Tag Archives: leadership

“Thinking” About How We Lead: How We Make Better Decisions and Produce Better Outcomes

As physicians we are trained to assimilate data, analyze and interpret findings, and make the correct decision–every single time.  Often these tasks must be performed very quickly and in emergency settings.  For those who perform invasive procedures, decisions are often made “on the fly” and can have significant consequences.  In addition to our clinical duties, physicians are now thrust into executive roles as well.  Managing practices, budgets, government mandates and regulations have now become part of everyday clinical life for many practitioners.  The concept of the physician executive is now commonplace—and for many doctors and practices– a key to survival in an unstable and volatile healthcare market.  Improving skills in both decision making and communication can be critical to success in the new world of healthcare.  Learning to LEAD is critical to providing outstanding care for our patients every single day.

This week in the Wall Street Journal, author Andrew Blackman explores the inner workings of a business executive’s brain–exactly how the brain functions when making effective decisions in the world of business.  Researchers evaluated how executives make decisions under a variety of circumstances–they localized the biologic processes that occur in the brain via advanced neurologic imaging techniques.  From a biological standpoint, this research provides great insight into how successful decision makers formulate plans and solve problems.  In addition, the research provides insight into how leaders can make more effective decisions when under duress.  Using complex imaging to map the electrical connections in the brain when decisions are made, researchers are able to better quantify–biologically–what makes some leaders better than others.

By shedding light on how our brain functions when making good decisions, we may be able to one day “train” our brains to utilize particular regions during specific tasks.  For now, much of what Mr Blackman reports concerning optimal conditions for making decisions is applicable to physicians and other leaders in medicine in one way or another.

According to the Wall Street Journal, there are several things to consider when making important decisions:

(1)  Deadlines and Time Pressures may Limit Creativity and Innovation

In medicine, every day is a deadline.  Schedules of patients packed into the office or procedure list remain a reality.  Making decisions under pressure is a big part of what physicians do on a daily basis.  However, the recent neuroimaging research indicates that often the deadline pressure may stifle creativity and lead to poor decisions.  Stress induces more activity from the area of the brain associated with “task completion” and less activity in the areas responsible for new and creative idea generation.  According to Harvard researchers, one way to potentially combat this change in thought centers during times of stress may be to train workers and leaders to become more self aware and use “mini meditation” to help the mind wonder.  Although in medicine, we are trained to REACT to acute situations, it may be that while we REACT, we can also work to explore other creative centers of our brains in the process.  By combining both quick REACTION and creative thought, we may not only be able to stabilize a critically ill patient but also provide a unique treatment plan going forward.

(2)  Worry and Uncertainty can lead to bad Predictions and poor decisions

I have been accused of being “Chicken Little” on more than one occasion.   Uncertainty is something that is commonplace in medicine yet it makes most of us uncomfortable.  As physicians we rely on data to make good decisions.  However, uncertainty remains a significant part of what we do in medicine on a daily basis.  We often deal with limited data and must make a decision based on the best available evidence.  Clinical trials bring us some level of certainty  but our patients are biologic organisms, each with potential differing responses to treatments and disease.  According to researchers, the areas in the brain that are activated when you are working on problems that are cause you worry are often associated with anxiety and disgust.  Many poor decisions are made due to the “worst case scenario” line of thought.  While worry and uncertainty can never be completely avoided, psychologists argue that the way to avoid poor decisions during these times, is to learn to accept uncertainty and control the things that you can control.  No decision is ever final–even in medicine there are opportunities to act, refocus and change directions if necessary.

(3)  Good Decision Makers may look past the Facts and Incorporate “Gut Instinct”

Many decisions in medicine are made by considering the best available data and incorporating clinical judgement and instinct in order to make a determination as to the best course of action.  Interestingly, when MRI scans were performed on the brains of very successful business executives who were involved in making difficult decisions, the areas of the brain responsible for emotion and social thinking began to light up more than the purely analytical areas.  Researchers concluded that those leaders who relied not just on facts but on gut instinct and emotion tended to be more successful.  Social thinking–in simple terms–is the ability to look at a problem from numerous angles.  Seeing the potential impact of a potential decision from multiple points of view can provide invaluable insight and may lead to better decisions in the long run.  In medicine, involving other team members–nurses, technicians, and support personnel–in the care and formulation of the patient’s treatment plan may actually help a physician leader to make better decisions.

