High Performing Health Systems Start with Physician Leadership

Physicians know medicine, but not all are leaders. 

Leadership roles in health care are ever-evolving. Achieving high value for patients must now be the overarching goal of health care delivery, with value defined as the health outcomes achieved per dollar spent. “What does it mean to be healthy?” is the question driving conversations regarding the definition of quality care.

Who better to guide this definition than those who work with patients directly? Physicians must be prepared to answer the call.

Healthcare organizations must empower physicians with the skills necessary to be effective leaders and embrace this focus on value delivery. This is why a strategic, organizational commitment to their leadership development is imperative to the transformation of modern healthcare. Placing physicians at the forefront of your leadership development strategy will serve to create true change in the way healthcare is delivered in the United States.

 

To cultivate aligned and engaged physician leaders, trust physicians to lead, and empower them to do so daily as your organization’s primary agents of change.

Healthcare organizations can promote the alignment and engagement that is needed by providing meaningful opportunities for physicians to lead. Actively engage physicians in your organizational strategy by asking physicians to lead in areas like the patient experience, readmissions, and reduction of outcome variations. Create intentional projects for both administrators and physicians to work on together. This partnership experience, and reciprocal trust-building, is directly linked to increased physician satisfaction and engagement, improved organizational alignment, and improved quality and safety metrics. It is a successful dyad model that will get results.

 

Our partnership with The Iowa Clinic provides evidence that high performing health systems start with physician leadership.

The Iowa Clinic, P.C. (TIC) is the largest physician owned multi-specialty group in Central Iowa with more than 140 physicians and healthcare providers practicing in 37 specialties. TIC was formed in 1994 and serves a population of 1.1 million, averaging 400,000 patient visits each year.

Like any other large multispecialty group, TIC was created by merger and consolidation of many diverse practices over time. Having a culture of “one group” has always been the goal of the TIC especially in facing the rapid change in healthcare. In order to transform its culture and not only survive but thrive in uncertain times, TIC recognized the increasing need for physician leadership.

TIC’s Board of Directors Chairman, Steven R. Herwig, said:

“National healthcare reform will have far-reaching effects on efficient and effective healthcare delivery. The transformation that is occurring in healthcare requires us to take our leadership capacity to a higher level by focusing on and providing additional skills and leadership tools that are beyond clinical skills.”

The Leadership Institute at The Iowa Clinic (LI TIC) was established with the goal to transform the leadership DNA at all levels of the organization and to create a strong pool of physician and healthcare leaders that impact TIC’s ability to fulfill its mission. This goal included engaging physicians and healthcare leaders in driving the healthcare transformation and enabling their success by providing them with the necessary skills to make it happen:


The Leadership Institute at The Iowa Clinic Skills Improvement and Loyalty Self-Assessment: Participants reported the following high impact improvement (% improvement in skills compared to before attending LITIC):

•  133% improvement in the ability to lead others.

•  200% improvement in the ability to work in teams.

•  350% improvement in the ability to think strategically.

•  167% improvement in the ability to effectively communicate and influence.

•  325% improvement in the ability to deal with difficult issues and situations.

•  140% improvement in the ability to manage the practice.

•  125% improvement in the ability to impact practice volume/revenue

•  150% improvement in the commitment to and active engagement in ensuring TIC’s success.

As one graduate noted:

“The Physician Leadership Institute has taught me that doctors can work together in a collegial manner to help shape healthcare reform, rather than just waiting to react to the change and hope to survive.”

Iowa Clinic leadership development

Providing physicians with leadership development is one of the most powerful investments that can be made in the future of your organization, and in the transformation of modern healthcare.

Mindfulness: A Key to Leading Self First

The Physician Leadership Institute is pleased to bring you an interview Jose Colon, M.D., MPH of Lee Physician Group and Founder of ParadiseSleep.com to discuss mindfulness as an essential tool for physician leaders to Lead Self First.

Thank you for joining our conversation this month, Dr. Colon. Let’s start with the basics: what does “mindfulness” mean?

