A Physician’s Guide to (Leading) Hospital Committees

technologyThere will be times when physicians must get things done outside of the clinical setting. Much of the time they will need to work with others that are not physicians.

It turns out that while medical school and residency prepared us to handle many situations these “corporate” entities (meetings, committees) are a mystery to most of us. What follows is a simple guide to understanding and succeeding in these environments. The goal is to achieve positive changes to the clinical environment that benefits our patients through collaboration with others in our organization.

leaderI think it is important to start with definitions as to where the power and authority (See definitions below) of the committees you will be working on (or leading) come from. While there will be some variation we will focus on not-for-profit institutions. Essentially the power and authority of committees comes from one of two sources. The Board of Trustees (essentially the owners of the institution) and the medical staff (the clinical entity responsible for care).

Each is responsible to provide the governance structure for the hospital/healthcare system. While they work interdependently they are technically independent of each other. The Board acts through its own committees and the administrative powers delegated to the executive team (think CEO and VPs).

The medical staff through its bylaws and rules and regulations. Through these governance tools the medical staff exerts its influence on physicians and other providers (dentists, podiatrists, advanced practice nurses, physician assistants, etc). Central to medical staff powers is the credentialing of physicians and providers to practice in the institution and the maintenance of those privileges. (See this White Paper)

committee_flash

While we tend to use “committee” to describe any regular meeting it is a generalization. For this piece I define committee as any group that meets regularly (indefinitely or for a set period of time) and for a specific purpose. It possesses some power or authority transferred to it from the entities already described. You can also think of committees as being focused on action (my favorite) or reporting and monitoring of information (useful but not my favorite).

So if you have been tasked with forming or leading a committee here is a step by step guide of what to do:

  • Determine the purpose of the committee you are going to lead. Can you summarize this purpose in a few short sentences (ie goals)? Better yet can you also spell out how you will accomplish these goals (think road map: frequency of meetings, etc)? If you can answer yes to both of these you have all the makings of a charter (statement of purpose and structure) for your committee.
  • Who do you need on this committee? In other words who do you need in the room to get it (your goals and objectives) done. In general you need leaders, enablers, local experts, and others with power and authority. Part of this is based on what level your goals operate on.

Are your goals Tactical (need front line staff, heavy on implementation with some operational staff), Operational (need departmental level or multiple departments…may need chairs, physician champions, nursing directors and some VPs), or Strategic (very big picture…still need some front line providers but heavy with VPs, chairs, directors and possibly board members or outsiders).

Getting the right mix of “bosses and do-ers” is critical.

  • What can you get done before hand? Lawyers are told “never ask a questions you don’t know the answer to” and we physicians go by “never ask a clinical question (or order a test) you don’t want the answer to”. The same goes for initiating a committee or running an ongoing meeting. You as the leader should have a very good idea what you want the recommendations and actions to end up being. Much of this can be done by developing consensus ahead of time with key members of the group.

 

  • Create an Agenda. This is the road map of how the meeting will go. There is nothing worse than being invited to a meeting and not being able to understand the purpose of that meeting or how to prepare. An agenda sent ahead of time lays out the goals of the meeting and helps pace the discussion to ensure all items get full attention. Don’t forget to provide time to review the results of previous meetings (minutes) and to allow time at the end for questions and next steps.

 

  • Running the meeting. Notice that the actual meeting is the 5th Think of this like a medical procedure you are performing. All the prep (planning, consent, preparing the patient, sterile fields, arranging your instruments) takes the bulk of the time while the actual procedure is only a small piece. The keys are as follows:
    • Start on time
    • Follow the agenda
    • Encourage discussion and new ideas but insist on civility and tolerance of alternative opinions
    • Do not allow people to stray off topic unless you the new path makes sense
    • Have a note taker to record action items, decisions, and other relevant information (the makings of your minutes)
    • End on time or early (giving time back to busy people if a gift)

 

  • The in-between. Committees are excellent places to “level set” with diverse participants and try and obtain consensus. They are not great formats for actually getting work done (unless achieving consensus on a decision is the work). So carrying out the tasks agreed to by the committee is done outside the committee room. This is where the “Authority” of the committee comes into play. It helps push action within the hospital.

 

  • Measuring success. Essentially have you met your initial objectives? If you have created a charter that reflects accurately your goals and utilized your agenda to keep on target it should be easy to determine your success after a period of time. Keep in mind the larger the group the more time accomplishing specific tasks may take.

 

  • Enemies of success
    • Unclear or unobtainable goals and objectives
    • Not updating the goals and objectives to fit progress
    • Failure to be fully prepared as the chair or leader of the meeting
    • Inability to stick to the agenda
    • Flaws in membership of committee
    • Lack of support from parent structures in the organization
    • Meeting hogs (always talking never listening)

In the end committees are an opportunity to bring diverse members of your department, hospital or healthcare system together to address a specific need or set of goals. Understanding and defining early these objects and being clear of who you need to accomplish your tasks are vital. As the Chair or leader of the committee accepting your role to influence and guide are vital. Committees can be loud and messy and like democracy are the “worst choice for getting things done except for all the rest”.

