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Physicians are facing many challenges in a rapidly changing health care environment, given the move to ACOs, team based cared, and changes in the payment model. Many of those Smiling senior doctor with stethoscopeworking in hospitals and clinics are finding themselves in leadership positions, which extends beyond their responsibilities focusing on their patients and the “diagnose and fix” model of solving problems. This new role includes knowing how to be a “facilitative leader”, engaging others in problem solving, and understanding how to manage change – things which were not taught in their medical school training. As doctors move into these leadership roles, they interact in new ways with other clinicians, nurses, auxiliary staff, and they may not always be aware of their impact on others and how to optimize their functioning in these new roles.  More and more institutions are designing leadership development programs and employing executive coaches to help physician leaders increase their effectiveness.

I participate in a learning group of coaches and organizational development consultants who work in health care, and recently I facilitated 2 conversations about leadership development, specifically asking: What’s different about coaching physician leaders?

We identified several challenges that are unique to coaching physician leaders, such as:

  • Physicians are used to being individual contributors, so it’s quite a shift to begin leading others – which means engaging other staff, asking questions and fostering collaborative problem solving.
  • Doctors need to change their mindset from “white coat leadership” to “facilitative leadership.”   That skillset includes knowing about change management, how you lead and manage change.
  • Research-oriented physicians, who work by themselves, tend more to introversion – and they may find themselves needing to stretch to extraversion to be more involved with other staff.
  • The role of the leader is often unclear to physicians who do not have mental models of leadership in a clinical setting, nor role models.
  • Some have little desire to do things differently, if seeing patients is what they prefer to do. Many doctors think “I don’t want a boss” or “I don’t need a boss because I’m responsible for my patients, or I run this practice”, as well as, “I don’t want to be a boss”.

One tool to help develop physician leaders, or any organizational leaders, is a 360 assessment, in which all of the people who interact with the physician are asked to give their assessment of his/her performance around selected leadership competencies. Coaches are often engaged to help leaders make sense of the 360 feedback, to make it a useful developmental tool. Many physicians are not accustomed to receiving feedback from people they work with, so this is a new way of doing business. What’s more, doctors are more attuned to patient feedback, in the form of patient satisfaction surveys – a more collective data collection, and not feedback directed to one person.

The coaches in our group reported a range of reactions to the feedback, from being open and accepting of the data, to being somewhat resistant to hearing the feedback. We brainstormed some strategies for helping the doctors work through the resistance and engage with the data:

  1. “It’s just data – and you can decide what to do with it”. Framing it this way helps to remove any judgment about it: “It’s not good or bad, it just is. Let’s see if we can make sense of it together.”
  2. What’s the kernel of truth in the feedback? This question supports “it’s just data”, and enables the client to look at the data separate from him/herself. S/he is not the data. It’s empowering to think that one can evaluate the truth or validity of feedback and determine what to pay the most attention to.
  3. What’s the impact of this behavior on others? On yourself? Asking this helps put the data in context of the desired intention of one’s behavior, which can be followed up with: “What’s the difference between your intention and their/people’s perception?” Oftentimes we, or our clients, aren’t aware of our impact – we intend one thing but achieve a different result. Most of us want our behavior to match our intention, and when seen that way, the feedback can be seen as helpful.
  4. It’s important to ask “Is this competency important in the person’s job?” If not, we should skip that data point. Some 360’s include this question, but not all.
  5. Look at the broader perspective of what’s happening in the system, i.e. is there anything in the system – the organizational structure, the job definition, the roles and responsibilities, the business processes, that are affecting the client’s ability to do their job well?
  6. Take time. Many of us have a strong reaction to feedback, especially if it presents a different image of ourselves than our self-image, so we need time to work through our reaction. If we have a strong reaction, we’re not in a state to think rationally/reflectively on the data, so we need to give people time to deal with their emotional reaction before discussing the data.
  7. Coaches also need to help clients process that emotional response, by acknowledging the feelings, and putting parameters around the data, i.e. The negative feedback or criticisms do not take away from the many wonderful parts of the client’s performance. We all tend to focus on the negative, and we need help putting it in perspective. In addition, the “areas for improvement” are meant to assist in the client’s development – they are not meant as a personal affront or disrespect.

What challenges does your organization face in developing your physician leaders?  Let me know how I can help you with your leadership development program.