I’ve written before that explaining mindfulness and meditation is like trying to explain in words what a cantaloupe taste like; words are not sensory. It’s something that is best learned, at first, through a guided experience. Mindfulness does not have to take a certain form to be effective. It can begin as simple awareness of one’s breathing, or observing your own thoughts in any moment.

 

Why do physicians need to know about mindfulness?

Mood problems are increasing so fast that by 2020 they will outrank AIDS, accidents and violence as the primary causes of early death and disability. UNILO (United Nations International Labor Organization). “Job Stress: The 20th Century disease.” UN Conference, Oct 2000, as reported by Reuters Medical News. Physicians need to know that mindfulness is an essential tool for their patients and for themselves. A technique called “Mindfulness Based Stress Reduction” (MBSR) has been found to improve symptoms of anxiety and depression, improve feelings of wellbeing, and has been shown to improve symptoms in just about every disorder it has been studied, from psoriasis to diabetes.

 

How did you come to be passionate about teaching mindfulness to physicians?

Right out of med school, I wanted to be a general pediatrician but felt I couldn’t give parenting advice when I wasn’t a parent. As Mo Kasti points out in his book Physician Leadership, this would be “Conscious Incompetence”, as I recognized my deficit. As a parallel example, our national healthcare system is flooded with disorders influenced by chronic stress as mentioned in the opening paragraph, and yet the gateway to health is being managed by physicians which statistically has higher stress rates than the population! According to Mo’s book, this would classify as “Unconscious Incompetence”, not recognizing the deficit. I am passionate about making physicians aware of this deficit so they can take action to integrate mindfulness into the practice.

Instead of general pediatrics, my path in medicine took a journey to child neurology and sleep medicine. I started my practice in child neurology and sleep medicine in 2008 with Lee Physician Group. Fresh out of medical training, I was enthused to help every patient that I could. I realized early there was a subset of patients with migraines, behavior issues, and sleep problems that just didn’t seem to respond to the medical therapies I was trained to treat. I realized the medical therapy was not treating the underlying symptoms of chronic stress. Like giving Tylenol when there is a throat infection, you may reduce the fever and make the patient more comfortable, but you aren’t treating the underlying infection.

In pursuit of trying to learn how I can help these patients, I began to learn about non-medication approaches to help stress and anxiety. This path led me to Mindfulness Based Stress Reduction (MBSR).

It’s not just patients that are affected by stress… it’s doctors too! Rates of clinical depression among medical interns have been reported to be 27% and 30%. Divorce rates among physicians have been reported to be 10% to 20% higher than those in the general population. The overall physician suicide rate cited by most studies has been between 28 and 40 per 100,000, compared with the overall rate in the general population of 12.3 per 100,000. (Southern Medical Journal. The Painful Truth: Physicians Are Not Invincible).

This is NOT about physician bashing, it is all about physician building.

Like PLI emphasizes, The Physician Leadership Journey entails identifying and closing gaps. Learning about MBSR can help our patients’ overall outcomes, as well as our own!

 

What should our readers takeaway from your journey of integrating mindfulness into your practice?

In Mo’s book Physician Leadership, he discusses one of the many reasons why physicians shy away from leadership is because such roles come with stress. Mindfulness greatly enhances physician engagement, leadership capacity, and overall wellness. An essential part of the physician leadership model includes emotional intelligence (EI), and self-regulation is part of EI.

 

Is it possible for busy physicians to teach patients about mindfulness?

Yes it is possible, just as doctors can counsel about tobacco cessation or weight management. And the Latin root of the word doctor is teacher, not he or she who refills scripts for preventable diseases. More practical, it is important for physicians to know about mindfulness and to identify resources in their community that they can refer patients for MBSR.

Click here for more information on mindfulness-based therapy.

 

Where can we learn more about integrating mindfulness into our personal and professional lives?

If you are intrigued to learn more about mindfulness, simply begin by searching YouTube with the key words “Mindfulness Based Stress Reduction”. You will find many rich interviews and mindfulness practices by Jon Kabatt-Zin, the founder of MBSR in the US through the Center for Mindfulness at UMass Medical School.

