Tip 11: Closing in on the knowing doing gap

Closing in on the knowing doing gap

In the past few issues we've been closing in on the "Knowing Doing Gap". I was first exposed to this idea early in my career as a physician when I began to ask the question "What really matters most to patients?" It became much more clear after being exposed to Jeffery Pfeffer and Robert Sutton's, Harvard Business Review book called, "The Knowing Doing Gap: How Smart Companies Turn Knowledge Into Action." While you can apply these lessons in many contexts, there is no wider "Knowing Doing Gap" than what we see in Healthcare. Readers of the Coach+Leader may have taken the time to stop and ask "What matters most to patients?", but many leaders and physicians have not. Again, it's not for a lack of caring, it's more about simply being too busy/focused on the "operational" factors to listen to the patient. So we naturally fall short in the delivery.

I had an insightful coaching conversation with a Chief Medical Officer last week. He told me that he was moving forward in working with his medical staff to develop role descriptions to improve physician leadership. While discussing some of the specifics in a meeting with some of his docs, he told me he made the mistake of using the word "accountability," because it seemed as if it was, or has become a dirty word with his physicians. He said that it seemed to instantly change the mood of the conversation and it took a while to get the discussion back on track. "I don't understand why I got that reaction," he stated. So, why did a group of highly accomplished physicians frame the word negatively? And as their CMO stated... "These are my good guys".

Well these so called "good guys" have a point. As soon as the "A" word was uttered, they were asking, "Accountable to whom... you, the CEO, the Board?" "Is this one more thing to do?"

They're reacting to the notion that we leaders believe we must hold people accountable for their performance and the results of their actions. This top-down approach to accountability doesn't often work out in anyone's favor, and is indicative of the "command and control" business environment that dominates healthcare. We should be asking ourselves: Do you see accountability as a challenge or opportunity? Is the idea of accountability being promoted as a carrot or a stick?

If you recall, our last Coach+Leader issue concluded that so many of these so called "accountability tools" are often perceived as top-down measures, punitive systems, corrective tools, etc. So naturally when we hear the "A" word being uttered by our bosses, it comes across negatively. How do we work around that? We need to shift from that old mindset to one that acknowledges and celebrates individuals that demonstrate the behaviors that matter most to patients.

Tip 11: How to close the "knowing doing accountability gap": Putting the patient in the center.

A few weeks ago you might recall our Coach+Leader issue titled: Accountable to no one... well maybe the patient? There's a hidden lesson in that title that's counter to the command and control way we've been getting things done. First we need to determine how and why this accountability conversation became so challenging? Then, we need to center the conversation on patient accountability.

If we're going to have a successful conversations on the subject of accountability, no one can argue that it must be about the patient. Think about it, when you put the patient in the center of your accountability discussions you remove the "command and control" barriers that dilute involvement. This puts fear and egos on the back burner and allows you to engage staff in a more personal and relevant dialogue. When we take the middle man (organizational leadership) out of the equation, the conversation is directly about the role we must play to be accountable to the patient.

Framing the conversation around being patient-accountable, shifts the purpose of accountability from a negative to a positive. I'm not suggesting that the word "patient" has magical powers, but I have used it many times to shift a seemingly top-down conversation directed at medical staffs, to a highly collaborative discussion that helps us acknowledge our need for improved accountability through a lens based on putting patients first.

Understand also that the "A" word does not need to result in a conversation about what do do, but more about how to show up with the behaviors that create the right conditions to reduce harm and improve care. Working with your staff/team to develop a role description to improve accountability can't be a conversation of what I (the leader) want from you, but a conversation of accountability based on what our patients require from all of us. You'll discover that this ongoing challenge of improving accountability becomes much less of a lofty conversation about what we leaders wish our staff would do, and more about the role we must all play to gain our patient's trust.

One final thought: For leaders that successfully collaborate with staff and build a role description, there is NO "Knowing Doing Gap"... everyone is clear about what matters most to patients, because it informs their day-to-day work and how they practice as leaders.

The Coach+Leader will return after the first of the year. Enjoy a happy and peaceful holiday.

Brian Wong, M.D.

---

Feel free to join me on Facebook to further this conversation - I'd be happy to visit with you about how you'd see your organization implement a role description.

Visit the Patient Driven Leadership Site.

The Coach Leader is a bi-monthly series of ready-to-use tips to assist you in developing a concrete leadership practice that has the most impact on improving patient care.  Why become a Coach Leader?

1. Patients expect us to work as teams.
2. Patient centered teams need a coach.
3. Every leader has a coaching role.

It's a straightforward point of view that focuses on best utilizing your time as a leader by emphasizing your role as a coach. As a Coach Leader, you'll gain the ability to mobilize your people into patient centered problem solving teams and have the most impact on improving care.

---

COMING SOON!

Everyone is looking forward to Dr. Brian Wong's upcoming book. After years consulting with hospitals across the country, Dr. Wong's unique perspective and deft storytelling takes us inside a hospital fraught with the day to day challenges Physician Leaders, Managers, and Nurses all face, and introduces cultural strategies to overcome them without adding more work to our overburdened days. Dr. Wong has created memorable, real-life characters illustrating today's most pressing challenges in a dramatic hospital setting every reader will recognize.

Tip 10: “Why are we here?" Answering the accountability dilemma.

"Why are we here?" Answering the accountability dilemma.

I must have struck a nerve in the last issue of Coach+Leader. A number of you sent thoughtful questions and personal stories citing inadequate accountability throughout your organizations. It seems that every healthcare leader I talk to is searching for real solutions to improve organizational wide accountability. Your questions and stories reinforced the need to continue addressing this accountability dilemma.

