Medicolegal Issues

Subtle Skills


 

Hospitalists with a hunger for taking on administrative roles often pursue an advanced degree. But whether it’s to assume a leadership role or just do a better job, it’s the not-altogether-obvious skills that can help hospitalists improve their careers and job satisfaction.

By refining communication styles, being receptive to mentoring, or learning how to influence decision-makers, hospitalists can convey competence to their peers and superiors. Intangible strengths such as these will help the hospitalist who wishes to carve a niche as a quality-improvement researcher, director of a medical education clerkship, patient safety officer, or medical director.

Who Needs What

The administrative skills hospitalists need depend on their career goals. Those who reflect on their career goals, identify their core values, and consider what is feasible at different stages in their lives can more quickly build the abilities they’ll need. This self-awareness is perhaps the first skill to develop.

The setting and practice model hospitalists work in also influences which skills they may need.

“Although the skills needed in different settings may be fundamentally the same, the politics differ between a community hospital and a teaching hospital,” says Sayeed Khan, MD, director of the hospitalist program of Lakeside Medical Group. “Communication skills may be even more crucial in a community hospital, where it’s less understood what a hospitalist is.” Such ability to educate people in Hospitalist 101 is yet another skill a savvy administrator or administrator-to-be should hone.

Hospitalists also need to understand quality control and other measures—and what the numbers mean.

Advance your career

  • Take time out to self-reflect: What are your career goals in the short-and long-term? The administrative skills you need may largely depend on what you want to do.
  • If you don’t know what you want to do, think about what really excites you, what you’re willing to “burn the midnight oil” for.
  • When you know what you want, articulate your goals to your supervisors.
  • Seek mentors to help you reach your goals. With potentially conflicting or divergent goals, seek more than one mentor to assist your decisions.
  • Determine which skills will help get you promoted along your lines of interest and find out the rules for promotion.
  • Negotiate protected time for study to develop the skills you need.
  • Put yourself on your supervisor’s radar screen by soliciting feedback more often than just annually.
  • Refine your public speaking.
  • Develop a good understanding of measures and benchmarks.
  • Refine your negotiations and interpersonal skills.
  • Don’t try to do it all. Perfect the skill of getting help.
  • Learn to say “no” without communicating negativity.
  • Establish an effective system for juggling family and career.—AS

For example, says Dr. Khan, it’s valuable to know:

  • What it means to have good bed days at the end of the month and an average length of stay of 3.3 days;
  • How that compares with other groups in other hospitals; and
  • The implications of those measures in terms of outcomes, dollar costs, and savings to the hospital as well as the group—and how that translates for the patient.

“Those are the types of figures that many hospitalists don’t really understand,” says Dr. Khan.

But hospitalists can learn by observing and studying. “I’m a good example of that in that I do not have a formal business background,” Dr. Khan says. “Along with the literature, networking with other people, particularly at the SHM annual meeting, can help hospitalists gain a better understanding of what these numbers mean and what the benchmarks are.”

He believes administrative skills can be divided into two categories: those related to metrics (the math behind what hospitalists do) and those related to patient care.

In regard to patient care, effective committee participation is an administrative ability that can influence the standard of care. For example, Dr. Khan is participating in committee work in the area of maintaining patients’ glycemic control.

“Historically, that issue was not well addressed,” he says. It is now recognized that patients who have tight glycemic control do much better while hospitalized, irrespective of whether they have diabetes. “But it’s difficult to get other clinicians to change their practice styles,” says Dr. Khan. “You can implement change in your own practice, and others can learn by example. But if you are on a committee that designs new protocols and those get implemented, then you’ve directly changed how medicine is practiced at that hospital.”

Being able to win buy-in for your ideas makes that possible. “Purely speaking, committee participation is not an administrative role,” says Dr. Khan. “But it is an administrative skill in that it is outside the scope of what’s normally required for a hospitalist.”

Get Help

Honing one’s receptivity to mentorship is another vital ability for the upwardly mobile hospitalist. Mentors can direct inexperienced physicians to resources that may help them develop proficiency. A mentor who has grappled with the same issues can help open doors to opportunities hospitalists may not know about.

As she reflects on her early career, when she had no mentors and no administrative experience, Sylvia C.W. McKean, MD, realizes she could have used guidance and advocacy. Effective mentorship helps hospitalists reach their goals faster with fewer impediments, she says.

