By Brian Wong M.D., M.P.H., The Bedside Trust, LLC

This article is part two in a series on physician leadership issues. In part one, Dr. Brian Wong discussed the need for physicians to provide patient-driven leadership through building trusted teams.

When Dr. Jenna Markum opened her eyes to greet the morning, she immediately felt impending dread before she heard the baby stirring in the cradle next to the bed. Then she relaxed knowing that she didn’t have to go into the community clinic today. As much as she loved being a physician, she was almost done in with burnout and considering not going back after her maternity leave expired.

Since the government cut funding for the clinic, she had been forced to work shortened hours, eliminate overtime, kiss good-bye most of the training and education programs, and see some of her good friends pink-slipped. On top of that, she’d been seeing 30–40 patients a day to make up for the cuts. She didn’t think she could go back to working harder for less, and to top it off, her once friendly workplace was turning toxic before her eyes, causing her to begin to care less about everything. That alone was enough to do her in.

Her cell chirped the familiar tone of her good friend Elise, the clinic’s nurse manager.

“Jenna, are you coming to the retreat today? I know you’re on leave, but we talked about this. This is the only seminar we’re getting all year, and this doctor who’s coming in is supposed to be great. Remember, he’s going to talk about how we can improve our working relationship with administration, which definitely would make things more tolerable around here.”

“I don’t know E. I was just relaxing knowing that I don’t have to go in today...”

Elise interrupted, “Come on Jen, you said you would keep me company and you already have a sitter. Worst case scenario, you and I will spend the day together.”

“Fine, I’ll try it today, but I can’t guarantee I’ll make it through the afternoon much less come back tomorrow. See you there.”

For Jenna, the workshop turned out to be remarkably different, totally changing her perspective of what a physician leader can be. Before going into it, just the mention of physician and leader in the same sentence didn’t make sense because the concept and its potential for positive change had never been adequately explained.

The morning exercises completely changed her perspective. She began to realize that putting all of the blame on government funding, or her colleagues and administrators, was kind of a cop-out. It became apparent to her that a lot of, if not all of, her unhappiness was self-imposed. Like the speaker said, “The place we’ve been hating is the place we’ve been creating.”

She realized that the problems the clinic suffered from were not unique; they were a snapshot of what was going on all over the country. Even more important, she became gratified and hopeful when she discovered she could help change things, and in the process improve patient care, just by changing the way she showed up in the clinic every day. When she walked out with Elise at the end of the day, all she could say was, “See you in the morning. I’m not going to miss tomorrow.”

The next day her sitter cancelled so she took a chance that her little one would be good and showed up with the baby in tow. The morning topics were equally as interesting as the day before. Then the baby started fussing about three hours in. She started packing up when Elise said, “Sorry Jen, I’ll take notes and clue you in later.”

“You won’t have to E. I’m calling my mom to come get her. I’d like to see how the rest of this turns out. Although I’m inherently skeptical about everything administration force-feeds us around here, this kind of makes sense. I don’t know if people will buy into it, but there’s no harm in hearing it through.”

The End Beginning

I wish I could say it was my good looks and engaging personality that prompted a new mother on maternity leave to attend both days of our forum, but the truth is there are not many things in life more compelling than the realization that you have the power and means to drastically improve your own situation.

I’ve seen hundreds of physicians like Jenna Markum begin to disengage. I immediately recognize the symptoms because I see it all over the country. The symptoms are overt and almost palpable: too much to do, rampant bad attitudes and disrespect, a widespread “every man for himself” approach to getting the job done, and people beginning to shut down.

This lack of physician–hospital alignment, disruptive behavior, and disengagement in general, are all symptoms of a larger problem that can’t be treated with short-term fixes or a binder full of initiatives. Even if you feel some temporary relief, they’ll be back with a vengeance. The only way to treat these symptoms and keep them from reoccurring is to find their root cause.

To do that, every physician—everyone—needs to realize their organizational role instead of solely concentrating on their jobs. We’re trained to do the best job possible (to better our job performance, etc.), but until we become cognizant of how our roles affect each others’ jobs, we’ll continue running around doing our own thing, condemned to face the same challenges over and over again. We’ll keep applying quick-fix Band-Aids unless we develop a cure.

With role clarity, comes the ability to see the big picture. Your job may be being a doctor, but your role is the same as everyone else's. Role clarity makes it immediately evident that we all rise or sink together—with no exceptions. We realize that collaborating with the administration and each other is the only way to improve things for physicians and for everyone.

And you can’t start big; you have to start small. It begins with one person: you. When you recognize role clarity, you’ll open yourself up to having the “right” kind of conversations. Conversations that lead us to accept that, “The place we’ve been hating is the place we’ve been creating.” If we can create it, we can change it and improve it. The only way to get control of a situation that spiraled out of control is to learn how to control yourself.

We do this by moving into an already established physician comfort zone, the elemental one-to-one conversation. As we all know, the doctor–patient relationship is intimate. Ten minutes after we meet a patient we’re probing them with questions and hands at an extremely personal level. We need to get comfortable having similarly intimate (minus the hands) one-to-one conversations with our colleagues. Leaders especially need to master one-to-one conversations to set the tone from the top.

After the one-to-one, the pathway clearly leads to the “one-to-many.” When individuals and then small dyads show up aware of role clarity and ready to have the right conversations, it naturally goes viral without the need for extra work and new initiatives. Instead, it takes a scripted daily practice that guides each layer of an organization through each step, beginning with leadership.

Physicians are respected as clinical leaders. They’re respected for their talents, getting results, and their dedication. To improve the culture and begin eliminating disengagement, they also need to be known as respectful team players that listen without judgment and are safe to approach and converse with.

Remember, the only thing you can really control is yourself. Then, you can affect the person across from you and then your team. When teamwork becomes apparent, the most important part of the equation will take notice: your patients. Your patients need to trust that everyone is working together for them. To give them what they need, we need to simplify our focus: "What matters most to patients determines how we practice as leaders." This is patient-driven leadership.

The Governance Institute thanks Brian Wong, M.D., M.P.H., CEO of The Bedside Trust, LLC, for contributing this article. He can be reached at (206) 619-8088 or visit www.patientdrivenleadership.com to learn more.