Let's take a few moments to further develop our understanding on how to build the foundation of an accountability based, patient-centered culture.

One email that caught my attention was from a veteran CEO that I met at a conference several months back. I asked his permission to share the message with you. He wrote: "Dear Dr. Wong, I thoroughly enjoyed reading your position and plan for improving organizational accountability. This is certainly a challenge that myself and other CEO's speak about and contend with daily. While I certainly agree with the premise and need for the development of a role description, I couldn't help but think about many of the measures we've already put in place. Just last year we revamped our code of conduct, performance evaluations, 360 reviews and a host of additional HR tools to encourage greater accountability and engagement. In addition, we recently brought in an outside resource to help our leadership update our Mission, Vision, Values. As far as I can tell, these investments have provided very little accountability improvement... leaving us with the same issues you detailed.  I don't want to come across as pessimistic, but if we can't improve accountability with these efforts, I'm a bit anxious about continuing down the road and expecting different results. Where are we going wrong and how are the solutions you're proposing different from what we are currently doing? "

Much of what we are doing in healthcare to encourage accountability and promote better engagement relies on reactive strategies, tactics and tools (i.e. code of conduct, performance evaluations, 360 reviews, etc). I have found that these tools are often perceived by staff as corrective, top-down measures...none of which initiate collaboration and better align leadership, physicians and staff.

You might be wondering, "But what about the recent investment in revamping his Mission, Vision, Values. Couldn't this be classified as a proactive/preventative measure that should be helping to improve workforce accountability?" Maybe in theory. The fact is, even the most well intended mission,vision,value statements fall flat when it comes to engendering personal change and improved accountability.

While I believe an organization's Mission, Vision, Values statement is important, it's a stretch to suggest it will set the personal standards, expectations and behaviors needed for an organization to achieve an accountability based, patient-centered culture. If you spend a lot of time in hospital executive offices, you'll often see organizations' visions, missions and values written down somewhere, often in the main lobby for you to ponder as you pass through. Other likely spots: the cafeteria, the doctors lounge ( if we are so lucky), and of course the homepage on the website. Yet, senior executives are often blind to the impact these guiding principles actually have and how well they are understood (or not), outside of the executive suite. That is, if you asked the average physician, director or nurse, my guess is that they might not even know the mission, vision, and values, much less it relates to their own work in taking care of patients.

In the last few issues of Coach+Leader we concluded that the lack of accountability we all see isn't caused by a shortage of people that deeply care for patients, but a deficit in what we identified as our leadership infrastructure. We determined that if we are going to produce sustainable gains in organizational accountability, then we must become intentional about setting the standards and communicating those standards on how we must work together. An Organizational Role Description will become a key tool as you progress to an accountability based, patient-centered culture.

Tip 10: Giving value to our mission, vision, values statement.

Lets take a closer look at what makes a Role Description the answer for improving organizational accountability. As you evaluate each quality, I suggest comparing and contrasting how it's different from your organization's mission, vision, value statement. I find this helps clients gain context and perspective for how a Role Description can benefit you and your organization.

1. Articulate specific targets: 
Studies in other industries show that engagement and satisfaction improves when leaders clearly convey what the shared goals of every work unit are. Physicians and nurses are no different. They don't get impassioned by fuzzy mission statements. They want to line up behind concrete goals that they can fulfill together.

Here's an example of a real team target taken from a client's Role Description: "To help improve the patient's experience, I must take listening to my colleagues and staff just as seriously as I would my patient". In a nutshell, drop the buzzwords and corporate speak, and use easily understood and unambiguous terms.

2. Make it personal:
Unlike mission,vision,value statements which can be perceived as big picture and often nebulous, Role Descriptions focus at the individual level much like a Job Description. At any level in the organization (physicians, administration, staff), employees are challenged to try to convert the vision of the organization into our day job. Your Role Description identifies and engages individuals in specific actions and behaviors that bring the vision and mission statement to life. We all know that the most compelling leaders communicate the organization's vision effectively. A Role Description goes one step further by helping you clarify how team members can best contribute, and convert the concepts into a usable practice. When leaders take the time to co-develop a role description with staff, we help everyone gain clarity as to how to personally have a greater impact on improving care and overall team performance.

This part of your leadership infrastructure allows us to bridge the gap between the vision of the organization and create a solid practice that guides our working relationships and easily translates into actions in our day-to-day job. Here is a sample of a Role Description taken from a Medical Staff that demonstrates this quality: "As a physician I need to make it safe for staff to speak up so that we can continue to prevent errors".

3. Create patient value.
I can't tell you how many times I've seen eyes roll when someone says "Are we really putting the patient in the center?" A role description leaves those "big audacious goals" where they belong and requires us to define the competencies, expectations and behaviors that have the most impact on generating patient value. This is where patient-centered care begins.

Hint: Begin with the T.R.U.S.T.E.D. card.
We have found that these attributes contribute greatly to improving patient trust and care. This process aligns our role with what matters most to patients and organically develops accountability. To request a card, email us at bedsidetrust@me.com and we'll be glad to send you one.

Bottom line: You can't force accountability... but you can certainly create conditions that produce and encourage it.

I look forward to continuing to discuss how best to build an accountability based patient-centered culture and sharing more road-tested ideas.

---

Feel free to join me on Facebook to further this conversation - I'd be happy to visit with you about how you'd see your organization implement a role description.

Visit the Patient Driven Leadership Site.

