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>>

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