Leaders Go First

Feedback is My Friend

A colleague sent me the following abstract that will appear in the May 2005 issue of Medical Education.

Sargeant J, Mann K, Ferrier S. Exploring family physicians' reactions to multisource feedback: perceptions of credibility and usefulness. Med Educ 2005; 39(5):497-504.
Purpose: Physician performance is comprised of several domains of professional competence. Multisource feedback (MSF) or 360-degree feedback is an approach used to assess these, particularly the humanistic and relational competencies. Research studying responses to performance assessment shows that reactions vary and can influence how performance feedback is used. Improvement does not always result, especially when feedback is perceived as negative. This small qualitative study undertook preliminary exploration of physicians' reactions to MSF, and perceptions influencing these and the acceptance and use of their feedback.

Special Status

Physicians often fall into the trap of developing a false sense of self-importance.  There are lots of aspects of practicing medicine that contribute to the development of this state of mind.  For example, when I'm called in for an emergency, everything and everyone around me is instantly put on the back burner until that emergency is resolved.  Everyone has to wait until I'm finished.

People call me "doctor" and for the most part give me a certain level of respect not always afforded to others.  Patients arrange their own schedules around their doctors appointments rather than vice versa. 

As a result of all of these factors, many of us develop a sense of having "special status."  We sometimes even come to believe that we care more about our patients than anyone else.

Once I've internalized the belief that I have special status I am more likely to discount the contributions made by others.

I had a physician client who asked me to help him with some morale problems he was having with the office staff.  I had the staff fill out a survey, then I interviewed each staff member about what it was like to work in the office for this physician. I was impressed with the sincerity and competence of the staff, their dedication and loyalty.

Each of them told me that their boss was a wonderful doctor, but that he was not very approachable and he seemed kind of cold to them.  They did not feel appreciated. 

When I reported back to the physician on his staff's perception of him, he was surprised.  He said, "Giving excellent patient care is so important to me that I focus so intently on taking care of my patients I just don't have time to pay that much attention to my staff."

I asked him if he thought they did a good job and he said that he did. Then I pointed out to him that each member of his staff was just as focused on providing the very best patient care as he was and in their various roles, they each gave outstanding patient care.  Each of his staff members was a critical part of the team in his office - an office which had a reputation in the community for giving excellent patient care.

He stopped for a moment then admitted that he had never really thought of his staff in that way.  Some time later I checked back in with the staff and learned that the physician had become much more open with them, making a point of thanking them for their work, complimenting them and taking more interest in them.  Morale was up and things were much better.

Albert Einstein once said, "A hundred times every day I remind myself that my inner and outer life depends on the labors of other men, living and dead, and that I must exert myself in order to give in the measure as I have received and am still receiving."

I think this quote is a good reminder that even though I AM a doctor, so what?  I'm no better or worse than anyone else.  I have no special status in the world.  To the degree that I remember to be grateful for all the things others have done and are doing for me - from inventing electricity to answering my phone and keeping my schedule straight, I am more open and approachable - more human - for in fact, that's all that any of us are.

Pandora's Box

Empathy is one of the Emotional Intelligence (EI) competencies that falls under the domain of Social Awareness (the 3 other EI domains are Self-Awareness, Self-Management, and Relationship Management).  I came across an article on empathy today as I was visiting Dr. Maurice Bernstein's blog the Bioethics Discussion Blog.   The article by Dr. James T. Hardy is entitled An Overview of Empathy.  It's a great read, as is Dr. Bernstein's post.

Dr. Hardy addresses the exact issue I was just discussing in my previous post on Emotional Intelligence and that is that many physicians are unwilling to make the effort to exercise their emotional intelligence.  Here's what he says in the article:

"Because empathy is such a powerful communication skill, we might suppose that clinicians would scramble to learn about and use it at every available opportunity. However, this is not necessarily the case. Clinicians have many reasons for not offering empathy to patients. An informal survey of practicing clinicians participating in a recent clinician-patient communication course revealed misgivings (and misconceptions) about empathetic communication. Concerns mentioned included:

• "There is not enough time during the visit to give empathy."
• "It is not relevant, and I'm too busy focusing on the acute medical problem."
• "Giving empathy is emotionally exhausting for me."
• "I don't want to open that Pandora's box."
• "I haven't had enough training in empathetic communication."
• "I'm concerned that if I use up all my empathy at work I won't have anything left for my family."

