Leading Your Physicians: Perspectives and Perceptions

With so many changes occurring in health care, leaders can help the physicians they lead gain healthy perspectives of what is happening and how it relates to them individually.

We live in a “VUCA” world, a term adapted by business and health care from the United States Army War College.1, 2 VUCA stands for volatility, uncertainty, complexity and ambiguity.

It is up to the physician leaders to first understand these domains and then to translate the responses to VUCA for groups and individual physicians. Every physician wants to know: What does this mean for me?

Leaders in health care can learn from military leaders who had to grasp these new skills. At the beginning of World War II, General George C. Marshall stated:

“It became clear to me that at the age of 58 I would have to learn new tricks that were not taught in the military manuals or on the battlefield. In this position I am a political soldier and will have to put my training in rapping-out orders and making snap decisions on the back burner, and have to learn the arts of persuasion and guile. I must become an expert in a whole new set of skills.”1

The Broken Covenant

Jack Silversin and Mary Jane Kornacki3 astutely pointed out that many physicians carry within themselves a sense of a broken covenant. Most physicians earnestly believed that they would be autonomous throughout their careers once they followed all the rules for becoming a physician. Loss of autonomy, increasing bureaucracy and whiplash changes in every field have led to many challenges, including a high burnout rate among physicians.

Tait Shanafelt and his colleagues found that 45.8% of physicians in a large national survey reported at least one symptom of burnout.4 More troubling, Shanafelt and colleagues concluded in a follow up study that “Burnout and satisfaction with work-life balance in U.S. physicians worsened from 2011 to 2014. More than half of U.S. physicians are now experiencing professional burnout.”5

The physician leader can help his or her colleagues by understanding and accepting what can and cannot be changed. For example, it is unlikely that even a large practice or medical association can greatly change the regulatory environment. However, physicians and physician groups can regain some semblance of control by lobbying at the local, state and national levels. The act of lobbying can be therapeutic. At least we will have the sense that we have done our best to deliver the message and that it has been heard.

Different Perspectives and Perceptions

Perspective and perception are important for physician leaders to grasp themselves and then to share those insights with other physicians. Physician leaders can help other physicians in turmoil make sense of the chaotic VUCA world.

A physician’s perspective refers to his or her point of view. Specialty, gender, age and tasks will affect a physician’s perspective. On the other hand, perception indicates the meaning or interpretation that an individual physician assigns to the event. Different perspectives (physician leader vs. frontline physician) shape our perception, but so do our values, attitudes and experiences.6

Like many physician leaders, it took me some time to fully appreciate that physicians who shared many characteristics — training, gender, age, place of birth — could have radically different perspectives and perceptions of events. I have to listen carefully to understand the individual physician’s interpretation of events. I try to understand why some events or reports can affect physicians so differently. Implementation of specific features of an electronic health record is a good example.

The Stockdale Paradox

Author Jim Collins related how he met Adm. Jim Stockdale, the highest ranking military officer who was captured during the Vietnam War and spent eight years in the infamous “Hanoi Hilton.”7 It is important to recognize that Stockdale had no release date and didn’t even know if he would survive. Despite this, he survived and helped his fellow prisoners survive.

Stockdale related that, “I never doubted not only that I would get out, but also that I would prevail in the end and turn the experience into the defining event in my life, which, in retrospect, I would not trade.”8

When asked who didn’t make it out, he replied, “Oh, that’s easy, the optimists.”9 The optimists were certain that they would be out by a given date and when they weren’t released, they were devastated.

Stockdale said, “This is a very important lesson. You must never confuse faith that you will prevail in the end — which you can never afford to lose — with the discipline to confront the most brutal facts of your current reality, whatever they might be.”10

Stockdale’s paradoxical lesson for leaders was to hope for the best while simultaneously dealing with the harsh facts of the situation.

What Can Physician Leaders Do?

The number and pace of changes for health care systems is startling. Physician leaders can seek to understand the perspectives and perceptions of physicians in their system. Calm, reassuring, factual guidance is needed.

Leaders can replace volatility with vision, uncertainty with understanding, complexity with clarity and ambiguity with agility.

How can physician leaders do this?

1. Listen well.

2. Communicate effectively.

3. Translate data into useable information.

4. Stop seeking permanent solutions.

5. Stay grounded in principles while focusing ahead.

6. Think divergently.

7. Be flexible.

8. Train tomorrow’s leaders now.

9. Advocate for your physicians.

10. Understand their perspectives and validate their perceptions.

Tactfully, we need to remind our physicians that the changes, though rapid and sometimes dramatic, eventually will subside. We shouldn’t perseverate on our W-2’s. Much is out of our control.

Sir William Osler said, “You are in this profession as a calling, not as a business. … Once you get down to a purely business level, your influence is gone and the true light of your life is dimmed.”11

Physician leadership has never been more important.

James S. Hernandez, MD, MS, is an associate professor of laboratory medicine and pathology at the Mayo Clinic College of Medicine in Arizona.

REFERENCES

1. Strategic Leadership Primer, third edition, Department of Command, Leadership and Management, United States Army War College.

2. Bennett, N and Lemoine, GJ. What VUCA Really Means for You, Harvard Business Review, January-February 2014. Accessed at https://hbr.org/2014/01/what-vuca-really-means-for-you

3. Silversin and Kornacki, Leading Physicians Through Change, How to Achieve and Sustain Results. ACPE, Tampa, Florida, 2000.

4. Shanafelt, et al, Burnout and Satisfaction with Work-life Balance among U.S. Physicians Relative to the General US Population. Arch Intern Med 2012 Oct. 8; 172(18): 1377-85.

5. Shanafelt, et al, Changes in Burnout and Satisfaction with Work-Life Balance in Physicians and the General U.S. Working Population Between 2011 and 2014. Mayo Clinic Proceedings, Volume 90, Issue 12, December 2015, Pages 1593-1596Mayo Clinic Proceedings, Volume 90, Issue 12, December 2015, Pages 1593-1596Mayo Clinic Proceedings, Vol. 90, Issue 12, Dec. 2015.

6. Difference between perception and perspective, accessed 1/6/16 at http://www.differencebetween.com/difference-between-perception-and-vs-perspective/

7. Collins, J. Good to Great, Why Some Companies Make the Leap…and Others Don’t. Harper Collins, New York, NY, 2001.

8. Golden, RL. William Osler at 150, An Overview of a Life. JAMA. 1999;282(23):2252-2258.

9. Zacharias, D. When “healing” loses its meaning: A cynical medical student meets Patch Adams, accessed at http://www.kevinmd.com/blog/2015/12/patch-adams-gave-hope-burnt-medical-resident.html