leadership pearls for the physician champion

Leadership “Pearls” for the Physician Champion

Jon Zlabek, MD, FACPGundersen Lutheran Medical Center

La Crosse, WI

[email protected]

Learning Objectives

• Learn the components of strong vision casting

• Improve your understanding of organizational change

• Understand the importance of strategic team structures

• Learn the importance of your leadership development

Gundersen LutheranService Area

• Clinic founded in 1891; Hospital in 1902

• 7,009 Employees ◊ 693 providers employed/434 medical staff

• 325 Bed Tertiary Medical Center

• Service area covers 19 counties in Wisconsin, Minnesota, and Iowa with 45 clinic locations

• Western Campus of the University of Wisconsin Medical and Nursing Schools

• Five Residency Programs• Minimally invasive surgery fellowship

Gundersen Lutheran Health System

Warning!Warning!Your Organization is

Unique!

Our Go-Live

• Went live on November 1, 2008: EpicCare Inpatient Spring 2008

◊ Including provider documentation

ASAP Pharmacy ADT, Registration, HIM and Billing

• Went live with CPOE February 4, 2009• Have a home-grown ambulatory system

http://www.youtube.com/watch?v=Pk7yqlTMvp8

Your Role: The Leadership Pyramid

Develop Yourself As A Leader

Lead Others

DevelopOther

Leaders

The Power of Effective Vision Casting

The Power of Vision

• Ways to “lead”: Authoritarian decree Micromanagement Through Vision

Leading Change – John P. Kotter

The Power of Vision

• Vision is a clear mental picture of what could be, fueled by the conviction that it should be

• Vision is a view of the preferred future

Visioneering – Andy Stanley

The Power of Vision

• It always stands in contrast to the world as it is

• Vision demands change


The Power of Vision

• Vision creates change by directing, aligning, and inspiring action

• It gives focus

• It guides and simplifies decision making


The Power of Vision

• Vision motivates to action, even if the initial steps are painful and require sacrifice

• A good vision has the “Eye of the Tiger” Ambitious, but attainable goals


The Power of Vision

• A clear, focused vision allows us to experience ahead of time the emotions associated with our anticipated future

• These emotions reinforce our commitment to the vision


Communicating the Change Vision

How to cast a compelling vision:

1. Define the problem – What problem is my vision designed to solve?

2. Offer a solution – Your vision is the solution to the problem.

3. Tell them why to act.

4. Tell them why to act NOW. Visioneering – Andy Stanley


• Simple and clear• Stories and examples• Multiple forums• Give-and-take communication• Explain perceived inconsistencies• Repetition – let them chew on it



• If you and those around you cannot describe the vision driving the change in less than 5 minutes AND elicit understanding and passion in the person you are talking with, you have a vision problem The elevator talk


• Vision leaks!

• You must recast vision once a month or when there is a bump in the road, whichever comes first

Who Can I Blame?

• “ . . . if the followers don’t get it, it’s because the leader hasn’t delivered it. And if the followers don’t own it, it’s because we’ve not made it accessible enough to own it . . .”

• “. . . as much as we want to blame the followers, the buck stops right here . . .”

Making Vision Stick - Andy Stanley

Recommended Reading

VisioneeringPastor Andy Stanley

Selected Principles of Organizational Change

“If you don’t like change, you’re going to like irrelevance even less.”

General Eric ShinsekiU.S. Army Chief of Staff

The Basics of Change

• Change is unavoidable • The pace of change will only get

faster• Resistance to change is universal

• A quick poll . . .

Developing the Leader Within You – John C. Maxwell

The Basics of Change

You need to know:

• The technical requirements of change

• The attitude and motivational demands that bring it about Don’t blow off the psychology of change!


2% Innovators

10% Early

Adopters

60% Middle Adopters 20%

Late Adopters 8%

Laggards


Marc Wright www.simply-communicate.com

The Kubler-Ross Model

Why People Resist Change

• They didn’t initiate it and aren’t involved with the process Changing vs “being” changed

• Habits and routines are threatened

• Fear of the unknown


Why People Resist Change

• Satisfaction with the status quo

• The purpose of the change is unclear

• Change creates fear of failure

• Lack of respect for the leader They view the change according to the

way they view the “change agent”


When Do People Change?