"In our experience, empathy facilitates the clinical interview, increases efficiency of gathering information, and honors the patient. Empathy need not be awkward nor emotionally exhausting; unlike sympathy, empathy does not require emotional effort on the part of the clinician. An appropriate statement or gesture of empathy takes only a moment and can go a long way to enhance rapport, build positive relationships, and even improve difficult ones. Studies have shown that when opportunities for empathy were repeatedly missed, visits tended to be longer and more frustrating for both physician and patient. (references 18,20) Conversely, empathy may save time and expense and often is a cost-effective method of facilitating early diagnosis and proper treatment."  (reference 10).

In reading through the reasons physicians gave for not employing empathy more often, I got a sense that we physicians are almost afraid of being too emotional.  The idea of "opening up Pandora's Box" smacks of fear of that which might be unknown and therefore uncontrollable.

I think Hardy's article speaks to the tremendous need for educating medical students, residents and physicians about emotional intelligence - what it is, why it's important and how to develop it. While many training programs do have courses to teach empathy, I think that teaching the emotional intelligence competencies would be much more effective through an integral approach rather than to pull out one competency and teach it in isolation.

Maurice's new blog and the article offer some definitions of empathy, sympathy and pity.  Both are worth the read.

Emotional Intelligence - How to Get Some In Healthcare

An interesting assortment of people attended our introductory class on coaching physicians this past Wednesday night.  One of the topics we discussed was the lack of awareness in the health care industry of the extensive work being done on emotional intelligence (EI)** and how EI impacts performance. 

My masters thesis - A Leadership Model for Transformative Change in Healthcare addresses this topic.  In the research I did for my thesis, I discovered very few references to studies being done on emotional intelligence in health care despite the fact that numerous studies in other industries have documented its importance as a key differentiator for high performers vs. average performers.

I've spoken many times on this topic and have found that physicians are less likely to be open to learning about it than nurses, managers and other health care professionals.

One possible reason is that emotional intelligence CAN be developed, but it takes conscious awareness over a period of time.  Although it can be learned ABOUT in a classroom, to actually increase one's emotional intelligence in any of the four areas (self-awareness, self-management, social awareness and relationship management) does take practice. 

Because it requires implicit learning (like breaking and making a habit) rather than cognitive learning (like memorizing a formula), increasing emotional intelligence will only happen through practice over time.  I think physicians hear this and decide its not worth the effort. Much of medicine today is geared toward the quick fix.  No wonder physicians don't get enthused about EI. 

On Wednesday night in our class, all of the participants (physicians, nurses, coaches and consultants) agreed that physicians as a group seem to have very little self-awareness regarding the way their actions and behavior impact others.  Research has shown that without self-awareness there is virtually a zero percent chance of developing the other three areas of emotional intelligence.  So lack of self-awareness just perpetuates the problem.

In my opinion, the only way for us to begin creating the shift that needs to occur is to start early by helping medical students to both appreciate and develop their own emotional intelligence.   It CAN be done and in fact, medical training would provide a rich, if not ideal environment in which to practice the skills.  With the right kind of program, medical students could graduate with a big head start in life, if only...

** For more info on Emotional Intelligence, I recommend reading any work by Daniel Goleman, but particularly Primal Leadership by Goleman, Boyatzis and McKee.  See the description in the left hand side panel of this site.

For more info about the courses we offer go to www.encompasshealth.com/class_hc.html.

Five Basic Needs

I read this poem, author unknown, a few years ago and saved it.  I think it captures the essence of my earlier post... "Still Pimping".  Whether I'm teaching medical students and residents, mentoring younger physician partners, interacting with nursing and administrative staff and especially in communicating with patients and their families, to the degree that I remember the other person has these five basic needs, I will be more successful.

My Five Basic Needs

I need to be seen.

   I need to be heard.

      I need to be respected.

         I need to be safe.

            I need to belong.

When all of my basic needs are met…then…

     I am ready to learn.

                                             Anonymous

From the book The Heart of Coaching: Using Transformational Coaching To Create a High-Performance Culture, by Thomas G. Crane, FTA Press, 1999. San Diego, California.

