Archive for the ‘Leadership’ Category

Quotable Quotes – Coaching and Mentoring

May 8, 2013

I attended a leadership conference the other day about coaching and mentoring.  I am sharing a whole peck of notable quotes that were presented to us.

Vince Lombardi

  • Winning is not a some time thing; it’s an all the time thing.
  • You’ve got to be smart to be number one in any business.  But more importantly, you’ve got to play with your heart, with every fiber of your body.  If you’re lucky enough to find a guy with a lot of head and a lot of heart, he’s never going to come off the field second …
  • And in truth, I’ve never known a man worth his salt who in the long run, deep down in his heart, didn’t appreciate the grind, the discipline.
  • But I firmly believe that any man’s finest hour- his greatest fulfillment to all he holds dear- is that moment when he has worked his heart out in a good cause and lies exhausted on the field of battle- victorious.
  • You don’t do things right once in a while… you do them right all the time.
  • Once a man has made a commitment to a way of life, he puts the greatest strength in the world behind him.  It’s something we call heart power.  Once a man has made this commitment, nothing will stop him short of success.
  • The quality of a person’s life is in direct proportion to their commitment to excellence, regardless of their chosen field of endeavor.
  • It’s not whether you get knocked down, it’s whether you get up.
  • Winning is not everything- but making the effort to win is.
  • The spirit, the will to win and the will to excel- these are the things that will endure and these are qualities that are so much more important than any of the events themselves.
  • They call it coaching but it is teaching.  You do not just tell them …you show them the reasons.
  • After all the cheers have died down and the stadium is empty, after the headlines have been written, and after you are back in the quiet of y our room and the championship ring has been placed on the dresser and after all the pomp and fanfare have faded, the enduring thing that is left is the dedication to doing with our lives the very best we can to make the world a better place in which to live.
  • Teams do not go physically flat, they go mentally stale.
  • Success is like anything worthwhile.  It has a price.  You have to pay the price to win and you have to pay the price to get to the point where success is possible.  Most important, you must pay the price to stay there.
  • Leaders are made, they are not born.  They are made by hard effort, which is the price which all of us must pay to achieve any goal that is worthwhile.
  • Winning is a habit.  Watch your thoughts, they become your beliefs.  Watch your beliefs, they become your words.  Watch your words, they become your actions.  Watch your actions, they become your habits.  Watch your habits, they become your character.
  • The difference between a successful person and others is not a lack of strength, not a lack of knowledge, but rather a lack of will.
  • Confidence is contagious and so is a lack of confidence, and a customer will recognize both.
  • If you don’t think you’re a winner, you don’t belong here.
  • It is essential to understand that battles are primarily won in the hearts of men.  Men respond to leadership in a most remarkable way and once you have won his heart, he will follow you anywhere.
  • If you aren’t fired with enthusiasm, you’ll be fired with enthusiasm.
  • If you can’t get emotional about what you believe in your heart, you’re in the wrong business.
  • There’s only one way to succeed in anything, and that is to give it everything.  I do, and I demand that my players do.
  • To be successful, a man must exert an effective influence upon his brothers and upon his associates, and the degree to which he accomplishes this depends on the personality of the man.  The incandescence of which he is capable.  The flame of fire that burns inside of him.  The magnetism which draws the heart of other men to him.
  • Some of us will do our jobs well and some will not, but we will all be judged on one thing: the result.
  • The object is to win fairly, squarely, by the rules- but to win.
  • Morally, the life of the organization must be of exemplary nature.  This is one phase where the organization must not have criticism.
  • Win without boasting. Lose without excuses.
  • All right Mister, let me tell you what winning means… you’re willing to go longer, work harder, give more than anyone else.
  • People who work together will win, whether it be against complex football defenses, or the problems of modern society.
  • The measure of who we are is what we do with what we have.

