Physician Leadership Challenges: Skills and Behavior

The previous blogs covered the challenges faced by healthcare institutions in two broad categories: (1) Strategy and (2) Organization and Culture.

Now let’s turn to a third and vital challenge – skills and behavior. Here are some examples:

Physicians Lacking Leadership Skills To Be Engaged In The Transformation:  Healthcare lags behind significantly compared to other sectors in producing leaders. Current medical educationand credentialing are devoid of leadership training and team-building, focusing more narrowly on clinical skills. The current system also dis-incentivizes physicians from active leadership roles.  However, hospitals where clinicians engage in management improved their performance by 50%  as compared to hospitals with low clinician participation.

Physicians Lack Of Adaptability And Flexibility To Change: Charles Darwin once said: It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is most adaptable to change. Unfortunately physicians tend to be more analytical thinkers and part of the “expert culture” with less flexibility and creative qualities that could be vital to transformation.

Not Enough Physician Change Agents:  A change agent is a catalyst who eschews bias that stagnate an organization and awakens dormant creative and collaborative qualities in others to achieve that qualitative transformation.  Physicians have never been trained to be a change agents with the necessary skills to assess, engage, influence , enlist and awaken the possibilities in others.A set of destructive physician biases ranging from entrenched hierarchies, lack of trust, and risk-averse behavior impede the development of such change agents.

Failing To Show Empathy: Successful leaders show what Daniel Goleman terms “emotional intelligence” and one of the aspects is self regulation, the ability to break destructive habits and regulate disruptive emotions that govern adaptability. Research shows that medical students show an alarming drop off in empathy, a critical component of “emotional intelligence” between their first and third year of training. The “broken covenant” in healthcare further increases cynicism in physicians sapping motivation needed for patient-centric care, organizational commitment, and leadership qualities.

Build Sustainable, Trusting Relationships With Others: Physicians steeped in expert culture see themselves outside of the rules that others have to abide by which negatively impacts the building of trusting relationships in an organization that relies on a collaborative culture for its success. These relationships are very important in sustaining organizational commitment.  Retention rates rise when physicians build trusting relationships with their co-workers.

Lack Of Collaboration: Physicians value results over process and disconnect themselves from others driven by other considerations. Physicians who take the effort to collaborate with the rest of the organization prove successful in its transformation. One such person is Ken Kizer, the MD described as “healer, leader, partner” and the force behind the success of the VA system organizing it into 21 centers of excellence and decreasing mortality by 40% for men 65 years and over as compared to the national average.

Providers Recognize Others’ Contribution And Create Team Spirit: Yet another fall-out from the expert culture vs collaborative culture is the inability of physicians to appreciate the role of others in healthcare success and build team feeling.  The corollary is the distributed leadership model that McKinsey cites in organizational alignment amongst physicians that has led to success.

Inefficient And Unproductive Medical Staff Meetings:  Most Medical staff meetings are little more than tactical discussions building little team spirit, or engaging in a strategic vision. Ask participants in these meetings to rate the meeting and believe the meetings are ineffective. One cause is that 70% of physicians did not know how to conduct an effective meeting including knowing how to engage the physician diverse work and communication styles.Successful leaders believe meetings should be action sessions where brainstorming problems and finding solutions are part of the push for results which ensures transformation.

Retiring Physician Leaders: Turnover in medical groups continues to climb along with the economy, says Lori Schutte, president of a healthcare recruiting firm in St. Louis, Missouri. When Cejka and the AMGA broke down physician turnover by group size, they found that smaller groups had a faster revolving door. Practices with 3 to 50 physicians posted the highest turnover rate — 11% — in 2012. Similarly, the retirement rate among physicians aged 64 years topped out at 19% in this group category. In comparison, it was only 10.8% in groups of 151 to 500 physicians and 12.7% in those with more than 500.

We find that younger physician generations are not interested in getting involved and would rather spend time with family then in meetings. Succession problems are particularly pronounced in the healthcare sector given that there are very few formalized programs in medical school that stress leadership qualities.  The leadership evolution also takes time and must go beyond self-help books and seminars.

Providers Stressed And Burned Out:  Healthcare’s broken covenant where physicians feel the brunt of governmental regulations, income limitations, and loss of stature has led to all too common phenomenon of burn out. Many cite the exorbitant amounts of money needed to set up practice, pay hundreds of thousands of dollars in liability, litigious nature, and failing reimbursement rates.  There has been an exodus of physicians into the safer havens of hospitals with private practices falling to less than 30% from 50% a decade ago.

Disruptive Behaviors:  Emotionally Intelligent individuals are self aware, regulate themselves, show empathy, motivation, and have very good social skills. These have been shown to the hallmarks of good leadership.  At the other end of the spectrum are those who play victim and the blame game, disinterested, do the minimum, are happy with the status quo, resentful of success, inflexible, and reactive.

Providers Using The Language Of Blame Versus Ownership: Do your physicians walk into a meeting blaming everyone else about an issue or they come in with the following statement: “We collectively own this issue and let’s together identify the solution” ? The blame game is a symptom of the lack of alignment between the physician and the organization. Effective leadership results in a sense of collective responsibility. Peter Drucker stressed the importance of self report and feedback analysis where expected results are matched to actual results and the reason for shortfall becomes a collaborative process. Highly motivated leaders never complain when things don’t go their way. Instead they re-channel their energies to engage in identification of the solutions.They show a passion for work that goes beyond their own personal gains. Goals are pursued with energy and persistence.  Their commitment inspires others to do the same.

Lack of Loyalty To The Organization: Physician retention failure and early retirement is becoming all too common.  Fully 20% of physicians find new jobs within the third year of hiring. Again, aligning themselves to the organization and its values provides a huge challenge.

Insufficient And Unhealthy Way To Deal With Conflicts: In many conflict style assessments physicians tends to fall into two styles under stress: they either avoid or confront conflict. Physicians in their medical training and credentialing are given no exposure to conflict resolution which results in either avoidance behavior or a confrontational style that stymies team building and organizational alignment. Highly effective leaders are extremely self aware, self regulatory, and show the empathy to deal with conflicts effectively.

Physicians Unaware Of Financial Implications Of Their Actions To The System: Physicians need to understand the consequences of their decisions and actions on the whole system beyond their order for the specific patient. Physicians in their medical training have very little exposure to the system and business side of healthcare and financial leadership.

In summation, the challenges are great, and the opportunities vast. Institutions that create physician leaders stand the best chance of creating a competitive, sustainable and profitable business model. Where do you stand?

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