

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

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

What are the features of the Carle Leadership Dyad model?

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

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

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

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

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

In Summary, Don't Kid Yourself

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

[embed_popupally_pro popup_id=”3″]

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

Next Steps

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

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

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

Thanks for joining me.

Until next time.

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

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.

But my wife answered. She determined that the caller wanted to speak to me. After clearing my head for a few seconds and focusing on what the caller was trying to tell me, I finally heard:

“This is Maya. I am calling to tell you that my father, Kan, died earlier this week.”

I quickly apologized for not recognizing her more quickly. She apologized for calling in the middle of the night (it was 4:30 PM in Japan where her call originated).

I thanked her profusely for informing me and expressed my condolences. I told that her father was truly a good friend and special person who would be sorely missed.

Digesting the News

Returning to bed, I was unable to sleep for several hours. I dozed for an hour or two, then got up at 5:30 A.M. and had a cup of coffee.

Shake out the cobwebs.

Kan and I met when I was working as a food chemist at Kraft Foods Research and Development in the late 1970s. I had graduated with a bachelor's degree in chemistry and started working at Kraft shortly thereafter. During my orientation, I met another newly hired food scientist, Thomas Stratton, Ph.D.

I didn’t meet Kan until some months later when Tom arranged a meeting of the three of us to discuss rooming together. I was the youngest and least educated of the three of us. Kan was also a Ph.D. chemist.

At our meeting, Kan seemed to be an aloof, highly intelligent scientist. After a short conversation, we agreed to work out an arrangement in which we would rent a house together less than a mile from Kraft R & D in Glenview, Illinois.

Having grown up as the oldest of ten children, I had developed some independence. I had been working since I was 12 years old (sweeping floors in the Catholic grammar school I attended). I saved my money, put myself through college with a little help from my grandfather and was financially responsible for myself throughout.

But I was still living at home. So at 22 years of age, I was ready to move out. Living in a four-bedroom bungalow with my parents, two brothers and seven sisters, all sharing two bathrooms, was a strong incentive to get out.

It was one of the best decisions I ever made.

Time to Move Out

Following that initial meeting, we found a large two-story house and the three of us arranged to rent it, sharing all of the expenses equally.

A Glenview home.

Needless to say, I came to know Kan very well. At twenty-nine years old, he was a brilliant, intense, traditional Japanese gentleman. He was also inquisitive and at times eccentric.

A Unique Roommate

He taught me to appreciate Japanese cuisine, eat gohan (rice) with hashi (chopsticks), and cook Tonkatsu.

He was intensely committed to learning, and fascinated with computing. Having obtained the 8080 and earliest 8086 microprocessors, he built his own desktop computer, and began programming.

He wanted to be ambidextrous, so he stopped using his right hand and forced himself to do everything with his left hand for several months.

I learned that while in graduate school he wanted to learn piano. So he used his knowledge of music from his early school days and began playing and memorizing Beethoven's Moonlight Sonata, one measure at a time. Within 10 months, he was able to play it flawlessly.

Self taught piano.

That taught me that anyone can learn a new hobby or vocation.

He was the consummate skeptic, always asking “why?”.

I remember one day I suggested that he wash his car. It literally had several years of dust and dirt that had accumulated since he bought it. We had a frustrating conversation in which I explained that it was best for the longevity of the car that it be kept clean.

But he repeatedly asked “why?” “What was the purpose?” The finish would be unaffected by not washing it. And the time devoted to keeping it clean could be spent doing more important things like programming, cooking or playing the ancient Japanese game Go.

I learned acceptance and detachment from Kan, and to remain curious.

His courage to move to another continent and create a new life, while maintaining connections to his old life in Japan, taught me how to conquer fear.

He taught me the value of experiencing other cultures. Getting to know Kan was like spending a year partially immersed in another culture. I was only 22 years old and soaked it up.

Living Together

Our agreement was that each of us would do all chores and evening meals for a week at a time. So, every third week, Tom and I got to enjoy home cooked Japanese meals. The other weeks we would feast on Tuna Noodle Casserole (one of Tom’s favorites) or meatloaf, corn and mashed potatoes (my version of my mother’s cooking).

