The 100 hospitalists who gathered in September at the Vail Cascade Hotel and Spa among Vail, Colorado’s high peaks for SHM’s second Hospitalist Medicine Leadership Academy showed their character early during a simulation led by David Javitch, PhD, a Harvard University instructor. The exercise usually goes like this: The leader auctions $1 bills, with bidders paying their highest bid whether they win or lose. Participants’ aggressive juices flow and someone usually pays $5 or $10 for the lone dollar. Then they realize that their irrational bidding behavior is fueled by their need to compete rather than to cooperate, and the leader discusses the value of cooperation over greed.
But the SHM Leadership Academy hospitalists played the game differently. Dr. Javitch earmarked the proceeds of the auction for a pediatric AIDS foundation. After early bids to $5, one Mississippi doctor who had worked in a hospital without water and electricity during Hurricane Katrina bid $100. The bidding ceased abruptly. Spontaneously, several groups took up collections to boost the donation’s size. This stopped the facilitator in his tracks.
Instead of giving the participants a lesson on the destructive power of greed and competition, the facilitator got a lesson about hospitalist altruism—a dedication to serving people that is transforming how patients are treated in America’s medical centers. This exercise revealed both the pros and the cons of hospitalists’ leadership tendencies.
The Academy Format
Working at round tables of 10, the hospitalists spent all four days in the same small group. Each group was led by a facilitator who guided its exercises, kept the discussion on track, and encouraged participation in feedback and Q&A sessions. The hospitalists were put through their paces by experts in various disciplines relating to hospital medicine, learning about the field’s leadership challenges, its business metrics, strategic planning, understanding various personality traits and communication styles, and managing change and transformation efforts.
The SHM Leadership Academy, which limits attendance to 100, balances lectures with exercises, simulations, personality and communication inventories, and time for questions and sharing about professional issues. There was also time set aside for networking, including at a cocktail party hosted by IPC: The Hospitalist Company, North Hollywood, Calif., as well as sightseeing, biking, and visits to Vail Village to explore local shops and restaurants
The hospitalist attendees came to the Leadership Academy from diverse paths and at various stages of their careers. Some physicians started hospitalist programs fresh from residency, some worked in large teams, some had been in solo and group practice before becoming hospitalists, some were employed by hospitalist groups and health plans, and one started as a community-based solo practice hospitalist. They work in a wide range of settings, from rural and suburban community hospitals to academic medical centers, and in cities large and small.
Russell (“Rusty”) Holman, MD, and Cogent Healthcare’s, Irvine, Calif., national medical director, spelled out the Leadership Academy’s goals: for hospitalists to run their programs more efficiently, improve morale within their groups, maximize team efficiency, and identify critical drivers of success.
“Our goal at this conference is for you to learn new things, to improve your skills as leaders, and to learn how to continually demonstrate value to your CEOs and CFOs,” says Dr. Holman, who also led participants through the analytic steps of a strategic plan in their small groups.
Laurence Wellikson, MD, SHM CEO, spelled out the challenges confronting hospital medicine.
“In a nation that spent $1.7 trillion on healthcare in 2003, or 15.3% of the nation’s GDP, with rising insurance premiums and out-of-pocket costs to consumers, hospitalists will be part of a systemic solution to controlling costs and providing high quality care,” says Dr. Wellikson.
He points out that hospitals are changing rapidly, requiring hospitalists to adapt to work environments in flux. The 20% annual turnover in nursing staffs, PCPs giving up inpatient care, subspecialists narrowing their hospital work, and overcrowded emergency departments all create both opportunities and challenges for hospitalists.
“Hospital medicine is growing rapidly and so are the demands on hospitalists,” adds Dr. Wellikson, who articulated SHM’s goal of helping hospitalists develop their leadership skills in a rapidly changing and complex field. He urges participants to transcend medicine’s “cult of uniqueness among individual doctors” and to lead teams that will reform hospitals internally and provide measurable improvements in patient care quality and reduce waste.
These trends are playing out in a healthcare system that’s forced to do more with less. Michael Guthrie, MD, MBA, executive in residence at the University of Colorado at Denver, points out that hospitalists must assume their CEOs and CFOs mindsets to understand the myriad challenges that arise from the swelling number of uninsured patients, the demands of aging baby boomers, malpractice liability, competition, rapid changes in technology, the need for new buildings, and the emphasis on patient satisfaction and safety. The rise of consumer-directed care resulting from employers shifting healthcare costs to employees has raised concerns about how “shopping around” among hospitals might affect clinical performance.