• Leaders create an atmosphere that causes at least one of these to occur: People hurt enough that they have to

change People learn enough that they want to

change People receive enough that they are

able to change


Creating a Change Climate

• Understand the history of your organization

• Develop trust with those you are leading

• Place influencers in leadership positions and get them on board early in the process


Creating a Change Climate

• Show people how the change will benefit them

• Give people ownership of the change Ask those affected to be involved Decisions should be made at the

“lowest” level possible – those in the trenches


When Change Doesn’t Work

• It’s a bad idea• It’s not accepted by the influencers• It’s not presented well• It’s self-serving to the leaders• Too much change is happening too

quickly


Errors of Change

• Making an error of change can have serious consequences: Creation of unnecessary resistance Employee frustration Poor implementations

◊ Too long and too expensive

Failing to deliver and sustain expected results


Error: Allowing Too Much Complacency

• Failure to create sufficient urgency is fatal for a change process

• Leaders underestimate how hard it is to drive people out of their comfort zones



• Reasons for high complacency: Past success Lack of a visible “crisis”

◊ “Things aren’t that bad” Low performance standards


• Leaders tend to: Skip creation of urgency due to lack of

patience Underestimate the power of the status

quo Confuse creating urgency with creating

anxiety and make things worse



Establish a Sense of Urgency

• “Problem-Cast” – tell them why the current situation is bad Use hard data about your current clinical

shortcomings – publicize the problems ARRA HIT dollars and timelines are important,

but don’t make it the central reason

• “Vision-Cast” - bombard them with the great future, but tell them they can’t capitalize on it with the status quo

Is This Your Guiding Coalition?

http://www.youtube.com/watch?v=6hKWM5Z1zds

Error: Failing to Create a Sufficiently Powerful Guiding Coalition

• Individuals and weak committees don’t have enough power to overcome the massive sources of inertia

• They may get it off the ground, but it quickly fizzles away



• A weak committee will fail: Not enough credibility Wrong composition

◊ Too many managers, not enough leaders

• People “smell” lack of long term success and then disengage



• No one individual can: Develop the right vision Communicate it broadly and effectively Remove the key roadblocks Generate short-term wins Lead and manage all the sub-projects Anchor changes in the culture


Create the Guiding Coalition

• The coalition needs to be powerful: Reputations and relationships Expertise Titles

◊ Assuming those with the title are strong leaders

Proven leadership capacity


Highly Recommended Reading

Leading ChangeJohn P. Kotter

Developing the Leader Within YouJohn C. Maxwell

The Importance of Strategic Team Structures

Physician Leadership Team

• A group of 5 specialty-diverse physician leaders who were my “Guiding Coalition”

• My “go-to” group for decisions that were too big for me to make alone; my trusted advisors


• I spent lots of time and asked a lot of advice from others before choosing and making the “pitch” to them

• Our group: Emergency Department Physician– 0.3 FTE General Medicine Section Chair – 0.1 FTE Hospitalist/Assoc. Director of Residency – 0.1 FTE OB/GYN Physician– 0.1 FTE Myself (Internal Med/Vascular Med) 0.5 FTE



Lead Others

DevelopOther

Leaders


• I poured lots of leadership development time and energy into them: Read several leadership books together Discussed difficult leadership decisions Discussed potential “fires” and how to

handle them Openly discussed our leadership

strengths and weaknesses

Recommended Reading

Developing the Leaders Around YouJohn C. Maxwell

Advisory Team

• Multidisciplinary group representing Physicians and Associate Providers in every inpatient specialty

• At least one per specialty• Total of 35 people

Advisory Team

• My “go-to” group for decisions that were too big and far-reaching for the Physician Leadership Team: New Same Day Surgery flow Navigator build Smart Text content

• Most functioned as their department’s Super Users

Advisory Team

• They must be committed to the project’s success in relation to their department and the organization

• They need to have your “back” and the project’s “back” when challenged

• They will take a lot of hits for you, so be very appreciative!

Advisory Team

• We “funneled” all communication to and from their department through them Able to answer most questions in a way

their department could best understand

MD Champion sanity: 35 people asking me questions instead of several hundred

The slides that follow are some of what I presented to the Advisory Team at our first meeting . . .

Advisory Team Roles

• You must give us your input!• This is one of the high-risk areas of the

project.• Represent your department . . . they are

depending on you!

