‘Physician Leadership’ Category


Physician Leadership: Deal Effectively with Difficult People

Kendall L. Stewart, M.D. 

Why are physician leaders hesitant to do this?

Everyone avoids dealing with difficult people. Physician leaders are no different. These emotional vampires suck the joy out of our lives. They are everywhere—at home, at church and at work. Heartier than cockroaches, they thrive in every human environment. The easiest thing is to avoid the bullies. Physician leaders can’t do that.

What is the case for doing it anyway?

Difficult people foul the air that we all breathe. While they cannot be entirely eliminated, they can be quarantined and contained. You cannot contain a hazardous spill by avoiding it. You must isolate it and dispose of it properly. You must store corrosive materials securely after the spill. And effective leaders take exactly the same approach with difficult people.

How can you do it?

1. Label them. You have been told this is a bad thing to do. Labeling others can be wrong, but not when dealing with difficult people. It is the first step to managing them successfully.

2. Confront them. Make it clear that they are difficult. Show them the accumulated evidence from their colleagues’ written complaints. Most of them will never get it. They will maintain they are right and everyone else is wrong. While their gaining valuable insight is out of the question, you can’t move to the next step until you confront them.

3. Extrude them. When you’ve made a reasonable effort to contain the damage that difficult people are causing, send them to your competitor. Your competitor will initially rejoice that he has lured away one of your most valuable assets. By the time your competitor realizes you have sent in a Trojan horse, it will be too late.

How do you deal effectively with difficult people?

Physician Leadership: Develop Physician Leaders

Kendall L. Stewart, M.D. 

Why are physician leaders hesitant to do this?

Most physicians want a leadership title, but they do not want to lead. It’s too hard. If physicians are reasonably competent, nice and productive, they are going to be successful. Successful leadership demands a great deal more. It demands that the physician produce exceptional results. This involves persuading other physicians to go along. Faced with this reality, most physicians rapidly lose interest. Sitting in the physician lounge and second guessing others is a lot more fun. You can’t develop physician leaders if you can’t persuade any physicians to be leaders.

What is the case for doing it anyway?

Against all odds, a few physicians are game. A few physicians see the possibilities. A few understand the challenges and are up for them. These physicians are the keys to their organization’s success. Those physicians willing to take the risks of leadership deserve the best training and experience you can provide. These are the physicians you want to bet on.

How can you do it?

1. Make the case for becoming a physician leader. Point out that someone is going to lead. Their professional lives will go smoother if they are making the key decisions. The risks are considerable, but so are the rewards.

2. Clarify your expectations for leaders. Remind them that leaders exist to produce results. Leaders do not exist to tell other people what to do. This is a huge cultural change for most physician leaders.

3. Ask them what they want to learn. If you clarify the results you want, they will tell you what they need to succeed. They will tell you they need to learn how to motivate others, how to manage conflict and how to grow a thicker skin. But don’t take my word for it. Ask them.

4. Ask them how they want to learn. They will tell you that they learn best through experience. They will want you to coach them through some real leadership challenges. They will want you to teach them leadership processes by letting them use those processes themselves. Does that sound familiar? These are the ways you want to learn too.

5. Remind them why they chose to be a leader. When they produce exceptional results, remind them this is why they chose to be leaders. These moments are infrequent, but they produce enough satisfaction to sustain a leadership career.

How have you developed physician leaders in your organization?

Physician Leadership: Field the Best-Possible Teams

Kendall L. Stewart, M.D. 

Why are physician leaders hesitant to do this?

Leaders avoid this because it is intensely uncomfortable. We all first learned the importance of fielding the best possible team in grade school. It seemed natural to pick kids for your team who could help you win the game. Then we grew up and got jobs. Suddenly, we believed we were entitled to those jobs for life no matter how well we performed. The belief that performance—not tenure—matters most is not widespread. The leader who insists on embracing such heresy will never be appreciated by those who fail to clear the bar. This is the price successful leaders pay.

What is the case for doing it anyway?

This is the only way to compete successfully. And the high performers will appreciate your willingness to cut out the deadwood. This does not mean you should insist that everyone be stars, just net-positive. Extruding the miserable cusses and slackers will send a strong signal to everyone that their position on the team must be earned daily. Organizational leaders are a special case. If you can do better, you must.

How can you do it?

1. Make your position perfectly clear. Announce your intention to field the best-possible team publicly. Put your own skin in the game by recommending that your boss make the same commitment.

2. Do it. Having the best intentions will get you no credibility at all. When you have the opportunity to trade up, do it. Actions speak. Words squeak.

3. Require those who report to you to do the same. Most leaders will avoid this painful duty whenever they can. You may need to force them to do the right thing.

How have you fielded the best-possible team in your organization?

Physician Leadership: Promote Transparency

Kendall L. Stewart, M.D. 

Why are physician leaders hesitant to do this?

