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Tuesday May 17, 2016

Six Lessons From Six Months as Medical Director

Take calculated risks. Lead by example. Be inspirational.

When I became the medical director of our office, I had a smattering of leadership clichés in mind that I thought I should follow. I anticipated that in my new role, I would communicate updates to the team, handle conflicts and set objectives.

But my first six months as medical director of our office involved little of the above. Instead, it's been a whirlwind of navigating teams and strengthening the patient and staff experience. Each day comes with 40 new lessons of you-don't-know-what-you-don't-know moments, personal growth and professional opportunities.

Here are a few of the interesting lessons I've learned.

Culture eats strategy for breakfast. Those who understand organizational psychology embrace this as gospel. It's the key factor in why companies with innovative ideas and solid revenue streams still fail. It's a business philosophy, but I've found it to be even more important in medicine.

An organization's core values need to be woven into decision-making at every level. We don't exist just to prescribe patients' medications. We are not here simply to track labs. Every person in my office is mission-driven (to transform health care). This is evident in both grand insurance battles and small gestures. Our team is diligent about prior authorizations and advocating for care our patients deserve. But we also never hesitate to make tea for a sad or an anxious patient in our waiting room. Our positive culture leads to internal coherence that sees opportunities in challenges. This didn't happen by accident. We invested in defining our culture.

Everyone -- including patients -- should feel ownership of your organization. In medicine, the term "stakeholders" applies broadly to employees, insurance companies, the specialists we refer to, the imaging centers we use and so on. But the most important stakeholders in medicine are the patients, who often feel as though they have little impact on health care. As a result, many medical organizations have started patient advisory groups. It's a good step, but I've learned patient feedback should be continuously integrated into health care organizations in as many ways as possible, not just via a feedback survey or siloed groups. My patients love sharing their experiences -- whether it's about their care, the lab or parking.

The next part is key: Be nimble enough to use feedback as a catalyst for change in your organization. We've expanded our services (we now perform endometrial biopsies, for example) as the result of patient feedback. We've even changed processes, such as instituting an RN consult before placing an intrauterine device. Listening to feedback is a key part of making sure patients feel ownership.

You'll know you are doing it right when patients refer to your office as "we" instead of "you guys."

Infuse your organization with a constant stream of new ideas. People who spend countless hours together start to think like each other. In fact, they start to sound like each other. They even use the same phrases. It's easy to spiral into an echo chamber where no one challenges group consensus. Ways to avoid the prevalence of stagnation include creative hiring and fostering a culture where individuals feel comfortable dismantling the status quo. In fact, 94 percent of senior business leaders said the right people and culture are the most important drivers of innovation(www.mckinsey.com), according to global consulting firm McKinsey & Co.

Meetings should be productive, clear and frequent. There are so many meetings. They are in person. They are via video conference. They are on the phone. Some meetings have just two people. Other meetings include hundreds from across our organization. At first, my meeting schedule was exhausting. I took a deep dive into the literature on meetings (this actually exists) and learned meetings require active management, with strict guidelines, attendees, timelines, etc. And it's better to meet frequently, because this contributes to accessibility and responsiveness. As a result, our meeting agenda includes goals and action items for each topic. We have developed a meeting cadence and determined who should be part of each meeting -- and who shouldn't. Our meetings are now more productive and efficient, and we avoid meeting fatigue.

Data without context is dangerous. In this big data era, everyone loves hard numbers. But sifting through those numbers without understanding how they fit an organization's mission is counterproductive. Even worse, sifting through them without realizing any trends or meaning is pointless. Patient volume, patient satisfaction scores, lab reporting times -- these are important, but they don't tell the whole story of an office or patient care. The clinical quality numbers (emergency department visits, blood pressure control, A1cs) can be even more nebulous without understanding your patient population. I'm still figuring this one out.

Invest in professional, leadership and team development. We hire people for potential, not perfection. They generally have core values that align with ours, but they still require structured training, careful mentoring and a path that will challenge them. Even in my short time at my practice, I've been delighted to see admins transition into membership advisers and site stewards become phlebotomists. And we emphasize that one role isn't above another -- it's just a different contribution to the team. It's for good reason: Companies with engaged employees who are inspired, empowered, confident and enthusiastic outperform those without by as much as 202 percent, according to Gallup.

Our team has learned the value of collective leadership. It makes sense that a group, and not just an individual, will have the best solutions to complex issues.

These leadership lessons don't include what I have learned about patient care. Those lessons can't be contained in one blog post. They are more suited for a novel.

This reminds me of another cliché: life-long learning. It's valuable to embrace. I anticipate the next six months (then six years, then six decades) will be rich with lessons.

Natasha Bhuyan, M.D., is a board-certified family physician in Phoenix. You can follow her on Twitter @NatashaBhuyan(twitter.com).

Posted at 12:39PM May 17, 2016 by Natasha Bhuyan, M.D.

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