“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.”