The Coach Leader is a bi-monthly series of ready-to-use tips to assist you in developing a concrete leadership practice that has the most impact on improving patient care.  Why become a Coach Leader?

1. Patients expect us to work as teams.
2. Patient centered teams need a coach.
3. Every leader has a coaching role.

It's a straightforward point of view that focuses on best utilizing your time as a leader by emphasizing your role as a coach. As a Coach Leader, you'll gain the ability to mobilize your people into patient centered problem solving teams and have the most impact on improving care.

---

COMING SOON!

Everyone is looking forward to Dr. Brian Wong's upcoming book. After years consulting with hospitals across the country, Dr. Wong's unique perspective and deft storytelling takes us inside a hospital fraught with the day to day challenges Physician Leaders, Managers, and Nurses all face, and introduces cultural strategies to overcome them without adding more work to our overburdened days. Dr. Wong has created memorable, real-life characters illustrating today's most pressing challenges in a dramatic hospital setting every reader will recognize.

Tip 9: Accountable to no one....well maybe the patient?

This issue of "accountability" continues to grow in popularity and isn't going away anytime soon. Not a week goes by where I don't hear real concerns and questions that directly relate to a lack of accountability from boards, administration, physicians, and most importantly, our patients. Such as:

"Are these nurses that are caring for my sister even talking to one another...accountability seems to go out the door with each shift?"

"How do I get my medical staff to abide by our code of conduct?"

"How do I get our physician leaders to take a greater interest in our strategic plan?"

"How do I get those guys to participate in the pre-op time outs and checklists?"

"How can I get my clinicians to take ownership of more patient safety initiatives and participate in our risk management processes?"

"How do I get my docs to attend RCA meetings where they are directly involved?"

"Why aren't these folks communicating better with our nurses and staff?"

Sound familiar? I'm guessing most of you experience or have experienced similar challenges. So why is accountability a regular top of mind issue for so many of us?

Let's drill down on this seemingly widespread concern of "accountability". For the purposes of this discussion, let's assume we're in agreement this lack of accountability is ambiguous. Beyond this, it's not just about perception, but a real challenge that we must meet head on. Let's attempt to clarify where it originates (the root cause), understand the impact on care (context), and how best to address it.

In the last issue of Coach+Leader, we spotlighted the phrase "But that's not my patient".... talk about a lack of accountability.  And we determined that statements like these don't happen by accident, but are a key indicator that our culture is not where it needs to be. More specifically, it's a tell-tale sign that we have a disconnect with where our role ends and begins.

Here is where it get's interesting. This challenge of accountability has real and deadly costs. The lack of accountability we all see, hear and feel accounts for a good number of the 187,000 preventable deaths in the U.S. last year. To find out where accountability issues originate, you have to keep asking why.  So why aren't we accountable to each other? Is it because we just don't care? Are we just too overwhelmed and don't want to play nice? I know that's not the case, as we didn't all get into healthcare to avoid accountability. I know we all care about our patients.  My across the room diagnosis is that we're simply too busy and forgot to identify the infrastructure and standards needed to guide how we must show up and work together in a patient centered way. In other words, if we were just as deliberate and intentional about setting the standards for how we must work together (An Organizational Role Description) as we have been about managing our jobs, duties, tasks, etc. we'd realize a significant level of accountability and unprecedented advances in patient centered care.

Tip 9: "Building a leadership infrastructure that breeds accountability."

We now know that the challenge of accountability has little to do with bad people and everything to do with the need for role definition (the root cause). And that's all fixable. First, if you want to create a culture of accountability, physicians, administration, and nurse leaders must work together to build consensus, beginning with a relatable definition of patient centered care. I say relatable because I see too many leaders assuming consensus exists and that we've done a good job communicating what this allmeans to staff. I've helped leaders to provide a relevant definition of patient centered care that relates to their team roles, and seen them influence accountability resulting in improved team care. Once we're all on the same page with establishing an organizational definition of patient centered care, we can begin to identify which skills and competencies hold us accountable to the outcome we seek. To sum up this tip in one sentence, what matters most to patients determines how we practice as leaders. When you align what matters most to patients to a well defined organizational role description, everyone experiences accountability in a direct and personal way. Use the T.R.U.S.T.E.D. card to guide some of these initial Role Description conversations with your team. To request a card, email us atbedsidetrust@me.com and we'll be glad to send you one.

In the next issue we'll discuss specifics relating to how to build an organizational role description that becomes the foundation of your leadership infrastructure.

---

Feel free to join me on Facebook to further this conversation - I'd be happy to visit with you about how you'd see your organization implement a role description.

Visit the Patient Driven Leadership Site.

The Coach Leader is a bi-monthly series of ready-to-use tips to assist you in developing a concrete leadership practice that has the most impact on improving patient care.  Why become a Coach Leader?

1. Patients expect us to work as teams.
2. Patient centered teams need a coach.
3. Every leader has a coaching role.

It's a straightforward point of view that focuses on best utilizing your time as a leader by emphasizing your role as a coach. As a Coach Leader, you'll gain the ability to mobilize your people into patient centered problem solving teams and have the most impact on improving care.

---

COMING SOON!

Everyone is looking forward to Dr. Brian Wong's upcoming book. After years consulting with hospitals across the country, Dr. Wong's unique perspective and deft storytelling takes us inside a hospital fraught with the day to day challenges Physician Leaders, Managers, and Nurses all face, and introduces cultural strategies to overcome them without adding more work to our overburdened days. Dr. Wong has created memorable, real-life characters illustrating today's most pressing challenges in a dramatic hospital setting every reader will recognize.

