2011


Physician Leadership: Build a Culture of Integrity

Kendall L. Stewart, M.D. 

Why are physician leaders hesitant to do this?

Every leader admits that building and maintaining an organizational culture of integrity is essential in theory, but the emotional price is steep. You have to tell the truth. You have to take the same position publicly and privately. You have to do what you say you will do and admit it when you are wrong. It is much easier to tell people what they want to hear, to enter into secret agreements and to avoid speaking on the record. It is easier to blame others. It is easier to hold your cards close to the vest. It is easier to cut secret deals while reassuring yourself that’s what everyone does. Every leader aspires to be a person of integrity. Not every leader is willing to pay the painful price on which that reputation is built.

What is the case for doing it anyway?

The people you serve will figure out pretty quickly whether you are a person of integrity or not. If they conclude you are not, you are finished as an effective leader. You may hold on to your leadership title for a time, but no one will take you seriously. You will not be a player. Few of us intentionally aspire to be empty suits, but there are more than a few of those around. Is that the way you want your professional life to turn out?

How can you do it?

1. Choose the reputation you want to build. Look around. There are real life examples of reputable and disreputable leaders in your own work environment. You know who they are. Choose your role models carefully. You will likely turn out to be the kind of leader you look up to.

2. Make a list. Do some practical research on integrity. Write down how leaders with integrity behave. Be specific and detailed. Post your list of requisite behaviors so you will see it every day.

3. Listen critically to all sides before taking a position. The urge to jump to accommodating conclusions when powerful complainers come calling is strong. Resist it.

4. Beware the secrecy trap. When people ask you to hold something they are about to say in confidence, stop them right there. Make it clear that you cannot agree to confidentiality beforehand. Actually, nothing a leader says or does is secret for long.

5. Do the right thing. You will usually know right away what the right thing is. It’s the hard option that you would rather avoid.

What exactly do you do to build and sustain a culture of integrity?

Physician Leadership: Accept People As They Are

Kendall L. Stewart, M.D. 

Why are physician leaders hesitant to do this?

We all want people to feel, act and behave the way we want them to. If they would only do that, we would feel better about them—and ourselves. People not only disagree, they are sometimes disagreeable too. The leader’s first impulse is to change them. We often persist in these futile efforts while knowing we have no chance for success. And to make matters worse, we allow ourselves to become frustrated when we fail. Many leaders view frustration as both an entitlement and a gift. It is neither.

What is the case for doing it anyway?

If you focus on understanding and accepting others instead of trying to change them, they will be much more open to your point of view. And you will likely discover some unexpected common ground. That will provide a foundation for further discussion and compromise. And you will be a lot less frustrated in your work.

How can you do it?

1. View your rising frustration as evidence that you have missed the point. When you are focused on accepting others as they are, curiosity replaces frustration as the accompanying feeling.

2. Ask clarifying questions. Avoid the inclination to confront, challenge and openly disagree. Resist the urge to make pronouncements and sweeping generalizations.

3. Acknowledge the reasonableness of others’ positions. After all, if you were in their shoes, you would think and act exactly as they do.

4. Ask them to identify the weaknesses in their cases. Most physicians are critics by nature and cannot resist the challenge to attack the prevailing wisdom even when it is their own.

What strategies have worked for you in accepting others as they are?

Physician Leadership: Focus on Strengths

Kendall L. Stewart, M.D. 

Why are physician leaders hesitant to do this?

We are all the same. We tend to focus on weaknesses and take strengths for granted. If you received 20 positive comments during your evaluation and two negative ones, you will find yourself ruminating about your perceived shortcomings. That’s because you want to be perfect and you want everyone to love you. While you recognize this is patently ridiculous, you can’t help yourself. It’s the way human beings are wired.

What is the case for doing it anyway?

The effort you and others expend in trying to overcome obvious weaknesses is mostly wasted. The time and energy you spend in improving your strengths will pay much better dividends. If you discover weaknesses that actually interfere with getting the job done, these things will have to change, but most personal shortcomings are more annoying than disabling. Simply admitting these quirks openly, asking for others’ patience and finding colleagues whose strengths can compensate for your weaknesses is enough. When you think about it, changing your entire personality to suit every person you interact with is an unrealistic goal anyway.

How can you do it?

1. Figure out what your strengths and weaknesses are. Ask your immediate superior to conduct a facilitated 360-degree evaluation of you. She will invite the twenty or so people you work most closely with to tell her what they perceive as your key assets and shortcomings at work. It would be nice if people would be honest with you themselves, but they won’t.

