“Clinical leaders of tomorrow must possess a strong background of medical and managerial expertise to develop and to shape policies in ways that ensure the highest level of patient care in years to come. If this does not occur, ultimately, physicians will become technical consultants in a dysfunctional health-care community that they have inadvertently helped to create and to sustain.”
Journal of Surgical Education:Volume 65/Number 3/May-June 2008:219
Are you afraid we are already there? Those words were written in 2008, and some say it is already too late – that we are in that dysfunctional future.
Are you a physician leader? Do you wonder why your charges – the physicians you are supposed to lead don’t listen to you, aren’t paying attention, or worse, do the opposite of what you are asking? Let’s chat about some of the things to not do. Are you guilty of one or more of the following?
Not Building a Base of Trust
Because you were hired to be a leader, or simply have been around for a while and promoted, do not assume that you have trust. Trust is built over time and requires effort.
Do you have a history with the physicians you are leading? Being promoted to a leadership position often transfers your relationship from a clinical colleague to “one of them,” – a “turncoat,” or a “suit,” even if you continue practice. If you are brought in from outside, your challenge is even greater, because you have no background or history with the folks you are now charged with leading.
Before physicians will listen, you have to ensure you are trusted. And that means finding out whether they trust the current administration, of which you are now a part.
Have you made an effort to meet every physician you now lead? Spend time with them? Build a relationship? Do you make rounds on them regularly, and not just in formal group meetings?
Not Confirming That Goals Are Aligned
As you get to know your physicians, are you learning what they want? What motivates them? Are they driven by the purest motives of the best patient care possible, or are they more driven by money, time off, or recognition?
We all want to provide great care, but there are always secondary motivators that have to be taken into account. You need to know these to understand how to get to mutual goals. Good patient care is not enough.
What’s in it for them, and more importantly, do they trust that your goals are true, or can you be accused of only trying to save or make the hospital money? This is a common failure.
As a leader, you may have bought into the hospitals’ goals – saving or making money, because you believe the hospital needs to survive to continue to provide clinical care. But your charges may only see the salaries and bonuses of hospital leaders, and not share that survival goal.
Even worse, some things you may need to ask them to do may actually hurt them. Reducing hospital days reduces the physician’s income and may cause more work pre and post discharge. Think carefully about whether your goals are aligned, and whether they see it the same way.
Ordering or Being Authoritarian
Are you guilty of saying, “The CEO wants us to,” or “It’s a regulation?”
We all obey speed limits because it’s the law, right? While a regulation or rule may be a reality, we know that that is not enough, so don’t use that alone in explaining why something needs to be done.
We don’t go too fast because we fear for our own safety or the safety of other drivers. Or we fear that we will be fined.
Helping the individual understand the real consequences of fines (if involved) on their personal clinical life does help. But be prepared to listen and explain why something they want done cannot be done.
After you’ve built trust and gained an understanding of that physician’s desired goals, you’ll want to ask: how does the goal of the organization align with the individual physician’s goals?
Offering Bad or Questionable Data
Have you ever been put in a position of having bad data? Had to retract something you told a patient because the final report differed from the preliminary?
Try not to present data that is not verified. In fact, it’s a good idea to say the data is as reported and needs to be verified without ever presenting it as final.
“This data shows that …, can you verify it before…”
But before you even present the data, make sure you have listened to the rest of these two blogs. Make sure you are trusted, and the ‘ask’ that is to come aligns with your respondents’ goals. Don’t start with, “You have to change this,” because until the receiver verifies it, it may not be right.
How do you feel when you are threatened? A friend and former colleague used the phrase, “Do you really want to die on that hill?”
Threatening a consequence should be the very last thing you do. If all else fails, it may be absolutely necessary, but be prepared to accept the consequences. And be prepared to mete out the punishment or consequence.
Think through all the possible consequences. Is the hill really worth dying for?
Not Building a Mutual Vision of the Future
Sometimes goals are far away. The goals you use on a daily basis – patient care will be better, we will save money so that we can … we will make more money so that we can… we can get you higher compensation, more vacation – also need to be attached to a vision of the future.
If things are bad now, try to mutually paint a bright, rosier day, when all this hard work is done. Don’t shoot for some utopian future in 10 years, but try to set smaller intermediate visions.
If we do this, in a year, this will be true.
This goes beyond just sharing goals, creates a vision of how things are better, and helps meet the aligned goals you’ve already established. Make them concrete and create the vision.