Arrogance

The word came up in two separate conversations, from two very different people. Every two weeks, we ask someone associated with ACPE to spend 45 minutes sharing his/her insight on the trends occurring in health care. Both people are nationally known, one a recruiter, the other a physician leader. With the number of physician leadership roles growing rapidly in the past few months, I want to share their comments because they’re important for both job seekers and leaders who plan on staying in their current organizations.

The recruiter said physicians seeking a new position for all the wrong reasons are spotted very quickly in the process. These physicians often say they’ve discovered how talented they are in management and know they would be successful in their first full time management role. They haven’t invested in management training because they possess “natural talent”, are highly critical of the leadership of their current organization and say they no longer enjoy clinical work. The term the recruiter used to describe their demeanor? Arrogant. Further, these doctors are quickly dropped from candidacy.

What does arrogant mean? Here are a few definitions – none of them conducive to effective leadership! “Overbearing pride evidenced by a superior manner toward inferiors.” “Haughtiness.” “Contemptuousness – the manifestation of scorn and contempt: every subordinate sensed his contemptuousness and hated him in return.” “The trait of being imperious and overbearing.”

The other guest, a health system physician CEO, said over the years he had to fire several excellent clinicians who had very poor communication skills and lacked self-awareness. They often had very good analytic abilities, great insight into problems and solutions, but could not manage a civil word with peers, subordinates or superiors. Some were friends. Again, the term arrogant was used to describe their behavior.

With teamwork replacing autonomy and independence, arrogance is a trait that will derail you and your career. It’s OK to be proud of your achievements as a physician, but it should come across as quiet confidence to others on the health care team. Some physicians DO have a natural talent for leadership and business. Most of us, however, must learn new concepts and behaviors we weren’t taught in our medical training. I’ve heard stories from coaches and mentors about successful behavior change in arrogant physicians who recognized how they were being perceived, and sought to change. Some of my most valuable experiences have been helping smart, talented physicians change their behaviors.

If you’re one of the hundreds of physicians who are looking for a rewarding role in leadership or management, be sure your first interview puts you in the best possible light. We want you to be successful. Many people are watching and curious about the impact of more physician leadership in the health care industry.

Notes from the road: An optimistic view of the future

Physicians are preparing to lead health care change across the country. This is perceived by some entrenched interests to be a threat. To patients and their families, and to physicians’ co-workers, this is a very positive development. I think whoever is closest to patients and consumers will be in the best position to impact change.

Crisscrossing the country over the past few weeks, here’s what I’ve seen and heard to justify my optimism. In Iowa, a large predominately rural health system has launched its Physician Leadership Academy. Each of the thirty-seven physicians were enthusiastic about learning how to improve dysfunctional work processes, develop innovative strategies, and find ways to improve patient outcomes of care. The initial class was nearly 50 percent larger than anticipated, and next year’s new class is equally committed and talented.

In South Carolina, the hospital association and medical association held a joint meeting to discuss what health care reform means for their communities. I talked with several ACPE members during that meeting. I learned that South Carolina has been collaborating with Atul Gawande on the surgical checklist project and with IHI on quality initiatives. The sense of common purpose and respectful disagreement on issues (not people or motives) between the medical society and the hospital association was very impressive. When it comes to interdisciplinary teamwork and measuring health care outcomes, I think South Carolina is a special place.

In Nevada, a large physician group has been managing financial risk for a few years, and doing very well. I listened to a sophisticated conversation at breakfast between two of the attendees about the clinical and financial management of heart failure patients across the continuum. I assumed both were physicians. Wrong. One was the CFO. I believe these kinds of conversations will become commonplace in integrated systems, ACOs, and medical homes if health care change continues in that direction.

In Nebraska, a rural community is beginning an important dialogue with its hospital board, independent and employed medical staff, and hospital staff about how to become a “physician led system, managed by business professionals”. Everyone will have to imagine how their roles will change, and what it means for relationships with large tertiary care centers in nearby cities.

