Tuesday, March 19, 2013

Tip 17: How does it feel to operate in the dark?

How does it feel to operate in the dark?

Bedside ImageWe wouldn't expect our surgeons to do it, so why would we set up our team members to? Although this sounds extreme, it's a day-to-day reality for many.

Exhibit A: "Just what is a physician leader?"

I started to share this story with you in our last issue of Coach Leader. This question was asked by a physician executive at a medical staff retreat I recently facilitated, which led to a number of physicians in the group suggesting that they weren't sure what the board and administration was asking of them when it comes to physician leadership. One physician said, "We hear this all the time, but I don't see what all this has to do with improving quality." Another stated, "I just don't know why we're doing this."

It's not just this group of doctors that find difficulty in connecting this expanded responsibility of physician leadership to their primary job of caring for patients. It's quite clear that our current context for physician leadership needs to be addressed throughout the industry. While we've discussed physician leadership in-depth in past issues and will continue to define it, it's worth pointing out that this confusion or "lack of context", is the source of accountability challenges reported by many of the organizations we hear from. 

If organizations are serious about experiencing physician leadership, improving patient accountability and strengthening their relationship with their medical staff, we must first start by addressing our "lack of context".  This goes for nurses, staff and administration throughout your organization, because these team members are not immune to this industry wide context deficit. We see and hear just as many questions and comments from staff indicating confusion and insufficient information related to the need for role design:

"I'm just not sure if they know what they're asking us to do?"

"How can they could expect any more from us...they just don't understand what we're up against!"

"That's not my patient."

"That's not my job."

Why should questions and comments like these stop leaders in their tracks? Because these team members are signaling that they are overwhelmed and unaware. They currently operate under a context based solely on their individual jobs. And when your current context is based on job alone, it directs a patient experience that can be best described as "every man for himself". This is a mindset many of us are all too familiar with, and a sure sign that our people are operating in the dark, unable to fully contribute toward raising the level of overall organizational performance.

Where does insufficient context come from and why is it compromising our ability to work more effectively for our patients? It's a bit ironic that in our content over context world, we are missing the key pieces of information that help us identify our role and relate it to a bigger team oriented picture. Consider the workplace environment and how each of us is bombarded daily with overwhelming amounts of content; rigorous continued education, staying up to date with new technology, more and more metrics to track, etc. With all the emphasis on content we begin to lose sight of how it all fits together – context. And so in a content over context workplace, it's quite reasonable that many of us are beginning to ask for more context as we attempt to sift through piles of content and distill what matters most. This directly leads us back to the question, "What does physician leadership have to do with improving care?" And it's why our people are quietly asking these context oriented questions and seeking a more definitive purpose and role.

One things for sure, insufficient context will lead to incorrect assumptions. The most costly assumption we find organizations making is one of defining job and not role. When team members lack context for their role, it limits the degree to which individuals invest in team and organization. We have assumed that because individuals (physicians, nurses, therapists, etc.) are skilled at their jobs, they must understand their team role needed to contribute to the greater mission of the organization. While our individual jobs are necessary for establishing context to identify specific tasks and actions, our jobs alone are insufficient for aligning and engaging the hearts and minds of individuals and teams to contribute to shared purpose... to improve care. If we are going to give rise to context and help our team gain needed perspective of their role, we must start thinking like a coach.

Tip 17: Coaching for Context:

Several months ago we set out to challenge some of our current assumptions about leadership and give rise to new context for healthcare leaders that improves our ability to serve our team and our patients. The goal was quite simple... take some of the unnecessary complexity and mystery out of what being a leader in healthcare really means. Understanding that if healthcare leaders we're a bit more clear on what mattered most to their team, we'd have an easier time focusing our efforts and emphasizing tools that have the most impact on helping them care for patients.

Two issues ago, I shared the personal mission statement of my upcoming book's main character, which is based on attributes of the talented leaders I've worked with throughout my career. This mission statement is in essence an extension of our T.R.U.S.T.E.D. model for improving patient accountability that many of you are familiar with. If you haven't yet had the opportunity to review it allow me to share a few pertinent highlights:

"YOU as a leader have the most impact on care because you help others see the role they play, not because you're better at your job."

"YOU know that a good team needs a good coach and that's what you are."

If we've been successful at anything, we've made the case that to be an effective healthcare leader – providing what matters most to our team and patients – you must be an effective coach.

While many skills and competencies contribute to becoming an effective Coach Leader, simply observing is one of the most fundamental. Yogi Berra said, "You can observe a lot just by watching." I would add that you can learn a lot just by observing. Just as a physician must utilize observation as a key tool to acquire knowledge about a patient; coaches benefit from simple observation and use that intelligence to more effectively  diagnose organizational problems.