That same week of cooking, I would spend a little time each day, sweeping, replacing paper towels and toilet paper, stocking the refrigerator, vacuuming and picking up the 2-story house.

I learned about teamwork, responsibility and hard work.

During that time together, we shared wins and losses, good times and bad, like brothers. Together, Tom and Kan helped me by providing perspective when my first serious relationship ended, by listening and sharing stories about their break-ups.

It was an experience of a lifetime that would never be repeated or equaled.

Failure Promotes Discovery

I never would have worked at Kraft, never would have met Kan and Tom, never would have experienced the maturity and wisdom of two older surrogate “brothers,” if not for one massive failure:

Being rejected by all of the medical schools to which I had applied.

My entire high school and college career had been focused on getting into medical school. At the time, it was the thing to do if you had a high grade point average and a bent for science. But it was also my family’s dream for me, and my dream for myself.

I was placed on a waiting list, but ultimately denied admission. So, I needed to get a job, save some money, buy a car and contemplate my next career move.

That's when I saw the ad for a food chemist at Kraft, and applied.

Failure Breeds Character

I cannot fully measure the positive impact of my experiences during the two years between graduating from college and beginning medical school in the fall of 1979. When I entered medical school, I was still an immature, sheltered, lower middle class kid with a lot to learn.

But I was much better prepared as a result of my time with Kan and Tom.

We never know how life will shape and mold us. But it is the rare “failure” that doesn’t teach us an important lesson.

It is best to embrace our failures, learn from them, and overcome or transcend them.

Moving On

Kan left his food science career shortly after I left for medical school. He transitioned to his true love: computer programming. He designed arcade style coin-operated video games in the early 1980s for D. Gottlieb & Co. These were the “old school” video games that replaced pinball machines. He was the proud creator of Mad Planets.

One of Kan's creations.

He later developed computer programs used by other computer programmers, and sold and supported a suite of software tools for almost 30 years.

Losing Touch

Kan and I did not keep in close touch over the years. We moved away from each other. He married and had three children. I married, attended medical school and residency, divorced and remarried.

I visited him on occasion. He and his wife visited us a few years ago. I spoke with his daughter about her career plans on the phone.

As he became older, he developed some medical problems and moved back to his home in Japan. We followed each other via Facebook.

I was saddened by his passing. But I never got the impression that he feared or dreaded death. He was fascinated by his illness and the beneficial effects of his home oxygen. He spent his last days with his family and friends, playing Go, and posting his oxygen levels as his illness progressed.

I believe he was satisfied with his life.

I know that I was privileged to have been a part of it.

And it was all due to a massive “failure” in mine.

The post Failure Promotes Discovery and Breeds Character appeared first on NonClinical Physicians.

Participating in CME (continuing medical education) has been a big part of my professional life. After completing my residency, and joining a hospital medical staff, the first committee I was assigned to was the “Program and Education Committee” (a.k.a. the CME Committee).

I really liked participating in this committee. It was more altruistic than some of the other hospital committees, where politics or power struggles often prevailed. We spent most of our time sorting through possible lecture topics and contacting speakers to travel from Chicago to provide a dinner or noon lecture.

Due to lack of interest by other members of the committee, I quickly found myself chairing the committee. I started attending the Illinois State Medical Society (ISMS) workshops for CME providers. I needed to understand the requirements for ongoing accreditation.

Within 18 months, we underwent our first accreditation survey. We we did pretty well. I had read the accreditation manual, so I was prepared to answer the surveyors' questions.

Joining the ISMS Committee

We were reaccredited without any major deficiencies. Shortly thereafter, the Chair of the ISMS Committee on CME Accreditation asked if I was interested in joining their committee. Technically, I was nominated by the Kankakee County Medical Society.

I joined and began attending monthly meetings. Because we were providing a service that enabled physicians to obtain high quality CME through local hospitals, I really enjoyed the work.