In San Antonio, Texas several dynamic young physician leaders from different branches of the military remind me that some of the best teamwork training and practice occurs in our armed forces. When an individual fails, the whole team fails. They hold both individuals and teams accountable for serious safety events. They correct the problems that lead to the adverse outcomes.

If you see a system around you that frustrates you, or isn’t good for safe and reliable patient care, start now to learn what you can do to change it. Your satisfaction in helping to lead change, and see your role as a physician in a new perspective, will give you exciting new options in your career.

Dog Sleds and Teamwork -- Or How a Team of Huskies Made Me a Better Manager

Years ago, before beginning my management career in health care, I trained our four Siberian/Alaskan huskies to pull a dog sled. My motivation was to allow our toddlers to enjoy the winter wilderness with a smile on their faces. Kids love dogs, and a down sleeping bag wrapped around them makes for a nice trip in the back country.

Now this is going to be dangerous: I’m going to share some insights on working with a team of dogs and how that might have some relevance to working with people when you and your team have a goal in mind. We love our dogs, but we should have at least that same love and respect for the people we work with, don’t you think?

There’s always a first time when you and the team get together to try something new. Each one of the huskies individually would instinctively pull on my ski-joring rope when I went cross country skiing. I thought getting each of them to work together would be a piece of cake. But the first time I hooked up the four dogs in their harnesses it was a disaster! The dog I chose for the leader was Junior, the oldest and alpha male of the group. Strong beyond belief, he was always the aggressor in the yard. I assumed that the others would follow his lead. Wrong. Junior would stop pulling to turn around and snap at or fight with the others. Harnesses were tangled, none of the others wanted to pull.

I was quickly growing frustrated -- and so were the dogs. I decided to “punish” Junior by putting him at the back, in the “wheel position” – the first dog immediately in front of the sled. I chose the youngest dog (Togo) with the mellowest personality of the group for the lead. Lo and behold, much to my surprise and delight, the team ran with the characteristic excitement and enthusiasm of a high performing sled dog team! Junior loved being in the wheel position because he could keep an eye on the others, and it was the best position for the strongest dog. The others (Wiley and Lupe) appreciated being able to run faster. The dynamics changed very quickly among the four of them.

Over the years, you learn valuable lessons about teamwork. Don’t expect your team to do something that you wouldn’t do yourself. Got a hill to climb? Get off the runners and run up the hill with them. Lost and unsure about which trail to take in a whiteout? Trust your team. Their instinct is correct and deserves your trust and faith. Praise them for a job well done. Keep the momentum going. Don’t slam on the brake suddenly and stop the forward movement until you’ve crossed the finish line.

I noticed that every time I stood up to use the footbrake to slow the team down, I’d lose my balance, and sometimes fall, bringing the team to a complete stop. “What’s your problem?” they seemed to be saying when they looked back to see why we weren’t moving. One day I asked a veteran sled dog driver how he managed to avoid falling when using his brake.

“I never use it until the race is over. I stay low like the dogs, dragging my feet or knees. Standing up on one leg, and raising the other to stomp on the brake, elevates your center of gravity, and makes you unstable.” I have no idea how that relates to our teams at work, but I thought it was interesting.

McChrystal's Downfall

How have you been perceived as a leader lately?

What’s fascinating about the uproar over General Stanley McChrystal's conduct is that it's not focused on differences over the war strategy in Afghanistan. Instead, it's about a leader’s behaviors. General McChrystal’s situation has a lot to teach us about leadership!

First, it demonstrates the fragility of titles, positions and roles of authority. You are in your position because a more senior member of your organization made a decision that they could trust you to be a valuable part of a team. Once that trust is fractured, your lofty title can disappear in an instant.