Communicate with the Implementation Team

Advisory Team Roles

• You need to tell those around you how the project is going: Must keep abreast with what is happening Plan an update at every department meeting Ask us clarifying questions as they occur

Communicate with Those You Represent

Lead By Example

• Maintain a positive attitude, even when things get rough . . . your colleagues are watching you closely

• You will be asked to be in the first wave of training and be “Super Users” so you can dispel myths and fears of your colleagues

Advisory Team Roles

Epic Super UserEpic Super User

Picture YourselfPicture Yourself

Executive Leadership

• It is critical to have Executive Leadership 110% behind the project Thankfully, ours was and still is

• In your interactions with them, remember a few important things . . .


• “Don’t surprise us” Let them know of controversial decisions

well in advance to avoid the hallway ambush

• Present likely scenarios in advance so they can process their responses What if “Dr. Jones” refuses to do XYZ?


• Full disclosure Don’t even consider anything less than

total honesty and transparency Trust is a vital commodity Your CEO should not lose sleep over

your management of this project


• Escalate issues appropriately Find your organization’s balance

between “hands off” and “micromanagement”

• Allow them to help you Present issues in such as way to allow

them to help you make the project succeed

The slides that follow are some of what I presented to Executive Leadership when requesting Physician and Associate Staff time to be Super Users . . .

Things Unique to Physicians #1

• Unlike other hospital employees, due to rotation schedules, some physicians may not set foot in the hospital for months Internal Medicine clinic-hospital docs Rheumatologists Dermatologists, etc


• The 2 week Go-Live “Blast” of support when Epic is onsite, or even the lower level support intensity the month after Go-Live won’t help some of them

• Therefore, they are at higher risk for troubles


• Most physicians and associate providers will use Epic only sporadically throughout the day, and in “bursts”, unlike nurses Morning rounds Afternoon rounds

• The rest of the day they live in the clinic or operating room


• Physicians will have questions not only when they are in the hospital, but also at their “home base” – usually in clinic This is a less chaotic environment to get

more Epic support A local knowledgeable person from their

department/section is important


• By far, physicians have been the group that struggles the most with change of this type

• A struggling physician group trickles down to negatively impact others around them (Nurses, HUCs, etc)

Creative Use of Physician and Associate Staff Super Users

• So, support for physicians and associate providers needs to: Be available for a longer period of time Be timed correctly for when they are

using Epic (rounding) Be locally available for questions when

they are not in the hospital (in their clinic)

Tips For the Physician Champion

Interactions with the Implementation Team

• You are the bridge/translator between the Implementation Team and end users You understand the clinical side already You must also have an understanding of

the technical side


• Consider taking full Clinical Documentation and Orders training Understand the build process Feel their pain

• Be intimately involved with the build You will understand and see things the

builders won’t and vice-versa


• Keep track of how the teams are doing to appropriately “time” your requests

• Don’t overburden them

• Give them what they can handle, when they can handle it


• Review training materials in detail and attend several early sessions to ensure the wrinkles are ironed out Identify workflows that will be difficult

• Give the training team tips on how to handle difficult providers Setting ground rules for the classroom How to relate with “Dr. Jones”


• Be a “thanking” machine! They are working like crazy and can’t

hear it enough

• Publically praise them whenever you can

• If a particular team is struggling, pour more into them


• Protect your Implementation Team. Call out providers being unkind to them

• Maintain an eternally positive attitude – there will be plenty negative thoughts and fears floating around

Implementation Team


Lead Others

DevelopOther

Leaders


• You have a captive audience of leaders who are likely embarking on the biggest challenge of their lives

• Use this opportunity to develop them as leaders: Leadership material recommendations Large group teaching One-on-one interactions

Pure GoldLeadership Nuggets

Illustrating Principles of Organizational Leadership through the Epic Project

Jon Zlabek


• Large Group Leadership Topics: Understanding organizational change Basic and advanced conflict resolution “Your potential exceeds your

expectations” The approach to “critics” Relating with difficult providers

Strong Relationships with End Users

• It’s culturally important to be a physician first Be in the trenches with them Know the local culture and workflows

• You must know the personalities and how they will react to changes Communicate uniquely with each person


• Listen before you react Even if you have the answer right away,

they need to be heard

• Empathize with them

• Have a contagious positive attitude Your attitude leads the way


Under-Promiseand

Over-Deliver

Communication

Don’t rely on:

• Cascading (trickle-down) communication Example – talking only at Department

Chair Meetings

• Email While efficient, it isn’t enough

Communication

• Get in front of them face-to-face in small groups at their department meetings We went to each department 5 times

Communication

• Tell them the expected “Wins” early and often (every time you present)

• Our big expected wins: Best Patient Care

◊ Safety, satisfaction, and quality

High Employee Engagement◊ Efficiency, recruitment, and retention

Decreased Cost of Healthcare

Communication

• Inform them early and often that this is an “all in” type of project – training and use. No one is exempt.

