Rural Physician Leadership Curriculum

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Rural Physician Leadership Curriculum

• West Virginia University
• Rural Family Medicine Residency Program

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Rural Physician Leadership Curriculum

• Module 4
• Hospital Committees,Teams Meetings

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Description
Rural Physician Leadership Curriculum

• Funded by HRSA Grant D22HP00306
• Objective 1
• Develop a competency based longitudinal
  curriculum in Rural Physician Leadership

Konrad C. Nau, MD
Principle Investigator Chair, Dept of Family
Medicine-Eastern Division WVU Rural Family
Medicine Residency Program
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Learning Objectives Module 4
Rural Physician Leadership Curriculum

• Understand the differences between hospital
  committees and teams
• Identify factors to consider when participating
  on a committee
• Understand meeting types and etiquette
• Identify signs that it may be time to leave a
  committee

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Functions
Committees Teams
- Permanent - See the forest - Oversee activities - Supervise Peers - Strategic Policy - Temporary - See the trees - Operational issues - Multi-disciplinary - Tactical operations
Crayton Fargason,MD
Curbside Consult on Hospital Committees and Teams
, 2001, American College of Physician Executives.

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Committees and Team Interactions

• Committees delegate work to Teams
• But not visa versa
• Usually process focused work
• example
• Credentials Committee appoints team to recommend
  critical care credentialing criteria

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Committees and Team Interactions

• Committees delegate work to Teams
• But not visa versa
• Usually process focused work
• example
• Credentials Committee appoints team to recommend
  critical care credentialing criteria

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Committees and Team Interactions

• Teams report to Committees
• But not visa versa
• Usually for policy recommendations
• example
• Alcohol Detoxification Team recommends standing
  orders for identifying, preventing, and treating
  alcohol withdrawal in hospitalized acute care
  medical and surgical patients

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Dont Confuse Your Teams

• Patient Care Teams
• Focus on individual patients
• Care for one patient at a time
• Hospital Committees/Teams
• Focus on groups of patients
• Care for the organization
• Care for the processes of the organization

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Group Decision-Making

• Applies to Teams and Committees
• Best for 2 types of decisions
• Information-Dense Decisions
• Decisions that Require Team Implementation
• Power Source
• Ability to consider multiple potentially
  competing perspectives

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Group Decision-Making

• Address complex decisions
• Make decisions where diffusion of responsibility
  is appropriate
• CEO / Committee relationship vs
• Attending /consultant relationship
• Make decisions over a period of time

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Strengths Group Decision Making

• Information-Dense Decisions
• Information from multiple parties required
• Take time to seat the right people
• Promote dynamics that will allow all relevant
  information to be
• extracted
• incorporated

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Strengths Group Decision Making

• Implementation Requiring Cooperation
• Seat all key participants in the process
• Facilitates initial buy-in
• Participants can sculpt decisions that they will
  have to implement
• Participants can vent negative feelings and put
  them in perspective
• Best done BEFORE the work is to be done

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Weakness Group Decision Making

• Passing the Buck - Tendency to decrease amount of
  work done by any one individual
• False assumption that group decisions are more
  balanced
• Dominant physician decides on end result of
  committee without eliciting relevant information
  from team members.
• Team feels that they have no real input or
  authority

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Weakness Group Decision Making

• Team asked to make decision that is clearly a
  management responsibility
• Team composition can be stacked in favor of only
  one side of an issue or lack key operational
  leaders
• Creativity requires at least some individual work
  effort for maximal option creation

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When asked to serve on a Committee

• Why me ?
• Why the Committee ?
• What is the Time commitment ?
• What is my Role ?

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Why me ?

• Expertise
• Power
• Personality
• JCAHO Mandated
• Potential
• Problem

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Why me ? Expertise

• Unique operational perspective of physicians
• Quality of Care knowledge
• Power of Persuasion

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Why me ? Power

• Income contribution to the hospital
• Mission Critical services
• Expense contribution to the hospital
• DANGER Your comments will tend to be
  interpreted as self-serving
• ADVICE Focus on the interests of the other
  committee members (Servant Leadership)

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Why me ? Personality

• Your ability to contribute to the group
  maintenance activity of the committee
• High Emotional IQ physicians are valuable
• Self-aware
• Motivated
• Self-regulated
• Empathic
• Adept in relationships

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Why me ? Personality

• And when we do not know, or when we do not know
  enough, we tend always to substitute emotions for
  thoughts.
• T.S. Eliot
• The Sacred Wood

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Why me ? Mandate

• Executive Committee
• Department or Service Chairs
• Medical Staff Officers
• Credentials Committee
• Quality Assurance/Performance Improvement/Peer
  Review

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Why me ? Potential

• Organizations must develop their human capital
• Management can evaluate and develop your
  non-clinical decision making abilities
• Opportunity for you to develop skills and create
  a reputation beyond your clinical competencies

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Why me ? Problem

• Bombastic and obstructionist physicians can be
  appointed to a committee as a means of managing
  their unpleasantness
• Unproductive and powerless physicians have lots
  of spare time to serve on committees

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Why the Committee ?