Tip 8: "But that's not my patient."

"But that's not my patient."

We've all heard that line before... and when working with a medical staff recently, it raised its ugly head again. I say "ugly head," because it immediately tells me that whoever said it is focused on his/her job description, and not their role description, which is what guides us to giving our patients what they really need.

Comments like that or "That's not my job," speak to a dire need for an organizational role description. When you're not cognizant of your organizational role, or when we fulfill our job as if that is the only thing that matters, patient care won't improve, and the idea of truly being patient centered will always remain an unattainable goal.

In my last issue, I highlighted the three ingredients required to design a patient centered culture:

• Role Design
• Focusing Leaders on Coaching
• Mobilizing Problem Solving Teams

Role Design is not a new business concept, nor is it a complex solution to dealing with cultural challenges.  The most innovative consumer-facing businesses outside of healthcare focus on Role Design to improve team collaboration and performance, instead of using many of the institutional carrot and stick strategies we've historically relied on in healthcare.

In healthcare, we haven't taken the requisite steps needed to design an organizational role that informs leaders, physicians, nurses and staff on how to work together to improve patient value. Instead, we've overwhelmed ourselves with an array of initiatives that only target the symptoms of a suboptimal culture, resulting in overburdened, disengaged physicians and staff, higher operational costs, and inferior patient experience and quality. An Organizational Role Description is the starting point to improving our culture and driving a new standard for how we show up and work together. More importantly, Role Design is the cultural foundation required to make teamwork possible.

Consider how your job description sets the standard/tone and focuses us on our duties/tasks, to make us accountable for our job performance. We must be just as intentional about designing our role description.

To do this, our organizational roles must be attached to a systematic process. We have systems in place for hiring and evaluations (job description), we have checklists for safety, and process improvement, but until now, we've lacked the equivalent process needed to understand our roles (Role Description). When leaders and physician leaders adopt Role Descriptions, everything changes... beginning with improved patient care.

Tip 8:  The prerequisites to an Organizational Role Description

Before you discuss developing an Organizational Role Description with your team, let's be sure we have a consensus for what really matters most to patients.... agreeing on that is the starting point to recognizing an organizational wide role that improves care and team performance.

Surprisingly, I often discover a lack of consensus related to ideas on what constitutes quality patient centered care (or what matters most to patients). If we are going to design a culture that reduces errors and prevents harm, physicians and leaders must be able to consistently communicate what constitutes patient centered care.

Creating a patient centered culture requires us to help our teams/staff discover and differentiate the critical difference between Role vs. Job. Our roles based on what matters most to patients: TRUST. As I've shared before, not only are these patient values (what patients need most) but they are values highly relevant to us as physicians and leaders and more importantly reflect the conditions that must exist to deliver better care and reduce errors.

In the next issue I'll continue to share road-tested tips that will help you build consensus and help you define an Organizational Role Description that sets us on the path of team problem solving based on what matters most to patients.

Feel free to join me on Facebook to further this conversation - I'd be happy to visit with you about how you'd see your organization implement a role description.

Visit the Patient Driven Leadership Site.

The Coach Leader is a bi-monthly series of ready-to-use tips to assist you in developing a concrete leadership practice that has the most impact on improving patient care.  Why become a Coach Leader?

1. Patients expect us to work as teams.
2. Patient centered teams need a coach.
3. Every leader has a coaching role.

It's a straightforward point of view that focuses on best utilizing your time as a leader by emphasizing your role as a coach. As a Coach Leader, you'll gain the ability to mobilize your people into patient centered problem solving teams and have the most impact on improving care.

---

COMING SOON!

Everyone is looking forward to Dr. Brian Wong's upcoming book.After years consulting with hospitals across the country, Dr. Wong's unique perspective and deft storytelling takes us inside a hospital fraught with the day to day challenges Physician Leaders, Managers, and Nurses all face, and introduces cultural strategies to overcome them without adding more work to our overburdened days. Dr. Wong has created memorable, real-life characters illustrating today's most pressing challenges in a dramatic hospital setting every reader will recognize.

---

Billing's MT session video.For those of you who would like to learn more about our statewide Patient Driven Leadership program we will soon have the entire video uploaded to thanks to the Billing's Clinic for making this video production possible.
Visit the Coach+Leader Blog. 
and the Patient Driven Leadership Site.

Tip 7: "I can't get no satisfaction."

What does culture have to do with patient satisfaction?

Everything... According to what my clients management team concluded when their CEO asked them to determine how best to improve overall patient satisfaction. Was their diagnosis right? I congratulate them for responding to the overwhelming evidence; to improve patient satisfaction and experience, we need to stop treating the symptoms and address their root cause. If the word "culture" feels too all encompassing let me simplify their conclusion: Patient satisfaction, like most of the challenges we're dealing with, has more to do with how well we all work together than anything else.

We healthcare leaders tend to get a little nebulous when talking about culture. We're more comfortable dealing with the concrete nature of operational initiatives instead. As I shared in the last issue, J.D. Powers, Bloomberg and many others are starting to pay more attention to human factors as the root cause of most of our challenges. And regardless of how abstract modifying a culture may sound up front, having a concrete step-by-step plan that does just that, makes all the difference in the world... especially to our patients.

In our last issue, we also identified the impact physician leaders (coaches) have on improving patient value... and how a culture that emphasizes physician coaching will significantly impact care. Notice the word "culture," in the previous sentence. Teaching your physicians to leverage their coaching abilities to create more productive teamwork... teams that solve problems together... is purely relational... and a concretely teachable practice, that will significantly modify your culture.