Coaches are well positioned to observe the subtle signs, actions and behaviors guided by our teams current context. Chris Osborn, a noted expert on coaching and President of Coach Training Alliance, emphasizes that coaching is a co-creative process that leverages the building of awareness and context. He suggests that following coaching's simple steps can create new behaviors based on what is observed. As Chris says "There is no more powerful process to lead people to greater outcomes." Like all Coach Leaders we work with, observing becomes an essential tool for seeing the questions and comments that demonstrate the need for context. Like all great coaches, you'll quickly discover just how essential setting context is for improved team performance. Lucky for us, coaching doesn't require us to have all the answers; our strength as a Coach Leader relies on tools like observing and asking questions. These are the only tools that will help us lead our teams out of the dark and help to set a more relevant context for them and the patient.

Coach+Leader will be on Spring Break later this month and will return April 10th. We look forward to getting your feedback on how these coaching tips are working for you.

Email me or share your thoughts on our Facebook page.

Brian WongDr. Brian Wong's highly anticipated book,'HEROES NEED NOT APPLY' releases this spring.

Listen to Dr. Wong as he discusses Heroes Need Not Apply: A Unique View on Accountable Culture Click here to listen>>

Brian WongCheck out the new video interview with Brian Wong, M.D.
to access Dr. Wong's Q&A as he discusses "Heroes Need Not Apply," Click here>>

Wednesday, March 13, 2013

Tip 16: Get to know the silent killer of accountability

Get to know the silent killer of accountability

Bedside ImageOur industry likes to use the phrase "silent killer" to refer to health conditions like hypertension, because there are often few noticeable symptoms associated with this dangerous condition that affects millions globally. High blood pressure is a slow killer, wreaking havoc on the body with acute manifestations such as stroke and heart
failure– which present many years after a persistent elevation in blood pressure first appears.
As in the case of hypertension, the "silent killer" for healthcare overall is also often invisible - and it leads us all to a state of "hyper-tension" We call this condition a "lack of context," and it is the root cause of unnecessary complexity and frustration in many organizations.

For a moment, consider that you're a passenger on a plane. The pilot announces that he has good news and bad news: the good news is that they are ahead of schedule; the bad news is that he doesn't know where they are heading. Sounds ridiculous if you're the passenger— but quite a reality for a lot of physicians, nurses and managers I meet working in healthcare.

We're all asked to work extremely hard at our jobs, but few fully understand how their role contributes to the team and the overall strategic direction of the organization. We have plenty of context for the many different jobs each of us is hired to do, but we lack context for the role we must assume together, to deliver quality team care consistently. A team without sufficient context has become our "silent killer" in that it creates conditions which lead to diminished accountability, and over time, manifests in ways that harms patients, including: 
  • physician disengagement
  • employee dissatisfaction
  • disruptive behavior
  • ineffective team and patient communication
  • low morale
  • high turnover
The true causes of these symptoms often go unnoticed or misdiagnosed, and the compounding affects can have a tremendous drag on organizational performance.
It's quite easy to see how these organizational symptoms have become commonplace in our industry. We must look at our organizations like we do our patients, and treat the root cause of the condition instead of each of its many symptoms. Come to think of it... I don't know any leader and/or organization that has been successful at eliminating these symptoms by treating them independently, nor do we have the time and resources to treat these symptoms in isolation.

Tip 16: Killed by a lack of context and it was his own damn fault

The good news... it's entirely preventable, treatable and reversible when leaders learn how to recognize the subtle signs this condition produces. Diagnosing this condition is easy if you know what to look for. And you may not need to look any further than your next team meeting. In a recent medical staff retreat I facilitated, a physician blurted out with frustration, "Just what is a physician leader?"

He's not the first doctor to ask this. In fact, this question has become quite common in our content-over-context world. I'm sure physicians at your organization ask similar questions. But is anyone listening to them?

Why would a surgeon that happens to be a physician executive not know the answer to a seemingly obvious question? How could such a silly little question bring a room of 70 physicians to a screeching halt. Would you be surprised if I told that not one of these physicians jumped in to offer an answer? No wise guy suggested he read the leadership training manual in the doctor's lounge, nor did they communicate that the question wasn't relevant to doctors' needs. None of his peers looked surprised and/or embarrassed that one of their own leaders would ask such a silly little question. Why do we assume any leader in the organization should have the answer?

What makes this particular question insightful yet terribly concerning, is that we are asking this medical staff to perform in a role that they do not clearly understand. The question itself indicates confusion and frustration around the role we are asking them to play. The "physician leader" question comes as a clear disconnect in the current context of what a physician is and does. As a coach, I see this as nothing more than an appeal for clarity and the opportunity to help this team make these connections and set new context.

In this particular case, a simple "lack of context" caused mass meeting confusion that led to momentary inactivity, reduced productivity, increased social discomfort, reduction in communication and generalized anxiety.

But the question we leaders should be asking is: If this is what a lack of context can do to a medical staff of 70 in a comfortable hotel meeting room, just how much pain is it causing on the floors of my hospital?