2. Look hard at the recurring perceptions in this evaluation. They won’t surprise you. You may be surprised that your colleagues see through you so clearly.

3. Admit your weaknesses freely. Always begin your efforts to persuade your colleagues with a frank admission of your perceived shortcomings and ask them to look beyond those. Everybody appreciates honesty.

4. Stop ruminating about your shortcomings. This mental tendency to fret pointlessly and destructively will sap precious time and energy that would be better invested in productive mental effort.

5. Focus most of your energy on your strengths. This approach will allow you to become even better at what you already good at. And it will offer a healthy distraction from the rumination that cripples so many leaders.

How have you successfully encouraged your colleagues to focus on their strengths instead of their weaknesses?

Physician Leadership: Clarify Others’ Expectations

Kendall L. Stewart, M.D. 

Why are physician leaders hesitant to do this?

First, we think we already know what others expect. Second, if they don’t expect that, we believe they should. Third, we are much more concerned about what we expect than what others expect anyway. Such arrogance is not confined to physicians, but we have taken it to a new level. These baseless assumptions are at the root of most failed communications. Here is the simple truth. We cannot read our colleagues’ minds very well. We should stop trying.

What is the case for doing it anyway?

Taking the time to complete this step in your conversations with others will increase your odds of communicating successfully and persuading your colleagues to join your cause. Instead of listening dispassionately, many physicians are thinking about how ignorant, selfish or wrong the other speaker is. Resisting your natural tendency to devalue any view that is different than your own will not be easy. After all, you are certain that you are right. Thankfully, this defensive certitude diminishes a bit as you get older. The only thing you will be sure of later in your life is that you are not sure.

How can you do it?

1. Face the reality that you cannot read other people’s minds. Every leader makes this mistake. You will too. Recognizing this tendency will give you a chance to overcome it. If you realize that clarifying others’ expectations is an essential step in every communication, you will remember to do this at least some of the time.

2. Create a simple communication checklist. Post it in plain sight. Refer to it or repeat the steps silently to yourself during your listening phase. We physicians don’t tend to listen to others very long before we burst in with our questions and pronouncements. One study concluded that physicians listen to their patients only 23 seconds before redirecting the conversation.

3. Ask clarifying questions to make sure you understand. Even when you are certain you know what your patient or colleague expects, take time to make sure. They will appreciate the effort.

4. Ask them whether you understand their position correctly. Summarize what you’ve heard. Ask whether there is anything else they want you to consider before you take a position or make a decision.

5. If possible, resist the tendency to respond on the spot. Ask for time to reflect and consider. This will decrease the odds that they will conclude your mind was already made up and that you were just going through the motions when you sought their point of view.

How do you clarify others’ expectations?

Physician Leadership: Promote the Use of Checklists

Kendall L. Stewart, M.D. 

Why are physician leaders hesitant to do this?

We don’t like checklists. We think they are dumb. We are smart people and we know what to do. We are special. We should be able to do whatever we feel like doing. Sure, we sometimes forget things and make stupid mistakes, but the people who support us are supposed to catch those. Genius cannot be bothered with details. And after all, perfection is God’s business. We all want to feel special and we will believe and do almost anything to convince ourselves that we are. But comforting delusions can be deadly.

What is the case for doing it anyway?

Check lists are not dumb. They are smart precisely because they are simple. Checklists are not designed to cover every action the leader needs to take, just the essential ones. Smart leaders use checklists because they recognize their value at keeping everyone focused on the critical steps in the process even when distractions abound. And distractions abound everywhere and all the time.

How can you do it?

1. Educate yourself about the science behind checklists. Read The Checklist Manifesto: How to Get Things Right, by Atul Gawande. You can get this book here.

2. Identify the checklists that have made the biggest difference in your organization. The smartest leaders have already put checklists to good use. Find these leaders and their lists. Learn from them.

3. Promote the use of evidence-based order sets. All physicians have created a set of mental templates to fall back on for the routine things they must do to respond to a particular diagnosis. Recognizing that they cannot possibly keep up with the emerging evidence for the best treatment for the disorders they treat, the exceptional physicians have long since adopted computer-generated order sets based on the latest scientific findings. These are nothing more than sophisticated checklists.

4. When you come across a process improvement opportunity ask yourself and others whether a checklist might be a part of the solution to the problem. Put “consider a checklist” on your problem-solving checklist.

How have you used checklists to decrease errors in your organization?

Physician Leadership: Communicate Effectively

Kendall L. Stewart, M.D. 

