Moving On Up

Dear Director,
I’ve served as the associate medical director in a few different ERs, only to be passed over when the department needed a new chairman. What am I doing wrong and how do I find out how to reach that next level or should I just count on being an associate director forever.
Signed,
Always an Associate

In today’s competitive healthcare arena, we all need to be looking for ways to improve. If we stagnate in our professional growth, not only will be passed over for promotion, but we could find ourselves unemployed. In his book, What Got You Here Won’t Get You There, executive coach Marshall Goldsmith talks about some of the innate faults that almost everyone has, how successful people are motivated (power, money, status, and popularity) and the 20 most annoying habits that tend to irritate co-workers and prevent advancement. Whether you’re an associate director trying to run your own shop, a pit doc trying to improve your patient satisfaction, or a hospital CEO who just wants to be a better CEO, there are practical steps you can make towards professional development.

Human Faults: Looking Inward
You can’t begin to grow if you don’t know yourself. As my wife and any doc who has ever worked in my department can tell you, I’m far from perfect. In fact, my wife loves to point out the faults that I have that are in Goldsmith’s book. I’ve had executive coaches, mentors and bosses all point out my peccadilloes and irritating quirks. Do you have someone reflecting back to you so that you have an accurate view of how you’re perceived? Let’s talk about a couple common situations and see if you recognize any of your own behavior.

Stop Being the Devil’s Advocate
At your monthly staff meeting, a new idea is being discussed. No matter how great the idea is, there’s one individual who raises their hand and says “Let me tell you why that won’t work,” or perhaps, “let me be the devil’s advocate for just a minute.” Chronic negativity is one of the most frustrating things a chairman can face. While I don’t expect universal agreement on any new idea, you’ve got to be willing to try something new when necessary. If you disagree with an idea, that’s fine, but be willing to make a suggestion that will improve the process. Too often it’s simply a “No, that won’t work.” This behavior doesn’t help the group and you’ll find that people will stop asking this person to give an opinion.

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Saying You’re Sorry
Next is the person who can’t apologize, and there are plenty of them in medicine. Apologies are such an important part of Goldsmith’s success plan that he dedicated an entire chapter to it in his book. I’ve seen a doc have a rude interaction with a nurse which then whipped through the department and immediately pitted the nurses against the doctors. This led to a horrible work environment for everyone. I’ve also seen countless arguments between emergency physician and attending staff about a specific patient encounters, which only creates more patient care issues. If you can’t authentically apologize, it’s very difficult to let go of the past and to move forward in a positive manner. An apology simply says to the person, “I hurt you and I’m sorry about that.” The genuine apology allows everyone to put the event behind them and move forward. Whether it’s been with the nurses or a vascular surgeon, I’ve seen apologies quickly make a bad situation evaporate.

To be fair, apologizing in healthcare can be particularly complicated as we do not want to admit fault to patients in case there are legal ramifications. Then there are the “blameless apologies” that we propagate. “I’m sorry we didn’t meet your expectations,” or “I’m sorry that the wait was longer than you would have liked.” What we’re really saying is that we’re doing the best we can and we hope you will tolerate us. But there are times when the explanation really takes away from us accepting responsibility. Often we’re often better served by simply owning up, saying “I’m sorry” and then shutting up.

Listen Up!
One of Goldsmith’s secrets to success is simply listening and focusing on the task at hand. In the busy ED, paying 100% attention to the patient while trying to document and listen for the secretary paging overhead that the orthopedist finally called back can be complicated. But without listening, the patient will know that you’re not engaged with them at that moment (there goes the patient sat score) and you run the risk of missing a key piece of history. I’ve personally learned that I can do better laying off the emails when I’m supposed to be paying attention at meetings. Again, it’s about focus and listening.

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Get a Coach
Personal development can be a daunting task. If you’ve examined your strengths and weaknesses and feel that you still need an outside appraisal, you could consider executive coaching, a practice which is working its way from the business world into medicine. While originally designed to help lower performers overcome challenges (like the good doctor with poor patient sat numbers), there is now a movement towards coaching your top performers to make them even more productive. Coaches are typically psychologists, organizational behavior specialists, or educators who work one-on-one with a client to provide immediate feedback and guidance. This allows for fast improvements and helps to raise the bar for an employee’s performance. The coach may serve as an independent sounding board (“How was that interaction with the nurse manager?” as a teacher of new skills or in leadership development.

Something to keep in mind when working with a coach – or with any feedback loop – is honesty, both with yourself and with the coach. Coaching usually includes 360 degree feedback, and an honest reception of this data is critical to success. As a department leader, I frequently wonder how the meeting was perceived by the staff or how I’m being perceived in meetings with administration. Although I may get some feedback from close friends in the department or at the meeting, they’re unlikely to be as unbiased and direct as a coach. If you’re thrust into a leadership role that you believe you’re not ready for, consider making executive coaching part of the negotiation process.

Who benefits
With the cost of recruiting a new physician somewhere between $150-250K, employers have a hefty incentive to improve underperformers and maximize everyone’s performance. The cost of an executive coach can be upwards of $5000/month and they are typically contracted for 3 months. Therefore, for the physician who provides outstanding productivity but lacks in good communication skills, this might be a good investment. It may also work for the chairman who is inexperienced but shows tremendous potential. If cost is a barrier, there is also a recent trend toward group coaching. This may sound awkward, but many people find it very useful – shared issues and shared solutions actually enhance the coaching experience.

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Emergency physicians are fairly competitive by nature and whether you’re a medical director or a staff physician, it’s in all of our interests to continue to improve in the job that we’re doing. Overcoming some of our basic faults and weaknesses can be achieved by adapting to feedback we’re given (formally and informally) and following some basic golden rules that we learned in elementary school. For others who need more in-
depth training or are transitioning to a new skill set that needs to be rapidly learned, executive coaching me be a cost-effective way of getting there. At the end of the day, raising your performance bar at work will make you a better employee, which generally translates into improved job satisfaction. And it might just help you climb to the next rung in your career.

Michael Silverman, MD, is a member of Emergency Medicine Associates and is chairman of emergency medicine at the Virginia Hospital Center.