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Clinical Leadership
So you have accepted, or are thinking about accepting a leadership position in your medical organization? Congratulations. Whether you achieve all you hope to achieve or not, your patients and those of your colleagues stand to benefit from your efforts. Winston Churchill once said of the British and the Americans that they were “two people divided by a common language.” The same could be said of doctors and administrators, doctors and politicians, doctors and bureaucrats, or any other dyad you can think of. Since we are having our conversations in English, it is easy to assume (Assumptions) we all use words the same way, and the words mean the same thing to everyone involved in the conversation. If you can learn this is almost NEVER the case, you are off to a good start. So how can you have a meaningful conversation, given the “language barrier?” Most importantly, you can try to become aware of your own ways of viewing the world. If you understand your own assumptions, you are in a better position to explore the other person’s assumptions. I have observed that most people, both doctors and administrators, do not want to spend the time necessary to understand each others assumptions and culture—they want to get to the deal. Insufficient time spent on these differences is the major cause for breakdown or breakup, depending on how deep the divergence really is. Another issue is to know you preferred style of leadership. (Leadership Styles) There are a lot of classification schemes out there—I just find this one easy to understand, and based upon observed behaviors. You don’t need to engage in psychoanalysis, either for yourself or for those with whom you interact. The scheme also predicts places where disagreement will occur. You must also have a realistic time frame for your expectations. Clinical realities usually play out in a matter of hours to days. Most of your leadership tasks may not play out during your term of office. You have to be okay with that to be successful. Perhaps the last thing to emphasize is that leadership is playing baseball. If you consistently bat 0.333, you will go to the Hall of Fame. As a doctor, you think you are expected to bat 1.000, so you may find this difficult. This expectation of yourself also creates control issues. It is tough to be held liable (accountable) for things you can’t control, so you may be in the habit of trying to control everything. This is delusional, of course, but a common one in medicine. To be successful, your TEAM must be successful. There is no individual success if the team does not succeed. |
Clinical Leadership Articles
A Data-Driven Argument for Physician Leadership Dr. J. K. Stoller of the Cleveland Clinic and associates have written an article entitled "Why The Best Hospitals are Managed by Physicians." A Good Place To Work Is your organization a just one? How do you know? Activating Patients - The Achilles Heel of Healthcare Reform? Studies show 25% of the population is not involved in their healthcare, but reform efforts assume wider application of evidence-based medicine is the key to better value. Perhaps it is the Achilles' Heel? Adding Versus Subtracting A recent study suggests people favor additive rather than subtractive solutions to problems. Advisory Report on Burnout, part 1 Health care worker burnout has become so prevalent, the US Surgeon General has issued an Advisory Report on immediate steps needed. Answering Strategic Questions Answering strategic questions is hard work and also uncertain, but these are not reasons to avoid asking them. Assumptions Doctors and hospitals operate with different cultures and unexamined assumptions may cause conflict. Big Medicine Big medicine may be financially necessary, but it poses risks unless care is taken to become a real system, which requires putting the clinical enterprise at the center. Building Team Effectiveness Care Management Transitional care management seems likely to be good for patients, but costly to hospital-based organizations. A recent study illuminates the challenge. Challenges to Achieving the IOM Attributes of a High-Quality Healthcare System Most people agree the Institute of Medicine's (IOM) description of the attributes of a high quality healthcare system are appropriate and worthy of trying to achieve. But it has turned out to be quite difficult to make progress. Clinical Integration 2015: A Hospital Perspective Health care organizations now assume "clinical integration" is necessary for economic survival, but the FTC continues to enforce antitrust actions blocking mergers and acquisitions. Furthermore, clinical integration usually means different things to hospitals and physicians. In this article I consider some immediate steps that can be done without legal complications to improve patient care and save money. All that is really required is a change in our mental models. Clinical Microsystems Clinical microsystems are composed of front-line clinicians engaged in direct patient care. Despite a lack of formal authority, they are the key to successful healthcare reform. Concordat The pandemic is a time of disruption. Can it be chance to "push the reset button? Culture Matters The scandal at the VA shows the importance of choosing performance measures wisely and the need to consider organizational culture in applying standard management techniques. Emotional Intelligence for Physicians How do physicians rate in the domains of emotional intelligence? Engaging Burned Out Physicians Equipoise Equipoise can be defined as a state of equilibrium or counterbalance. We would do well to seek it both personally and as institutions. Getting Excited Watching people think constructively is exciting, but rare. Getting to Why Reduced government spending by definition means someone's income goes down. To mitigate those changes medical organizations need to get to "why." Heroes Is the heroic age of medicine over? If not, what would heroism look like? Horizontal Violence and Nursing Staff Turnover A recent study shows horizontal violence - conflict between nurses in a hospital - is common and a major cause of job dissatisfaction and intention to leave. What can be done about it? How did you know? How do experts know? The roles of formal and tacit knowledge are considered. How To Make Physician Leadership Real So you recognize the need to get physicians involved in the leadership of your organization. Now what? Individual and Organizational Stress During the Pandemic Individual Resilience Fear is a normal response to threat, but how do some people develop resilience in the face of it? Knowledge Management Knowledge management (KM) covers any intentional and systematic process or practice of acquiring, capturing, sharing, and using productive knowledge, wherever it resides, to enhance learning and performance in organizations. Which strategy for knowledge