Why do physician leaders find this hard to do?

Every physician leader believes she communicates effectively. And everyone else disagrees. It’s not that leaders don’t wish to communicate effectively. It’s that communication is so dependent on needs and perceptions. If the people you are trying to communicate with have no interest in hearing you at the moment, they just ignore your message. Don’t take this personally. You do the same thing. There is no other way to cut through the message clutter and get through your day. And a lot of people ignore their email and expect an individual conversation at their convenience. Then there is the need for repetition. You talk until you are sick of hearing yourself talk. You are convinced you have communicated to every stakeholder twice. But you missed more than a few important folks. And they feel left out because—they were.

What is the case for doing it anyway?

Effective communication is critical to your mission. Good intentions are not enough. The failure to communicate is the most common grudge people hold against their leaders. While you may be better than most, you are far from perfect and you still have a huge opportunity to improve. Just accept this as a fact. Keep trying harder.   

How can you do it?

1. Get your message down. Cut the verbiage to the bone. Concentrate on telling people only what they need to know, not everything you want them to know. Speak to their needs, not from yours. Find an emotional hook if you can.

2. Design a comprehensive personal communication process. Decide when you will call, when you will meet, when you will send an email message. Send text messages. Use social media. Write letters and notes. Generally speaking, the way people communicate with you is the way they want you to communicate with them. Make rounds. Make communication individual.

3. Stick to a schedule. Decide who you will communicate with every day, every week and every month. Inform everyone of this schedule and then do it.

4. Welcome questions. Thank others for bringing rumors to your attention. Invite clarifying questions after every attempted communication.

5. Accept the blame for every communication failure. If you do not accept responsibility for a problem, you cannot fix it. You forgot to include a key stakeholder. Your message might have been clearer. You might have found a more effective way or chosen a better context. You might have worked harder to prevent misunderstandings. You might have dampened your emotional arousal more and thereby confused the message less. Apologize and mean it. It was your fault.

What effective communication strategies have you observed and used? What communication challenges have given you opportunities to learn and improve?

Physician Leadership: Respond to Others’ Needs

Kendall L. Stewart, M.D. 

Why are physician leaders hesitant to do this?

Our own needs keep getting in the way. We all have needs. We naturally believe ours are the most important. One of the needs physician leaders have is the need for others to agree with their point of view. Having decided what is best, we are puzzled and annoyed when our colleagues don’t immediately reach the same conclusions. So long as your needs continue to obstruct your view, you will have a hard time seeing—much less understanding—the needs of others. This is a real problem for the physician leader who aspires to persuade and produce results.

What is the case for doing it anyway?

Human beings are primarily driven by their needs and resulting emotions—not by reason. If you are going to persuade your colleagues to go along with you on an issue, you must craft a solution that will meet their needs too. If you cannot find a way to do this you will spend most of your time as a physician leader feeling frustrated.

How can you do it?

1. Identify your own needs. Our needs hide among the emotional weeds in our lives. You might not even recognize the needs that are driving your current intentions. Here’s a clue. The stronger you feel about an issue, the stronger are the underlying needs you are striving to meet.

2. Set your own needs aside for a moment. You can actually do this but only after you recognize and accept them. You can make a conscious decision to isolate them temporarily instead of unconsciously repressing them. Be careful. This only works for a short period of time. Suppression morphs into repression pretty quickly.

3. Try to figure out your colleagues’ needs. Don’t be cocky. You can never be entirely sure what someone else needs or feels. Ask them. They won’t always know or, even if they do, they won’t always tell you the truth. They may simply need to disagree with you to preserve their reputation as an independent doctor who stands up to administration.

4. Accept their needs as legitimate. Dismissing others’ needs as selfish or immature is worse than failing to recognize them in the first place. People just feel what they feel. Accept it, respect it and deal with it.

5. Reconsider your options. Now that you know or suspect the needs involved, you may be able to think of new options. You may think of a compromise that gives each of you part of what you want. When you are trying to come up with a list of option, consult with others. They will often think of options you did not see—because your vision was distorted by your own needs.

How have you observed leaders use insight into others’ needs to achieve their goals?

Physician Leadership: Prepare for Meetings

Kendall L. Stewart, M.D. 

Why are physician leaders hesitant to do this?

Physicians have been attending meetings for years. They have long since come to view them as a waste of time or an opportunity to find fault. Unless they are scheduled to present, they expect to listen passively, impatiently waiting for the speaker to read their minds and meet their needs. Naturally, physician leaders bring these jaundiced expectations with them to their new administrative jobs. Physicians are not alone. The need to prepare never occurs to most meeting attendees.  

