Leaders Go First

The Hidden Cost of Conflict Among Healthcare Teams

The conflict, low morale, dissatisfaction and disruption that often go hand in hand with a mismatch in culture carries with it significant costs that may not be immediately apparent.  However, they can be quantified.  Here are a few examples of calculations used to quantify the costs:

·         One study done by the American Management Association on the cost of conflict showed that a manager will spend between 20% to as much as 50% of his/her time dealing with conflict in the work place.  In one particular healthcare system, the cost of conflict in managers’ time alone calculates out to

45 Managers x $85K/year x 30% = $1.147 Million

·         The Gallup Organization calculates the cost of the loss of one employee at 6 times that person’s annual salary.

1 Nurse x $65K/year = $390K

·         A business analyst uses the following formula to calculate the cost of dissatisfied employees:

Number of employees in the organization	50
What percentage is dissatisfied? (for any reason)	20%
Motivation level of dissatisfied employees - (what is their productivity as a percentage of the productivity of satisfied employees or as an ideal employee?)	60%
De-motivated level of dissatisfied employee	40%
Average hourly salary of de-motivated employ	$25
Average number of hours worked per week	40
Dissatisfied employee weekly wage bill:
(20% of 50 employees) x ($25 x 40 hours)	$10,000
Dissatisfaction cost per week (40% x $10,000)	$4,000
Annual dissatisfaction cost (50 weeks)	$200,000

·         The loss of one highly productive surgeon because of dissatisfaction with the service provided by disgruntled and inefficient OR staff will have a significant impact on revenue.

·         A surgeon performing an average of 20 cases/month at an average of $900/case
will take $216K/year in revenue with him should he go to a competitor.
Over 5 years, the loss in revenue would total over a million dollars.

The Benefits of High Employee Morale

A study published in Fast Company, May 2001, “Maister Class: Transform Morale Into Money” by Jennifer Reingold found that a company could boost its financial performance by as much as 42% by raising employee satisfaction by 20%.  In comparing financial performance of global offices, the top 20% of these offices significantly outranked the other offices by scoring one particular statement regarding employee satisfaction higher than their counterparts: "Enthusiasm and morale are high."

Peak Performers & the Vertical Learning Curve

One of the hallmarks of peak performers is that they are acelerated learners.  They reframe what others might label as mistakes or failures as "learning opportunities".  They are constantly and voraciously learning. 

Most of us arrive in medical school because we ARE peak performers.  Being a peak performer is the price of entry. But something seems to happen between the end of school/training and mid life.  I'm not sure whether we get tired of learning or we just get so busy that its easier to fall back on what we already know, or perhaps there's so much learning to do to keep up with advances in clinical medicine that we sometimes feel maxed out and just give up.

Regardless of the reason, as an industry, we are now paying a heavy price - specifically in our unwillingness to learn to use technology.  And until we buck up and embrace technology, we will continue to pay. 

The American College of Physician Executives (ACPE) did a survey last year on physicians and technology.  Read the article entitled Survey Reveals Physicians' Love Hate Relationship with Technology by David O. Weber from The Physician Executive, March-April 2004 pp. 4-10.  The results are enlightening and I highly recommend it.

There's an excellent article in the latest edition (March-April 2005 p.40) of The Physician Executive entitled Professionalism in Medicine:  The New Authority by Dr. Anthony Oliva.  This article, published exactly one year after the article above points out how physicians are losing ground as a result of our slow adoption of technology.

Oliva starts off by describing how the medical profession struggled to create and confer professsional authority over a period of many years.  But now our authority is being quickly eroded by forces in the marketplace like consumerism, performance information (now dissimenated electronically in the form of "best doctor lists") and marketing by pharmaceutical companies and other entities.

Oliva stresses the importance of physicians taking a leadership role in securing our professional authority for the next generation of healthcare practitioners rather than allowing the marketplace to usurp it.

Barriers to our success (roughly paraphrased from the article) are:

1. We have failed to set our own standards (allowing the marketplace to set them for us).
2. We lack the technology infrastructure to document and evaluate performance.
3. We do not have the systems in place to hold ourselves accountable.
4. We have not even begun to allow for the transparency needed to create the cultural shift.