Being in the know makes people feel special. They are not eager to give this perceived advantage away. People also want the freedom to take one position in public and another in private. They don’t want to upset others or take the heat for what they really think. Most tempting of all, complainers often come to physician leaders with the urgent desire to reveal something important but only under the condition that what they are about to divulge be kept in strictest confidence. Physician leaders want to be viewed as trustworthy, so they often mistakenly agree. Requesting confidence beforehand is the oldest leadership trap in the book. And physician leaders fall for it every day.

What is the case for doing it anyway?

Transparency holds everyone accountable—including you. This means you will be forced to take a public position early on and defend it. This means you must demand the pertinent data and examine all sides of the issue before you rush to judgment and take a premature position you may eventually be forced to change. Such painful backtrackings will teach you the value of transparency fairly quickly.

How can you do it?

1. Never agree to the condition of confidentiality beforehand. Explain that you cannot possibly agree to that before you know what you are agreeing to. Then leave it up to the complainer whether to proceed. If they have a real beef, they will go ahead. If they are just attempting to poison the well, they will quietly slither out of your office.

2. Require those who come to you with a complaint to go on the record. Take careful notes. Send them an email summary of what they said. Yes, they will be furious. And they will avoid dropping by to gossip in the future. Mission accomplished.

3. When other physicians come to complain about their colleagues, ask them whether they have talked to that colleague themselves. They usually have not. Offer to meet with the two of them together. Amazingly, the complainer’s self-righteous ardor will cool to disinterest before your very eyes.

4. When confronted, take the position that you will take a position. The people who seek you out will usually want you to agree with them and their skewed view of things—right now. Don’t fall for this.

5. Take a considered position. Listen to everyone’ views. Obtain the clarifying data. After acknowledging and accepting others’ emotional arousal, set it aside. After a sufficient time for reflection, explain your conclusion and how you arrived at it.

How have you promoted transparency in your work environment?

Physician Leadership: Keep Your Commitments

Kendall L. Stewart, M.D. 

Why are physician leaders hesitant to do this?

It’s not that physician leaders intentionally fail to do what they say they will. The problem begins with making commitments too quickly. Politicians have perfected the art of telling everybody what they want to hear. This is a temptation for physician leaders too. Procrastination and disorganization are challenges for everyone. It is a lot easier to promise than to perform. That’s why leaders have frequently been counseled to “under promise and over perform.”

What is the case for doing it anyway?

Failure to keep your word may be the most serious mistake you can make as a physician leader. If you adopt the convenient political strategy of telling people what that want to hear, they will quickly dismiss you as just another politician. If you develop a pattern of failure to follow through, you will lose your credibility as a leader. The stakes are high.

How can you do it?

1. Write it down. When you make a commitment, put it on a list and keep it there until the duty is done. It is startling how many leaders fail to follow this simple process.

2. When you have done it, document it. Just as with the patient record, if is it not documented, it was not done.

3. Close the loop with the people that matter. If a physician calls to complain and you pass the ball to someone else, follow up with that physician to make sure that the colleague you delegated the matter to followed through.

How do you follow up on your commitments?

Physician Leadership: Remain Detached and Curious

Kendall L. Stewart, M.D. 

Why are physician leaders hesitant to do this?

We physicians are a fairly opinionated lot. We have invested many years convincing ourselves and others that we are special. We know what’s best. We are all above average. We are the experts. If we don’t know it, it’s not worth knowing. We rarely make mistakes. When a mistake occurs, it is almost always someone else’s fault. And we feel very strongly about all of this. If you don’t believe it, just question us and watch now arrogantly most of us will respond.

What is the case for doing it anyway?

Emotional arousal is blinding. It is hard to think clearly when you are angry, fearful, hurt or embarrassed. Moreover, people pick up on how you feel. You cannot hide your feelings. And the people around you will react instinctively to how you feel. They may attack, defend or retreat into stony silence, but they will not take risks or offer creative solutions. If you remain emotionally detached and genuinely curious, they are much more likely to speak to you honestly about what they think and feel. The pool of available options will deepen as a result.

How can you do it?

1. Recognize the problem. Most leaders believe that their negative emotional arousal is both justified and motivating. It is neither. It is a leadership failure.

2. Recognize your own arousal. This is not as easy as it sounds. Strong feelings erupt without warning and trigger problematic behaviors before we even realize we are aroused.

3. Do not act on your feelings. Keep your mouth shut until you calm down. Never click “Send” while you are still upset.

4. Help others recognize their arousal. They are no better at seeing themselves objectively than you are. Offer to consult with them about their arousal if they will do the same for you.

5. Ask clarifying questions. “Might we be overreacting?” “Should we sleep on this?” “Are we allowing our emotions to blind us to other options?”

How have you observed physician leaders improve the decision-making process by remaining detached and curious?

Physician Leadership: Solicit Input from Stakeholders

Kendall L. Stewart, M.D. 

Why are physician leaders hesitant to do this?

Once leaders decide what they want to do, they naturally switch to the selling mode. They want to hear from those who agree with them—from those who disagree, not so much. Leaders with made-up minds are reluctant to wake sleeping dogs. Like every other committed leader, they want to achieve their objective with the least effort required. They don’t want to take heat. Partisans do not welcome dissent. Soliciting feedback is hard work. It takes time. And inviting others to criticized your proposals is unpleasant.