The goal of the following tip is to help you establish a relationship between how you personally lead, your organization's leadership approach, and how it affects your culture. Because whether or not you set out daily to improve your culture, whatever you do will affect it one way or the other. The way you interact and lead has direct implications for building a patient centered culture. That's why empowering physician coaches, and instilling a practice of coaching in general, generates the teamwork and group problem solving skills necessary to create a culture that's always focused on improving patient care.

Tip 7:  "I can't get no satisfaction."

Whether you're working to improve the performance of your leadership team or patient satisfaction, it begins with understanding that your challenge is cultural, not operational.  We need to ask ourselves, "Is our culture aligned with, and based on, what matters most to patients?" or "Is it perfectly aligned to get the results we're currently experiencing?" Once we accept a cultural solution as the only sustainable solution, we then need to stop talking about transforming cultures and actually take the steps needed to affect cultural change. To do this, we must first understand the components of a patient centered culture.

As you review these three key ingredients , I ask that you consider how they could help build consensus for your leadership team (and eventually your entire workforce) when it comes to defining a healthy patient centered culture. And consider this, each of these key ingredients has implications and relevancy at the individual, team and organizational levels.

1) Role Design: Creating a patient centered culture begins with designing our roles based on what matters most to patients: TRUST.  An Organizational Role Description is the starting point to improve patient care and a prerequisite for improving team function.

2) Focus Leaders on Coaching: Coach Leaders create the conditions needed to improve patient care and trust. Each of your leaders will need to develop the one-to-one coaching skills necessary to create patient centered relationships, a prerequisite to teamwork and essential to improving organizational culture.

3) Mobilize Problem Solving Teams: To best improve patient care, leaders must focus their time on creating the conditions necessary for improved team problem solving. Improving patient care is dependent on this essential leadership skill and your organization must recognize this competency as a measure of a high performing culture.

Summary: Improving patient satisfaction and solving most of your operational challenges depend on modifying your culture based on what matters most to your patients.  By designing and leveraging your newly established role description/coaching culture, you'll have the tools and knowledge to mobilize Patient Centered Problem Solving Teams, and realize the measurable relationship between team performance and improved care.

Over the next several months, I'll be drilling down on each of these 3 key ingredients to building a patient centered culture, and sharing strategies, tactics and tools that will help you have the greatest impact on your culture

Feel free to join me on Facebook to further this conversation - I'd be happy to visit with you about how you'd see your organization implement a role description.

Visit the Patient Driven Leadership Site.

The Coach Leader is a bi-monthly series of ready-to-use tips to assist you in developing a concrete leadership practice that has the most impact on improving patient care.  Why become a Coach Leader?

1. Patients expect us to work as teams.
2. Patient centered teams need a coach.
3. Every leader has a coaching role.

It's a straightforward point of view that focuses on best utilizing your time as a leader by emphasizing your role as a coach. As a Coach Leader, you'll gain the ability to mobilize your people into patient centered problem solving teams and have the most impact on improving care.

---

COMING SOON!

Everyone is looking forward to Dr. Brian Wong's upcoming book. After years consulting with hospitals across the country, Dr. Wong's unique perspective and deft storytelling takes us inside a hospital fraught with the day to day challenges Physician Leaders, Managers, and Nurses all face, and introduces cultural strategies to overcome them without adding more work to our overburdened days. Dr. Wong has created memorable, real-life characters illustrating today's most pressing challenges in a dramatic hospital setting every reader will recognize.

---

Billing's MT session video.For those of you who would like to learn more about our statewide Patient Driven Leadership program we will soon have the entire video uploaded to thanks to the Billing's Clinic for making this video production possible.
Visit the Coach+Leader Blog. 
and the Patient Driven Leadership Site.

Tip 6: How physicians are improving patient value

Recap of last week:

If you didn't happen to see last weeks interview with the editor of iProtean, she asked me to connect the dots between the current physician shortage and the challenging issue of physician leadership. I shared that my experience working with hospital communities across the country quickly made it clear that the related causes of the shortage are manageable at the "front line" level, and are acutely related to the need for Physician Leaders.

Intro: 

I don't know how you would react, but when I saw the graphic of The Hulk dressed in scrubs at the top of a recent Bloomberg article, "Doctors Without Boundaries," I didn't see it as much of an exaggeration. Everyone from Bloomberg to JD Powers (article: Patient Satisfaction Influenced More by Hospital Staff than by the Hospital Facilities) is writing about how human factors are the biggest influence on patient satisfaction and care.  All of these articles and studies are simply highlighting the symptoms of a widespread problem. Over the years, my experience with client hospital systems has helped me to uncover the single root cause of the problem: a deficit in physician leadership, and more importantly, a working definition of what being a physician leader means.

The last few months I've been sharing tips that have direct implications for how to design a collaborative leadership infrastructure with physicians, and the costly issues associated with this challenge. Business as usual (relying on the traditional carrot and sticks approach to improved physician involvement), isn't getting us anywhere. We need a more sustainable, solution oriented approach to the problem.  And we need to understand how to get our biggest influencers, physicians, to lead the way to improving patient care.

Tip 6: 

I hear from many organizations investing in a variety of physician leadership programs that aren't producing results. Not because their approaches are ineffective, but because they lack relevancy for most physicians. To achieve relevancy and engagement, you must clearly illustrate that the sole purpose of physician leadership is to generate patient value. When you frame physician leadership as the single most important effective way to increase patient value, your physicians will listen. And along with connecting physician leadership to patient care, when you further (and simply) define physician leadership as coaching, buy-in becomes almost immediate. Let me explain.

