What’s different about coaching physician leaders?

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By Abby YanowOrganizational Development Consultant & President of the Boston Facilitators Roundtable

Many physicians are finding their role is changing from a “diagnose and fix” role to “facilitative leader”, in which they need to engage others in problem solving and understand how to manage change – things which were not taught in their medical school training. Many health care institutions, recognizing this shift, are designing leadership development programs and employing executive coaches to help physician leaders increase their effectiveness.

I participate in a learning group of coaches and organizational development consultants who work in health care, and recently I facilitated 2 conversations about leadership development, specifically asking: What’s different about coaching physician leaders?

We identified several challenges that are unique to coaching physician leaders, such as:

  • Physicians are used to being individual contributors, so it’s quite a shift to begin leading others – which means engaging other staff, asking questions and fostering collaborative problem solving.
  • Doctors need to change their mindset from “white coat leadership” to “facilitative leadership.”   That skillset includes knowing about change management, how you lead and manage change.
  • Research-oriented physicians, who work by themselves, tend more to introversion – and they may find themselves needing to stretch to extraversion to be more involved with other staff.
  • The role of the leader is often unclear to physicians who do not have mental models of leadership in a clinical setting, nor role models.
  • Some have little desire to do things differently, if seeing patients is what they prefer to do. Many doctors think “I don’t want a boss” or “I don’t need a boss because I’m responsible for my patients, or I run this practice”, as well as, “I don’t want to be a boss”.

One 119px-Rx_symboltool to help develop physician leaders, or any organizational leaders, is a 360 assessment, in which all of the people who interact with the physician are asked to give their assessment of his/her performance around selected leadership competencies. Coaches are often engaged to help leaders make sense of the 360 feedback, to make it a useful developmental tool. Many physicians are not accustomed to receiving feedback from people they work with, so this is a new way of doing business. What’s more, doctors are more attuned to patient feedback, in the form of patient satisfaction surveys – a more collective data collection, and not feedback directed to one person.

The coaches in our group reported a range of reactions to the feedback, from being open and accepting of the data, to being somewhat resistant to hearing the feedback. We brainstormed some strategies for helping the doctors work through the resistance and engage with the data:

  1. “It’s just data – and you can decide what to do with it”. Framing it this way helps to remove any judgment about it: “It’s not good or bad, it just is. Let’s see if we can make sense of it together.”
  2. What’s the kernel of truth in the feedback? This question supports “it’s just data”, and enables the client to look at the data separate from him/herself. S/he is not the data. It’s empowering to think that one can evaluate the truth or validity of feedback and determine what to pay the most attention to.
  3. What’s the impact of this behavior on others? On yourself? Asking this helps put the data in context of the desired intention of one’s behavior, which can be followed up with: “What’s the difference between your intention and their/people’s perception?” Oftentimes we, or our clients, aren’t aware of our impact – we intend one thing but achieve a different result. Most of us want our behavior to match our intention, and when seen that way, the feedback can be seen as helpful.
  4. It’s important to ask “Is this competency important in the person’s job?” If not, we should skip that data point. Some 360’s include this question, but not all.
  5. Look at the broader perspective of what’s happening in the system, i.e. is there anything in the system – the organizational structure, the job definition, the roles and responsibilities, the business processes, that are affecting the client’s ability to do their job well?
  6. Take time. Many of us have a strong reaction to feedback, especially if it presents a different image of ourselves than our self-image, so we need time to work through our reaction. If we have a strong reaction, we’re not in a state to think rationally/reflectively on the data, so we need to give people time to deal with their emotional reaction before discussing the data.
  7. Coaches also need to help clients process that emotional response, by acknowledging the feelings, and putting parameters around the data, i.e. The negative feedback or criticisms do not take away from the many wonderful parts of the client’s performance. We all tend to focus on the negative, and we need help putting it in perspective. In addition, the “areas for improvement” are meant to assist in the client’s development – they are not meant as a personal affront or disrespect.

What challenges does your organization face in developing your physician leaders?  Let me know how I can help you with your leadership development program.

*The hidden curriculum of medical education have been identified as: loss of idealism, adoption of a “ritualized” professional identity, emotional neutralization, change of ethical integrity, acceptance of hierarchy and the learning of less formal aspects of “good doctoring.”

Abby Yanow is an Organizational Development consultant and Executive Coach.   She has 14+ years of experience working with leaders, teams and boards of mission-driven and health-related organizations to increase their effectiveness and impact.  She coaches leaders to lead change and to motivate their teams; she coaches teams to improve their problem-solving and decision-making skills.  In addition, Abby works with boards and staff to clarify their roles and responsibilities, to develop and execute their vision and strategy in support of their mission.

Abby has facilitated strategic planning for several public health agencies:  Diabetes Control and Prevention, Mass. Tobacco Control Program,  Nutrition and Physical Activity.  She has also consulted and coached directors and teams for Joslin Diabetes Center, Midwives of Mt. Auburn Hospital, Boston Medical Center, Brigham and Women’s Hospital.  Abby is known for her excellent listening and facilitation skills, and her ability to ask questions that help clients achieve clarity and insight, and have helped clients get “unstuck”.

http://www.skillfulfacilitation.com

 

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2 Responses to What’s different about coaching physician leaders?

  1. Pingback: Are you a nurse who likes to take the ball and run with it?

  2. Beth Boynton, RN, MS says:

    Great article, Abby. We need to have physicians who are collaborative leaders in order to optimize the teamwork necessary to provide safe, compassionate care and understanding different needs and challenges of physicians seems like a wise step in this direction.

    In addition to your astute list, I’d add that docs need to be mindful of cultivating respect for ‘followers’ and be able to step into that roll themselves, i.e. a sharing of power and this is sort of a pivotal issue w/ docs and nurses. We nurses need to take the risk and accountability of taking on more power while docs (and other leaders) need to let go a little bit.

What are your thoughts?