 

Definitions-matterDefinitions:

Authority: The right to give orders, make decisions, and enforce obedience.

C-Suite(-ers):  It took me forever to understand this term. I kept trying to figure out who was in the A and B suites until I read that all the C’s stand for chief (CEO – chief executive officer; CFO – chief financial officer, etc). An excellent list that defines the common C-suite-ers can be found at:  http://www.beckershospitalreview.com/hospital-management-administration/38-hospital-and-health-system-c-suite-executive-positions.html

Enabler: These are interesting people because they get things done. Sometimes they act as catalysts, sometimes they simply enact things.

Goals: The end point or future state you want to achieve (ie destination). See Objectives

Leadership:  the process of influencing people by providing purpose, direction, and motivation while operating to accomplish the mission and improve the organization. http://usacac.army.mil/sites/default/files/documents/cace/DCL/DCL_SewellEngNovDec09.pdf

Objectives: Steps needed to achieve the goal(s). These are more specific and detailed.

Operational: The what. The link between what needs to be done to achieve your strategic objective and how (tactical) it gets done.

Power: The ability to influence somebody to do something that they would not have done otherwise. Sometimes related to Authority but not always.

Strategic: The why. Drives your operational goals and objectives. High level and focuses on outcomes. This is the blunt end of the spear pointing the tip towards its objective.

Tactical: The How. The implementation of strategy following an operational plan. Accomplished by those at the bedside or sharp end of healthcare.

 

Starting a Committee Checklist (A Physician’s Guide to Hospital Committees)

What are the goals of the committee?

What are your objectives?

What is the constituting authority of this committee (ie who do you report to)?

Have you written your prelim charter?

Who are the vital participants (by role or name)?

Who are optional but important participants?

How often will the group meet?

How will you define success (ie end of committee)?

Who will be taking notes and creating the minutes?

When and where will you be meeting?

 


Mr. Rondell Williams, saying goodbye, and being afraid to sleep…

Private-ED-Rooms-SJRMCWe said goodbye to Mr. Rondell Williams twice in one week. The first was at his goodbye party organized by the nurses and techs in our department. He was leaving us for a new opportunity within the hospital. He would be close by but not a day-to-day part of our department. He was excited and proud and we were excited and proud for him.

Rondell was a product of our community. Born in our hospital 32 years earlier. He had kin who also worked for our hospital. He started as a security guard at 18 and after a brief stint in the military had returned. He had been a registration clerk in our department for about eight years. Essentially a front line support person.

The second time we said goodbye was at his funeral 10 days later. He died unexpectedly and suddenly, surrounded and cared for by those he had cared for. It was a truly beautiful funeral service attended by several hundred people. Rondell had a large family and many friends.

There also were people from literally every nook and cranny of our hospital.  Nurses, techs, administrators, and physicians. The local Police and Fire Departments were also well represented. Gathered to say goodbye to this special man.

All organizations have their Rondell’s. They are vastly more important than their titles imply. They are the ones who hold us together. They define our institutions. Mr. Rondell William’s was no exception.

positive energyWhat made him so special? It was simple. He literally was an endless reserve of positive energy. It was bottomless. He distributed it freely and without reservation to everyone. To  patients, their families, EMS and Police, and especially our staff. He knew everyone’s name, and of course there were the handshakes.

Rondell cultivated a personal relationship with everyone he encountered. It came in the form of his greeting to you (Dr. Ahhh-din-aro!), and a death grip handshake with various elements of dapping (or a big hug) each specific to the individual. Ours ended with the phrase “Semper Fi”!

Then came the hook. The thing he would talk to you about. The thing you would bond over. For me it was men’s suits and shoes (“looking great Dr. Adinaro!) for others it was just as private and unique. The effect on the recipient was universal. It made your day just that much better. He was a walking confidence booster. Until he was about to leave he never told us how proud he was of us. But we knew. His care of us was intentional and much needed.

We ER folk all wear a certain amount of armor to cope with the sadness, violence and loss that we experience on a daily basis.  We all do a certain amount of whistling past the grave yard. Our humor can be somewhat ghoulish. Then we go home and try to put those feeling behind us. To forget the parts of the world that both repel and attract us.

Grief and mourning are profound and difficult things for everyone. But it feels particularly difficult for those on the front end of healthcare. There is no distance. You must mourn while you take care of others. You must grieve  while seeing others sick or dying. You must confront your own mortality.

His death sent a shock wave through the close knit staff of the Paterson ER. Those first few weeks were very difficult. The loss of one of our own gets under that armor.  Our success at coping with the normal grief we experience is varied. Some days good. Others not so much. The loss of one so close tests our coping mechanisms.