What is the case for doing it anyway?

Being prepared for a meeting confers a considerable competitive advantage. Just appearing to be prepared will set you apart. Actually being prepared will confound everyone in the group. And what’s more, few will ever figure this out.  Your colleagues will just keep on showing up like mindless drones and allowing you to set the tone, control the agenda and direct the outcome. This is the most satisfying conundrum of organizational life. What an opportunity!

How can you do it?

1. Begin by figuring out what you want to accomplish. Focusing on results always clears the mind. What exactly is the problem? What questions need to be asked and answered? What additional data do we need? Who do we need to consult or inform? What are the options? Which is the best option? What are the next steps? Who will do what by when?

2. Bring questions (and answers) to the meeting. Nothing sets the leader apart like asking (and then answering) the right questions.

3. Bring data. The less people know, the more strongly they feel about it. Get the facts. Reveal your sources. Invite others to share their research. Enjoy the stunned silence.

4. Prepare a presentation. Send it out before the meeting to save everyone time. Few leaders will invest the time and energy to do this. This is a sure fire way to make certain that your ideas will not have to compete for airtime with the other windbags.

How have you observed physician leaders lead by being prepared?

Physician Leadership: Communicate the Physician Perspective

Kendall L. Stewart, M.D. 

Why are physician leaders hesitant to do this?

Physicians are reluctant to share the physician perspective for several reasons. There is no one physician perspective. Every physician has her own view. Sharing some common physician perspectives can be helpful, but it is stupid to presume to speak for all physicians. Many physicians feel entitled, and speaking openly about such collegial arrogance can be embarrassing. Given the natural resentment many feel for privileged physicians, laying out typical physician perspectives may be perceived as rubbing salt in the wound.

What is the case for doing it anyway?

No matter how uncomfortable it may make them, organizational leaders need to know how their key physician stakeholders feel. Since few physicians will speak forthrightly about their feelings except behind others’ backs, the physician leader has a duty to inform his lay colleagues. If you explain these feelings of entitlement in an apologetic way, your colleagues can accept these perceptions without becoming too defensive. The opportunity to gain useful insight into a physician’s motivation is lost when we are ignorant of his feelings or dismiss them as ridiculous.

How can you do it?

1. Ask your physician colleagues what they think. In a private conversation, they will not be able to restrain themselves. They will tell you what they feel and think.

2. Accept their feelings. This should go without saying, but people will not speak openly if you judge them or dismiss their feelings as unjustified. You do not have to agree with them to accept how they feel.

3. When you explain how physicians feel, take pains to explain why their feelings make perfect sense from their point of view. You will find it helpful to warn your listeners that what you are about to tell them will make them uncomfortable. This gentle warning will help them not react so angrily to what they are about to hear. It is helpful to remind them that if they were in the physician’s shoes, they would feel exactly the same way.

How have you observed physician leaders explain physician perspectives effectively?

Physician Leadership: Improve Key Processes

Kendall L. Stewart, M.D. 

Why are physician leaders hesitant to do this?

Process improvement is tedious, painstaking work. Most leaders don’t have the patience for it. They just want things to improve naturally. But things don’t improve by themselves. Someone has to figure out exactly what is wrong first. Physician leaders are eager to delegate this kind of work. But physicians are frequently the owners of the key processes in question, and they cannot delegate the diagnosis and treatment of their problems entirely to others.

What is the case for doing it anyway?

It’s the only option you have. If you keep on doing what you are doing you will keep on getting the same results. There is no shortcut to improved performance. You must examine your processes, find the flaws and figure out ways to improve them. You will discover that most of your colleagues are amazingly satisfied with mediocre performance. Your passion for improvement will quickly set you apart. It will invite considerable ridicule. It will also attract the best and brightest to your cause.

How can you do it?

1. Identify a process that could be improved. This is not very hard to do. When results are less than stellar, there are always underlying processes that could be improved.

2. Recruit a small group of determined zealots. You will never convince the masses that processes matter. Find those rare people who understand and are eager to do the analytical work that everyone else despises.

3. Diagram the process in question. Focus on exactly what is happening today. Don’t be tempted to tinker until you fully understand current reality.

4. Imagine what the process would be like in a perfect world. Most of us think immediately of why something won’t work. Until you break free of these mental limitations, you will not see the possibilities that exist.

How have you observed others improve their key processes?