What is the case for doing it anyway?

Most people want to express their opinions or at least be invited to do so. Not everyone will contribute. Those who do would prefer that you do exactly what they say, but everyone recognizes that decisions must eventually be made. They understand they will not always be happy with the result, but they will be a lot less unhappy if they are consulted before the final decision is made. Real leaders welcome dissent, respect it and use it to achieve their goals.

How can you do it?

1. Decide who the stakeholders are. Every decision affects someone. Take a few moments to figure out who will be affected and who might like to participate in the decision-making process. Even those who have no real interest in offering an opinion are usually pleased to be invited to participate in the process.

2. Invite input appropriately. Present the issue in a way that invites stakeholders to consider the case for and against their point of view. This even-handed approach will remind even the most opinionated to respect contrary perspectives.

3. Value data over emotion. Make it clear that while you welcome any and all opinions, you will give preference to evidence-based recommendations when making the final decision.

4. Clarify who is opining and who is deciding. This is not a mystery. The people who are signing the checks are deciding. Everyone else is opining.

5. Set a deadline. Do not let the arguments go on forever. Endless discussions always turn repetitive and personal. You can never know everything you need to know.

6. Make the best decision and move on. Whatever you decide will sometimes turn out to have been a mistake. When that happens, make another decision and move on again.

How have you observed physician leaders solicit input from stakeholders effectively?

Physician Leadership: Confront Others Effectively

Kendall L. Stewart, M.D. 

Why are physician leaders hesitant to do this?

Confrontation is hard. Because it is so unpleasant, most of us avoid it. Because we avoid it, we allow ourselves few opportunities to get better at it. And because it is hard and we are not very good at it, we avoid it. And so it goes. Like everyone else, we leaders spend most of our lives avoiding discomfort.

What is the case for doing it anyway?

If everyone read your mind and automatically did exactly what needed to be done while behaving respectfully and responsibly, you would never need to confront others. Has that been your experience in life? Inappropriate behavior is inevitable. Conflict is the result. Confrontation is the only way to deal effectively with these challenges while pursuing exceptional organizational results.

How can you do it?

1. Set realistic goals. No amount of confrontation will transform jerks into nice people. Focus on the one or two behaviors that must change.

2. Prepare. Do not confront others by the seat of your pants or when you are angry or poorly prepared. Take the time to think through exactly what you intend to say, how you intend to say it and what you expect to accomplish.

3. Make notes. Effective leaders do not attempt to wing these crucial conversations. Explain that you have made notes because this conversation is important and you want to make sure that you cover all of the important points.

4. Do not argue or get sidetracked. Ask the person you are confronting to listen without comment until you are finished. Promise him the same courtesy when you are finished. Deliver on that promise.

5. Document the confrontation. We all hear and remember what we want to hear and remember. Clarify your position in a letter.

6. Proceed to the next step. Confrontation is just one step in the process of holding others accountable. Painful as it is, you must follow confrontation with continued accountability or your efforts will have been wasted.

How have you observed physician leaders confront their colleagues successfully?

Physician Leadership: Make the Best Decision and Move On

Kendall L. Stewart, M.D. 

Why are physician leaders hesitant to do this?

There are a number of barriers to reaching the best-possible decisions. The data needed to make decisions is seldom perfect or complete. Emotionally aroused leaders are inclined to jump to conclusions before considering all of the alternatives. Just like everyone else, leaders are strongly inclined to take the easy way out and go along with the crowd. Faced with painful options, leaders may be paralyzed by the fear that their decision will be unpopular. But the most common reason leaders are hesitant to make the best decision is that they have not followed a thoughtful and rigorous decision-making process.

What is the case for doing it anyway?

You cannot avoid making a decision forever. You will never have all the data you need. You will never be able to fully trust the data. No matter what you decide, someone will criticize you. The only reasonable approach is to make the best-possible decision you can and then move on. If your decision turns out to be wrong, just make another decision. Leaders don’t have to be perfect. They just need to learn and improve. That may sound easy. It’s not.

How can you do it?

1. Take time to figure out what the problem actually is. The issue everyone is upset about is frequently not the real problem at all. When it’s time to make a decision, ask yourself what problem you are trying to solve. Ask whether this is the real problem. Making the right decision about the wrong problem is not that helpful.

2. Consider your options. Remind yourself and your colleagues that emotions are blinding. People who are aroused cannot see all of their options. Ask detached observers to help you identify your options. These dispassionate consultants will invariably think of options you failed to see.

3. Examine the pros and cons for each option. Leaders skip this critical step all the time. It is tempting to rush to judgment. Impulsive leaders just want to do something, anything. Going with your gut is overrated. Other leaders prefer to discuss options endlessly, fearful of doing the wrong thing, inviting criticism or not being liked.

4. Invite all interested parties to weigh in. Giving people a chance to express their opinions is never a problem and sometimes produces ideas or solutions you would have otherwise overlooked.

5. Announce your decision and get on with it. If new information arises, you can always reconsider and decide something else.

How do you make the best-possible decisions?

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?