As healthcare executives, we must communicate clearly and effectively. This can be difficult at times. One-on-one communication is fairly straightforward. But how do we communicate regularly with dozens of physicians, hundreds of constituents, or thousands of patients? And how can it be done in a way that encourages a two-way dialogue? Perhaps healthcare executive blogging is the answer.
As chief medical officer, one of my primary challenges was connecting with the members of the medical staff. I regularly needed to inform them about initiatives undertaken by the organization, new mandates by accrediting agencies, upcoming staffing changes and dozens of other issues.
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!”
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.
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.
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.
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.
It was both exciting and intimidating to participate in weekly operational and strategic meetings as a new member of the team. One of the first things I observed was how the CEO was building trust among the team members at almost every meeting.
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.
Don was about 15 years my senior. He was an awesome mentor. We met while working on projects for the Illinois State Medical Society (ISMS) Committee on CME Accreditation. This committee was responsible for approving intrastate providers of AMA Category 1 CME.
A Mentor To Me
Don was the chair of the committee prior to my being appointed to it. So he had been involved in CME for many years. I later served as chair myself for five years. Now he is officially retired from his job as Chief Medical Officer for a large independent hospital. But he continues to volunteer his time doing CME surveys and teaching young educators about CME accreditation.
Long before I made the move into an administrative position, Don inspired me to consider such a move. He was clearly well-respected by his physician colleagues, and by the ISMS staff with whom he worked. He and I shared a commitment to the accreditation process so that physicians could have access to high quality CME.
In the 1950’s, one-third of hospitals were run by a physician leader. By 1982, less than 3% were physician-led. That number is running about 6% now. And the healthcare industry has been in the throes of major changes.
One of the consequences has been the growing employment of physicians. The expansion of this employment model is having serious negative effects on our profession.
Physicians have become commoditized. Today, we seem to be treated more like run of the mill laborers than highly trained professionals expected to provide ideal patient care.
Looking back, I may not have taken the most obvious route to becoming Chief Medical Officer. But the journey was fairly sequential. And there were several resources that helped me to feel confident as a physician leader.
There is more need today than ever for skilled physician leaders. There are several specific steps that hopeful executives can take to enhance their competencies. But each physician will need to determine his or her own path based on his or her circumstances.
When trying to acquire these skills, it is best to follow Steven Covey’s admonition: “Start with the end in mind.”
I have found that volunteering in various community activities can provide meaningful lessons for physician leaders. I think it is especially useful to work on a nonprofit board. Doing so provides real value to your community while enhancing several important skills.
A Touching Letter
About fifteen of us were sitting around the conference room table. The hospice executive director was reading a letter from a client’s daughter.
The daughter wrote about how thankful she was for all of the support that had been provided for her family during the days leading up to her mother’s death. The family had grown quite attached to the hospice staff, and they to her. The daughter explained how they had become like family. Her mother was at peace during her final days and they were comforted by this.
As a member of the hospice board of directors, I was touched by the sincere gratitude expressed by the daughter. I was impressed and proud by how committed the staff were. And I was thankful to be a part of this team.
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.