Lou Holtz

  • How you respond to the challenge in the second half will determine what you become after the game, whether you are a winner or loser.
  • No matter how bad someone has it, there are others who have it worse.  Remembering that makes life a lot easier and allows you to take pleasure in the blessings you have been given.
  • Your neighbors will make judgments about you based on how your lawn and house look, and people who see you passing will judge you based on how clean you keep your car.  It’s not always fair, but it has always been true.  Appearances matter, so make yours a good one.
  • It’s always better to face the truth, no matter how uncomfortable, than to continue coddling a lie.
  • Ability is what you’re capable of doing. Motivation determines what you do. Attitude determines how well you do it.
  • If what you did yesterday seems big, you haven’t done anything today.
  • I’ve never known anybody to achieve anything without overcoming adversity.
  • Life is ten percent what happens to you and ninety percent how you respond to it.

John Wooden

  • Nothing will work unless you do.
  • Ability may get you to the top, but it takes character to keep you there.
  • A coach is someone who can give correction without causing resentment.
  • Make sure that team members know they are working with you, not for you.
  • Things turn out best for the people who make the best of the way things turn out.
  • As long as you try your best, you are never a failure. That is, unless you blame others.
  • Be most interested to find the best way; not in having your own way.
  • Be slow to criticize and quick to commend.
  • Big things are accomplished only through the perfection of minor details.
  • Don’t let what you cannot do interfere with what you can do.
  • Everything we know, we learned from someone else!
  • Failure is not fatal, but failure to change might be.
  • If you don’t have time to do it right, when will you have time to do it over?
  • If you’re not making mistakes, then you’re not doing anything. I’m positive that a doer makes mistakes.
  • Never mistake activity for achievement.
  • The most important key to achieving great success is to decide upon your goal and launch, get started, take action, move.

George Halas

  • Nobody who ever gave his best regretted it.

Mike Ditka

  • You’re never a loser until you quit trying.

Leroy Satchel Paige

  • You win a few, you lose a few.  Some get rained out.  But you got to dress for all of them.

John Madden

  • Coaches have to watch for what they don’t want to see and listen to what they don’t want to hear.
  • Self-praise is for losers. Be a winner. Stand for something. Always have class, and be humble.

Pat Riley

  • Excellence happens when you try each day to both do and be, a little better than you were yesterday!

Casey Stengel

  • Gettin’ good players is easy. Gettin’ em to play together is the hard part.

Tony Dungy

  • Hard work and togetherness. They go hand in hand. You need the hard work because it’s such a tough atmosphere….to win week in and week out. You need togetherness because you don’t always win, and you gotta hang tough together.

Paul “Bear” Bryant

  • If anything goes bad, I did it. If anything goes semi-good, then we did it. If anything goes really good, then you did it. That’s all it takes to get people to win football games.
  • In a crisis, don’t hide behind anything or anybody. They are going to find you anyway.
  • Little things make the difference. Everyone is well prepared in the big things, but only the winners perfect the little things.

Yogi Berra

  • If you don’t know where you are going, you might wind up someplace else.
  • It ain’t over till it’s over.

Don Shula

  • My responsibility is leadership, and the minute I get negative, that is going to have an influence on my team.

Tommy Lasorda

  • The difference between the impossible and the possible lies in a man’s determination.
  • I believe managing is like holding a dove in your hand. If you hold it too tightly you kill it, but if you hold it too loosely, you lose it.

Rick Pitino

  • The only way to get people to like working hard is to motivate them. Today, people must understand why they’re working hard. Every individual in an organization is motivated by something different.

Joe Paterno

  • The will to win is important, but the will to prepare is vital.

Chuck Noll

  • You can’t make a great play unless you do it first in practice.

Phil Jackson

  • Love is the force that ignites the spirit and binds teams together.

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Time for Clinicians to Have Greater Access to Mental Health Records

January 4, 2013

As the clinician who is primarily responsible for Ministry Health Care’s Electronic Health Record, I deal with a number of thorny issues.  None is thornier than providing access to clinicians who are treating patients but yet preserve patient confidentiality.  There are a number of built in safeguards that allow user access to patient records on a need to know basis.