Second, like the General, many of us physicians have superiors who are “civilians” – e.g. not clinicians, not doctors. When we find ourselves in disagreement with our non-clinical colleagues, do we state that disagreement face to face, or do we make demeaning comments about them to our subordinates? I suspect that sometimes the stresses of leadership and management make all of us say and do things that don’t reflect well on us. One of my friends who once worked with McChrystal told me that the behavior described in the Rolling Stone article, in which McChrystal openly disparaged other high-ranking U.S. officials -- was out of character from the man he knew a few years ago. Still there’s no excuse to ridicule and disparage the thoughts and ideas of others who may disagree with us.

Third, are you a role model of professional and respectful behaviors for your staff? If your closest staff feel comfortable belittling others, they may be acting that way because you a). exhibit those same behaviors yourself, or b). you haven’t told them it’s unacceptable behavior. Do you routinely attribute not-so-flattering motives to people who disagree with you, or whom you perceive as adversaries? I find my judgments about the motives of others are more often wrong than right. I try to ask them rather than assume I know their motives. I hope my failure rate on fundamental attribution error is decreasing as I get older and more experienced!

It’s hard to imagine how this situation could have ended without McChrystal being replaced. Not only did McChrystal’s comments demonstrate disdain and disrespect for his superiors, but his inner circle of leaders was guilty of the same behaviors!Would you want to work in an organization or unit where these behaviors were the norm?

Ask yourself what you would do if you were the CEO (President Obama). Knowing that our preference as physicians is to avoid confrontation or conflict, would you have fired the general yourself? Asked HR to do it? Found a way to live with the situation while you gave the general another chance? Would you find out how the front line troops felt about their commanding officer before making a decision?

Maya Angelou says, “People will forget what you said. People will forget what you did. But they will never forget how you made them feel.” As leader of your practice, business, unit, or health system, how do your staff and colleagues feel about working with you?

Lessons from ACPE's Annual Meeting

It always takes me a few days to unwind from the intensity and new ideas coming out of our Annual Meeting. This year's meeting in Washington, D.C., and that's me in the picture with my wife, Janet, and an actor who portrayed one of the "founding doctors" during our induction ceremony for Fellows and Certified Physician Executives.

At the meeting, we heard from Dave Snowden about Complexity Theory and how it can be applied to the chaos of health care. He pretty much exploded many of the status quo ideas about a linear, predictable and manageable control mentality when it comes to improving our health care system! His analogy of parents trying to “manage” a 6 year old’s birthday party and all the unexpected twists and turns inherent in such an endeavor was hilarious.

He mentioned that we should be aware of “outliers” from the norm. Thinking about that, I met two medical students who found their way to our Annual Meeting and asked them why they came. Both were curious about physician leadership and system change. At least one has already decided he wants to be involved in system change when he graduates. I want to meet more outliers like these, and like the many young physicians who were attending their first ACPE meeting and are excited about being agents of change.

It feels like a renaissance is occurring among a growing number of physicians. No longer content to watch from the sidelines, or rail against powerful forces with major roles in health care, these physicians are excited and optimistic about the role they can play in shaping the system to better serve patients, and the professionals who work in the system. Many said they’re tired of the “us vs. them” way of thinking. They know that the strategic importance of financial statements, linking quality and safety to the business functions of medicine, and knowing how to influence organizations to change are new knowledge content that will be important.

We heard from David Cutler, a health economist, and from six leaders who gave us updates on what they expect in payment, safety, comparative effectiveness research, IT, medical home, and integration. The innovators among us – probably most of us – were imagining what new ideas can disrupt the status quo, and change the health care landscape.

Finally, I want to thank Harry Leider for his leadership as President of ACPE over this past year. He demonstrated to me, to our Board, and to our members how enlightened and effective leaders work. One of Harry’s greatest achievements was organizing seven Task Forces on key issues. Their reports were given in person to the Board. The analysis and recommendations were insightful, strategic, and very useful. You’ll be seeing more in the months to come about what ACPE is doing to implement those recommendations. Thanks to the more than 200 members who contributed to this vital work.