We must, as a profession embrace technology - but even more basic still, I think we should be looking deeper for what might potentially be an even greater problem.  Even though our young physicians are graduating with great savvy in technology, will there just be some other disruptive phenomenon that comes along when these physicians are in mid-life?  Will they be as resistant to change as we physicians in mid-life are now?

Because acelerated learning is so critical to the success of peak performers, if physicians are to thrive as peak performers now and in the future, perhaps we should be teaching young physicians not just how to use technology (which in my mind is just content), rather we should be teaching them how to learn.

The Forest for the TRIZ

I just finished taking a class on TRIZ (Russian acronym for Theoria Resheneyva Isobretatelskehuh Zadach).  TRIZ (pronounced TREES) is a robust creative problem solving methodology developed by Genrich Altshuller in the 1950s. 

This process has been used extensively in many industries for innovative problem solving, new product/service development, creating and improving systems, capturing cost savings, boosting productivity and developing breakthrough technology.  It has not- surprise, surprise, been used to any great extent in healthcare.  I think it has tremendous potential and I'm looking for an opportunity to apply some of the concepts I've learned. 

Two quotes our instructor shared on the last day of class are the following:

“The worst sin of all is to do an excellent job at that which should not have been done at all”   --NY Times, anonymous

“We never have time to do it right, but we always have time (and money!) to do it over.”    -- Anonymous.

When I saw these quotes, I immediately thought of healthcare.  The first and most critical step of TRIZ is to define the problem.  If you don't take the time to get that part right, you'll be forever doing it over or worse still, working on the wrong thing altogether! 

I think we're continually doing things over in healthcare either working on the wrong problems or creating the same problems, making the same mistakes because we haven't taken the time to properly identify and define the problems in the first place.   Society is definitely paying the price. 

Altshuller developed the TRIZ methodology after he studied thousands and thousands of patents and discovered that there are really only a limited number of prinicples (about 40) involved in all of them.  According the Altshuller there is already an answer to every problem in existence, all one has to do is take existing knowledge and apply it differently.  The TRIZ methodology is a systematic way to innovate new solutions based on priniciples that have already been thought through.

I was attending a course at the American College of Physician Executives a couple of years ago.  I asked another participant attending a different course whether he was getting anything out of it.  He said, "Well, it would be a lot better if they would stop wasting our time giving us case studies on non-healthcare companies." 

When will we get it?  What is it about us docs that we feel compelled to continually reinvent the wheel (or just stick with the same old wheel we've been using) despite the fact that the wheels we develop aren't working anyway?  TRIZ is just one of the excellent methodologies that have been proven to be effective in other industries.  Anyone interested in learning more?

 

Little Acts of Leadership

William James said:

"I am done with great things and big plans, great institutions and big success.  I am for those tiny, invisible loving human forces that work from individual to individual, creeping through the crannies of the world like so many rootlets, or like the capillary oozing of water, which, if given time, will rend the hardest monuments of pride."

Physicians typically interact with dozens of people every day - patients, family members, hospital staff, office personnel, children, spouse, colleagues.  Each of these interactions offers a new opportunity to practice extending "tiny, invisible loving human forces". 

Leadership is not just about doing big things or making a huge impact through highly visible acts.  Leadership is not just reserved for a few docs who are willing to do these big things.  It's something each of us must consider if we are to make a difference in our industry.  It's about making a conscious choice as often as possible to be the best person I can be, to try on a new perspective for viewing the world. 

For one full day, try extending just a little more patience, interest, empathy, care or attention to each person you encounter, then, at the end of the day, see how you feel.  Imagine the difference this could make in the way people view physicians if we all tried this experiment.

Still Pimping...

I enjoy reading the blogs written by medical students and residents because they often take me back to the days of my own training, which, for the most part I remember with great fondness! 

However, reading this excerpt from Doc Shazam's blog Mr. Hassle's Long Underpants I felt frustrated and sad.  It captures, in my opinion, one of the biggest problems with medical school education today and it seems that things haven't really changed since I was the med student. 

Doc Shazam (a resident in Emergency Medicine): "The medical students (student doctors) are frequently intimidated and do what they're told no matter how hard you try to make it a friendly working environment for them...and have the impression that if I like them, they'll get into our residency (far from true).   Medical school ingrains such an attitude of hierarchy and teaching by "pimping" (the Socratic method), that trying to have an easy going conversation is next to impossible, especially for medical students that have come straight from college."