One of the thorny issues is determining who outside our organization should have even basic access. In general, we allow outside organizations to access our EHR if the information is utilized for active patient care. Ambulatory surgical centers, nursing homes, medical clinics and emergency rooms at other health care organizations are good examples.  We know timely access to health information allow clinicians to make more informed health care decisions. We do monitor their access to make sure they are exercising their privilege appropriately.

Our thorniest issue involves access to mental health records.  Federal law places restrictions on mental health records and Wisconsin law goes several steps further. I am over simplifying this a bit, but from an EHR perspective, patient records generated by our mental health specialists are totally segregated from the rest of the patient’s record and not readily accessible to non-mental health clinicians.  Even though a patient’s family physician may refer a patient to psychiatrist, the family physician does not have direct on-line access to the psychiatrist’s evaluation.

We often get pulled in two directions; primary care clinicians saying they need access to all of a patient’s record while mental health professionals say their records need to be restricted.

Our primary care clinicians rightly feel that inadequate patient care is provided without full access to patient records.  A recent study is proving them right.

A team from Johns Hopkins compared outcomes at several health care systems where mental health records were accessible or not accessible. They found health care systems that had online psychiatric health care records readily available to clinicians had fewer psychiatric readmissions than systems that either had paper records or restricted online access. Click here to see a summary of the study.

We have a terrible shortage of mental health professionals.  Shared EHRs containing mental health records accessible to all clinicians is vital to providing quality care, reducing health care costs and ensuring appropriate utilization of our scare mental health professionals.  Our current restricted environment is also preventing greater collaboration between our primary care clinicians and mental health professions that would improve care to patients.  It is time for State and Federal law to change allowing clinicians to access mental health records.

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Encourage Health Care Workers to Get the Flu Shot: Use the Carrot or the Stick?

November 1, 2012

Flu Fighters button proudly displayed by Ministry Health Care employees who have received this year’s flu shot. Join us in protecting you and your loved ones today, get your flu shot.

This year many health care entities want to protect their employees from getting the flu and transmitting it to others. Some have taken the stick approach by making the flu shot a condition of employment. The policy has rightly generated some backlash.  Others, like Ministry Health Care has taken the carrot approach; either receive the flu shot or wear a mask during the flu season – it is the employees choice.

Using the carrot approach, there has been no backlash.  Ministry also provides the cool button shown above that is worn by each employee who receives the shot.  I got mine earlier this week.  As I make my rounds through out Ministry, I am seeing an increasing number of employees wearing their buttons.

Come November 15th, when  we are required to either display the button or the mask, I bet I see very few masks.  Join us in protecting yourself and your loved ones by getting your flu shot today.

So what works better, the carrot or the stick. You decide.

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MMG-Tomahawk Moves Chart Room Off Site

May 14, 2012

This was a big week for our EHR Program.  Ministry Medical Group Tomahawk (our EHR Pilot site) reclaimed it’s medical record room.  We had hoped this project would eventually mean the end of our on-site chart rooms but we elected not to formally list the objective as part of our ROI.  Clinicians are very attached to their paper medical records, providing a date when the paper record would be moved offsite was thought to unnecessarily add stress to going live with the EHR.

With use of the Electronic Health Record (CattailsMD) MMG-Tomahawk clinicians were able to reclaim the paper chart room and convert it for use by patient care staff.

With use of the Electronic Health Record (CattailsMD) MMG-Tomahawk clinicians were able to reclaim the paper chart room and convert it for use by patient care staff.

We did everything we could to minimize the need for a paper record going forward:

  • We had at least six months of clinical data in the EHR before going live
  • We back loaded medical information needed to drive decision support such as health preservation and disease management reminder tools
  • We provided a direct link from the EHR to our legacy information systems
  • Most importantly we added no more documents to the paper chart after go live.

Our clinicians stopped routinely asking for the paper chart within a month of going live.  At about one year post go-live, most chart pulls were for medical release of information not direct paper care.  At two years post go-live, charts were rarely requested for direct patient care.

With a transformation to Patient Centered Medical Home, clinicians at Tomahawk needed more clinical space and started to eye the chart room as the answer to their needs.  The clinicians then actively lobbied to reclaim the chart room space.  Moving the chart room off site has been perhaps our easiest EHR objective to achieve.

