Physicians are facing many challenges in a rapidly changing health care environment, given the move to ACOs, team based cared, and changes in the payment model. Many of those
working in hospitals and clinics are finding themselves in leadership positions, which extends beyond their responsibilities focusing on their patients and the “diagnose and fix” model of solving problems. This new role includes knowing how to be a “facilitative leader”, engaging others in problem solving, and understanding how to manage change – things which were not taught in their medical school training. As doctors move into these leadership roles, they interact in new ways with other clinicians, nurses, auxiliary staff, and they may not always be aware of their impact on others and how to optimize their functioning in these new roles. More and more institutions are designing leadership development programs and employing executive coaches to help physician leaders increase their effectiveness.
I participate in a learning group of coaches and organizational development consultants who work in health care, and recently I facilitated 2 conversations about leadership development, specifically asking: What’s different about coaching physician leaders?
We identified several challenges that are unique to coaching physician leaders, such as:
- Physicians are used to being individual contributors, so it’s quite a shift to begin leading others – which means engaging other staff, asking questions and fostering collaborative problem solving.
- Doctors need to change their mindset from “white coat leadership” to “facilitative leadership.” That skillset includes knowing about change management, how you lead and manage change.
- Research-oriented physicians, who work by themselves, tend more to introversion – and they may find themselves needing to stretch to extraversion to be more involved with other staff.
- The role of the leader is often unclear to physicians who do not have mental models of leadership in a clinical setting, nor role models.
- Some have little desire to do things differently, if seeing patients is what they prefer to do. Many doctors think “I don’t want a boss” or “I don’t need a boss because I’m responsible for my patients, or I run this practice”, as well as, “I don’t want to be a boss”.
One tool to help develop physician leaders, or any organizational leaders, is a 360 assessment, in which all of the people who interact with the physician are asked to give their assessment of his/her performance around selected leadership competencies. Coaches are often engaged to help leaders make sense of the 360 feedback, to make it a useful developmental tool. Many physicians are not accustomed to receiving feedback from people they work with, so this is a new way of doing business. What’s more, doctors are more attuned to patient feedback, in the form of patient satisfaction surveys – a more collective data collection, and not feedback directed to one person.
The coaches in our group reported a range of reactions to the feedback, from being open and accepting of the data, to being somewhat resistant to hearing the feedback. We brainstormed some strategies for helping the doctors work through the resistance and engage with the data:
- “It’s just data – and you can decide what to do with it”. Framing it this way helps to remove any judgment about it: “It’s not good or bad, it just is. Let’s see if we can make sense of it together.”
- What’s the kernel of truth in the feedback? This question supports “it’s just data”, and enables the client to look at the data separate from him/herself. S/he is not the data. It’s empowering to think that one can evaluate the truth or validity of feedback and determine what to pay the most attention to.
- What’s the impact of this behavior on others? On yourself? Asking this helps put the data in context of the desired intention of one’s behavior, which can be followed up with: “What’s the difference between your intention and their/people’s perception?” Oftentimes we, or our clients, aren’t aware of our impact – we intend one thing but achieve a different result. Most of us want our behavior to match our intention, and when seen that way, the feedback can be seen as helpful.
- It’s important to ask “Is this competency important in the person’s job?” If not, we should skip that data point. Some 360’s include this question, but not all.
- Look at the broader perspective of what’s happening in the system, i.e. is there anything in the system – the organizational structure, the job definition, the roles and responsibilities, the business processes, that are affecting the client’s ability to do their job well?
- Take time. Many of us have a strong reaction to feedback, especially if it presents a different image of ourselves than our self-image, so we need time to work through our reaction. If we have a strong reaction, we’re not in a state to think rationally/reflectively on the data, so we need to give people time to deal with their emotional reaction before discussing the data.
- Coaches also need to help clients process that emotional response, by acknowledging the feelings, and putting parameters around the data, i.e. The negative feedback or criticisms do not take away from the many wonderful parts of the client’s performance. We all tend to focus on the negative, and we need help putting it in perspective. In addition, the “areas for improvement” are meant to assist in the client’s development – they are not meant as a personal affront or disrespect.
What challenges does your organization face in developing your physician leaders? Let me know how I can help you with your leadership development program.
*The hidden curriculum of medical education have been identified as: loss of idealism, adoption of a “ritualized” professional identity, emotional neutralization, change of ethical integrity, acceptance of hierarchy and the learning of less formal aspects of “good doctoring.” (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC520997/)
Physician photo from nursinghomepro.com
Excellent article. I think 3 other areas to look at are:
1) the development of empathy in physician leaders, because physician training typically has a chilling effect on empathic response, but empathy is a very important skill for facilitative leadership
2) risk tolerance – physician training tends towards the reduction of risks as much as possible, and
3) related, tolerance for ambiguity
All of these are areas where physicians must work against their training in order to cultivate essential leadership skills.