Not too long ago, I had an opportunity to teach some 1st, 2nd and 3rd year residents on styles of leadership.  After I had presented some material, I divided them into groups and assigned each group a particular leadership style.  Using some reflective questions as a guide, I asked them to discuss when each style might be most effective and to come up with examples of when they had either used or witnessed that style being used. I asked each group to choose a spokesperson to share the results of his/her group discussion with the larger group (about 30 residents).  To my surprise, there were several groups in which no one would volunteer to be the spokesperson. 

I think this was the direct result of the teaching methods described by Doc Shazam that are still being used in medical education today.  These methods teach students to keep a low profile, to avoid risk and never to do anything that might cause them to "look bad" in front of their peers.

In my opinion, we are training doctors who then go out into the world and carry these attitudes forward. 

Three unfortunate outcomes are:

1. Physicians who go into teaching turn around and use the same tactics that were modeled to them because those are the only tactics they know. This is self perpetuating.
2. Even worse, some physicians use these tactics with great gusto because for a moment, they have the opportunity to feel powerful superior to the student by humiliating him in front of his peers, staff and even patients.
3. But worst of all, physicians complete their education trained to keep a low profile and go into self-protection mode when challenged.  In my opinion, this is one of the root causes for the great shortage we have in the number of physicians willing to step up to the challenge of leading the change we so desperately need in healthcare.

For two years ending in 2002, I had the privilege of attending Antioch University (Seattle campus) where I earned the degree of Master of Science in Management.  During that time, I discovered the absolute joy of learning in an environment of mutual respect where students and professors learn equally from each other and the process is as valuable as the end result. 

Each student is valued for his or her contribution to the class and to the learning process.  Students are accountable for their own learning and there is no place for fear and "teaching" methods like "pimping."   

I also discovered my own love for teaching in a course I took on Transformative Learning Design as part of my Masters.  During that class, I developed my own philosophy on teaching.  I believe there are some medical schools working to develop more effective teaching skills for their faculty members.  I am committed to finding them and figuring out how I might contribute.  I think I have some excellent ideas.

Bigger Than My Reasons - Part II

Isaac Perlman, one of the world’s foremost violinists was playing a concert in Fischer Hall in New York City in 1995.  One minute into the piece he was playing, there was a loud pop.  People in the audience could see that one of his violin strings had broken. 

Fully expecting him to stop and change the string, the audience was amazed that he continued on without a moment's hesitation and finished the entire concerto.  As he finished, the audience rose in unison to give him a rousing standing ovation as they marveled at the feat he had just accomplished – playing this extremely difficult piece in its entirety on just 3 strings of his violin. 

Later after the concert during an interview, he was asked why he had decided to continue through the piece without stopping to change his string, something that everyone would have expected him to do.  Mr. Perlman replied, “Sometimes it is an artist’s task to find out how much music he can make with what he has left.” 

When I choose to be bigger than my reasons (fear, adversity, illness, feeling unprepared, fatique or whatever they are), I am often surprised and delighted to discover that I am capable of doing far more than I ever imagined.

Bigger Than My Reasons

Friday night I started noticing a bit of a sore throat and by Saturday morning realized that I've caught the bug that's been going around my neighborhood.  This has been a great opportunity for me to practice one of my most important leadership tools - my willingness to be "bigger than my reasons". 

To be most effective as a leader, I participate fully with what's in front of me now.  It's a waste of time, energy and focus for me to wish things were different from the way that they are right now in this moment.  A more effective approach is to accept things as they are now and use that as my starting point, my given.  So, given that I'm feeling draggy right now, what will full participation look like for me today?  This is an act of self-compassion.

There's a fine line to walk in situations like this.  I want to honor my physical well-being and at the same time honor the commitments I've made to myself and to others.  For many years, I honored my commitments to others at the expense of myself, punishing my body and being anything but a good role model for my patients.  Whenever I got sick - which was a frequent occurrance once myringotomy and tonsillectomy season rolled around - I would stay sick for weeks because I was so busy taking care of everyone else, that I forgot to take care of myself.  My illness would become the reason I was crabby to the staff, the reason I was tired, the reason I was less loving and present for my children when I got home at night, etc., etc.  I became my cold.