Sometime later, the ISMS chose me to chair the Committee on CME Accreditation. Early in my term, Murray Kopelow, the new President and CEO of the Accreditation Council on Continuing Medical Education (ACCME), visited us during one of our committee meetings. The ACCME is the body that promulgates all of the rules for achieving and maintaining accreditation for CME providers.

Getting to Know the ACCME

As a consequence of Dr. Kopelow’s visit, I later became a member of the Accreditation Review Committee of the ACCME. The ARC is the committee that reviews all national CME providers for compliance with its Criteria for Accreditation, and provides its recommendations to the Board itself for final accreditation decisions.

For more than 20 years, I have been doing surveys for new and ongoing CME providers for the ISMS and the ACCME. And I have attended many of the annual meetings of the Alliance for Continuing Education in the Health Professions (ACEHP). Hence, I have spoken with many CME planners.

And I still help in planning CME for the Kankakee County Medical Society and for a private education company that creates internet and print-based CME.

Needless to say, I have seen many changes in the CME world over the years. I have witnessed the consolidation among CME providers as they attempt to reduce costs and staffing needs.

CME Providers Give Up

I have seen providers simply exit the CME “business” because of increasing paperwork requirements and seemingly more stringent accreditation requirements. Some of these new requirements resulted from reports that CME credit was allegedly being offered for what seemed to be vacations at ski resorts and tropical islands.

Many state medical societies have seen a drastic reduction in intrastate accredited CME providers. From 2008 until 2017, the number of state accredited providers dropped from about 1,600 to under 1,200. The number of hours of instruction has also declined over the past decade.

Interestingly, the hours of instruction by national accredited providers has remained fairly stable.

In spite of these changes, there is an ongoing need for CME. Most states have requirements for their physicians to participate in accredited continuing education.

Physicians are committed to lifelong learning. They often prefer to participate in CME through local accredited providers. And they certainly want to obtain American Medical Association Category 1 Credit for their CME participation.

Last CME activity before the program closed down.

They also prefer to take advantage of local, low-cost education that is relevant to their practices.

And, in spite of its need to “tighten-up” the planning process (by ensuring that proper adult learning principles are applied and commercial influences are avoided), in my opinion the ACCME is committed to helping its CME providers more easily meet its requirements. For example, it has eliminated requirements that were redundant.

Reintroduce Your CME Program

I am writing today to encourage those of you that have abandoned your CME program to return to CME. And to suggest that if you have never been accredited to grant CME credit, now may be the right time to do so.

The lecture hall is ready to go.

I offer the following reasons to encourage you to jump back into CME. These reasons apply to hospitals and large medical groups, primarily.

Keep in mind, too, that other groups of professionals, including nurse practitioners, physician assistants, and pharmacists, can benefit from these activities.

Let me start by defining some terms:

• A lecture, online educational session, conference, symposium, series of regularly series, etc., will all be referred to as an activity (rather than a program).
• The accredited entity that grants AMA (American Medical Association) credit is called the provider.
• The CME program is the structure, policies and procedures that produces activities by the provider for its audience.

One more thing: this entire article reflects my own thoughts and opinions. In no way do I represent the ACCME or its policies or opinions.

Without further ado…

Top 25 Reasons to Get Back Into CME

It's not as difficult as it used to be…

1. There are more resources and support than ever. Between the ACCME itself and organizations like the Alliance for Continuing Education in the Health Professions (ACEHP), many state medical associations, and state and regional chapters of the ACEHP, there is plenty of help to start and run a CME program.
2. There are more educational formats than ever. As a surveyor, I have seen every imaginable format for CME. Live lectures, conferences and national meetings are still popular. But you can use “enduring materials” such as written monographs and journal-based CME. There are also multiple forms of Internet-based activities from live activities to archived courses. I've even seen providers use Google Hangouts to offer valid CME activities.
3. It does not have to be complicated. If properly planned and designed, a CME program need not be overly complicated or expensive to maintain. Many hospitals design their programs to be able to grant credit for regularly scheduled series (RSS) that they wish to hold anyway:
   • grand rounds
   • tumor board
   • quality committees
   • patient safety committees
   • lung nodule clinics
   • any similar meeting in which clinical information and educational content is included, as long as it meets the definition of CME and the planning requirements.