 

Dr. Colon’s children meditating before bed.

As a physician and father of a 6 year old boy and 3 year old girl, I cannot afford to take time away for a mindfulness retreat and leave the family. I did however complete the 8 week MBSR course by theUMass Center for Mindfulness through Sounds True.

The integration of these practices into my life has had a profound effect on my ability to be a human being, rather than just a human doing, and more meaningfully connect with myself, my family, and my patients through mindfulness. If you would like to experience a moment of mindfulness from my perspective, I invite you to view this introductory video: Awareness of Breath

 

The Physician Leadership Institute thanks Dr. Colon for the time he has spent with us this month discussing sleep health and mindfulness. Both are powerful tools for engaged and happy physicians who know that in order to lead others, one must Lead Self First.

 

Jose Colon, M.D., MPH, specializes in sleep disorders, and is author of several sleep books and a writer for the Santiva Chronicle. Dr. Colon is dual board-certified in sleep medicine and neurology with special qualifications in child neurology. He is a member of the American Society of Clinical Hypnosis, The Institute for Functional Medicine, and a founding member of the Society of Behavioral Sleep Medicine.

 

Congratulations to the 2015 CHI Leadership Institute for Hospital Medicine!


Congratulations to the graduates of The 2015 CHI Leadership Institute for Hospital Medicine!

These graduates began their journey to transformational leadership in 2014 and have now demonstrated the skills to Lead with Purpose, Lead Self, Lead with Strategy, Lead People, and Lead for Results!

About CHI:

Catholic Health Initiatives, a nonprofit, faith-based health system formed in 1996 through the consolidation of four Catholic health systems, expresses its mission each day by creating and nurturing healthy communities in the hundreds of sites across the nation where it provides care. One of the nation’s largest health systems, Englewood, CO based CHI operates in 19 states and comprises 105 hospitals, including four academic health centers and major teaching hospitals and 30 critical-access facilities; community health-services organizations; accredited nursing colleges; home-health agencies; and other facilities that span the inpatient and outpatient continuum of care.

About the 2015 CHI Leadership Institute for Hospital Medicine

With a commitment to creating a model leadership development program for its physicians and administrators, CHI engaged the Center for Transformation and Innovation to deliver a comprehensive leadership transformation program: The CHI Leadership Institute for Hospital Medicine. The goal of the CHI Leadership Institute is to produce the next generation of transformational leaders, and to provide the leaders with the skills necessary to make a lasting impact in the community. Its focus is to identify and develop high potential leaders by growing and improving the ability to lead CHI in fulfilling its mission.

Tangible improvements were seen in the participants’ ability to effectively lead by example, drive results, develop internal teams and collaboration, lead change and foster innovation, think strategically and make sound decisions, manage conflict, and communicate with and influence others.

In addition to reporting significant gains in overall work satisfaction, loyalty to the organization, and engagement…

The CHI Leadership Institute for Hospital Medicine was a transformational journey that enriched the participants at a personal and professional level, and in turn, benefits the organization and patients they serve.

The institute served as CHI’s ongoing commitment to excellence in healthcare through the investment and development of physician and healthcare leaders. 100% of the participants would recommend participation in the CHI Leadership Institute to others at the Catholic Health Initiatives system.

Again, we extend a warm congratulations to the graduates of 2015 and look forward to their continue success!

Deepen Physician Engagement through Self-Reflection

 

VIDEO: Simon Sinek on How Reflection Informs Personal Growth

Think Tank Leader Simon Sinek uses daily self-reflection with great success, as do many other professionals worth listening to!

 

So WHY should physicians take time to reflect during an already busy day?

  1. Self-reflection requires that we ask courageous questions of ourselves before we expect others to follow our lead.
  2. Self-reflective physician leaders are far more satisfied in their daily work and committed to forwarding their organization’s mission, vision, and values.
  3. Through self-reflection, physicians will grow as people and professionals, and become more deeply engaged in the transformation of healthcare.

 

How do we begin?