This generalized condition is not limited to this medical staff retreat, a segment of providers, or a particular type of hospital. Like hypertension "lack of context" can affect everyone. It can be observed daily in doctor-to-doctor consults, team discussions at the bedside, board meetings, etc., and it's remarkable at producing ineffective conversations inhibiting our ability to perform for the patient.

Now that we are all aware of this condition, let's get used to spotting the subtle signs we have become accustom to overlooking... like when we hear, "but that's not my patient," and "I wish she would just do her job."

As Yogi Berra said, "We're lost, but we're making good time." The point is... context matters and your patients lives are at stake when your team doesn't have it. Tune in next time as we take a closer look at how leaders can coach their teams and bring about the context we, and our patients, all desperately need.

Email me or share your thoughts on our Facebook page.

Brian WongDr. Brian Wong's highly anticipated book,'HEROES NEED NOT APPLY' releases this spring.

Listen to Dr. Wong as he discusses Heroes Need Not Apply: A Unique View on Accountable Culture Click here to listen>>

Brian WongCheck out the new video interview with Brian Wong, M.D.
to access Dr. Wong's Q&A as he discusses "Heroes Need Not Apply," Click here>>

Bedside Trust and Coach Training Alliance form partnership

CTA Logo
FOR IMMEDIATE RELEASE Seattle, Washington, March 5, 2013/PR Newswire/-- The Bedside Trust, a nationally recognized healthcare consultancy specializing in medical leadership and building Patient Accountable Cultures for healthcare systems is pleased to announce they have selected Coach Training Alliance (CTA) as a strategic education partner. This partnership enables The Bedside Trust and CTA to equip a greater number of physicians, nursing and clinical leaders with essential coaching tools required for improved patient experience and quality of care. This collaboration is in response to a growing need for medical leadership, most notably physicians, to focus on the coaching specific leadership skills that have become increasingly relevant to improving team and organizational performance.

"Our medical leadership solutions have always emphasized coaching tools to ensure physicians, nurses and other clinical leaders are best positioned to lead teams and have the most impact on care", notes Brian Wong, M.D., CEO of The Bedside Trust. "Our partnership with CTA, deepens our commitment to helping our current clients and leaders in our industry become more adept at coaching." Dr. Wong cited that CTA's executive team and faculty were uniquely qualified for healthcare. CTA's CEO, Chis Osborn, is the current Vice Chair of UC Health and is the Past Chair of Poudre Valley Health System. Dave Kruger, M.D., serves as the Dean of Curriculum for CTA, and is a former a Clinical Professor of Psychiatry at Baylor College of Medicine.

"Brian Wong, M.D. added, "We are encouraged that more hospital systems are realizing the benefits of coaching education as a core component of their physician and nursing leadership solutions. Having spent over 30 years as a physician and medical director the most important leadership lessons I've learned is that patients expect us to work as teams, today's care teams need us to lead as coaches of a team, and together the Bedside Trust and CTA are providing the coaching abilities our hospitals and patients require.

Chris Osborn, CEO of CTA added, "There is arguably no industry that faces as much fundamental and structural change as healthcare in the coming decade. Working with Bedside Trust provides us an opportunity to make this change more effective, more transparent and ultimately more human for the patients whose care is at the center of what everyone hopes to achieve.  The application of core coaching skills by medical leaders will ensure higher levels of engagement, communication and adaption providing not only higher levels of quality care but a higher appreciation for that care by the patient. Ultimately, we are talking about unleashing the capability of teams to save lives and raise the bar for patient centered care.  Coaching skills have been noticeably absent to the patient centered care discussion and application- we look to change that."

"We are excited to be working with The Bedside Trust and innovating the coaching solutions that clinical leaders need to focus on their role as coaches. As physicians, Dr. Wong and myself, have a first-hand understanding of the expanded role physicians and clinical leaders are being asked to play to improve care daily. By incorporating the tools, methods, and principles of coaching into their practice, healthcare professionals are better equipped to collaborate with their colleagues, lead staff more effectively and deliver higher quality care without adding more to their already full workload.

Together, The Bedside Trust and CTA are offering a series of coaching tools that provide medical leadership with essential and practical coaching education specifically designed to improve leadership effectiveness and generate substantial patient value.

For more information please contact: Jonathan Long - Managing Partner, The Bedside Trust at by email at bedsidetrust@me.com or by phone at 206-619-8088

About Coach Training Alliance

Coach Training Alliance is a global leader in coach and leadership training and proud to be leading change in the healthcare with its Medical Leadership education programs.   CTA has trained and certified over 6,500 coaches in 13 countries over the last twelve years using its ICF credentialed, distance delivered model of co-creative change.  Coach Training Alliance is a collection of the finest educators, mentors, coaches, and facilitators in the profession of coaching. Over the last decade CTA have assembled a team of proven faculty that are today the leaders in their fields.  CTA offers a full range of coach training curriculums including Human Capital Coaching, Certified Coach Program, Social and Emotional Intelligence education programs.

For more information regarding CTA please call (303) 991 0388 ext 4. and/or visit their website at www.coachtrainingalliance.com