First, let's accept that all roads lead to Rome. All of the challenges you face: the prospects of a physician shortage, recruiting and retaining talent, creating a safe culture, improving patient experience, poor alignment, disruptive behavior, lack of physician engagement and accountability... they all share a common denominator/root cause, and that's the need for a physician coaching culture. Notice that I'm substituting coaching for leadership. Engaging your physicians in a coaching role is not only a practical, relevant approach to leadership, it offers a more definitive and actionable expectation of how we can improve team performance and generate real value for the patient. Feedback from physicians in my client hospitals tell me the "coaching" is much more tangible than "leadership," and tying the benefits of coaching to "What matters most to patients," seals the deal. If you'd like more clarity on the theme of coaching, check out some of our past issues where we provide road tested insights on physician's as coaches.

Secondly, most of your medical staff has different philosophies on leadership, it's purpose, objectives and expected outcomes. Take the time to identify the impact physician leadership (coaching) can have on improving the patient experience, satisfaction and quality. It's the only way to generate buy-in and sustained involvement from all your physicians. By beginning with a relevant definition, you're opening the door to designing a physician leadership culture that will most effectively improve patient care - and when physicians realize that, leadership will become a valuable aspiration that all of your physicians will seek to attain.

Feel free to join me on Facebook to further this conversation - I'd be happy to visit with you about how you'd see your organization implement a role description.

Visit the Patient Driven Leadership Site.

---

Congratulations to the Montana Hospital Associationstaff for a successful Patient Driven Leadership Champions for Quality Conference. I look forward to continuing to collaborate with many  physicians and clinical leaders that are working tirelessly to improve quality not only in their communities but throughout the state.



Billing's MT session video coming soon! For those of you who would like to learn more about our statewide Patient Driven Leadership program we will soon have the entire video uploaded to thanks to the Billing's Clinic for making this video production possible.

Visit the Coach+Leader Blog.

Tip 5: Confronting The Physician Shortage

In the last Coach Leader we talked about designing our roles as coaches so that a physician's role evolves to best meet the needs of patients and staff. In the hospitals that we're working with that currently subscribe to our "role design" approach, physicians are becoming more engaged as they almost immediately see the benefits of coaching as a tool to improve care and the patient experience.

When the editor of iProtean recently asked me about the impending physician shortage based on a recent article in The New York Times, we talked about physician role design as a preventative measure we can take to substantially reduce the effects of this shortage. The following interview speaks to the real connection between role design and this impending crisis in the context of reworking or evolving the roles of physicians into physician coaches, and how it directly impacts the shortage. It's easy to see how physician coaching results in giving our patients what matters most to them, while improving conditions for physician leadership and team performance.

As the federal and state governments continue to implement the provisions of the Affordable Care Act, experts express concerns about the lack of physicians to care for the expanded pool of patients.  "The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed.  And that number will more than double by 2025, as the expansion of insurance coverage and the aging of baby boomers drive up demand for care.  Even without the health care law, the shortfall of doctors in 2025 would still exceed 100,000." (The New York Times, July 29, 2012.)

Health experts, including many who support the law, say there is little that the government or the medical profession will be able to do to close the gap by 2014, when the law begins extending coverage to about 30 million Americans.

The shortage has been described as an invisible problem; that is, patients still get care, but the process is often slow and difficult.  An additional concern is the lack of experienced physician leaders to manage the implications of the shortage over both the short and long term.

We asked Brian Wong, M.D., CEO of The Bedside Trust and iProtean expert, to provide his insight on the anticipated physician shortage and the importance of physician leaders.

iProtean: There is a lot of talk about boosting physician leadership programs to help hospitals leverage existing physician resources in a smarter way. What are some practical actions administrators and physician executives can do to prepare for the anticipated physician shortage?

Brian Wong, M.D.: My solution for this impending crisis is quite similar to the treatment plan that I have put into practice to prevent related symptoms such as poor physician relations, poor retention, disengagement, lack of physician collaboration, poor staff relations, etc.  Not only are these symptoms directly related to the shortage crisis, they carry substantial costs and impact care on a daily basis.

Allow me to rephrase your question in a more patient centered way:  "How can physicians contribute as leaders so that we have a greater impact on care without adding more to our workload?"  The answer to this "ultimate" question positions your physicians to stop these recurring symptoms in your hospital community, while also addressing the root causes of physician shortage in our industry that led to diminished capacity:  a deadly combination of early retirements, practice restrictions (closed panels), shortened hours, and non-direct patient care career changes.

To be successful at expanding physician capacity without increasing workload, we must design a physician's role so that it aligns with what matters most to patients, while creating the conditions for the team-oriented approach required as this shortage advances.  Organizations must be intentional when it comes to physician role design. Many of the hospitals that come to us for assistance seek improved physician involvement and higher levels of accountability to improve patient experience and care, but they lack the ability to clearly define and communicate the specific role physicians need to play.

iProtean:  Please clarify what implications physician role design has on physician leadership development and the specific issues it addresses for organizations.

Brian Wong, M.D.: Having spent over 30 years of my career as a physician and physician executive, my point of view on physician leadership may surprise you.  Most physicians did not get into medicine to become leaders and have a less than enthusiastic response to leadership training.  Role design is a practical and concrete solution for organizations that need more physician involvement but realize the constraints of leadership programs that require a year's worth of soft skill development and a binder full of initiatives.  Getting physicians to show up as leaders is possible when you connect their role with patient needs and what physicians are naturally good at.  It's a simple business case:  every physician has a coaching role.