(4) Effective Leaders must stay positive and Inspire Teams

When leaders begin to inspire teams of people and lead with passion, certain other areas are activated in the brain–particularly those areas associated with positive emotions and social thinking.  Along with involving other team members in the care of the patient, it is essential for an effective leader and decision maker to incorporate “praise, encouragement and rewards” when motivating teams to perform at a high level.  Creating an emotional bond among members of a medical team can be as simple as asking for input from all involved parties and recognizing outstanding contributions to patient care.

The Bottom Line…

Business executives are adept at making determinations that affect millions (if not billions) of dollars and these decisions can move markets.  In medicine, we must make decisions every single day. While some decisions may be trivial, others may permanently impact the lives of our patients and their families.  Moreover, from a business standpoint, the management of a medical practice in today’s market requires impassioned leadership and great skill in order to remain viable. The work that is done with neurologic mapping in decision making may have provide us with guidance in the future as we develop new leaders.  It may be that through practice and coaching, we will one day be able to activate specific areas of the brain when we are working to make tough decisions.  The strategies and skills that we are able to glean from these types of research activity will allow us to be more effective physicians, leaders and executives in the years to come.


Charisma In Medicine: Inspiring Others To Improve Patient Care

By its very nature, Medicine involves close personal contact with others.  Communication with patients, families, staff and colleagues is essential to success.  All physicians have different ways in which they communicate–some more effective than others.  The best communicators are able to inspire, engage, and cultivate trust.  Everyone is born with different skill sets and communication styles may vary widely.

Recently, I came across an article in Inc.com that discussed the importance of charisma and how it can improve the success of leaders in the business world.  Author Jeff Hayden goes on to describe 10 habits of very charismatic leaders.  As I read the piece, I began to reflect on ways in which these tips could make me and my physician colleagues better communicators and better leaders in the world of medicine…

As we always do when tackling an issue in medicine, lets start with the available data….

Websters defines charisma as :

1. A personal magic of leadership arousing special popular loyalty or enthusiasm for a public figure

2. A special magnetic charm or appeal 

So, how can this help us take better care of our patients?  If we are able to inspire and produce excitement amongst our team–from nurses, to physician extenders, to support staff–both our patients and our employees will have a better experience when working with us.  If we are able to appeal to our patients and their families we are able to provide much needed trust and are more likely to be able to partner with our patients in an effective way. 

As we examine Mr Hayden’s Tips for Charismatic Leaderships more carefully, we can find insight into ways in which we can improve our own communication with patients, colleagues and staff:  (In each case below, I have listed Mr Hayden’s Tips from his Inc.com article and then applied them to our space as physician leaders)

1. Listen more than you talk–This one is tough for many physicians.  In training we are taught to speak up when you know the answer.  We are often motivated to provide quick results and to communicate them readily.  We strive to quickly assimilate facts and produce a plan.  However, much can be learned by listening–to patients, to families and to other healthcare team members.  When team members see that their ideas are considered by the leader, the tend to be more engaged and more productive.  It matters not who gets credit for the individual pieces of the puzzle–it is more important that the puzzle is completed successfully and the credit becomes a group effort.

2. Do not practice selective hearing–It is essential that physician leaders treat all team members with respect.  Everyone has a role to play and it matters not what title or status a particular individual may hold in the team heirarchy.  By including everyone (and making each person feel like a contributor) we inspire hard work and more participation. Ultimately the patient receives much better care. 

3. Put your stuff away–In the age of mobile phones, ipads and computers on the hospital wards distractions abound.  However, when leading a team and listening to others express opinions and ideas, it is essential to leave the digital media in its holster–nothing makes others feel more unimportant than a disinterested leader.  Take time to engage each person on the team and avoid the distractions of a text, a phone call or a tweet.

4. Give before you receive–In medicine it goes without saying but be sure to put your patients and their families first.  Within the care team, allow others to take credit and receive praise for a job well done before any is directed your way as the leader.

5. Don’t act self important–Medicine breeds ENORMOUS egos–particularly in world-renown academic centers.  To be more effective, we must put ego aside– forget the fact that you may have published half of the manuscripts in the medline search that the medical student just performed.  Focus instead on others and what they bring to the team.  Remember, we are all human–we are all connected.