• Proactively address every excuse! Computer skills training Typing training Tons of computers for access “Page me” if you get stuck – don’t struggle

Communication

• After Go-Live, get in front of the departments again: Thank everyone for their help Focus thanks on the Advisory Team

member in front of their peers Ask for optimization requests Report on the pre/post metrics to anchor

the change in the culture

Anchoring Change in Culture

• “Culture changes only after you have successfully altered people’s actions, after the new behavior produces some group benefit for a period of time, and after people see the connection between the new actions and the performance improvement. Thus, most cultural change happens [at the end, not at the beginning].”


How We “Connected” the Change to the Improvement

• Mortality• Length of Stay• ED Throughput• OR Start Time• Patient Satisfaction• Documentation Audits• Medication Events

• Lab and Radiology Utilization

• Professional Charges• Paper Savings• Transcription Savings• Implementation

Savings

Don’t forget the “Soft Wins”!

The slides that follow are some of what I presented to departments before Go-Live . . .

DeepDeepThoughtThoughtss

bybyJON ZLABEKJON ZLABEK

http://www.deepthoughtsbyjackhandey.com/yesterday-1.asp?DayW=4

Go-Live Expectations

• The Go-Live process will be a HUGE thing Get ready for a wild ride, baby

• All of the benefits from this project WILL NOT be seen in the first few weeks-months

Go-Live Expectations

• There will be bugs to work out

• Believe it or not, we’re not going to catch everything in the thousands and thousands of decisions we have to make

Please be patient!

We Are ALL Leaders . . .

Leading By Example

• Maintain a positive attitude, even when things get rough Go-Lives of this magnitude can get

“bumpy” . . . expect some difficulty Medical and non-medical staff are watching

you closely and taking cues from your reactions to change

Whether you like it or not, you are a role-model

We Are ALL Leaders . . .

Communication is KEY!

• Please read and keep abreast with what is happening Department meeting updates Talking with your Advisory Team Rep Bridges (our weekly newspaper) Medical and Associate Staff E-Newsletter GLadiator Link (our intranet)

• Ask us clarifying questions as they occur

http://gladiator.gundluth.org/default.asp?UserId=JAZlabek

A Normal Part of Big Change

• People tend to experience different emotions at this stage of change in a big project like this . . . Excitement Concern, worry, fear . . .

• These are normal!

Keep Perspective . . .

• Thousands of organizations are using electronic health systems

• Hundreds of organizations are using Epic• They succeeded.

• Some of the reasons we’re in great shape . . .


• Epic’s inpatient system has been consistently rated #1 by customers Many other hospitals are working with

lesser-rated vendors

• The Epic Inpatient 2008 version has many new features to streamline care and make our lives better Other hospitals using Epic have paved the way

for improvement to our benefit


• We will be the first hospital to Go-Live with “partial dictation” Other hospital’s MD/PA/NPs need to type a lot,

or else dictate all the notes

• We have been using an electronic medical record for over 10 years in the clinic A lot of other places were still on paper when

their hospitals went live

We Will Prevail

• There is absolutely no doubt in our minds that we will have overwhelming success during Go-Live

We Will Prevail

• However, we need to stay on track and work together: You will need to be focused during

training There will be a learning curve There will be tweaks to make along the

way Patience please . . .

Engaging Everyone

• Everyone who “touches” hospital and Emergency Department patients must participate for success

• Administration is 100% behind the policy of everyone being engaged

Training

• Training details: Please arrive on time and be free of

patient care duties (ideally “pager off”) Training is not the time to question or

challenge workflows ◊ Write down your questions and ask me after

class

Please be respectful to your trainers!

Physician Champion Tips At Go-Live


• Lots and lots of caffeine• Lots and lots of sugar

You should easily burn off more than you can ever consume!

• Have a fresh pager battery at all times!


