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How Physician Leadership Can Maximize the Patient Experience

Wednesday, November 2, 2016
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To maximize the patient experience, physician leadership is essential. 

There are well over 100,000 books and articles written on the topic of leadership. You would think with so much knowledge on the topic, we would be great at it by now. However, that’s not the case in many—if not most—situations. For instance, a confusing element about leadership is clarifying the difference between leadership, management, and coaching. The fact is that to different degrees they do merge, so here’s a simple way to clarify the differences. 

Let’s say you’re 10 years old and attending summer camp. Everyone in your tent is looking forward to outdoor sports activities, but unfortunately, it starts to rain. Nobody knows what to do, and the counselor has fallen asleep. Some of the kids start playing Monopoly, others are playing video games or cards, and a few are wrestling in the corner of the room. Basically, everyone is doing their own thing or getting very bored.

One of the campers says, "Let's go to the recreation center and play dodgeball." The initial reaction from the other campers includes:

  • "Nah, we don’t want to do that." 
  • "It’s raining outside and we’ll get wet walking to the rec center!" 
  • "I'm already reading a book."  

This camper does not give up, though. Against resistance, she convinces the other kids to go to the rec center. This camper is the leader. She set up a vision and has gotten everybody else to follow. Meanwhile, the manager in this scenario is the kid who gets the key to the rec center and finds the dodgeballs, and the coach is the camper who teaches the others how to play dodgeball and win. 

 What does this scenario tell us?

In essence, leaders typically have to overcome resistance. If people would just do things without the leader leading them, they wouldn’t need a leader. Leaders also get people to stretch and change behaviors in directions they would not have considered on their own. Managers, however, manage the process set by the leader, and coaches help people to be better at the process that they are expected to implement. That’s the difference. 

Keep in mind: leaders aren’t just CEOs, they’re supervisors too. In fact, if you manage just one person, you're a leader, you're a manager, and you're a coach. Therefore, depending on the scale of a healthcare organization, these three roles may merge to a greater or lesser degree. Additionally, sometimes there are leaders who have no “authority power.” For example, if a coach and team captain fail to show up to a baseball practice, and one of the players convinces everyone to start practicing, that person is obviously a functional leader—just without a title. 

How do you know if you’re a good leader? See if anyone’s following you! So, leadership doesn’t mean just giving good speeches. It’s nice to give good speeches, but you don’t have to be great at oratory. The definition of great leadership is that, whether you’re the quietest or loudest person, people implement your vision. 

Are some people naturally good leaders? Do they seem to be born leaders? Of course. Just like some people are naturally better athletes.

Can you learn to be a leader? Absolutely. In truth, anyone in a leadership role can get better at it. 

Leadership Calls for Courage, Knowledge, and Action 

It takes courage to lead. Some people instinctually resist what others tell them, so leaders must overcome their objections. This means there will likely be conflict. If you loathe conflict, then leadership will be difficult for you. You can try to attain consensus, but unless everybody is in complete agreement, you may still be leading against established beliefs, attitudes, and habits of the group. 

Consider the Cohen Brown Leadership Unpopularity Law: “In order to be a great leader, you do not have to be unpopular. However, you can’t be afraid to be unpopular.” So, if your ultimate goal is to win a popularity contest, you will probably not be a great leader. 

Also, even if you have to lead against resistance, you can reduce opposition with logic. More importantly, you need to understand and practice the adage, "The ordinary leader gets the people to think highly of the leader. The extraordinary leader gets the people to think highly of themselves."  

There is another reason that leaders need courage: The Leadership Bet. This means that when a leader gets everyone to follow them and implement their vision, there is no guarantee that the implemented vision will work—or work as well as other options. There’s always a risk that even brilliant implementation of vision may not produce desirable outcomes. Consciously or subconsciously, leaders know this.

What’s more, the most compelling vision, the most motivational goals, and the most exquisite planning mean nothing unless people act on them. Frequently, organizations deliver great lectures and distribute videos about a company’s vision, goals, and plans, but nothing much happens because there is a “disengaged” clutch. Leaders must engage the clutch and make sure to transduce the potential energy embodied within visions, goals, and plans into the kinetic energy of action. 

Improving the Patient Experience Requires Effective Leadership 

The phrase “patient experience” has gained traction in recent years in the healthcare industry. In fact, though, the concept is well over 10 years old in the business world, where it’s known as the “customer experience.” Indeed, you would be hard pressed to find an annual report from a major company that doesn’t talk about how its company is customer-centric and focused on maximizing the customer experience. 

Unfortunately, slogans rarely change behaviors in and of themselves. Stating that a company strives for and is focused on maximizing the customer experience is just the beginning. The same applies to the patient experience in healthcare. Patients don’t really care about intent; they care about their personal results. That is, their own personal experience and that of their family members and others.  

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In medicine, the patient experience breaks down into two major categories. 

Functional actions include identifying symptoms, making proper diagnoses, implementing the right treatment, and following up and following through to ensure that all “after care” is effective. They also include “zero defect” implementation of all protocols.

A perfect example of protocols is what happened when I visited the ICU of a hospital where a family member was receiving treatment. Posted outside of the ICU unit was a list of seven rules that all medical staff had to follow. I was extremely impressed. As a medical doctor who also happens to be in the consulting and behavior-change business, I said to myself, there is no way I can improve on these protocols. Unfortunately, as soon as I entered the ICU, a nurse ran up to me and said, “Your father-in-law fell out of his bed.” Naturally, I queried why. The response was, “Someone forgot to put up the guard rails.” Not a good idea when you have a 96-year-old patient. 

