Robert Chang writes…
While the current recession (if I dare use that word) is running its course, further downstream effects remain a very tangible leadership issue, in particular for middle management. The superficial issue that we are facing is staffing for a relatively uncertain patient census over the next year which brings out one of many deeper issues of credible leadership.
So what is leadership? I should hardly think I could speak to it in its entirety but I think the experience that we have been having is helpful to work through some of the practicalities of leadership and what it may look like.
Leadership is a topic that we talk about, read about and experience (both good and bad) every day. Our spouses, patients, hospital administration, the president and our dog may lead us. The marketplace, sickness and weather, however, do not lead us, although we do need to respond and interact with each of these. Leadership requires direction. To distinguish words for the purposes of this blog, forward and clear direction distinguishes good leadership from management, which I often fall into. Management sustains a group but doesn’t move it in any tangible direction. We often only require management to remain solvent, but often need leadership to overcome the unexpected or to move forward successfully during good times.
There are various components to leadership that all of us have touched on already and others that we will likely explicate later. Two key components that were highlighted in our current scenario with staffing issues are 1) the importance to remaining close to the work and 2) a clear sense of history and current situational awareness that comes from proximity to the work.
The previous year, our group had been slightly understaffed with a much higher census than anticipated that made it staggeringly difficult while on service and was morale-breaking. We had increased our capacity by moving from six to eight active physicians during the day and two to three active physicians during the night in anticipation of another banner year. The census, of course, did not follow suit and we had the aforementioned drop in patient numbers per physician, although it was also partially related to a drop in length of stay. Having worked on the service last year (and currently) and knowing the woeful state of morale, we let the census issues ride for a few months to allow the docs a breather as well as determine the stability of the trend. In the meantime, we were pursuing conversations with other services that were “orphaned” and without routine inpatient services where we could offer help if it seemed the low census on our end would continue to trend. Finally, we sought an answer to the continued issue of sudden aggressive spikes in admissions to the hospital as well as the perennial concern of promotion in the academic arena. Since we were having increased activity on our consultative services, one current proposal is to increase staffing on the consult service as an opportunity for resident teaching and exposure and a valve for sudden increases in unscheduled inpatient admissions. In all of these solutions, we’ve been maintaining an awareness of what our frontline physicians needed to help our leadership protect our physicians and yet allowed us to move in directions that would take advantage of the current state of the hospital as well as opportunities for growth.
Unfortunately and fortunately, leadership skills are not terribly surprising or sexy but rely on characteristics that we already have in spades – clear, direct communication; a great deal of respect for things that are common, dangerous or easily fixed; and a sense of direction (discharge or disposition in the patient care arena).
Some references that I have found helpful to clarify vision, improve the way we communicate or provide some perspective on leadership include: Business as a Calling by Michael Novack (a Catholic perspective on business with an excellent first several chapters on why we would even pursue excellent leadership), What They Don’t Teach You in Harvard Business School by Mark McCormack (an eclectic collection of stories that highlight techniques and perspectives that are not easily categorized from one of the most successful gurus of managing stars of sports), The One Minute Manager by Kenneth Blanchard (a quick read of dealing directly with individuals in a mutually productive way) and finally the classic Getting to Yes and Difficult Conversations by the Harvard Negotiation Project, which are generally helpful for communication on difficult topics, whether with a patient, colleague, boss, spouse or hospital CEO.