August, 2011


Physician Leadership: Hold Yourself Accountable

Kendall L. Stewart, M.D. 

Why are physician leaders hesitant to do this?

You may think you are special. Most physicians do. From the moment you were accepted to medical school, people kept telling you how special you were. Then you learned from physician teachers who kept telling you how special they were. No wonder so many physicians believe this nonsense—and start behaving accordingly. You see other physician colleagues getting away with behavior that would not be tolerated in others, and that confirms it. The rules are meant for lesser mortals. Why should you hold yourself accountable for your behavior when no one else does? Role models have a powerful impact on others; that impact is not always positive.

What is the case for doing it anyway?

Physician leaders set the tone. People will look to you to be an example. Even those who regularly misbehave themselves will watch you carefully. They will look for evidence of your hypocrisy as an excuse to keep on misbehaving. They will reckon that you cannot hold them accountable for behaving the same way you do. Since you will be expected to confront your colleagues when they behave badly, your failure to hold yourself accountable will undermine your credibility and influence.

How can you do it?

1. Review your organization’s code of conduct carefully. Be honest with yourself. How do you measure up? Do you behave the same way when no one is there to notice?

2. Seek out colleagues who will tell you the truth. Ask them if you are practicing what you preach. Ask for specific examples. Resist the urge to be defensive when they point out your shortcomings. Thank them for doing you the service of being honest. Ask them to keep the feedback coming.

3. Review your organization’s Rules of Engagement. If they have not written such a document, create a draft and invite your fellow leaders to work with you to clarify expectations about how you will work together to achieve your goals.

How do you hold yourself accountable?

Physician Leadership: Contain Disruptive Behavior

Kendall L. Stewart, M.D. 

Why are physician leaders hesitant to do this?

Very few of us look forward to spending time with people who are loud, obnoxious and angry. It’s one thing to watch these folks make fools of themselves on a television reality show; it’s another thing entirely to deal with them in the workplace. Physicians ordinarily serve people who are grateful for their service. Disruptive people don’t want help. They just want their way. They are not glad to see you coming and they will make that clear. Managing disruptive behavior is like unclogging the sewer. No one wants to do the work, but everyone agrees it must be done.

What is the case for doing it anyway?

Unfortunately, managing disruptive behavior is a big part of the physician leader’s job—particularly when the person behaving disruptively is another physician. Because of the power differential, a raging physician is an organizational emergency. As a physician leader, you are the designated dragon slayer. It goes with the territory. Get used to it. Become good at it.

How can you do it?

1. Show up in person if possible. This effective dampening technique is usually not possible. Bad actors rarely misbehave in the presence of authority. They mostly show themselves in situations where they are confident that no one will challenge them.

2. Launch an immediate investigation. You will likely first hear of an outburst through a complaint. Talk to everyone who was involved, including the person who allegedly misbehaved.

3. Do not jump to conclusions. Listen to all sides. Do not offer your opinion until you have completed your investigation.

4. Follow a process that is consistent, fair and firm. Most organizations have written policies for managing disruptive behavior. Familiarize yourself with that process before you need to use it. You can review one such process here.

How do you manage disruptive behavior?

Physician Leadership: Manage Conflict

Kendall L. Stewart, M.D. 

Why are physician leaders hesitant to do this?

Most of us avoid conflict like the plague. Everyday conflict, the kind accompanied by raised voices, jaundiced perceptions and unreasonableness, is unpleasant. Even those physicians who pride themselves on being plainspoken are more inclined to speak frankly about their colleagues rather than directly to them.

What is the case for doing it anyway?

Physician leaders cannot avoid conflict. Complainers will bring it to you. No matter what decision you make, someone will be upset. Not making a decision will upset others. And chronic, unresolved conflict will drive your best people away. Since you cannot possibly avoid conflict your only choices are to manage it well or poorly.

How can you do it?

1. Prepare for it. Conflict is inevitable. People often behave selfishly. Thin-skinned souls are offended by unintended slights. People have genuine differences of opinion. We all want others to meet our expectations. They frequently do not.  All of this produces conflict. It may be destructive or constructive. Unmanaged, it is usually destructive.

2. Move quickly to contain destructive conflict. Nothing good comes from disruptive behavior. This unpleasantness is what comes to mind when you first think of conflict. When they are angry, people say and do things that can never be undone. If you have the opportunity to intervene during an outburst, you can sometimes prevent lasting scars.

3. Calm yourself and others. Emotional arousal limits everyone’s ability to think and behave rationally. When you are consulted about some recent outburst, insisting on a cooling off period is usually the most helpful next step.

4. Listen objectively to both sides. This is just common sense. And like most common sense, it is not very common. When you assume the investigator role, you are taking charge of the problem. If you investigate deliberately and promptly then take the appropriate action, you will manage conflict better than most organizational leaders. You can review some additional comments for managing conflict effectively here.

What process do you follow to manage the conflict that comes your way?

Physician Leadership: Become an Effective Team Player

Kendall L. Stewart, M.D.

Why are physician leaders hesitant to do this?

We are accustomed to being in charge. We are the experts. We give the orders and people carry them out. That’s the way we like it.  We are not accustomed to following anyone. Becoming a team player requires us to admit we are dependent on others. Other team members have expertise, experience and skills we don’t possess and that we desperately need. This is an uncomfortable position for physicians who have convinced themselves they already know everything that matters. Arrogance is the insecure physician’s preferred coping strategy. Sadly, everyone but the physician sees right through it.

What is the case for doing it anyway?

Teamwork never appears just because a group of nice people decide to become a team. It is always the result of some problem that cannot be solved any other way. When you focus exclusively on the results you want to achieve, you will realize you need help. But people can only help you if you let them. If you are condescending and dismissive of their perceptions and suggestions, they will quickly lose interest in helping you with your problem. If you ask people for help and show them the respect they deserve for their efforts, they will often go to great lengths to help you achieve exceptional results. It’s very satisfying. The chance to be a part of a winning team is the reason why leaders become leaders.

How can you do it?

1. Identify a problem you cannot solve by yourself. There are plenty of these. In fact, you will need help with most of the problems in your professional life.

2. Ask a leader you trust to help you fix the problem. Offer your support—and mean it—but do not agree to lead the team. This will give you a chance to practice followership. You will never become an effective team player until you have learned to follow.

3. Draw your colleagues out. Make everyone comfortable. Ask clarifying questions. Invite them to speak up. See things from their perspective. Welcome their disagreements and challenges. Thank them for sharing their perceptions. Solicit their advice. Take what they say seriously.

4. Pull your weight. Show up on time. Be prepared. Pay attention during the meetings. Keep professional interruptions to a minimum. Follow through on what you say you will do. You can learn more about how to become an effective team player here.

What have you done to become a more effective team player?