6. Realize that other people are important–As Mr Hayden states clearly–”you already know what you know..you can’t learn anything new from yourself”  Listen to what others have to say–focus on their opinions and learn from their biases.

7. Shine the spotlight on others–Everyone feels validated by praise.  There is never enough praise to go around.  As the team leader make sure that you are adept at deflecting praise from yourself to those around you.  Team members who feel that their work is recognized and appreciated as excellent tend to work harder and produce more.

8. Choose your words–How we go about asking others to perform tasks can greatly alter their perception of the task.  If a task is presented as an obligation, it is viewed very differently than if it is presented as an opportunity or a privilege.  By carefully choosing your words you inspire others and make them feel as thought their position on the team is a critical component for success.

9.  Do not discuss the failings of others–Let’s face it, the hospital is a fishbowl and people gossip.  However, nothing is more destructive to team dynamics that when a leader speaks negatively about a team member, a colleague or another physician.  This behavior undermines morale and does not inspire confidence.

 10.  Admit your own failings–It is essential for teams and leaders to feel connected.  Nothing promotes connection more than when a leader admits his or her own mistakes and failings to the group.  However, when admitting a mistake it is essential that the leader set an important example–when admitting a failing also admit what was learned through the event and what corrective actions you plan to take to avoid the mistake in the future. This sets a wonderful example for self improvement for the team and at the same time promotes connectedness within the care team.

What’s the Bottom Line?

Effective communication and inspiring leadership are essential to the success of any medical team.  When teams are engaged and focused on the ultimate goal–the care of the patient–outcomes improve.  It is the job of the physician and other team leaders to motivate people and form cohesive, effective teams.  As leaders, we can learn a great deal from the business and political world–charisma is a characteristic that can move markets and change the course of entire nations.  Charisma allows a leader with a vision to effect change.  Charisma can be the difference in connecting with patients, families and co-workers.  Charisma can ultimately improve care and improve the delivery of care–the key is to learn to focus on them….not on me…..


Are You “Top Brain” or “Bottom Brain”? Implications for Healthcare Reform

Recent evidence suggests that they way in which we think and behave may be controlled by how well we use different systems within our brains.  In the past, the concept of “left-brain” versus “right-brain” has been accepted as a way to explain the differences in which people perceive and attack problems.  This theory is actually based on very little real science.  New evidence backed by years of neuropsychiatric research now suggests a completely different paradigm for how individuals process stimuli, respond to events and ultimately make choices and execute plans (aka behavior).  Certainly, no “system” in the brain functions completely in isolation from the others–but how we use them relative to each other significantly impacts how we may function as leaders and as members of a team.  Understanding the neuropsychiatric basis of thought and behavior can help us identify those destined to lead, those with creative minds for designing concepts, those that can see the “big picture”, those who can interpret and respond to emotion effectively and those who are adept at execution of tasks.  As we examine the current state of healthcare reform, it is evident that a more effective team must be assembled in order to achieve success.  Currently, the efforts in Washington are beginning to fall apart–the rollout of the ACA Exchanges has been a debacle.  The politicization  of healthcare has limited our ability to effect real reform.  Effective teams are diverse in composition and complementary in talents–they should not be based on political party affiliation.  As we develop a new healthcare system,the ability to place people in the positions best suited to their strengths is paramount in order to achieve the best possible patient outcomes.

This past week in the Wall Street Journal, authors Kosslyn and Miller, explore the way in which the brain processes information and how this process impacts our behavior and our ability to lead others.  Dr Kosslyn, a neuroscientist at Harvard, describes the new way in which higher brain functions are now thought to occur.  Rather than “right brain” and “left brain” cognition, new research divides brain functions into “top brain” and “bottom brain”.  Anatomically, the “top brain” contains the parietal lobe and the larger part of the frontal lobe.  The parietal lobe is known to manage input from many different sensory modalities and is essential in determining spatial sense and navigation.  The upper part of the frontal lobe is known to be associated with planning, recognizing consequences of actions, and short term memory actions.  In essence the frontal lobe is all about reward, attention and motivation.  In contrast the “bottom brain” consists of the occipital and temporal lobes (with a bit of the lower portion of the frontal lobe included).  The temporal lobe is important in storing visual memories, comparing incoming sensory input with stored information and processing emotion and language.  The occipital lobe is important in processing visual input.  Together, these “bottom brain” functions are utilized to compare new information with old and to apply meaning to our experiences and the world around us.