Patient Benefits

1. You will achieve better patient outcomes. This is the ultimate goal of effective CME. There is good evidence that participation in CME enhances physicians' care and produces improvements in outcome for patients, especially if it is integrated with QI efforts. As I discussed in Benefits of CME/QI Integration, not only can QI be integrated into your CME planning, using QI data for needs assessment and evaluation is one of the best ways to apply your CME resources. Well designed and utilized CME helps elevate the competency of a medical group or hospital medical staff.
2. New medical technologies, services and medications can be introduced. A great way to introduce new equipment and technologies that are underutilized is through a CME activity. There are countless examples of the slow adoption of new technologies and protocols. For example, screening for CAD in heart failure patients is still underutilized, as is the use of ICDs after acute myocardial infarction in older patients. Ideally, this will be part of a concerted plan to develop indications, contraindications and proper referrals for new techniques.
   
3. Patients expect it. Patients expect their physicians to interact with experts and to continuously maintain current knowledge in their specialties. Consumers are attracted to healthcare organizations that demonstrate a commitment to using the latest technologies and systems of care.

Cleveland Clinic Miller Family Pavilion

Organizational Benefits – Improved Quality, Image and Referrals

1. Producing CME can enhance your image to referral physicians and institutions. If your organization promotes its educational activities to local, regional or national audiences, and especially if you feature your physician faculty, the organization becomes known as a center of education and learning.
2. Physicians can be featured and promoted.* Medical and surgical specialists often use cutting-edge technologies that referring physicians are not aware of. When experts present evidence-based protocols to primary care physicians, they generate more (appropriate) referrals for the specialist.*
3. Hospital length of stay can be reduced. Hospital LOS is a measure of quality and care coordination. Developing educational activities that support care management can help reduce LOS. This will reduce costs and meet patients' desire to return home as soon as possible.
4. CME can help reduce readmission rates. High readmission rates result in penalties to hospitals under  the Hospital Readmissions Reduction Program. Content that focuses on care coordination, better communication with patients, medication reconciliation and prompt office follow-up are some of the topics appropriate to such efforts.
5. Providing CME demonstrates a commitment to lifelong learning. Lifelong learning is important to all participants in healthcare, from support services, to nursing, physicians and executive leadership. Market the organization as a center for learning to board members, the community and other stakeholders.
6. It demonstrates commitment to physician well-being.* If the organization uses CME to address psychosocial issues, burnout, or even improving productivity and patient flow, it will be seen as more concerned about its physicians. This creates good will.
7. CME can be used to address organizational strategic goals.* This is often overlooked. But once your executive team has identified strategic goals for the coming year(s), CME activities can be developed and coordinated to help support the goals. This is one great way to further communicate the strategic vision of your organization to its physician stakeholders.

Organizational Benefits – Improved Teams

1. Multidisciplinary activities promote more effective teams and collaboration.* By developing educational activities that involve whole teams, such teams can be made more collaborative and effective. Some activities might address teamwork directly. Others might present clinical topics, but with a focus on the unique role of each of the disciplines. A good example is the kind of training that occurs an Advanced Cardiac Life Support (ACLS) courses.
2. CME can promote the (desired) organizational culture.* This requires executive leadership to be involved in planning. Then as activities are developed, attention to desired the mission and vision of the organizations can be woven into the CME planning process.
3. Physician engagement will be improved. As discussed previously, physician engagement is a problem at many institutions. It has numerous negative consequences for the physicians and their employers. Properly planned and implemented CME can be used to encourage teamwork and a focus on quality improvement. These are issues that physicians are passionate about.
4. You can improve physician productivity.* When engagement is better, physicians are more passionate about, and involved in, their work. This leads to more energy, more ambition and higher productivity.
5. Turnover in staff can be reduced using CME.** By participating in CME as a team, a shared sense of mission can be instilled in the participants. This results in more cohesive, productive teams. For this to work, the CME enterprise must focus a significant part of its efforts on multidisciplinary team education.