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Conflicts of Interest

January 11, 2009

The Pharmaceutical Research and Manufacturers of America (a pharmacy trade group organization) has recently announced new guidelines addressing conflicts of interest with clinicians.  Member pharmaceutical companies will be barred from distributing office supplies, clothes and other gifts with company logos or product brand names to physicians and clinics. The new guidelines also prohibits the companies from paying for physicians’ meals, including those during medical education events, and requires that all grant money allocated for continuing medical education programs be handled by personnel who are not from sales and marketing departments.  The guideline does not address the common practice of paying clinicians to promote drugs on a speaking circuit or serve as paid consultants.

A number of years ago, Ministry Health Care updated it’s corporate integrity policies banning the receipt of gifts of material value from any vendor and specifically restricting pharmaceutical representative access to our clinicians.  We had a few clinicians who bristled at the policy stating a pharmaceutical representative could not influence their decision-making. Drug companies simply would not waste their money trying to influence clinicians if their tactics did not work.

Clinicians also related drug samples provided by pharmaceutical reps are given to needy patients. In response, we started a very successful Patient Drug Assistance Program. This program helps our needy patients apply for drug assistance directly from the drug company.

I am proud of the stance Ministry Health Care has taken and fully support it. It is also time for our government to establish similar policies for all government employees including our legislators.  Special interest group sponsored educational junkets are said to provide valuable education for our senators and congressmen; education that undoubtedly leaves them more favorably inclined to vote for legislation supported by their benefactors.

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EHR Journey 1.2

July 23, 2008

Once embarked on an EHR journey, Ministry needed to develop supporting corporate infrastructure, tasks such as finding a Chief Information Officer (CIO) and Chief Medical Information Officer (CMIO). While those efforts were underway, we pulled together a team of clinicians and staff who were using or had used an electronic medical record in the past. This team gathered virtually on a regular basis to develop a joint vision of what practicing clinicians need in an EHR.

I have found clinicians who have used EMRs in the past possess unique insights as to how an EMR can be used to improve provision of care. Clinicians who have not used an EMR, tend to develop workflows duplicating their paper flows rather than finding new processes to leverage the technology.

We gathered over the noon hour once a week via a telephone conference. We generally talked about a topic and flushed out our functional specification.  Offline, we developed representative screen shots depicting the functionality we desired. Screen shots and functional requirements were shared using PowerPoint Presentations sent via our internal e-mail server. Today we would collaborate using WebEx as the communication tool.

 

By the time Ministry had hired a CIO and CMIO, the clinicians had formed a very clear vision of our functional specifications.

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Electronic Health Record 1.0

July 13, 2008

Where does one start on the EHR journey? At the beginning.  Where is the beginning?  The beginning should be squarely focused on the business needs of the organization.

Our journey grew out of series of strategic development sessions.  Our two major medical groups had been acquired within the past 10 years and each had developed a business model centered on a regional hospital.  Each regional business unit had developed the basics necessary for a functional EMR but there were no true links between the units.

A number of tactical initiatives grew out of our strategy sessions. We discussed how we might achieve the various initiatives and came to the conclusion a system wide EHR was a prerequisite.

Lesson: The EHR (or any other initiative) has to be based on the business needs of the organization.

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PowerPoint, Keep it Simple

July 2, 2008

PowerPoint is an essential ingredient for many presentations. Remembering it is an ingredient and not the whole meal can be the key to successful communication. We communicate to transfer ideas, an overly complicated PowerPoint diverts attention from the presenter to the medium and reduces knowledge transfer. When it comes to PowerPoint, less is more.

Keeping It Simple:

  • Pick a simple format and stick with it
  • Use no more than four to seven lines per slide
  • Simplify the wording of each line
  • Reduce lines of text when including images
  • Rarely use animation, it usually distracts the audience
  • Rarely use sound, sound as well can distract the audience

Your audience can read text on the slide, you do not need to read it to them. Your verbal presentation should amplify each slide’s context adding depth and understanding.