Clearly, it’s not okay for a facility to say “99 out of 100 times we implement the protocols.” Even with the busy schedules and time pressures imposed on healthcare professionals, medicine must strive for zero defects, especially regarding the elimination of simple and preventable errors. 

Bedside manner is the second factor affecting the patient experience. As healthcare professionals know, different types of bedside manner can result in either a heartfelt “thank you” or a malpractice lawsuit—from the very same functional outcome. As medical-legal results show, apologies after a medical error significantly reduce lawsuits, while the lack of apologies almost guarantees lawsuits. 

But the scope of the “bedside manner” phrase is too limited in today’s real world of healthcare delivery. I think it’s time to redefine the concept more broadly as: “all verbal interactions between medical personnel and patients/patients’ families … and between healthcare professionals themselves.” 

This means that the patient experience involves how even a very time-challenged nurse responds to a simple request by a patient, as well as the nurse’s attitude expressed by his or her words, facial expression, and body language. The patient experience of bedside manner is ultimately all behavioral, as it is the only way for patients and their loved ones to perceive how they are being treated and the attitudes of those treating them. This includes expressing accurate empathy, caring, clearly communicating, and so forth. 

But as we all know, ingrained behavioral habits are hard to change—however good our intentions may be. 

Linking Physician Leadership and the Patient Experience 

Improving the patient experience will not happen as a result of some Big Bang type of event. Like any major change, it requires strong and consistent leadership.

But when can we stop leading and managing the patient experience? Won’t there come a time when it becomes so natural that it continues on its own? Not in your lifetime or mine, not as long as human DNA stays as it is. Commonly, new behaviors and cultures regress to their pre-intervention baselines without continuous energy being expended to maintain and hopefully improve new behavioral and cultural realities. Furthermore, leadership in a vacuum rarely produces great outcomes. Leaders cannot help their teams make breakthroughs in performance if they don’t apply the tenets of leadership to something specific—like improving the patient experience. In other words, without real-world application, leadership remains solely an academic endeavor. 

Consequently, the first person who needs to change behaviors is the leader. He or she must be a role model, rather than just merely a good communicator. It is incumbent upon physician-leaders to be the role model for everyone in their sphere of influence. If, for instance, a physician is abrupt with a patient, it is not a surprise that their healthcare network may also be abrupt.

One of the most important areas of physician leadership is role modeling. And one of the most important things to role model—to increase positive patient experiences—is what Cohen Brown calls TOFU. No, I’m not talking about a white curdy substance filled with protein. In this case, TOFU means “Taking Ownership and Following Up.” TOFU includes physician leadership when referring to specialists, communicating lab results, and so forth—and not just assuming that someone else will take ownership.

TOFU also includes zero defects follow-up. For example, when any kind of medical tests are performed, patients anxiously await results. To create a maximum patient experience, it shouldn’t be the patient’s responsibility to call the doctor’s office and ask, “Did you get the results?” It is the physician’s or medical group’s responsibility to proactively communicate results to patients. Even though I am a physician, I frequently have to aggressively contact providers to get results for my family. This should not be the case. 

Additionally, it behooves great physician leaders to know precisely what success looks like. One of the best ways to arrive at this knowledge is to start with reverse engineering. That is, physicians and others in leadership roles have to ask a simple question for each and every scenario: “What do you think patients, families, and staff would consider to be a great patient experience?” Notice that the question doesn’t ask what you think a great patient experience would be if you were the patient.

In fact, a major starting point for increasing the patient experience is to understand what the vast majority of the patients would consider a great experience, rather than projecting your own views alone. This approach starts from intake protocols at a hospital, a private office, or a clinic through everything that occurs, and continuing through discharge, as well as phone conversations, emails, texts, follow-up visits, and so on. 

Bottom line: Things do not change because people just want them to change. And if you do not know what success looks like, it is unlikely you will achieve it. So, without physician leadership that role models correct patient experience producing behaviors, the concept of patient experience will likely be relegated to just another slogan.

Remember: Knowledge is not power; doing is power. Physician leadership is critical. Only when physicians personally take on this responsibility, will the patient experience significantly improve.

For a deeper dive into this topic, join me November 13-15 at the ATD 2016 Healthcare Executive Summit.

About the Author
Martin L. Cohen, M.D., chief executive officer and co-chairman of Cohen Brown Management Group, Inc. and Breakthrough PerformanceTechSM, is one of the leading strategists, consultants, managers, motivators, lecturers, and trainers in the industry today. Together with his partner, Edward G. Brown, Dr. Cohen has led the Cohen Brown Management Group and Breakthrough PerformanceTech to become world leaders in maximizing performance, and in sales-and-service culture change. Their global client list includes companies in the United States and in more than 100 countries worldwide. They have also successfully implemented Breakthrough PerformanceTech within major nonprofit organizations. As the inventor of Performance Drilling®, one of the key tools from Breakthrough PerformanceTech, Dr. Cohen is now leading efforts to revolutionize learning and verbal human performance worldwide, both in business and within every aspect of society. Prior to forming Cohen Brown Management Group, Dr. Cohen received his medical degree from the University of California, Los Angeles School of Medicine in 1971. He completed his internship in internal medicine at Cedars-Sinai Medical Center in Los Angeles, and obtained his psychiatric degree from the UCLA Neuropsychiatric Institute in 1975. Dr. Cohen formerly maintained one of the largest psychiatric practices in Los Angeles, specializing in behavioral and attitude change. He was also a visiting professor of management at the Peter F. Drucker Graduate School of Management at the Claremont Graduate University in 1975 and 1976. Additionally, Dr. Cohen has designed and funded medical research projects that have resulted in eight published articles in prestigious medical journals.
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