In the next section, I list some of the direct benefits to practicing physicians. Keep in mind that any benefit to physicians will also accrue to medical groups or hospitals trying to attract physicians, and will often benefit patients.

Physician Benefits

1. Providing CME meets physician expectations. When asked, physicians consistently indicate that they want local sources of CME and expect their employers/hospitals to provide it for them. It is a benefit that will attract physicians to your medical group or health system. Most physicians believe that investment in education demonstrates an investment in them.
2. Local CME reduces the cost of education for physicians. Continuing education can be costly for the participant, whether involving travel or registration fees. Physicians appreciate being able to obtain required educational credits at a low or nominal cost.
3. Live activities promote interaction between colleagues. If planned appropriately, live CME activities can foster interaction among participants that builds relationships and collegiality. Working together through participative CME encourages better coordination of care outside of the “classroom.”
4. It's an opportunity to provide mentorship to young physicians.* Presenters, lecturers, and authors of CME content can serve as formal or informal mentors. Such mentors can support participants and develop long-term relationships with those involved.
5. You can address non-clinical aspects such as professionalism, communication, process improvement, and self-care.* Most of us have been involved in organization that have pockets of disruptive behavior, poor communication, and growing burnout in its professionals. CME can be used to address those topics directly, or can tackle it more tangentially while addressing patient care issues.
6. Local CME will improve interaction between medical students, residents, fellows and practicing physicians (what ACCME calls the “medical education continuum”).* By creating activities that involve physicians at all stages of their careers, faculty can model best practices and develop life long relationships. Involving all levels of learners provides mentoring for the younger members, and a feeling of continuity in the more senior members.
7. Regular interactive CME can improve morale, increase physician loyalty, and reduce burnout.* Anything that enhances inter-professional teamwork, networking, goal setting and deeper engagement can combat burnout. When physicians believe that their needs are being addressed, and work in teams on meaningful projects, loyalty improves.

Its Time to Reintroduce Your CME Program

There is no more rewarding endeavor than providing a service that helps physicians, improves teamwork, promotes the workplace and improves patients' lives. That's what CME can do when well-planned and implemented with pride.

Next Steps

Follow these steps to restart your CME program:

1. Survey your physicians to assess their interest.
2. If there is interest, get someone from your finance department to help you put together a pro forma. Realistically assess the costs of running a bare bones program that will provide at least one monthly activity, including the costs of initial and ongoing accreditation.
3. Present a proposal to the CEO or executive team of your organization to form a team to investigate the feasibility of starting a CME program. Don't forget to include the benefits listed in this post when making your case!
4. If you get the approval to proceed, start by accessing the resources of the ACCME and the ACEHP.

I welcome your comments and questions. And I am happy to assist in any way I can, if you decide to proceed.

John Jurica @ Vital Physician Executive

*These reasons are taken from commentary published by Graham T. McMahon, MD, MMSc, President and CEO, ACCME, that can be downloaded by following this link:

The Leadership Case for Investing in Continuing Professional Development

**From a recent report on interprofessional education titled: By the Team for the Team: Evolving Interprofessional Continuing Education for Optimal Patient Care

For more Subscribe here.

Take a survey:  Survey Page

Contact me 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 Top Reasons to Reintroduce Your CME Program 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.

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

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

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

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

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

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

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

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

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

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

Who is Responsible for Building Trust in Their Team?

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

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

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

What Tactics Are Effective for Building Trust?

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

1. Encourage Personal Relationships

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

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

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

2. Promote Individual Commitment to Being Vulnerable

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

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

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

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

3. Encourage Fierce Conversations and Embrace Collegial Conflict

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

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

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

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

4. Admit mistakes

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

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

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

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

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

Final Thoughts

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

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

Signs of a Lack of Trust Checklist

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.

See you in the next post!