*The hidden curriculum of medical education have been identified as: loss of idealism, adoption of a “ritualized” professional identity, emotional neutralization, change of ethical integrity, acceptance of hierarchy and the learning of less formal aspects of “good doctoring.” (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC520997/)

Physician photo from nursinghomepro.com

The buzz in health care these days is about health and wellness, making connections between the multiple factors that contribute to wellness, and focusing on how our communities can help keep people healthy. Examples include:

  1. Access to healthy food in communities and in schools; making sure there are grocery stores or supermarkets that are accessible to the community.
  2. Increasing availability of nutritious food – growing food locally, supporting community gardens and farmers’ markets. Making it possible to pay for food at farmers’ markets with SNAP coupons. (Supplemental Nutrition Assistance Program).
  3. Physical activity – access to recreational activities, availability of outdoor parks and sporting areas, existence of sidewalks, clearing snow from those sidewalks.
  4. Emotional and social well-being, including mental health; reading to children to support early childhood literacy.

Live Well Watertown (LWW) is a coalition formed by a CHNA grant (community health network area) to support LWW large groupcommunity-based health activities. LWW is working on town policies on food, nutrition and physical activity. LWW conducted a Community Forum in March 2015 which brought together 22 health-related organizations. The purpose of the forum was to generate partnerships and collaborative projects, and to strengthen the ties between and among these groups, including:

  1. Organized group fitness activities: The town’s Recreation Dept. which hosted a show-shoeing event. Bike/Ped (Pedestrian) committee. People working on an ordinance requiring snow removal to enable safer walking.
  2. Social and emotional well-being: Autism Family support group. Youth Coalition.
  3. Food and healthy eating: Farmers’ Market: Providing healthy snacks for students at afternoon sporting events. Community Gardens. A church that teaches middle schoolers gardening skills, and then engages them to help neighbors who need help creating a garden.
  4. Healthy living initiatives: Boys and Girls Club.
  5. Intergenerational projects focused on well-being: Caregiver support group. “Neighbors helping neighbors”.

We designed the event to allow for maximum time for people to meet each other, to learn about the 22 organizations, and to discuss their interests and projects in small groups. The outcomes included next steps from each breakout group, and hopefully coordination of people working together on these projects. People expressed appreciation for the forum and the opportunity to learn about all of the projects going on around town. The key takeaway is that people want to meet more frequently, to talk with their neighbors and group members, and to work collaboratively to achieve collective impact to improve their communities.

Have you worked with anyone who has a perfectionist tendency?  Or are you a perfectionist? If so, how has it been to work with yourself?! Tiring, no? Always going the extra mile to make sure that things are perfect – and that no-one will be able to complain – right?

I’ve worked with several “recovering perfectionists” (smile) who wanted to lighten their load. They realize how difficult it is to maintain such a demanding level of performance; they struggle to categorize tasks into “must be perfect” and “darn good is also acceptable”. A few years ago I was at a potluck dinner, where one woman, Sue, brought a raspberry pie. It oozed red around the corners, so Sue complained that it wasn’t perfect. Could have fooled us – we thought it was fabulously delicious – so perfection was in the eye, or tastebuds, of the beholder!

When we go overboard in one direction or another, there is usually a story that we’re telling ourselves about that. For example, I may tell myself that I have to prove that I’ve been productive, given the amount of time I’ve spent working on a deliverable. I may not consider if my time was well-spent, or if the deliverable might have been fine with less time. Or we might think that being perfect gives us a certain edge over others, i.e. “If I don’t do it perfectly, I’ll lose my power.”

When I design curriculum for a workshop, I like to find cartoons or clip art that superbly convey a point I’m trying to make. I can spend hours (half-hours) looking for “the right image”.  I end up wasting a lot of time that would be better spent on other content. What I’ve discovered is that it’s often serendipity when I come across a great cartoon or image –  not the result of a long search.   You might ask: How does it serve me to go down the rabbit-hole of searching?   I might want to impress the audience, or, the image might be a crutch if I think the content won’t engage the audience.

In my coaching I work with my client to explore the story they are telling themselves. What does perfectionism stand for? What’s hiding behind that? There’s almost always an interesting story behind their behavior. Trying to change our behavior without understanding the underlying story is rarely effective – that’s why New Year’s Resolutions rarely work.

Raspberry pie anyone?!