These two “brain systems” do not function independently–they work in concert and to differing degrees in different people.  The ways in which these two systems interact and function together may very well explain how some are effective leaders, others are creative thinkers and still others are more interpretive and can better understand and deal with emotion.  The authors theorize that the way in which we combine the “top brain” and “bottom brain” functions falls into 4 categories.  I found that these categories are very applicable to business and to medicine–many of the important functions of business committees and medical teams can be represented by each of these four cognition types.  However, it is important to note that although each type is different–none are better or more desirable than others.  That being said, each category of cognition may be more likely to succeed at a particular job or in a particular role on a team.  Successful reform of our current healthcare system will require the assemblage of a competent team of experts that will address the most pressing issues in healthcare today–each member should have different talents in order to bring new ideas to the table.  Ultimately, our job is to provide high quality, effective, compassionate care to our patients every single day–no matter what political party we endorse.  We must create a system that allows doctors to do what we do best–diagnose, care and treat.  I believe that by putting people in positions that play to their strengths and creating groups with complementary talents (by applying this new neuropsychiatric theory) we have a chance of actually achieving successful and sustainable healthcare reform.

According to Dr Kosslyn’s research individuals may be separated into distinct groups based on the ways in which they use the “top” and “bottom” brain systems: (Here are my thoughts as to how each cognition type may impact a team assembled to fix the issues with healthcare reform)

1. Mover:  According to the top/bottom brain theory, a mover typically uses both top and bottom brain in complementary ways.  Based on the situation presented, the Mover is able to combine input from both systems and respond to situations as they evolve by integrating inputs from both systems to varying degrees.  These people are well suited to lead others because much of what they do involves planning and then responding to the consequences of their actions and choices.  They learn from their mistakes and take calculated risks.  In our current healthcare crisis, Movers will be essential in crafting a system that will provide essential healthcare benefits for patients in a way that will not bankrupt the system nor deprive some of care.  Movers will adjust to issues with the website rollout and adjust plans (or delay individual mandates)  as the situation dictates (rather than press on with systems that do not work).  Movers will ensure that care will be based on good outcomes data supported by  randomized controlled trials. (rather than arbitrary government requirements for box checking).   These people excel at weighing the risks and benefits of a particular therapy and organizing others to execute the plan.  Movers in medicine are insightful and self aware–they work hard to improve outcomes and are able to adapt when things do not go as planned.

2. Perceiver:  These individuals tend to utilize the bottom brain in more diverse ways and do not rely as much on the top.  These people are adept at making sense of what they perceive and try to place their understanding of emotions or situations in context.  These people are essential in medicine and provide a broad view of the issues at hand–think “the 10,000 foot view”.  These team members do not usually create or execute plans–rather they provide insight and perspective.  They serve as essential advisors for leaders in healthcare reform.  They can provide candid feedback and help others see mistakes and shortcomings so that they can be corrected.  For example, “maybe we should delay the rollout of the exchanges given the fact that our software is not yet ready to meet the needs of those that will try to register this month”  Often these are the wisest members on the team.  The Perceiver will be essential to the success of any healthcare reform–the Perceiver will focus on success of implementation rather than meeting arbitrary deadlines and building a legacy.

3. Stimulator:  These people typically use the top brain a great deal but utilize bottom brain functions very little if at all.  These people are great at creating and implementing plans but are unable to learn from their mistakes.  They do not incorporate the consequences of their current actions into future plans.  However, these people are highly creative and think about problems in very different ways that others–in healthcare reform these people will come up with the ideas that ultimately may result in success.  The status quo and the “tried and true” will not suffice.  Healthcare reform is a daunting task and will take the efforts of those who think in extraordinary ways.  These people can be effective but MUST be held in check by a strong leader who can help to curb their enthusiasm at times.  However, thinkers of this type often produce innovative ideas that change the course of history.

