As I think back to my early experiences as a hospital executive, I recall a fairly steep learning curve. The AAPL management courses I attended helped. But it wasn’t until I saw the principles taught in those courses applied in the real world that they started to sink in. And that’s also when I began to see my greatest shortcoming as a leader.
Most financial, human resource and management concepts eventually became second-hand. With mentoring and experience, I became comfortable with most aspects of my job.
But there were several duties that I struggled with through much of my career. They remained my greatest shortcomings. But I developed strategies to overcome them.
My practice partner and I had been working together for about a year in our small family practice. A medical equipment salesperson approached us promoting a new device that would surely bring in additional practice revenue.
After considering the purchase, we decided to proceed. We signed a loan agreement and purchased the device. It would take 5 years to pay back the loan. We were convinced the device would generate procedures that would easily cover the loan payments.
Eighteen months later, we had only used the device about a dozen times, and we were stuck making that monthly payment with little revenue to offset the cost.
We had been overly optimistic in our assessment of the need for the device. And we had not considered what we would do if it failed to match the salesperson’s inflated return on investment.
Before describing how to unlock leadership through coaching, I want to mention that Vital Physician Executive was featured on Future Proof MD. Please check out Future Proof Docs – The Vital Physician Executive and let me know what you think.
How to Unlock Leadership Through Coaching
My thinking about coaching has been evolving.
The Death of Socrates – by Jacques-Louis David
As I described in my post comparing coaching and mentoring, coaching can be defined as the process of helping someone improve a skill by offering feedback as an impartial but knowledgeable observer.
In that model, a coach is focused on improving an individual’s skill in a certain area. This follows the old sports model of coaching.
Julie waited patiently in the small waiting area in the administrative suite. As the Director for Inpatient Nursing Services , it was time for her biweekly meeting with Patricia (Pat), the Chief Nursing Officer. Pat opened the door to her office and motioned for Julie to come in and sit down. As she did, Pat recalled the lecture she attended the previous year about how to evaluate direct reports, and the subsequent adoption of their new process.
It was early August, and Julie and Pat had already received the most recent update on Julie’s balanced scorecard. The scorecard listed four key responsibilities as well as the three goals she and Janice had agreed upon at the beginning of the year. The scorecard contained data through the second quarter, ending June 30.
After some small talk, and briefly discussing a new manager on one of Julie’s units, they shifted their conversation to Julie’s scorecard. During the previous year the entire organization had implement this formal, objective evaluation process as a pilot. It had worked well, so it had been officially implemented in January.
Each hospital CEO must determine which departments should logically report to each senior executive. Historically, the vice president for medical affairs or chief medical officer was hired to address the medical staff and its governance, continuing medical education and quality improvement. But there is another department head that should report to the senior physician executive of a hospital: the hospital pharmacy director.
Medication administration is one of the most important functions of a hospital. Safe, effective and timely administration of medications requires coordination of multiple hospital staff departments, integration of electronic medical records, implementation of pharmacy automation, and monitoring and managing drug costs.
I didn’t consider workplace violence to be a top priority at my hospital. I’d hear about staff injuries from patients in the emergency room and intensive care unit, but they seemed sporadic and isolated. Later, I began to hear about the fears that the nursing staff was expressing about the aggressive behavior of visitors and patients in those locations.
Then my daughter started working as a social worker at a large medical center in the Chicago area. One day, she was providing services to a young injured gang member treated while under police custody. One of his constant companions was his 16-year-old girlfriend.
When the patient was out of the room for testing one day, the girlfriend asked my daughter if she could help her get away from her boyfriend. She felt threatened and abused. My daughter provided information needed to seek assistance, including the name and location of a shelter. And, the victim could readily report her concerns to the police who were guarding her “boyfriend” while he was hospitalized.
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.
For this post, I thought I would discuss SMART goals and use them for my blog for 2017. It is quite common for each executive in a healthcare organization to create management goals for the coming year. Then the CEO and the senior executive team discusses and approves them. All of the divisional goals are ultimately presented to the Board of Directors.
Your directors will create their goals as well, as we discussed in SWOT Analysis and Goal Setting. You will then review their goals and help adjust them as needed.
Using the SMART acronym will help you to identify appropriate goals. And they will ensure that you continue to remain indispensable to your CEO and board.
The end of the year was looming. I sat with my directors in a brainstorming session. We had previously walked through a SWOT Analysis (Strengths, Weaknesses, Opportunities and Threats). We had identified dozens of ideas in each category of the analysis, using the process that I described in When To Use a SWOT Analysis. Now how would we proceed from SWOT analysis to goal setting?
This was an annual ritual. But I wanted it to be more focused. I wanted the team to create really meaningful goals. Our goal setting charge was to create four or five management goals for each department that would be challenging, but attainable. These goals would help to advance the mission and the vision of the organization.
We had a construct that we followed. It consisted of “pillars” from the management plan overview that each department would try to address. Depending on the department, there might be more goals in a certain pillar. For example, the Director of Quality would have more goals under the Quality Pillar than under the Finance Pillar.
Recruiting new staff is a big challenge. I have found the job interview to be especially unrewarding. It is time-consuming. And the results are often disappointing, in terms of finding the best team members.
I am no HR guru, and no expert on the use of screening programs for hiring. But I have been involved in interviewing and recruiting many new employees for my practice and the hospital where I worked as CMO.
Based on discussion with administrators at other hospitals, it seems no one has a system that effectively identifies new team members who will be both effective and a good cultural fit.
But there is a tool that seems to help. With it, you can screen out those without the necessary skills and those that exaggerate their experience and expertise. I call it the Root Cause Analysis Approach to interviewing.