I've learned that it doesn't have to be an either/or.  With consciousness and creativity, I have the choice of making it a both/and.  So first, I accept that I am feeling under the weather today and that full participation for me today might not look exactly the same as full participation for me on a day when I am at my very best. 

I think of ways to support my body (get a good nights sleep, dose up on vitamin C, take my zicam, think of a time later when I can take a 10 minute power nap, do a light workout instead of my regular workout). 

Then I focus on what is in front of me now and give it my best.  Rather than let my physical state be a reason for not participating fully, I focus on being bigger than my reasons.  I AM NOT MY COLD!  Before I know it, I'm fully engaged with what's in front of me now and thoughts of my cold have slipped into the background.  At the end of the day, I realize that I actually forgot about my cold and really enjoyed my day.   Since I adopted this strategy a couple of years ago, I've found that I rarely get sick and when I do, I get over it much more quickly. 

Just for fun, try being bigger than your reasons, whatever they are today.  Let me know if it works for you.

My Unique Gift

People have written volumes on the purpose of man/woman.  Almost everyone ponders the meaning of life at some point.  People who have no sense of purpose are more likely to drift, suffer from depression or just exist day to day through dull, unfulfilling lives.  On the other hand, people who have a clear sense of purpose tend to enjoy life more fully, contribute more to their families, communities and to society and to experience more fulfillment.

I have discovered that an empowering position to hold is the following:

"The reason I am alive is to contribute my unique gift to the world." 

Each of us is born with a unique set of talents or natural abilities.  We are further shaped through our early experiences by the beliefs, attitudes and opinions of our families, friends, mentors and society.  All of these factors combine to determine the uniqueness of each individual.  That uniqueness is the gift each individual has to express in the world.  In fact, to withhold expression of my unique gift is actually damaging to my spirit.

There are many ways to discover the gift that I am. 

I recently attended a wonderful workshop on Peak Performers lead by Nikki Nemerouf for a group of TEC CEOs.  Nikki has developed a handy Internet-based tool for helping people discover and define their gifts.  The URL is www.giftsite.org. 

I highly recommend visiting this site and spending a few minutes defining your own gift.  You can also do it as a team building exercise or with family members and friends.  It's fun and it's completely free.  The site provides a way to send "gift cards" to other people (I sent one to my daughter at college) and gives some great tips on how to use the process with groups and teams.

As physicians we often limit ourselves to thinking that our gift to the world is healing, and perhaps it is.  But each of us has a unique way of expressing our gift - a unique spin so to speak.  Go through the exercise.  You might discover that in addition to being a talented healer, you could have a completely different gift to contribute.

Check it out and let me know what you think!

Spiral of Lethargy

One of the most helpful strategies I've learned for managing my energy is not to waste one speck of it worrying about what I should have done or didn't do or could have done differently, except to see whether there are lessons to take away that will help me be more effective going forward.

I have freed up lots of energy taking this approach. Rather than get down on myself, I stay curious and reflect about what didn't work and focus on staying in action with what does work.  Focusing on the past can be an insidious drain.

One of my clients was recently very much stuck in a downward spiral of lethargy after losing her job.  She spent a lot of time focusing on what she could have done differently and developed some fear around what might happen in the future.  Having been in this position before myself, I shared my formula for successfully extracting myself from this life-sucking emotional state.

1. Decide - I make the decision that I do not want to be in this position another minute.
2. Exert Control - I choose something, even the smallest thing, over which I have control - For example, I make up my bed (this was my strategy as a resident when at times I felt like my whole life was under someone else's control!)
3. Make a commitment to myself that I KNOW I will keep and KEEP it! - This could be as small as I will eat lunch at noon or I will balance my check book or I will make a call I have been putting off.  The act of making and keeping commitments to myself builds self-esteem.
4. Celebrate even the smallest success.
5. I remember to have compassion with myself.

Once I begin taking these steps, I build momentum.  Having a support person or a group of people to whom I am accountable is also a big help.

Opportunity

One of my friends, Dr. Bob Rausch writes about energy and how to create more of it.  In his newsletter today he included this quote that I really like. 

Walter C. Cole  states, "Look for the opportunity in every difficulty instead of being paralyzed at the thought of the difficulty in every opportunity." 

Another friend of mine refers to this as looking for the gift.  Adopting this attitude toward life is a great way to build resilience.