4. Adaptor:  These people utilize neither the top or bottom brain systems in complex or analytical ways.  These individuals tend to be impulsive and respond to the situation at hand.  As the authors of the Wall Street Journal article state, they “go with the flow”.  They are, however, responsive and action oriented.  These types can be essential members of the team.  They are effective as “worker bees” and can accomplish a long list of tasks.  In healthcare reform we must have  these cognitive types–they are the workhorses that make the plans happen and accomplish the much needed day to day implementation.  (think website design and rollout)

How our brains function has much to do with how we behave in groups and how effective we can be in the care of patients.  In the past, we have separated thinkers into right and left brain–now, we have a better way to think about cognition.  The degree to which individuals utilize the top and bottom brain functions can determine the best role for them on a team.  A team cannot exist with just one type of thinker–all must play a role and all complement one another.  As we continue to struggle with healthcare reform, we must assemble talented teams of individuals in order to be successful.  Although it remains a highly political issue, we must rise above the politics and focus on the patients that we claim to serve.   We must utilize individuals from all four groups of cognitive types in order to improve care and create real reform.    Identifying the best people to serve on a particular team is critical–putting each individual in the best role for success is essential.


Exploring The Leadership Potential of Three Little Words: Applying “I Don’t Know” To Medicine

Recently I read an interesting article on leadership published at Inc.com.  Although most of the journal is focused on those in business, many of the pieces on leadership are very applicable to those of us in Medicine.  In this article author Curt Hanke writes about the inspiration and leadership positives found in the three simple words:  “I Don’t Know.”   On first blush, we may think that a leader speaking these words may no longer inspire confidence and may lose the support of his or her troops.  However, as Mr Hanke goes on to detail, the words “I Don’t Know” may provide inspiration and motivate teams to perform even better.

As physicians, we are leaders–we lead teams, we lead students and other trainees, and most importantly we lead patients.  There are times when we lead and guide patients and families on very challenging journeys through brutal, sometimes devastating diseases.  Often, being a good leader is the most important part of our job.  With leadership comes many responsibilities– and those whom we lead look to us to show confidence as we provide guidance in uncertain times.

As physicians are leadership roles are two fold:

1. We lead teams of caregivers with a common goal–the best outcome for our patients.  Our teams look to us for confident judgements during crisis (such as during a code blue) and guidance when making day to day clinical decisions.  Our teams are bright and capable.  Our team members are diverse both in training, ability and in education–nurses, physical therapists, pharmacists and other physicians–all working in concert to achieve clinical success.

2. We lead patients and families.  We are the experts in a complex field that is foreign to many–we are relied on as guides, as advisors as well as generals on the field of battle.  We must inspire confidence and show kindness at all times.  Our patients are often frightened and uncertain.  We must help them learn, grow and adapt to changing medical and clinical scenarios.

To lead in this way can be very challenging but is not terribly dissimilar from leading in the business world.  We must be prepared–with knowledge of disease and the best available therapies.  We must be aware of the strengths and weaknesses of each individual on our medical team (including our own) and we must be able to motivate those in very different roles to band together for common good.  We must lead patients and families with compassion–we must understand things from their perspective and apply their needs into the equations we use to make clinical decisions.  We must lead both groups with honesty.  We must be willing to say “I Don’t Know” when appropriate.

Then we must harness the power of “I Don’t Know” in four distinct ways (according to Mr Henke):

1. Creates Possibilities--As a leader, saying “I Don’t Know” in medicine, may create an opportunity to bond with patients, families and team members.  Having the courage to articulate your shortcomings as the leader may actually garner more respect and tighten bonds through your honesty.

2. Inspires Engagement–As a leader, saying “I Don’t Know” in medicine may provide opportunities for others to take center stage and bring forward ideas that they may have otherwise kept to themselves.  It allows others to think more creatively and inspires team members to find “ownership” in working to solve a particular clinical mystery or treatment problem.

3. Avoids Complacency–As a leader, saying “I Don’t Know” in medicine provides me with the motivation to learn more and to be better.  Not knowing the answer right away drives me to reflect on my particular skill set and take stock in what I can do better both as a leader and as a team member.  When the leader works to improve, it often inspires growth among team members as well.

4.  Inspires “Fun” During Difficult Times–As a leader, saying “I Don’t Know” rather than a positive effect on morale–A culture of “I Don’t Know” produces engaged team members and these engaged team members are more productive.  Ultimately a more productive medical team results in more positive patient outcomes.

Effective leadership is vital to success in both business and in medicine.  The most effective leaders know their own limitations and are not afraid to share that with the team that is inspired to follow them.  Courage to say “I Don’t Know” may be the difference in discovering the most accurate diagnosis and prescribing the most effective treatment plan for a patient and their family.  Be willing to admit when you fall short–as Socrates stated “The only true wisdom is in knowing [what] you don’t know”