Here’s What Happens When You Fail to Communicate

The Disasters That Can Happen When Communication Breaks Down

Over the years, I have witnessed some minor disasters that could have been averted with a little better communication and planning. Some of these nightmares were of my doing. Some were by other overconfident leaders who could not find the time nor self-discipline to engage in the fierce conversations that were needed to avert them. But bad things can happen when you fail to communicate consistently.

One of the more common traps I’ve seen involves the contract termination of a well established hospital-based group. This most often occurs with emergency medicine, hospitalist, anesthesia or radiology groups. Either the group is unhappy with its old contract, or hospital executives are dissatisfied with the group’s performance. The CEO, COO or CFO, following months or years of frustration, declares in a closed senior executive meeting, “we need to look for a new group!”

breakdowns if you fail to communicate

Root Causes

These failed transitions cause chaos in the involved patient care arenas, unhappy medical staff and delays in care. Several conditions exist that lead to this political nightmare for the CEO and board. 

Monthly Favorites – January 2017 Edition

A few interesting and entertaining items involving freaks, finances and fun

Rather than lecture you on some aspect of hospital leadership or management, I am sharing my favorites from the blogs that I read regularly. The topics will generally be about leadership. However, since I follow a number of personal finance blogs written by physicians, I share those, too. And there may be a few that are completely out of left field, if I think they are interesting or entertaining.

favorites - january 2017 lighthouse

This month’s favorites…

Interview with Jeremy Blanchard from Language of Caring

Advice from a Seasoned Leader for Young Executives

One of my favorite pastimes is to listen to interviews on podcasts like the Tim Ferris Show (of The 4-Hour Workweek fame). I also like to read written interviews such as the recent one by Physician on Fire with Jim Collins. After starting this blog, I began to wonder if an interview might be of interest to my readers.

One of the subgroups of my audience is physicians who are just starting or considering a career in management. I therefore decided to add interviews that I think will help them navigate their careers.

microphone interview

The interviews will be with seasoned executives in a variety of settings. To start, I will focus on my guests’ background, education and experience. I will be inquiring into their opinions’ about advanced degrees. And I will always include a question about their advice to emerging physician leaders.

4 Crucial Steps to Take Before Choosing a Management Career

Use Total Immersion to Educate Yourself

I was about 5 years into my medical career. It was a busy and exciting time. I finally felt confident in my clinical skills and I was ready to immerse myself in a new subject matter. I had not yet considered a management career.

total immersion

My partners and I had started a pension plan and we were making regular contributions. But none of us really knew how we should invest our contributions. I realized that I needed to learn about investing.

I needed to go through a crash course on mutual funds, stocks, bonds and asset allocation. And the Internet did not exist, so there were obviously no blogs like White Coat Investor, Physician on Fire or Future Proof MD to read.

So, what did I do?

VITAL Physician Executive Additions: Top Picks and Resources

Check Them Out

One of the things I enjoy is checking out the websites, blogs and podcasts recommended by my favorite bloggers. I also like to check out their book recommendations. So, I am using this post to announce Vital Physician Executive additions: two new pages.

vital physician executive additions

The first is a list of Top Picks. This is a list of the best of the blogs and podcasts that I regularly scan and/or consume. I think that you will enjoy them. I recommend that you check them out.

Why Demoralize Your Employed Physicians Over Tail Coverage?

Going to War Over Tail Coverage Is Self-Defeating

I was sitting across the table with a new family physician recruit for the third time. He was a particularly challenging recruit to work with, but we really needed family physicians. We had added several physician assistants and nurse practitioners and we needed qualified primary care physicians to collaborate with them. We were back to discussing tail coverage.

tail coverage battle

I had explained to the candidate that it was our practice to require tail coverage to be covered by the physician. It was one of the ways that we used to promote longevity of the relationship. We would be willing to waive the requirement in the event that we decided to terminate the agreement without cause, or if the candidate became disabled or died (to protect his or her estate). But those were the only exceptions.

He ultimately accepted the terms, after negotiating a higher sign-on bonus and student loan repayments. But I could tell he was unhappy about the tail coverage issue.

Do the Right Thing

Leaders Follow Through on Commitments

Brenda was having her usual busy day. She had just started her morning coffee and was getting ready to leave the house. As she glanced at her schedule, she saw that she had agreed to meet with her siblings that afternoon. They were supposed to discuss their elderly parents. There were issues that needed to be clarified before proposing some options about future living arrangements. It was going to be difficult to do the right thing.

This was a very important meeting, and the other four siblings really wanted Brenda’s input. She was the eldest sister and lived near her parents. The options to be presented would have an impact on everyone in the family.

The meeting had been rescheduled several times, generally because of conflicts with Brenda’s schedule. Here it was, now looming on her calendar for 3:00 P.M.

Christmas Morning Thoughts and Stories

Enjoy a Few Stories and a Video

I remember the old movies depicting the chaos and excitement of children waking up early and rushing to check the Christmas tree for presents, just as the sun comes peeking over the horizon. Then, the parents slowly, but happily, wake up and join the children on Christmas morning.

Compared to our house, with 10 (yes, TEN) children, those scenes resembled a solemn funeral procession compared to the cyclone that hit our house at 5:30 AM on Christmas morning. Sometimes our parents would join us. Other times my father would sit up, grab an ashtray, and light up a Camel or Viceroy before giving his blessing to proceed without him and my mother.

christmas morning crowd

As the oldest siblings, my sister Cathy and I would maintain some degree of order as we tried to keep the younger animals at bay and distribute presents in an orderly manner. Within a few minutes, paper would be flying, screams of joy could be heard, quickly followed by fights breaking out over who touched whom, and which toy was the best or doll was the prettiest.

The leadership lesson I learned was to surrender and stop trying to control the situation. Allow everyone to enjoy the moment. Make sure no one was hurt. Then supervise the clean up a couple of hours later, when the adrenalin had dissipated.

Hospital Quality Improvement Mirrors Strategic Execution

Follow the 4 Disciplines and Improve Quality and Organizational Success

I started this series describing an approach to execution of management goals described in the book  The 4 Disciplines of Execution (4DX) by Chris McChesney, Sean Covey and Jim Huling. The design of the WIG (wildly important goal) was described in detail. But what comes next?

execution disciplines

Let’s imagine that your team has selected a WIG. And the goal is written in the format of “from X to Y by when.” According to the authors of 4DX, the next step is to develop lead measures. Lead measures, if implemented, will result in improvements in the lag measure.

How to Go From Goal Setting to Execution

Understanding the 4 Disciplines of Execution - Part 1

I made it a habit to meet with my directors on a monthly basis to update them on news from the senior executive team and CEO. We used the opportunity to prepare for our annual budget and set management goals. There was always some trepidation about execution of our goals, as our annual bonuses were linked to achieving them. During the year, we also used those meetings to assess our progress in achieving our goals.

target execution

In a previous post, I described the importance of writing SMART goals. SMART is a good start. Goals must be clear. And they must allow us to envision what accomplishing the goals will look like.

But the so-called holy grail is not simply the statement of a clear goal, but having processes in place to achieve execution of those goals. The purpose of writing and executing them is to produce results that advance the mission and vision of your organization.