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Addressing the Medical Staff – Disruptive Behavior

June 30, 2008

 

In previous posts, I have presented an interview with one of our administrative clinicians outlining how he deals with disruptive behavior and the Principles of Partnership we have with Ministry Health Care clinicians. We also must deal with this issue at our hospitals, most of which have independent physicians.  Regardless of the setting, we have to establish the baseline for acceptable behavior. One of our hospital medical staffs formed a Respect Committee that then interviewed a number of individuals.  The interviews uncovered numerous examples of respectful behavior and a few examples showing disrespect.  The Committee then produced a PowerPoint presentation that has served as a cornerstone establishing respectful behavior.  The basic contents of the PowerPoint is listed below. Examples of respectful and disrespectful behavior has proven to be helpful on many occassions.

Ministry Health Care:  Values Behavior

  • Treating Others with such a sincere regard that each person  feels important and worthwhile
  • Recognizes others for their achievements and capabilities
  • Provides honest, non-judgmental feedback to others
  • Creates an environment where frustrations and concerns can be expressed without fear of repercussion

 

Ministry Medical Group Professional Practice Standards

  • We believe each patient, customer and staff member is important.  …. we strive to treat each person in a respectful nature that honors his or her importance and worth.

 

 

 

 

Cultural Assessment Questionnaire:

  • Ministry-wide and local norms
    • Physicians in this organization treat other staff members with respect
    • Employees Treat Each Other with Respect

What Additional Data Did We Want to Gather?

  • Are there recognizable characteristics of “Best Practices”?
  • Are there characteristics of the opposite?
  • What makes staff feel that they are respected?
  • What makes staff feel that they are disrespected?
  • Can we show improvement in staff perception of respect over time?
  • Can we change behaviors to achieve this end?

Respect Committee Intentions

  • This is NOT a disciplinary committee
  • Emphasize the POSITIVE, the IMPROVEMENT
  • To be EDUCATIONAL, not punitive
  • To provide TOOLS for the Medical Staff  and MMG Clinic Divisional Chairs to  improve RESPECT
  • To EDUCATE all employees regarding respect issues and holding ALL WHO WORK here to the same standards
  • Try to learn something about SUCCESSFUL physician/nurse and physician/employee relationships that can benefit all.

WHY

  • IT HAS DIRECT CONSEQUENCES AFFECTING PATIENT CARE

 

Intimidating and verbally abusing nurses and pharmacists may lead to patient harm:  Institute for Safe Medication Practices (ISMP) Survey of Nurses and Pharmacists

  • 7% involved in medication error where intimidation played a role
  • 49% said history of intimidation altered the way they asked for clarification of medication orders
  • 40% said at least once in past year a concern was overlooked in order to avoid confrontation

Types of Behavior :

  •     Condescending language 21%
  •     Impatience 19%
  •     Verbal Abuse 48%
  •     Threatening body language 43%

 

AMA News: Sept 2004

  • Staff Less Tolerant of Rude Doctors
  • Survey of Physician Executives :
    •      One physician can taint the culture of the unit
    •      83%  problems with physician behavior involve disrespect
    •      50%  problems only reported when doctor completely out of line and serious violation occurs
    •      95%  met with disruptive physician in last two years
    •      40% said physicians who generate high amount of revenue are treated more leniently than doctors who bring in less revenue    OUCH !

 

What We Did

  • Focus groups were interviewed  with representatives from Clinic and Hospital  departments with high and low respect scores. Included  nursing and  clinical staff,  administrative, and non-clinical employees.
    • Confidential
    • Qualitative
    • Individual Responses
    • Highlight the most pressing and prevalent problems

 

Questions Asked

  • What are some examples of times you felt very respected by physicians?  What specific behaviors caused you to feel this way?
  • In general, is this behavior on the part of most or all physicians? Or is it more specific to a minority of them-but a minority who have a significant impact on others?
  • What are some examples of times you felt you were not respected by a physician? What specific behaviors caused you to feel this way?
  • In general, is this behavior on the part of most or all physicians? Or is it more specific to a minority of them-but a minority who have significant impact on others?
  • What physician/employee situations have you heard of?
  • How many times have you heard about situations versus times you actually experienced them?
  • How frequently does this behavior occur?