We begin by assessing the realities of the terrain we are in.

In Why other professions can’t relate to medicine,  James C. Salwitz, MD, provides some thought-provoking observations on what it means to practice modern medicine:

…when an insurance company, following an ethical and classic business model, wants hundreds of “pre-certs” for medical procedures; doctors are insulted by the requests as conveying distrust in their clinical ability, undermining their autonomy and risking their patient’s health.  From the insurance company viewpoint, these are reasonable, routine, actuarially derived requests, but for the doctor it is personal and even dangerous.

When hospital administrators talk about better “outcomes” and “quality” data, doctors hear criticism of their commitment to the patient.  Because such requests may require changes in work pattern or style, doctors feel it may increase the risk of error.  Physicians see their role as the personal touch at the bedside, so the thought that someone else might force themselves into the room, someone who has not sacrificed, as has the physician, is confusing and threatening. 

 

Such demands can feel like threats to who physicians are, to the fabric of their professional identity and to the many years of work spent developing their expertise. This can have a deeply detrimental effect on physician engagement.

Physicians can learn to remain engaged and respond to such challenges with greater effectiveness by using a process of daily self-reflection.

We suggest using the following questions from the Physician Leadership Institute:

¨  Have I demonstrated an act of self-care today?

¨  Have I assessed my character and my actions?

¨  Have I demonstrated courage in showing my authentic self in my conversations?

¨  Am I remaining curious in the face of challenges?

¨  Have I demonstrated emotional intelligence by learning to understand and hold others’ concerns as my own?

¨  Have I displayed kindness through words and actions?

¨  What worked well today?

¨  What does success look like for me?

¨  What will I do differently tomorrow?

The Physician Leadership Institute teaches the essential self-reflection techniques that enable courageous acts and courageous conversations. Classes are designed around individual assessments and provide opportunities to apply what is learned in real-world scenarios. PLI then partners with physicians to create personal strategy maps that help physician leaders remain self-reflective and courageous on the job, so they may continue to thrive and innovate each day.

Healthcare administrators must play their part to support physicians in this process of leadership development, including self-reflection. Administrators must acknowledge their physicians are rising to leadership positions at a time of great convergence. Big data + big technology + big regulations= huge demands on physicians, and all must be integrated into providing top quality patient experiences and outcomes. Their identity as practitioners, and therefore their daily engagement, is being lost.

Teaching physicians essential leadership development exercises, such as daily self-reflection, is one of the most powerful investments that can be made in the future of your healthcare organization.

~ Mo Kasti

Are you ready to create a culture of self-reflective physician leaders who are deeply satisfied in their daily work and engaged in forwarding your organization’s mission, vision, and values?

Why Sleep is a Strategic Resource: by Dr. Jose Colon

This month, we are pleased to have Jose Colon, M.D., accept our invitation to speak to us about why sleep is a strategic resource essential to achieving healthcare transformation. Dr. Colon tell us:

Sleep can be the difference between a life well-lived and one that is suffered through. Are you taking sleep seriously?


Asclepius was the god of medicine in the ancient Greek religion and remains the symbol of medicine today. His symbol consist of a non-venomous snake that was often used in healing rituals, and they slithered around freely in dormitories where the sick and injured slept. These temples can be considered the very first hospitals, and yet the sick didn’t go there for medications, they went for sleep!

More has been learned about sleep in the past 10 years than in the 100 years prior. Even as we are learning more about the importance of sleep, the amount of Americans that report sleeplessness is increasing: nearly 40 million Americans suffer from sleep disorders. (NIH) 30% of US workers report nightly sleep durations of ≤ 6 hours, in contrast to 50 years ago when only 3% of the population reported such short sleep duration. (Luckhaupt)

 

The consequences of sleeplessness have a profound effect on the mind, including concentration, working memory, mathematical capacity, and logical reasoning.