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.

Grocery Story Lessons

I just got back from the grocery store where I ran in, picked up six items, whizzed through the self-service line and was out again all in just 10 minutes.  As I was driving away, I got to thinking about my initial resistance to self-service at the grocery store. 

Normally I'm a technology junky.  I love gadgets and I'm certainly self-sufficient, but for months, I walked past the empty self-serve aisles to stand in line for a live checker.  So what had I been allowing to get in my way of learning how to use the scanner in the self-serve line? 

Hummm.... weighing the produce?  finding the barcodes?  foregoing the opportunity to be waited on?   No, these were just silly superficial things - well except that I do like to be waited on.

I decided to use one of my most powerful get-to-the-bottom-of-things tools.  As a leader, I tell myself the truth and frequently ask, "What am I pretending not to know?"  Reflecting on this powerful question, I came up with a more likely candidate: 

• I don't like to change my comfortable habits!  Even when doing so would be of benefit in the long run.  Ouch - I think of myself as a person who embraces change.

One day, the lines were long and I was in a big hurry so I did bumble through the self-serve line with the help of the clerk who showed me how to do the produce.  It was really a piece of cake and now I opt for self-serve every time. 

Not all change is as easy as learning how to use the self-serve line at the grocery store, but this entire experience was a good reminder to look for other areas in my life where I resist change, then to ask myself, what am I pretending not to know?

Location, Location, Location!

I'm sure you've heard the old saying about the three most important traits that make for the best piece of real estate.  Yep, you got it, location, location, location! 

I think the three most imporant traits for a leader are  Self-awareness!  Self-awareness!  Self-awareness!

What is self-awareness and why is it so important?

Self-awareness is the recognition of how my thoughts, feelings and actions relate to the results I'm creating in my life. 

Emotional Intelligence* researchers Boyatzis and Burckle (1999) discovered that without self awareness, a person has virtually no chance of successfully and reliably demonstrating self-management.  Even subjects who had a high level of self-awareness were successful in self-management only about 50% of the time.

Without self-awareness, I am likely to go bumbling through life never recognizing the role I play in creating my own results.  I may have the sense that life happens to me rather than recognizing that I have the power to make things happen and create my own results.

To the degree that I recognize how my thoughts, feelings and actions relate to my results, I have more opportunity to choose how I will respond in any given situation.  Increasing self-awareness takes practice, but the pay-off is exceptionally high.  That's why I think the three most important traits of a leader are Self-awareness!  Self-awareness!  Self-awareness!

To learn more about Emotional Intelligence, read Primal Leadership by Goleman, Boyatzis and McKee.  See notes under my Best Books list to the left.

Be the Best Boss

Today I discovered Don Blohowiak's wonderful Blog Leadership. Now.  His post for today is well worth the read.   I think one of the challenges we have in healthcare is that doctors often forget that they ARE bosses.  We get so focused on taking care of patients that we often forget that other very important role most practicing physicians have - managing a staff. 

In a recent workshop, Don asked the participants what they could do to lead their staffs to greatness.  One guy offered this gem of a response:

"Be the best boss your staff will ever have."

Don says,

"Oh, yeah!

What an exquisite personal goal. Imagine the power of holding this aspiration in your mind every day in the workplace.

How do you operationalize such a lofty objective?

Well, you already know what great bosses do, don’t you? (And if you’re not sure, it’s easy to find out. There are now, literally, tens of thousands of books and untolled articles documenting the how-tos.)

The real challenge is not in scouring a bookstore or traversing the far reaches of the internet. The toughest territory remains in an easily identifiable little space that’s easy to point to but hard to penetrate: The vast layers of complexity between our ears.

Still, I can recommend the first two steps:

1. Repeat to yourself, immediately before entering the workplace, “Today, I’m doing the things I need to do to be the best boss my associates will ever have.”

2. Whenever a situation arises (like every other minute or so) that requires your managerial wisdom, before you act on impulse, pause and ask yourself this question: “How would the best boss these folks will ever have handle this situation?”

You’ll probably be amazed at the answers that come to you, the actions you’ll take, and the results you’ll get."

Thanks Don!  Leadership doesn't have to be about changing the world or being famous.  Sometimes it's just about stopping a split second to ask yourself these questions that could make all the difference.