“Mentorship is critical,” says Dr. McKean, medical director, Brigham and Women’s Hospital/Faulkner Hospitalist Service of Brigham and Women’s Hospital in Boston. “But knowing how to receive the information you’re getting and how to apply it to your own specific professional goals can really help you develop the skills that will help you move your career forward. Informal mentorship is one area where there has been less opportunity for women in the past, resulting in more promotions for men.”

Other skills women may especially need are learning the written and unwritten rules of promotion, being more assertive in finding out what they are, and developing diplomacy—including learning to say no with finesse.

“The reality is that if you are in an environment that has predominantly male leadership, it is important for [a woman] to have male advocates to support whatever it is that you are trying to do,” says Dr. McKean. “In some instances they may have to speak for you.”

Efficiency and setting priorities are also important skills.

“I learned very early on that efficiency was critical to managing several roles—administrative, patient care, and raising three boys,” says Dr. McKean. “There were some things, however, that in retrospect I did not need to do. For example, I did my own home-improvement tasks instead of hiring someone else to do them. For women in particular, you don’t have to be a super everything. At different phases in your life your priorities will vary. Get help so that you’re not spending time doing tasks that don’t further your goals.”

Communication

Facility with communication, of course, is paramount in every aspect of medicine. Being poised, articulate, concise, and persuasive to get your message across, says Dr. McKean, goes a long way toward advancing one’s career.

“It took me a long time to realize this,” says Dr. McKean. “For example, whenever I generated reports I tried to have as much information in there as possible because I thought it would look like I was very knowledgeable. A one-page document that summarizes the key points is often more effective in getting people’s attention.”

Another subset of communication is skill at public speaking, which may lead to being invited to give lectures.

Dr. Khan believes shy, less-articulate clinicians can begin to improve their public speaking by serving on committees. “Unless the committee is a committee of two, that is the appropriate forum to begin voicing your opinions and expertise on a particular matter,” he says. “There’s a certain comfort level built into that because you’re not necessarily speaking on a topic you are unfamiliar with.”

Another intangible administrative skill, he says, is the ability to deal with people from different walks of life. Some highly placed hospital administrators don’t have clinical backgrounds and will require explanations of clinical situations that mesh with their business understanding.

Time Management

Organization is a critical administrative skill no matter what career path a hospitalist follows.

“As hospitalists we are typically juggling more than one thing at one time,” Dr. Khan says. “As a hospitalist who is involved in administrative tasks, if you’re not organized, that is a path to failure.”

Strive to hire the right people for clerical and administrative staff positions. They will fill in the weak spots to keep you on track and present a good image as your front person. But having a good clerical or administrative assistant doesn’t let you off the hook; you, too, must demonstrate solid time management. Make sure you take good notes at committees, quickly access data or documentation, and research and report back well.

The Interpersonal

Robert L. Benak, MD, a hospitalist and medical director of Champlain Valley Physicians Hospital (CVPH) Medical Center, a 341-bed acute care hospital and 54-bed skilled nursing facility in Plattsburgh, N.Y., thinks the most important intangible skills involve managing relationships.

Again, self-reflection helps. “Understand what your personality is like on a calm day and what it is like on a stressful day,” he says.

He says it’s critical to be able to negotiate with others. “Understanding what lies underneath, what common and different interests the two negotiating partners have helps you focus on getting the best compromise of conflicting interests to resolve a disagreement in an amicable and effective way,” he says.

Dr. Benak, who joined SHM around the time his group started in October 2006, thanks the SHM Leadership Academy for strengthening his interpersonal skills. He has tried to bring home what he learned to his group of five hospitalists.

Recently, he had to determine whether to designate a patient with abdominal pain as a surgical or medical patient. Dr. Benak invoked his “ability to sit down with the orthopedic surgeon and general surgeon, recognizing that they’ve got legitimate interests and concerns, as do I, and figuring out what works well for us, and more importantly, what works best for the patient.”

That ability to compromise is indispensable to growth as a hospitalist, he says.

“I was a chemistry major in college and loved working with concrete, though sometimes complicated, problems where you’re either right or you’re wrong,” he says. “I’ve come to see that giving up being right, and giving up any sense of entitlement I may feel in having the principal position, are skills. Even if you think the other person is being unreasonable, you have to accept that as a fact and figure out how to cope with that in a way that is a credit to yourself and your program.” TH

Andrea Sattinger is a medical writer based in North Carolina.

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