Alarmingly:

  • 18 hours sustained wakefulness produces performance impairment equal to blood alcohol level of .05% and 24 hours of wakefulness is equivalent to a BAC of .10% BAC (Dawson).
  • Sleep-related fatigue costs business $150 billion a year in medical costs, absenteeism, workplace accidents, and lost productivity. (Institute of Medicine)

Somewhere along the line of doctors teaching doctors that dates back to Hippocrates, the importance of sleep was de-empathized for both doctors and their patients. Sleep is often not part of general medical curriculum. Personally, I received one lecture on sleep apnea as a medical student, and received zero lectures on sleep during my primary care residency. Medical schools and residencies can even promote a dangerous culture of pride in sleeplessness.

I stumbled upon sleep science when I was completing my fellowship in Neurology with qualifications in Child Neurology at Vanderbilt University, where the department of Sleep was part of the Neurology department. Had I not come across sleep science during the insomnia I was going through at that time, I may have joined the 30-40% of the general population that suffers from chronic insomnia, a dangerous condition with far reaching effects. The average physician has the same amount of sleep health education as I had through my primary care training: nearly nothing.

This is the reason why sleep disorders are largely under-diagnosed in patients: doctors themselves are often sleep-deprived, and simply unaware of its effects on their lives and the loves of their patients. So what can be done?

There is a booming industry for hypnotic sleep aids, and repeated evidence-based studies have shown that treatment with Behavioral Sleep Medicine is more effective than medications in short and long term outcomes of these habit forming drugs. (Morin CM et al.   JAMA 1999;281; Brem S. Clinical Adviser) But before you begin to explore the world of Behavioral Sleep Medicine, I encourage you to simply be aware of the importance of sleep to your well-being and to that of your patients. Incorporate questions about sleep health into your practice. A sleep health dialogue can uncover information to potentially improve the outcome of your treatment plan.

As Hippocrates said,

“Sleep and watchfulness, both of them, when immoderate, constitute disease.”

In our current sleep deprived society, when patients can improve their sleep, quality of living and health outcomes are improved. And for physician leaders, a well-rested mind will allow for concentration and reasoning to help tackle the problems of tomorrow.

I take great pride in being a doctor, the tradition of taking the Hippocratic Oath and being part of a lineage of doctors teaching doctors. It is perhaps one of the oldest and most honorable professions. The Latin root of the word “doctor” is teacher. I hope to bring awareness towards the disparity of sleep education in mainstream medical curricula, and to encourage physician engagement in continuing medical education that involves sleep health.

Yours in Health,

Jose Colon, M.D., MPH, specializes in sleep disorders, and is author of several sleep books and a writer for the Santiva Chronicle. Dr. Jose Colon is also the founder of Paradise Sleep, an organization dedicated to education in sleep health. Dr. Colon is dual board-certified in sleep medicine and neurology with special qualifications in child neurology. He is a member of the American Society of Clinical Hypnosis, The Institute for Functional Medicine, and a founding member of the Society of Behavioral Sleep Medicine.

 

To request a free eBook copy of any of his books, including The Sleep Diet, A Novel Approach to Insomnia, you may contact Dr. Colon through www.paradisesleep.com

 

References:

National Sleep Foundation 2010 Sleep in America Poll —International J. of Psychology, 88 (2013), 64-73.

Luckhaupt SE, author. Short Sleep Duration Among Workers – United States, 2010. MMWR Morb Mortal Wkly Rep. 2012;61:281–5.

Institute of Medicine (US) Committee on Sleep Medicine and Research; Colten HR, Altevogt BM, editors. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington (DC): National Academies Press (US); 2006. 4, Functional and Economic Impact of Sleep Loss and Sleep-Related Disorders. Available from: http://www.ncbi.nlm.nih.gov/books/NBK19958/

Morin CM et al.   JAMA 1999;281; Brem S. Clinical Adviser

Sabrina Brem, DNP, FNP-BC. Insomnia: Using cognitive behavioral therapy in primary care. Clinical Adviser 2015.
http://www.clinicaladvisor.com/insomnia-using-cognitive-behavioral-therapy-in-primary-care/article/392219/

Dawson & Reid, 1997; Williamson & Feyer, 2000.

 

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