• Be on the go and in the trenches

• Put out fires immediately

• Go to the command center only: For food To resolve burning issues To check on the Implementation Team


• Carry candy – the cure for many a stressed-out end user

• Carry relevant tip sheets and other support material with you to hand out

How I Addressed Resistance

• First of all, do your best to prevent resistance: Strong, clear vision communicated

repeatedly Administration that is solidly behind you “Nip it in the bud” when you first hear

about it – Have great spies


• Second, LISTEN PATIENTLY Let them fully vent NEVER strike back at this time Top quote from a surgeon:

◊ “His/her behavior stinks, but that’s how a surgeon asks for help”


• Third, remember your role (protect your sanity) “Going electronic was a board decision –

I’m just the implementer” “I didn’t invent Epic” “I am not the Epic police – I can’t punish

anyone for bad behavior”


• Third, remember your role (protect your sanity) “There is a defined escalation pathway

in place for your concerns. I’ll be happy to guide you if you wish”

Second best quote of the project: ◊ “Epic isn’t meant for the older docs who are

ready to retire, it’s for the next generation of physicians”


• Lastly, work your butt off to teach them and fix things Offer help immediately – this resolves

most lower level resistance right away “Under-Promise” and “Over-Deliver” Follow up with them to let them know

you are still working on a solution and/or what the resolution is

The Importance of YOUR Leadership Development

The Leadership Pyramid


Lead Others

DevelopOther

Leaders

• Success in current and future environments depends on your competitive drive and lifelong learning

• You must intentionally and continually develop yourself as a leader Don’t even consider “winging it”


Leadership and Lifelong Learning

Who’s Gonna Pay?

• If you are not willing to pay the price of developing yourself as a leader, your people will pay the price of your poor leadership

• Who is gonna pay the price?

The Way of the Shepherd – Leman & Pentak

Who is ultimately responsible for

YOURYOUR leadership

development?

Foundation of Leadership - Trust

1. Integrity Honesty Congruence – walk the talk Humility - quick to apologize & forgive

2. Intent Pure motives Mutually beneficial agenda Act in the best interest of others

The Speed of Trust – Stephen M.R. Covey

Foundation of Leadership - Trust

3. Capabilities Know and use your talents and skills Keep up to date

4. Results Take responsibility for results, not just

for “trying” Communicate the results “Beginners are many; finishers are few”

The Speed of Trust – Stephen M.R. Covey

Recommended Reading

The Speed of TrustStephen M.R. Covey

speedoftrust.com

A Leadership Development Plan

• Form solid trusting relationships with those around you, then:

1. Lead something2. Read everything you can on leadership

– leaders are readers3. Attend leadership courses/conferences4. Learn from leaders better than you –

get a leadership mentor

Highly Recommended Reading

The 21 Irrefutable Laws of LeadershipJohn C. Maxwell

Epic – Home Life Balance

• Awesome wife and kids!


Your career is a 30+ year marathon, not a sprint

Take a step back and look at the big picture . . . What matters most?

Leave work at work

Family comes first


Movie recommendation about this issue:◊ “Click” with Adam Sandler – stresses the

importance of “Family Comes First”◊ The modern day movie version of the song

“Cats in the Cradle”


• I did my very best to avoid taking work home, and when I was getting crushed, tried to do it early AM or late PM Worked very hard to compartmentalize

my two worlds Personal policy:

“Taking work home will be uncommon”


• Took strategic blocks of time off: After big bursts of project intensity Times that the Implementation Team

needed me less Took more than a day off at a time Pager free – pushed every work thought

out of my mind


• I actually grew in other critical areas of my life that helped keep me going:

Improved my spiritual life◊ One tends to experience the need for divine

intervention more in projects like this

Improved my physical conditioning with a few triathlons last year and now in training for a marathon

My Top Leadership Lessons

• Your career is a 30+ year marathon, not a sprint; Leave work at work – family comes first

• Never rely on cascading communication

• “Under-Promise” and “Over-Deliver”

• Your guiding coalition and initial structure set-up are critical – take your time and get it right

• Your leadership development is the key to your success – be a “student” of leadership

“It ain’t an easy job, but when you bring a couple thousand

Gundersen Lutheran employees through

implementation, and you ain’t lost a one of them . . .

Ain’t a feeling like it in the world.”

leadership pearls for the physician champion

Business

physician

advisory team

30 year marathon

physician

people resist

leadership

leading change

advisory team