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

When I first joined the executive team at my hospital as its VPMA (vice president for medical affairs), little did I know that conflict would become a welcome part of the job. One of the most challenging aspects was learning to contribute more openly in weekly strategic meetings. I had some exposure to strategic planning meetings as a hospital board member and on various committees in my state medical society.

But this was different. The CEO, COO, CFO and seven or eight VPs met weekly to discuss strategic initiatives and other challenging issues. I was intimidated by the fact that we would be making decisions that affected thousands of employees and patients, residents and clients.

So I was sometimes reluctant to jump into the conversation. The CEO was good about encouraging me to contribute during the meetings. Truthfully, I mostly listened carefully for the first year of meetings, adding little until I began to feel more comfortable with the process.

My reticence was in part due to my introverted nature. I was also a perfectionist and self-conscious about comments I thought might be seen as unwelcome or unhelpful.

It was not until several years later, after the CEO that hired me had moved on, that the new CEO led us through a concerted effort to improve our functioning as a team. We started by working on trust, as I previously discussed in Lack of Trust in the C-Suite. When we felt that trust had improved, the team moved to the second building block of effective teams described by Patrick Lencioni in Five Dysfunctions of a Team: Conflict.

Conflict is Essential in Executive Teams

I could readily understand the need for trust in a team. We needed to work together, and have meaningful conversations.  We needed confidence in one another. But actively inviting conflict to our meetings seemed counter-intuitive.

I had tried  to avoid conflict most of my life. I wanted to please people. I did not want to confront and possibly aggravate them. As a physician, I was trained to de-escalate anger and frustration in patients, not promote it.

But we learned, by reading Lencioni's book and working with an executive coach, that we would need to embrace conflict within the team, in a non-threatening way, in order to fully dissect and address critical decisions.

As Lencioni states: “All great relationships, the ones that last over time, require productive conflict in order to grow.” Note the words “productive conflict”. This must be distinguished from “destructive fighting and interpersonal politics.”

I agree wholeheartedly. Based on the work that we did, our team was much more effective when we had a passionate discussion about a difficult issue. Should we consider proceeding with a major expansion in the face of difficult economic circumstances? Should we develop a new service line that would require significant financial and human resources for several years? I realized that avoiding conflict resulted in poor decisions and often only delayed the inevitable day of reckoning.

We learned that we should not shy away from tackling difficult questions. And, rather than attack a person or their position, we learned to be inquisitive. Because of the time working on trust, we knew we could be open and not be attacked or belittled by our colleagues. And there would be no politicking or back office deals made outside of the meetings.

Ask Probing Questions

During these fierce group conversations, I found that it was best to ask questions, rather than make statements. The point is not to have a debate, but to fully explore an idea using all of the available talents and perspectives of the team. It's important that during these discussions the CEO (or whoever is chairing the meeting) encourages full participation. He or she may need to allow seemingly difficult and uncomfortable confrontations to proceed, while assuring that personal attacks do not go unchallenged.

Let's consider a situation in which the team is deciding whether to open a clinic in a small town 15 minutes east of our town. To do so will mean leasing an office and hiring a new family physician to work there. The VP for Strategic Planning, COO and CEO all believe it is a pretty good opportunity, based on the fact that many of the patients living in that area now tend to utilize a hospital 30 minutes further east.

Poorly Facilitated Conflict

During team discussions, comments like these will not be helpful:

• The last time we tried this, we lost a lot of money and alienated the local physicians.
• We really don't have the funds to devote to a project like this.
• We'll never be able to find a physician for that location.
• This plan seems really poorly thought out.

Promoting Positive Conflict

Constructive comments that might be more helpful include questions like these:

• Do we have any insight into the reaction of the local physicians and/or the community to opening this clinic?
• What does the pro forma look like? What kind of ROI are you projecting? Can you show us the assumptions that went into that projection?
• What does HR say about the ability to recruit a new physician to this site? Have you explored the possibility of moving one of our established physicians to the clinic to work there part-time to get things going?
• Perhaps we could all take your presentation and review it in more detail. Then could we run through a SWOT analysis at our next meeting?