Most of the physicians with whom I work are natural coaches.  Unfortunately for the patient, coaching is not often treated as an organizational practice and a part of the culture as it is in medical school.  So why did it stop?  Once outside the academic setting, nobody reminded us of this important role, and our collective coaching acumen deteriorated into what physicians themselves might call "disuse atrophy."  When physicians understand their primary focus includes fulfilling their organizational role as coaches, team performance improves dramatically and patients benefit.

One medical director I'm working with noted "When I ask my physicians to start thinking like a head coach of a team it gives them a specific role to play and the opportunity to set new standards for how we work as a team to benefit the patient."

Role design is not a new business concept, nor a complex solution to these common challenges.  The most innovative consumer-facing businesses outside of healthcare leverage cooperative infrastructure models (role design), as opposed to using our current institutional carrot and sticks approach for improved physician collaboration and capacity.  In the healthcare industry, we have not taken the requisite steps to design a cooperative infrastructure with our medical staff.  Instead, we have resorted to an array of initiatives that target only the symptoms resulting in overburdened, disengaged physicians; higher operational costs; and inferior patient experience and quality.

iProtean:  What advice would you give to a leadership team looking to begin addressing physician role design-related issues?

Brian Wong M.D.: Take time to help your team gain clarity on your current state, the costs your current state has on patient care, productivity, etc., and the results you require.  It's important to guide conversations based on what matters most to your patients rather than the "do more of this and less of this" approach I've seen all too often. Consider these three patient-driven points as your discussion guide:

• Patients expect us to work as teams.
• Patient-centered teams need a coach.
• Every physician has a coaching role.

These three tenets will provide the structure and focus for an initial discussion that will begin to better define the role physicians must play within your organization.

The first step in building a more cooperative infrastructure with your physicians begins with a few conversations. As the conversations build, consider a few of these road-tested questions that generate greater clarity and direction:

• When it comes to designing collaborative relationships with physicians, is our institution an enabler or an obstacle?
• Have we taken the steps to collaborate with our physician executives to develop a clear organizational definition of physician leadership?
• Has this definition been accepted, well communicated and appropriately vetted by the medical staff leadership?
• Do our physicians have an organizational role description that guides the type of physician involvement and teamwork we'd like to see in our community?
• How might a more clearly defined role description affect job satisfaction and fulfillment for current and future physicians?
• As we invest resources in physician leadership related activities, what are the expected outcomes; i.e., improved teamwork, improved staff relations, accountability to quality goals, etc.?
• How might a culture based on physician coaching affect your goal of better care, better experience and lower cost?
• What primary coaching capabilities and actions (formal and informal) can our physicians fulfill to have a greater impact on care daily?

Questions like these will help your organization begin to define role clarity for your physicians. If you are going to improve the capacity and contribution of your physicians you must create a coaching culture.  Being intentional about role design will retain and attract physicians, create a more collaborative environment and, most importantly, improve the patient experience and quality of care.

Feel free to join me on Facebook to further this conversation - I'd be happy to visit with you about how you'd see your organization implement a role description.

Visit the Patient Driven Leadership Site.

---

Congratulations to the Montana Hospital Associationstaff for a successful Patient Driven Leadership Champions for Quality Conference. I look forward to continuing to collaborate with many  physicians and clinical leaders that are working tirelessly to improve quality not only in their communities but throughout the state.



View a video clip from the Billing's Montana session! To learn more about our statewide Patient Driven Leadership program and/or request a full length video please email your request to bedsidetrust@me.com.>>>

Visit the Coach+Leader Blog. 

Tip 4: Ultimate Question for a Healthcare Leader

The Coach Leader is a bi-monthly series of ready-to-use tips to assist you in developing a concrete leadership practice that has the most impact on improving patient care.  Why become a Coach Leader?

1. Patients expect us to work as teams.
2. Patient centered teams need a coach.
3. Every leader has a coaching role.

It's a straightforward point of view that focuses on best utilizing your time as a leader by emphasizing your role as a coach. As a Coach Leader, you'll gain the ability to mobilize your people into patient centered problem solving teams and have the most impact on improving care.

The Ultimate Question for a Healthcare Leader

Yesterday, I had an eye opening conversation with a medical director I admire. He'd read the initial Coach+Leader tips and called me to share that while the ideas sounded inspiring, he just couldn't do any more or ask any of his docs to either... his staff was already at capacity and suffering from initiative overload. Having felt it often, I understood that feeling of being overwhelmed, inefficient and fragmented. Knowing his frustration got me to thinking that there are some aspects of coaching and leadership that require more effort than others, there are also a good number of actions we can take that result in saved time, less rework, and greater efficiency.

This led me to the "The Ultimate Question": How can we contribute as leaders so that we have a greater impact on care without adding more to our workload?

While I can't promise you that there are not aspects of coaching that require skill development and practice, the most important aspects of coaching and leadership are more about how we show up... how we lead our staff, and eventually affect our community. It begins with identifying the leadership skill (coaching) that allows you to spend more time proactively leading your organization versus managing recurring problems. This is the first step toward having the most impact on improving patient care.

Here are a few highlights from the past 3 tips:

1. Start thinking like a Coach. Patients need us to work as teams. Patient centered teams need coaches. Every leader has a coaching role
2. Improve team performance by helping your team as a coach understand their role. Our organizational role must be based in patient values (T.R.U.S.T.E.D.)
3. Help to improve team problem solving by making it safe for your team to speak-up and share ideas. The measure of a team is how well they solve problems together.