04a_t607Most nurses and doctors show some form of burnout after a few years. We blame it on the long hours, intense situations, working nights, but rarely accept exposure to death as one of the causes. For me it was trouble sleeping. More specifically of being afraid to go to sleep because I might not wake up. It started after the loss of my Sister-in-law and was intensified by the job that I love and it lasted for years. It was accompanied by intense bouts of depersonalization.

Until I wrote those words just now maybe I had told two people besides my wife about that. It is not in the DNA of physicians to talk about the effect their careers have on their mental health. I suspect the same thing is true for nurses. It is embarrassing to admit that it might not be healthy for me to be an emergency physician any more.

quality-assurance-cultureIt has now been a few months since we lost Rondell. He is far from forgotten and I think about him frequently. The department has continued on. New bonds and support systems have formed. Many, I suspect, inspired by this great man. I sleep better at night and am less afraid. Writing and talking has helped as well as drawing courage from those close by. I am still willing to chase the tail of the tiger who can bite me.

I hope these words are a comfort to others. And that Rondell’s family knows how much we loved him.

Semper Fi.


The 5-Tools of Physician Leadership in the 21st Century

moneyball posterVery rare to come upon a young man like Billy. Who can run, who can field, who can throw, who can hit and who can hit with power. Those five tools you don’t see that very often….we’re looking at a guy who is a potential superstar.” (Moneyball, 2011)

 

In the movie MoneyBall they refer to the lead character (played by Brad Pitt) as being a five tool player when he was being recruited out of high school. Being a 5-tool player mean being able to (for both average (1) and power(2) ), throw with speed and accuracy (3), field (4), and is fast with great base running skills (5). It is acknowledged that most players only have 2 or 3 of these and that a true “five tool baseball player” is rare.

All physicians are leaders. We lead clinically every day. We provide leadership as we care for patients, supervise residents and medical students, and interact with all the other allied health providers. the concept of the 5-Tools of Physician Leadership is geared to those that provide leadership to other physicians.

I believe that there are also five vital tools that Physician Leaders in the 21st Century need to have. They address the fundamental thing we need….the ability to lead change in chaotic times.  The more they hone these skills the more successful they will be. Like in baseball very few will be perfect in all five .

The tools that physician leaders need to  have are:

  • Solid and respected clinical skills (1)
  • Comprehensive communication skills (2)
  • The abilities to Create (3), Execute (4) and Sustain (5)

While the first two are hardly “new”, the emphasis on creating, initiating and sustaining change are a 21st century phenomenon.

Clinical Skills:

tt-positions-greenNo matter how much the practice of medicine changes or will change it is ultimately a conservative and somewhat insular discipline. While we practice many specialties there are commonalities: The experience of medical school and residency and the focus on patient care. Without a solid clinical base recognized either from years of clinical practice or possession of coveted knowledge it is unlikely other physicians will follow you. Furthermore the perception that you are no longer sufficiently clinical (ie swinging a hammer) can also reduce your value on clinical matters. Simply put physician leaders must stay grounded somehow in the clinical world no matter how difficult that could be time-wise.

Communication:

email picThis is perhaps the most difficult of the 5-Tools to define. It takes some courage to get up in front of your distinguished peers and tell them to do something.
It is even harder to get them to listen. We are used to communicating with each other clinically. But this is different. You have to find both universal messages that work for all physicians but also appeal to the differences within and between specialties.

Communication also requires mastering different media. In an average sized hospital it would almost be impossible to communicate only in person. Most physicians (40ish and above) can be reached reliably through emails. Very few physicians under 30 these days ever open email and prefer texting and other mobile app based venues.

Create, Execute and Sustain:

technologyMedicine is becoming more integrated, more coordinated and requires cooperation across not only specialties but also disciplines (nursing, allied health, etc). If physicians are to lead they must be able to influence the way care is provided. Physicians should be well suited for these tasks. From 3rd year of medical school on we have been creating differential diagnosis, initiating treatment plans and sustaining the attention required to complete our rigorous training.

These three tools though are separate and unique. We have all met physicians who have great complex ideas that they expound upon at every staff meeting. They have vision and passion (to create) but are unable to translate that into action or sustained results.

On the opposite end is the physician who is frequently belittled by colleagues but loved by chairs. She or he is always the first one to turn in their required paperwork, is never late with their charts, and carries forward the protocols and policies of their department (the Sustainer).

The Executor is like the shock troop of change management. Able to rally their medical staff or department and charge full force into the unknown. They are able to translate the creative ideas into action and start the ball rolling. They understand the pros and cons of the change and provide the energy to get the initial job done. Like the Creators however they frequently lose interest after a while and sustained change is threatened.

Summary:

As stated earlier it is rare to find a truly 5-Tool Physician Leader. Some of the most successful I have known only possessed 2 or 3 but were smart enough to surround themselves with others who possessed the other tools. It is important to remember that while these tools are vital to a physician leader they are not the only skills needed. Comfort with data and analytics (both Big and Little Data) along with a fundamental understanding of finances and budgeting are crucial as well.