What do you get when you bring together a group of coaches/consultants and 8 executive directors?? Here’s what the directors reported:

  • Most remarkable 5-person therapy!  I got a number of great small Aha!s which confirmed the good things that we’re doing, as well as identifying areas for my personal growth.
  • Clarity – what I came in with was not what I ended up talking about.  Really good therapy!
  • Phenomenal process!  Such useful information in a safe way.  Hugh Aha!  I had issues that were really symptoms of a bigger problem. It’s seldom that I get to sit down with folks in a non-threatening process.  The team got me down to the data and away from my assumptions.  I got great insights, ideas and steps forward.  I appreciated the expertise and the variety of insights.

The Boston Facilitators Roundtable (BFR) is an organization that I lead, whose members are coaches and Organizational Development consultants.   In Nov. 2014, we offered the third iteration of a very successful event hosting executive directors (ED) for collaborative coaching by BFR members.  Working in small groups, consultants ask questions to help the directors get clear about their problems, examine their assumptions and frame their future action.  As often happens, a director realizes that their initial framing of the problem is not accurate, and they arrive at a clearer understanding of the actual problem.

I designed the successful format for this program with input from other BFR members. There are a few key elements to the process:

  • The director presents an organizational challenge, and consultants get 5 minutes to ask clarifying questions, not more.
  • Then the consultants discuss the problem among themselves for 10-15 minutes, while the director sits back and listens. Directors report that this sitting-back part is fascinating, as they listen in to experienced consultants discussing their problem.
  • The directions to the consultants are very clear about the purpose of this event: to help the directors get clarity. As good coaches, we know the importance of asking useful questions, and holding back on giving advice. At a later point in the format, the directors usually ask for suggestions – and that’s when we think it’s ok to provide advice, not earlier.

This is an Action Learning program, which is designed to provide multiple layers of learning:

  1. The directors benefit from the coaching and consultation from consultants
  2. The consultants benefit from hearing the approach and the questions that each person asks, which builds our coaching skills.

As President of the Boston Facilitators Roundtable, it’s gratifying when the directors and BFR members get high value from our programs.  To read more feedback, click here.

This program would be beneficial for any senior managers, directors or board chairs.  Also, if you’re a foundation that would like to multiply the value of learning for your grantees, let’s talk.  We can augment this program to include a coaching piece to help directors or board chairs recognize their personal dynamics and how that impacts the board and/or the director.  Let me know if you’d be interested in having such a program for your organization.

I recently facilitated a workshop on Polarity Management to a group of surgeons and doctors, who found it extremely beneficial. I had a “before and after” experience when I learned the model – after you see it, you think, “This is so obvious; how did I not know about this model?” In the workshop, we used the tool to discuss the polarity of focus on Cost AND focus on Quality, in which people identify the upsides and the downsides of both poles. The reason this is AND rather than “versus”, is that in a polarity both poles are interdependent and necessary to the system. You can’t get rid of a focus on cost, just like you can’t get rid of concern for quality – you need both to make the system work.

 

The discussion helped surface several other polarities that happen in their hospitals, and uncovered assumptions that some staff have. For example, one assumption is that “anybody going after quality is blind to cost”. Something else that goes unstated is our interpretation of “quality” – how each of us defines it, and how we as a group define it – another necessary conversation. Each case calls for a facilitated discussion in which there is collective “sense-making”. That means that people share their interpretations and surface their assumptions, so that the group comes to an agreement about the definition of terms.

The workshop also helped identify some discussions that are calling to be had in health systems, especially in light of the Affordable Care Act (ACA). For example, one participant articulated this important question: “How do we set different measurement standards to help us resolve this polarity?” Some participants commented that many doctors are anxious about how the ACA will affect patient care, and their income. Others question physicians’ motivation for choosing medicine, which for some/many seems to have changed over the years, from initial idealism to a focus on money. So you can see the value of the conversation that went beyond the initial polarity.

Lastly, the piece that emerged for me as a facilitator is my interest in providing a safe space for health care providers to talk about their fears and concerns. One format for this is to invite physicians from various health centers to a group conversation; being the sole representative from a health center might give people the freedom to say what they really think, without fear of their colleagues’ disapproval or condemnation. I imagine other people have been thinking about this. What ideas have you heard for this safe arena for sharing?

For anyone who creates or oversees the creation of learning events:

Hackman bigYou generate learning events to deliver professional development, at monthly meetings or at conferences. How are you ensuring high-quality sessions from your presenters?