Final Thoughts

I cannot emphasize enough how fear of conflict can impede progress in becoming an effective team. Please let me know your thoughts in the comments.

And don't forget to sign up for regular updates on my sign-up page.

As usual, you can also email me directly at:  john.jurica.md@gmail.com

John

The post Effective Teams Crave Conflict appeared first on NonClinical Physicians.

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

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

Why Bother?

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

Signs of a Lack of Trust

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

Here are some of the behaviors to look for:

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

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

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

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

3. The executive team dreads meetings.

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

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

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

5. Lack of discomfort.

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

6. Participants rarely admit their mistakes.

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

Next Steps

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

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

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

Also, please subscribe to these posts by clicking here: Subscribe. I'd like to send you notices of future posts and get your recommendations on future topics to discuss.

The post Six Signs of Lack of Trust in the C-Suite appeared first on NonClinical Physicians.

In the last post, I talked about the Five Intentions I believe every physician executive should have for their direct reports. The intentions are to:

• Inform
• Assist
• Mentor
• Maintain accountability
• Evaluate

In Part 2, I want to provide some specific actions that can be taken to fulfill those intentions and cultivate your direct reports.

Now, let's get to the tactics I found most useful.

1. Meet Regularly

In order to influence your direct reports (DRs) you must have consistent face time with them. Set a weekly schedule to meet with them. Don't let other priorities interfere with these meetings. This is the primary time you will have to achieve your five intentions with them.You should include time to talk about personal issues – family, hobbies, etc.

2. Use an Agenda

My preference is to have the direct report create the agenda each time. But the agenda should follow a very consistent pattern that includes topics that will impact the five intentions. When I had issues I wanted to discuss, I would email my director and ask her to be sure the item was on her agenda for the meeting.  This served the additional purpose of allowing my director to prepare for the discussion.

A sample agenda should include the following items:

• Updates from you on any recent senior executive meetings
• Updates on status of goals or ongoing projects
• Review of “evergreen” department metrics (budget, satisfaction, volume measures, etc.)
• Open ended discussion about areas where assistance is needed – how can I help?

3. Non-agenda Items

• Spend a little time at almost every meeting providing feedback about the director's performance.
• Provide coaching with respect to important skills – writing, presenting, managing.
• Ask about any professional development being explored. Encourage participation in leadership training.
• Discuss participation in community organizations and encourage the DR to join community boards and volunteer with non-profit organizations
• Identify opportunities for the director to present to the executive team. Review and critique those presentations in advance.
• Acknowledge the director for any recent accomplishments, goals achieved, recognition in the community, etc.

4. Listen

• Spend most of the time in these meetings listening, not lecturing.
• Take notes. Write down agreed upon deadlines for milestones of projects and other goals. Bring those notes to future meetings to maintain accountability.
• Be present, not distracted about other issues you may have or deadlines that are looming that do not involve this director.

5. Ask Questions

As a senior hospital executive, I had access to regular business coaching. On one occasion, during our one hour session we discussed a particularly challenging issue involving an interim director that was clearly not working out. As we neared the end of our session, I felt that I had determined the course of action that I needed to follow. On reflection, I realized that my coach had not actually provided any advice to me. He had made very few declarative statements. Most of his comments were in the form of questions.

I have found that achieving the five intentions above is easier if you ask questions rather than give answers. Fierce conversations, as defined by Susan Scott, are characterized by intense mining for insights.

Your direct reports usually have the answers, so don't let them throw the monkey on your back when they have a challenge or dilemma to resolve. If your DR is coming to you with a “problem” she should have one or two possible solutions already prepared to discuss. Push your directors to seek the answers themselves, rather than expect you to tell them what to do.

6. Other Tactics

Incorporate clarity into all of your conversations. I discussed the importance of clarity in a previous post (The Three Disappointments of a Lack of Clarity). Close your meetings highlighting the actions that were agreed upon and the deadlines attached to each. Which items will be discussed at your next meeting? Which will be due in one month, six months, etc.?