Sample of Comments Regarding Positive Respect

  • MAJORITY of physicians
  • Has IMPROVED over couple years
  • HOSPITALIST program has decreased call issue complaints and a change for the better, hospitalists working together
  • LISTENING and taking  suggestions.
  • INCLUDING nurses as part of a team by discussing plan of care and asking for input
  • ACKNOWLEDGE skill level, opinion and judgment
  • RECOGNITION for good patient care
  • THANKING YOU  for asking questions, bringing patient concerns to the attention of the physician
  • APOLOGIZING  when a mistake has been made
  • Basic MANNERS…thank you, acknowledgement in hallways even if just say “hi”, using pleasant voice, eye contact
  • ASKING rather than telling
  • Creating a learning environment
  • There are no “dumb” questions, no belittlement
  • Performance is improved by physicians who teach
  • Errors are handled non-judgmentally
  • Physicians act upon being called
  • Compliments in front of others and patients
  • Positive outweighs the negative

 

Sample of Comments Regarding Disrespect

  • Minority, some departments
  • Dismisses what you (staff) are doing
  • Expecting problem to be immediately fixed
  • Complaints about other departments/doctors
  • Belittling in front of patients or peers
  • Inappropriate comments about other physicians to patients
  • Not dealing directly with the issue
  • Yelling, hanging up phone
  • Taking out frustration on wrong people
  • Using sarcasm or intimidation
  • Requests to move patients to other areas without discussing reason
  • Unavailable, not answering page
  • Personal things taking precedence of work related duties
  • Being told not to call for certain reasons by on-call physicians and reprimand for calling
  • Unapproachable, avoid connecting
  • Being asked to lie/give excuses when physician is scheduled to be in two places at once
  • Taking out anger on staff for being awoke or called while on call
  • Criticizing staff for not being as prepared or skilled as another unit
  • Poor communication of treatment plan
  • Physician behavior differs between hospital and clinic
  • Heard about disrespect more than experienced it
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Disruptive Behavior

Interview with Dr. Norm Chapin

June 20, 2008

My name is Dr. Norm Chapin. I am the Medical Director for Columbia Memorial Hospital in Hudson, New York.

How big is the hospital?  They are currently staffed for 120 beds.

Can you describe for me some of the steps you’ve made in rising through the leadership ranks?  I graduated from my residency in 1985 and for the first 5 years from 1985-1990 I practiced clinical emergency medicine.  In 1989, I was assigned responsibilities related to EMS education and ED quality management.   In 1990, I took a directorship position of a very small Emergency  Department near Detroit, Michigan and I worked there for about a year. I realized that I had taken that position maybe a little bit sooner then I was ready. I felt like I did not have adequate administrative experience.   My wife and I were looking to move out of Detroit at the time so we moved out of Detroit in 1991.  I went back to just practicing clinical medicine and emergency medicine again.

Then a couple of years later I was given the opportunity to assume responsibility for the Quality Management Program in the Emergency Department.   I started doing some administrative work again and in 1996 when I accepted a position as Assistant Director of an Emergency Department near where I had been working.

At that time, how much time was split between clinical practice and administrative practice? At that time, our normal clinical commitment was 144 hours per month, 12 – 12 hour shifts and I was doing 120 hours of clinical and 24 hours a month administrative time.

As time went on did you do anything in particular to improve your leadership abilities or management abilities?  At that time, other than having a mentor I really didn’t take any formal courses in administration and leadership. Most of my CME classes were straight clinical courses.  I was doing more teaching all the time and I was learning more about how to present data to people but it was pretty much seat of the pants learning.  I really didn’t get into any kind of formal education at that time.

When did you get into any kind of formal education?  In 1999, I was promoted to the Chief of the Department and I joined the American College of Physician Executives and I began taking some of their courses. I took my first course from them in 2000.  I also joined the ACPE list serve and began receiving their publications.  I was initially going to get my CPE Certification through ACPE and I took approximately 50 credit hours or so toward that but never completed it.