Five steps towards dynamic programs:

  1. FORMAT:  Identify a format that works best for your members. What’s important to them? Networking, learning new tools, peer coaching?
  2. NETWORKING:  You can include informal networking time before your meeting, and you can create something more structured, for example:  have people introduce themselves in their small groups.  Give them a guiding question, such as:  What brought you here today?  What would you like to get out of this meeting?   Bonus step:  connect the guiding question to the topic of the meeting!   I.e. “What’s a current challenge you’re working on relative to (topic x)?”
  3. STANDARDS: Define standards of excellence for your programs, for example: Members will have a chance to get to know 5 new people; Participants will report feeling engaged and able to contribute knowledge; There will be a buzz in the room from small group discussions; People will leave with 2-3 skills or tools that they can apply in their work or practice.
  4. ENSURE SUCCESS: Coach presenters in advance on the desired format and standards. Review their agenda to make sure it conforms with your standards. Tell presenters: I want to be sure that you’ll be successful with our audience!
  5. DURING THE MEETING:  Don’t be afraid to intervene gently but firmly during the session if the energy is lagging. If necessary, engage someone with facilitation skills who can do this for you.

When we create learning events, we often focus on what the presenter can provide to participants – at the same time, participants want to feel that they are contributing value to the conversation; members bring their own knowledge to the table, so an ideal meeting will include both!   When you coach the presenter, you might suggest that they build off the wisdom in the room.

If you have a topic or question about program design that you’d like to see featured here, let me know.

How Can I Help You?

Has this ever happened to you?  Someone asks you for advice or suggestions, and when you respond, s/he gets upset that you didn’t deliver what they were asking for.   Darn.   You/we both forgot to clarify what s/he wanted from the conversation.  We can actually help our friend get clear about what they want, and also be more clear about what we can offer.

Try this approach: when someone asks for assistance,  begin by asking:  What is it that you’d like from me?   How would you like me to help you?

  1. Do they want you to ask questions to help them figure it out for themselves?
  2. Do they just want to vent and have you listen?
  3. Would they like you to give recommendations or to help brainstorm solutions?
  4. Are they asking for your opinion?

That way you know what’s expected from you, and you can decide whether or not you’re in a position to deliver.   Anything we can do to clarify the framework of communication can only be for the good.

As a leadership coach, I always attempt to clarify what my client is asking for.   Coaches are trained to ask questions, and to help the client gain clarity, and I try not to give advice unless someone asks for it.  It helps with friends too!

“Real communication is a creative process at the highest level of human potential. When human beings come together for this purpose, something new is literally created in consciousness. Miraculously, the mind of enlightenment itself begins to emerge through the collective and an extraordinary potential is revealed.”  Andrew Cohen

group convo cloudsThis is music to a facilitator’s ear :)

This resonates with my premise when I’m facilitating:  Groups have collective experience and wisdom and it is my job to bring that out.  Participants know when they’ve created something new in their discussion.   You know when you’ve been witness to a unique conversation.  At the minimum, people are sharing what they know with each other; it’s not generally a process of creating new thought.   Enlightenment occurs when we discover some new truth or new possibility together, and that generates energy and excitement – which are the foundation for creativity and innovation.

training and new skillsPicture this:  Your organization is delivering skill-building programs to several project teams, all at different stages of team development.  Do you have one curriculum for all these teams?  Hopefully not – you/we need to adjust the curriculum to the different stages of development of the teams.  For example, if team members are doing very well at figuring out the distribution of roles among the team, then you can skip that.

I saw this in one client’s training programs and advised them to adjust the curriculum.   The case studies they/we use should also come from the industry or work examples of the participants.  If you’re working in health care, you wouldn’t use an example of a museums board of directors.  Adult Learning 101.  In addition, the trainers need to identify more clearly the learning objectives of the different teams – which they could do through a survey or a focus group.  Whatever’s necessary to streamline the workshop to the needs of the participants – and to get them off their blackberrys ;)

I also noticed that the trainers were facilitating the discussion among team members (on project content), while the team leader was sitting down and participating in the discussion.  Why?  If we’re trying to build capacity –  that’s what training is for – then the trainers should let the team leader facilitate the discussion, and then they can sit in the back and be available to coach the team leader if necessary.   That might be a new role for trainers, but could be fun learning to observe and comment only when needed.   That’s capacity-building at many levels!

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