In my previous post (Five Intentions for Direct Reports), I mentioned that I was inconsistent with informing my direct reports about updates from my executive team meetings. My solution for that was to hold monthly meetings with all of my direct reports together. I used these meetings for three main objectives:

1. To meet in a relaxed setting over a meal (usually lunch) and share personal stories
2. To enable my directors to interact with each other
3. To update them as a group about topics being discussed by the system leadership

If you use these tactics and apply them to regularly, you will be an effective leader and manager. Some of these one-on-ones will focus more on goals. Some can be focused on budgets, or other specific items. But, over time, all of these issues should be consistently addressed with your DRs.

What tactics have you seen that successfully engage your colleagues or employees?

The post Tactics to Cultivate Direct Reports appeared first on NonClinical Physicians.

• They report to you. So they have a solid line relationship to you on the organizational chart.
• You may have recruited and hired them when the previous DR moved on.
• You are held accountable for their performance. The performance of your division is determined by the performance of all of your direct reports' departments.
• You formally evaluate their performance.
• You discipline them if the situation demands it.
• You terminate them if circumstances warrant it.

In working with direct reports, there are two primary aspects I'd like to reflect on…

• What to do
• How to do it

In this first of two posts, I want to describe what I believe are the major intentions of your interactions, or the “What” that you should focus on. A subsequent post will outline some of the tactics that can be used to achieve these intentions. Since my DRs were generally department directors, I will refer to them as such.

The Five Intentions

1. To Inform

As the Chief Medical Officer, I was meeting weekly with the executive team, including the CEO. So, I was involved in numerous conversations about external threats, opportunities, strategic direction and other important issues. This is one of the areas that I struggled with the most: consistently updating my directors of what was going on at the executive level.

It wasn't that I was concerned with sharing sensitive information. I was simply focused on the director's issues. I had not implemented a routine for summarizing recent updates for them on important topics. Eventually, I came up with a process that helped me to be more consistent with this objective which I will describe in Part 2 of this series.

2. To Assist

My directors and I had essentially the same goals and objectives. Their projects were my projects. Their budgets were my budgets. They ran their departments with their unique style. But they generally did their jobs very well.

Sometimes they met barriers to achieving their goals. Patient volumes and revenues may have dropped, so staffing was being squeezed down. The IT or HR departments may have been slow to respond to requests for support. Other strategic goals would compete for their time. There were countless barriers that could arise.

My job was to reduce or eliminate the barriers to achieving their mission and goals, if I could. I was not there to solve their problems for them. But I could intervene if a manager or director in another department needed some convincing. Or I could free up resources from one of my other departments. Sometimes I would convene interdepartmental meetings to foster cooperation on important projects.

3. To Mentor

A good executive wants the following for his/her directors, because it is good for them and for the organization:

• To grow intellectually, personally, and emotionally
• To develop new business, communication, and management skills
• To advance professionally

I tried to remember to provide opportunities for my directors to participate in learning opportunities and to hone their management skills. Ultimately, in the spirit of good succession planning, I was training them to be able to take on my duties in the future.

4. To Maintain Accountability

My primary duty was to help my directors look at their responsibilities from a strategic standpoint. I encouraged them to adopt stretch goals each year. When we met, my job was to remind them of those goals and assess their progress. I challenged them to stay on track. I pushed back if they made excuses for failing to follow through. Ultimately, I was there to assist them in being accountable to themselves.

5. To Evaluate Performance

Annual evaluations were mandatory. During my tenure, they evolved from fairly subjective opinions in a variety of domains (communication, leadership, citizenship, teamwork, community involvement, etc.) to quantifiable metrics like achieving department goals, meeting budgets, achieving satisfaction scores and improving quality. But, evaluation and feedback should be ongoing and timely, not just an annual event.

Outcomes

If you focus on these five intentions, you will be an effective leader and administrator. You will enrich your DRs' lives and empower them to achieve their goals.

Next time, I will present some means to achieving those ends.

Are there other intentions we should have as we work alongside out directors and managers?

The post Five Intentions For Direct Reports appeared first on NonClinical Physicians.