management is appropriate in dialysis clinics? Leadership Lessons From the Military Lessons from leading the military in Afghanistan have implications for which medical organizations will thrive in the current turmoil. Leadership Skills Leadership Skills That Are Commonly Lacking Good clinical care depends on small unit leadership, but most organizations do not foster the necessary leadership skills. Leading Through Teams Making Leaders Is leadership nature or nurture? Probably both. Managers or Operators Physicians often blame the "suits" for their problems. Maybe medical organizations need more operators and fewer managers. Measuring Teamwork Measuring Teamwork is difficult, but important if healthcare systems are to invest in their development. This article reviews the literature and provides suggestions for action now. More on Biases A recent series of articles in the New England Journal of Medicine provide more insight into the issue of bias in medical decision making. More on the Quality Paradox The quality paradox is the number may improve while the experience of care worsens. What's new? More on Turnover from the Departing Staff Point of View New Leadership Skills for Physicians David Brooks has identified highly valued skills in the modern world. The good news is that physicians already use three of them. On Change Why do people change? A consideration of the desirable future state. On Failure Failure is inevitable. Successful organizations expect failure even from highly reliable processes. A consideration of how to tolerate failure. On Resilience On Strategy A central question for healthcare organizations as they face the future is what is our goal? While taking care of patients might seem the obvious answer, it is the one that is usually not considered. Organizing for Success - Another Viewpoint Organizing for Success - Key Requirement Organizing for Success - Lessons from Keystone The Keystone Cooperative ICU Project obtained major improvements in safety. The "soft science" lessons need to be applied more widely. Paradoxes for Physician Leadership I started this website to share some notions about physician leadership. I have also reviewed many other people’s ideas about these subjects, some of which I have shared in other articles. What strikes me about much of the “literature” on physician leadership, though, is how they fail to grapple with the inherent paradoxes of the role of physician leader. Here are some that I think matter, with some links to other articles on this site, which develop the ideas in more detail. Perspectives on Physician Leadership Physician leadership is receiving more attention. Three recent articles illuminate the need for and the challenges to physicians leading. Physician Engagement Is physician engagement a strategy to promote physician leadership, or a code word meaning how do we get the doctors to do what we want? Physician Leadership 2020 Lee and Cosgrove identify six challenges in the decade ahead for physician leaders, but many organizations currently lack meaningful physician participation. Physician Leadership That Leads to Success Some organizations deem physician leadership essential, others don't. Why? Putting Patients At The Center Of Healthcare Putting patients at the center is crucial for healthcare organizations, but how can it be done? Quality Improvement 3.0 Is it time for clinical quality improvement 3.0? Quality Metrics Reliability or Dependability Is reliability too narrow a goal? Shouldn't we strive to be dependable, with its connotation of both reliability and trustworthiness? Restoring the Commons A consideration of the interactions of patient preferences, evidence-based medicine and peer review. Rushing to a Solution? Does our rush to solve organizational problems make them worse? Scenario Planning How do physicians deal with complex, uncertain health care situations? Scenario planning is better than quoting statistics. Shared Decision Making A consideration about decision making at the person, group and organizational levels. Staff Shortages When there is no room at the inn due to staff shortages, the standard of practice will have to change. We need to think about what this might mean. Strategic Questions for Physicians Part 2 Specialist physicians also face strategic choices and no matte which is made, the future will bring major changes. Stupid Stuff Wouldn't it be wonderful if we got rid of stupid stuff? Teams and Learning Organizations A brief introduction to the concept of the learning organization for physicians. The Case for Physician Leadership Why the successful healthcare organization of the future must find a way to create physician leadership if it is to achieve the IHI Triple Aim. The Center Effect Some dialysis units have consistently better performance than others, even after adjusting for individual patient variables, which is termed the center effect. This has important implications for hospitals and health care organizations as they respond to public reporting of data. The Costs of Leadership It is tempting to assume that the “younger” generations are unduly cynical, conditioned as they are by advertising and social media, but staff in all organizations have a “B. S. meter,” and it is usually both sensitive and specific. The Costs of Leadership Part 2 I wonder if the excessive reliance on metrics is so leaders can say the “numbers made me do it.” Is this just a modern, secular version of “the devil made me do it?” The Doctor-Patient Relationship The doctor-patient relationship is central, but is threatened by excessive focus on productivity. But is the productivity-driven payment system corrupt? The One Best Way The Problem of Scale Have we lost our moral compass as medical organizations have grown larger? The Stress Continuum The stress continuum was developed by the military, but is applicable to all healthcare organizations. The Tragedy of the Commons Recognizing the Commons is critical for success in an era of rapid change. Time Span Preferences and Physician Leadership Turnover From the Perspective of the Departing Uncertainty “It is time…to realize that changes in culture, investment, leadership, and even the distribution of power are more important for progress toward the Triple Aim than measurement, alone, ever was or ever will be.” Understanding the Patient Experience Perhaps it is the ability to see an individual, not a group that counts. Unit Culture and the Leader Creating and maintaining a positive, patient-oriented culture that supports doing the right thing the right way is the central task of medical leadership today. What Are You Looking For In a Leader? Picking leaders is critically important to an organization, so what should you look for? What Matters What really matters to practicing physicians? Why Physicians Don't Lead Why don't physicians lead? Maybe a better question is how do you create opportunities for constructive leadership? |