Take a closer look at the short list above. These patient driven ideas depend on leaders being focused on how to show up to create the conditions needed to improve care, rather than how much of their "to do" lists they accomplish.  Improving care begins and ends with integrating a coaching mindset... which takes no additional work to do... and leads to less recurring problems to deal with.

Feel free to join me on Facebook to further this conversation - I'd be happy to visit with you about how you'd see your organization implement a role description.

Visit the Patient Driven Leadership site.

Tip 3: Reach for your whistle first... then your stethoscope.

The Coach Leader is a bi-monthly series of ready-to-use tips to assist you in developing a concrete leadership practice that has the most impact on improving patient care. Why become a Coach Leader?

1. Patients expect us to work as teams.
2. Patient centered teams need a coach.
3. Every leader has a coaching role.

It’s a straightforward point of view that focuses on best utilizing your time as a leader by emphasizing your role as a coach. As a Coach Leader, you’ll gain the ability to mobilize your people into patient centered problem solving teams and have the most impact on improving care.

_____________________________________________________________

Reach for your whistle first... then your stethoscope.

In the last issue, I shared an everyday example of a physician helping colleagues defuse an argument that was impeding patient care. Some of you responded to the posting with surprise that a physician would readily approach the situation from a coaching perspective, with the goal of improving patient centered teamwork. It turns out, that most of the executives, nurses and docs I work with are natural coaches... when they learn to switch their primary focus from getting their individual jobs done, to fulfilling their organizational role as coaches.

Design your coaching role: One physician executive wrote to me, “I think my job would be much easier if all of my 160 physician’s acted like coaches of a team.” She wanted to know how an organization like hers could attract physicians with a coaching mindset. So I shared some of my last week's experience in Montana facilitating a quality collaborative. I had the opportunity to ask a series of questions to a number of physicians, nurses and executives, including, “Where would you be today without coaching?” The ensuing discussing led us back to the beginning... to medical school, nursing school or grad school, where we all realized that the most effective teachers/mentors, were the ones who delivered as coaches. The 100+ Montana leaders continued by validating the overt benefits of coaching - including improved metrics on physician staff relationships, reduced re-work, and a culture of teamwork emerged... which all translated to improved care... not to mention the savings of significant dollars that we lose every day from poor organizational performance. Unfortunately, most of the hospitals they all ended up in didn't emphasize coaching at all. Instead, everything revolved around their jobs. Now that they've become aware of the significant benefits of coaching, beginning with improving patient care, they're making role design (emphasizing their organizational role as coaches), their first priority. It helps that we all inherently know how to coach - we just have to decide to do it... again!

Getting serious about Role Design: Coaches know that building a highly functioning team is a deliberate process. We have systems in place for hiring and evaluations (job description), we have checklists for safety, and process improvement, but we don't have equivalent processes in place for what it takes to understand our roles as coaches... our "role description."

When our clients and audiences realize they can design organizational roles, everything changes. Leaders in Montana understood that they must make this happen throughout their organizations. They realized that designing and implementing a role description is the key to improving patient care.

Feel free to join me on Facebook to further this conversation - I'd be happy to visit with you about how you'd see your organization implement a role description.
_____________________________________________________________

Congratulations to the Montana Hospital Association staff for a successful Patient Driven Leadership Champions for Quality Conference. I look forward to continuing to collaborate with many physicians and clinical leaders that are working tirelessly to improve quality not only in their communities but throughout the state.

Billing's MT session video coming soon! For those of you who would like to learn more about our statewide Patient Driven Leadership program we will soon have the entire video uploaded to Thanks to The Billing's Clinic for making this video production possible.

 Visit the Patient Driven Leadership site.

Tip 2: Let's move the conversation forward...

In our first issue, we outlined the business case for all healthcare leaders to take on the role of Coach+Leader:

1.  Patients expect us to work as teams.
2.  Patient centered teams need a coach.
3.  Every leader must have a coaching role.

While many of you noted the simplicity of these points and the clear purpose it offered, a number of you asked us to get a little more definitive about what being a Coach+Leader actually feels like and accomplishes. 

Tip 2:  Let's move the conversation forward...

When we as executives, physicians and nurse leaders focus on our role as coaches, we help our teams solve problems together more effectively, which directly impacts care. And it all begins with acting like a coach.

Think of a coach who had an impact on you? What attributes did he or she demonstrate that you now admire? The positive approach "your" coach shared with you plays an even more important role in the ultimate team sport, healthcare. On the field, good coaches know how to help their team perform at optimum levels, but in healthcare, working at optimum levels hinges on our ability to solve problems together as teams. And as leaders, it's our primary objective to direct our people toward that end.

In healthcare, although it begins with leaders, I've seen the tremendous gains made when physicians begin to treat all of their relationships as coaching opportunities. Here's an example of a "coachable moment". A client recently reported that one of their physicians defused a disruptive conversation between a fellow physician and a staff member by showing him his T.R.U.S.T.E.D. card as an informal reminder. By referring to this coaching tool, he prompted his colleagues to think about their organizational role as a Patient Centered Problem Solving Team, prompting the conversation to shift toward, "What matters most to their patients?"

Bottom line: Coach+Leaders improve team performance by helping everyone understand their role. To request a Coach+Leader card simply reply to this email and visit us on Facebook to share your thoughts.

Visit the Patient Driven Leadership site.