Dr. Guthrie stresses that value is in the eyes of the beholder and that the hospitalist’s work greatly affects other care team members’ satisfaction, relationships with other physicians, patient satisfaction and safety, and the hospital’s business interests.
“Hospitalists use their knowledge, ideas, skills, and expertise with process improvement to get things done with and through other people,” he explains. “When we understand what problems need to be solved and what our measures of success are we can have the rapture of accomplishment.”
Turmoil throughout the healthcare system and rapid growth of the hospitalist movement provided an apt backdrop for remarks Jack Silversin, DMD, DrPh, made in a session titled, “Leading and Managing Change.” Dr. Silversin is the president of Amicus Inc., a consultant firm based in Cambridge, Mass. He urges physicians to transcend their traditional roles as protectors of the status quo to become sponsors of change instead. Physicians as change agents publicly demonstrate their commitment to being leaders in several important ways.
“Change is definitely more work than maintaining the status quo,” says Dr. Silversin, “but organizations need doctors who sponsor change rather than resist it.”
Working through a simulation of a headstrong hospitalist trying to strong-arm her way to a 24/7 schedule for hospitalists rather than having the medical staff or moonlighters taking night call, participants developed their own insights into handling change.
“You’ve got to start small and gain credibility with little victories rather than doing something major right away,” said one attendee.
Trying to get non-hospitalists to support change was another idea: “Leadership doesn’t always have an MD credential attached to it,” added Dr. Silversin.
Being a change agent means looking inward as well as outward, and to that end attendees at the Leadership Academy spent time exploring their personal strengths and communication styles. Having completed a “Strength Deployment Inventory,” a self-scored test published by Personal Strength Publishing of Carlsbad, Calif., that measures an individual’s motives and values, prior to the conference, the hospitalists—led by Dr. Javitch—determined their strengths and weaknesses on altruism, assertiveness, and analysis. Small groups and dyads role-played situations where a colleague, an administrator, or a subordinate had a vastly different approach to problem-solving and decision-making.
“There are no right or wrong answers here, just a growing awareness of what our strengths are and things we need to guard against,” says Javitch.
Timothy Keogh, PhD, clinical associate professor of Managerial Communication at Tulane University, New Orleans, discussed that effective communication—both spoken and nonverbal—is a key tool skill mastered by good leaders. Explaining that everyone’s façade masks things that are hidden consciously or unconsciously, self-awareness can help us “enlarge our arena and tap into talents that can flower.” He also points out that 80% of our communication style is due to our personality and 20% to environment, and that it “costs us energy to flex.”
Dr. Keogh encouraged attendees to adapt to other communication styles so the listener can hear what is being said. For example, someone with a dominant communication style might be perceived as pushy by a one with a conscientious perfecting style. Completing the DiSC, a self-scored communication and personality style inventory from Inscape Publishing of Minneapolis, 22% of the hospitalists were predominantly creative, while 18% were perfectionists, and 12% inspirational communicators. Dr. Keogh says that this pattern is consistent with norms for physicians, and urged attendees to study how personality types can improve their handling of emotions, goals, values, fears, and judgments.
Throughout the sessions hospitalists raised issues, some of which mesh with others in the hospital, such as top administrators, and some of which don’t mesh. Many spoke candidly about their difficulties growing a hospitalist program beyond an admitting service into a full-blown inpatient medicine service—particularly with office-based colleagues waiting in the wings to be relieved of hospital work. Physician recruitment and retention were very much on their minds, as were rocky relationships with subspecialists, turnover in top administration that results in having to “resell” the hospitalist program to new leaders, and constant pressures to seek new ways to reduce average length of stay and emergency department throughput. Achieving a balance of patient care, committee responsibilities, and teaching and research for physicians interested in those areas were also mentioned.
Looking to the future, Mary Jo Gorman, MD, MD, SHM president-elect and chief medical officer of IPC: The Hospitalist Company, indicates her organizational vision: “It isn’t easy to build something brand new in only one year, so I plan to build on SHM’s momentum. My goal is to keep defining and building hospital medicine as a career rather than as an extension of the house officer path.”
With 100 hospitalists now armed with a new tool kit, Dr. Wellikson outlined SHM’s plans for upcoming Leadership Academies: “Our next Academy is Jan 9-12, 2006 in Tucson [Ariz.], and we’ve added a medical directors’ forum for managing burnout.” An advanced Leadership Academy is also planned for 2006. TH