You are enrolled in a more formal program now.  How did you decide to do that?Well, between 1999 and now I had assumed additional administrative roles.  Within the hospital I was elected as Secretary and Treasurer of the Medical Staff. The Emergency Management Group that has the contract at our hospital had branched out and I had taken a leadership role in getting two new contracts for the group. I was involved in negotiations with 3rd party payers, involved in negotiating with hospital administrators about contracts, I was doing a lot of recruiting, a lot of human resources types of things and I just realized that I needed to have a better background on the business side of medicine and healthcare in general. I’ve been interested for the past 4 or 5 years and going for my masters degree I had been challenged to really find the time to do that.  I had looked at several programs that were completely self study.  There was a little bit of a deadline to them but most of them were studying on your own, taking full on-line courses with no residency periods and that just didn’t work for me because it was too easy for me to push off the deadlines and I didn’t stick with any of those and didn’t think they would be a good fit for me just knowing my own personality.

A couple of years ago I met Mike Stahl who is the Director of the Physician Executive MBA Program at the University of Tennessee.  I talked with him. I was very interested in the program. It had a good track record.  We got a new ED contract shortly after my initial contact with Mike and I became totally immersed in the start up. Last year, 2007, I met Mike again at a national emergency medicine conference and applied to the program. I t was just very good timing for me. I applied and was accepted at the MBA program. I’m not quite half way through yet but it’s going very well.

In your current position what percent clinical are you and what percent administrative?  Right now, I am only doing about 24-30 hours a month in the Emergency Department and the rest of the time I am Administrative.

Do you see your clinical time further decreasing or staying about that level?  Emergency Medicine is a pretty demanding specialty and I still feel comfortable clinically right now but I when I became the Director, I went to half time clinically. That was back in 1999 and there was probably only one or two months in there that I actually only worked half time.  I was always picking up shifts for people because of scheduling problems and things like that so I always felt like I maintained a pretty good comfort level with clinical medicine. In the last year my clinical time has gone down to 2 or 3 shifts a month it is getting harder for me to maintain my comfort with practicing there.  I think over the next year as my administrative role continues to evolve, I’ll probably stop clinical medicine completely.

What advice would you give to young physicians who are considering being involved in leadership activities?   I would discourage young physicians from making a decision regarding full time administrative too early in their career.  I think my first mistake was taking on an administrative role before I really matured enough as a clinician to sustain that.  I don’t think I had enough maturity to deal with physicians who have been practicing for 20 or 30 years.  I don’t think I had earned my stripes so to speak.  I also think I tried to go from a position where I had very minimal administrative responsibilities when I was a director of a department too quickly.  So I think the best advice is to go slowly, make sure that you enjoy doing the administrative things, make sure that you gain enough experiences clinically so you can really be assured that your skills and your understanding of how healthcare works either in your specific specialty or throughout a multi specialty physicians organization or a managed care organization or a hospital organization which ever your practice has placed you.  M ake sure that you really do understand the organization well before you decide to take a real significant role there.  Committee participation, involvement in medical staff affairs, participating in performance improvement projects in the organization are each excellent opportunities to gain leadership experience.

What special skills or unique insight do you think physicians bring to the leadership table than non-physicians would not?  Well, I think we really understand other physicians better than non-physicians do.  I think we also understand patients in a way than non-physicians don’t, because we have really been with them through a lot of medical crisis.  We really understand their fears and their concerns.

I think we understand what physicians and what patients expect of physicians in a way that non physicians might not understand.  I think that gives us an advantage when discussing strategic initiatives within a healthcare organization or discussing  the vision or mission of a healthcare organization.  We have a different perspective of the complexity and how difficult it is sometimes to meet patient’s expectations and needs.  There are also aspects of healthcare as a business that we don’t understand or have a very different perspective of.  I think a team where both of those perspectives are represented at the Senior Executive level ,   gives  organizations a huge advantage in   responding  to some of the pressures that they face.

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