• Who initiated the committee/team
• Authority boundaries
• Resources
• Probability of Success
• Clarity of goals
• Political factors

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Time Commitment ?

• All other businesses readily accept this
  professional imperative
• Build in in your schedule
• How often , how long
• Preparation time needed
• Committee service builds valuable long term
  relationship capital for your practice

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What is my Role ?

• Active Participant
• Regularly attends
• Respectful communicator
• Follows group agenda
• Group Leader
• Attend to group cohesion
• Help set agenda and maintain focus
• Ready to assume Risk

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What is my Role ?

• Group Leader Roles
• Opinion leader
• Facilitator
• Arbitrator/Negotiator
• Keeper of the Discussion Rules
• Devils Advocate
• Keeper of the Voting Rules

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Types of Meetings

• Bad meetings, and what they indicate and provoke
  in an organization, generate real human suffering
  in the form of anger, lethargy, and cynicismit
  impacts peoples self esteem, their families, and
  their outlook on life.

Patrick Lencioni
Death by Meeting A leadership fable about
solving the most painful problem in
business Jossey-Bass, 2004
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Types of Meetings

• Daily Check-In
• Weekly Tactical
• Monthly (or Ad Hoc) Strategic
• Quarterly Off-Site Review

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Types of Meetings Daily Check-In

• Time 5 minutes
• Purpose/Format
• Share daily schedules and activities
• Keys to Success
• Dont sit down
• Keep it administrative
• Dont cancel even when some people cant attend

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Types of Meetings Weekly Tactical

• Time 45 - 90 minutes
• Purpose/Format
• Review weekly activities and metrics
• Resolve tactical obstacles and issues
• Keys to Success
• Set agenda after initial reporting
• Postpone strategic discussions

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Types of Meetings Monthly Strategic

• Time 1-4 hours
• Purpose/Format
• Discuss, analyze, brainstorm
• Decide on Critical Issues affecting long term
  success
• Keys to Success
• Limit agenda to one or two topics
• Prepare and do research
• Engage in good conflict

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Types of Meetings Quarterly Review

• Time ½ - 2 days
• Purpose/Format
• Review strategy, industry trends, competitive
  landscape, team development
• Decide on Critical Issues affecting long term
  success
• Keys to Success
• Get out of the office
• Focus on work
• Dont overburden the schedule

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Types of Meetings Medical Mixup

• All four types are separately held in the most
  successful private/group practices
• Hospital administration and management tend to
  hold all four meeting types separately
• Hospital/Medical Staff Committees tend to mix all
  4 types into once a month meetings

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Types of Meetings Medical Mixup

• Results of the Medical Meeting Mix
• tactical gt strategic
• acute problems gt chronic problems
• fatigued participants leave meeting towards the
  end
• right when most decisions get made

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Types of Meetings Medical Mixup

• If several meeting types must be held in one
  sitting
• Strictly allocate time for each type/function
• Agenda setting and adherence is critical
• Try not to mix more than 2 meeting types

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Meetings Prepare/Prepare/Prepare

• Agenda
• Start with specific goals/objectives
• When
• Where
• Who

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Size of Meetings

• Size Matters
• Group dynamics change at various sizes
• 2 7 participants
• 7 15 participants
• 15 30 participants
• Over 30 participants

M. Doyle D. Straus
How to Make Meetings Work Jove Books, NY 1982
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Size of Meetings 2 7

• everyone can play multiple roles
• Facilitator - Recorder
• Chair - Group Member
• Good size for
• All types of meetings esp. process detail
• Detractors
• ? Critical mass for best creativity
• Decision quality may be questioned

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Size of Meetings 7 - 15

• Good size for
• Problem solving meetings
• Decision making meetings
• Best size for creative synergy
• Warning
• Need separate Facilitator and Recorder
• Complexity requires attention to structure and
  agenda

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Size of Meetings Restaurant Lessons

• Groups of 6 or more will have an automatic
  gratuity of 15 applied to the bill
• Everyone feels they overpaid
• Nega-synergy
• The probability is high that 1 or 2 low tippers
  will adversely effect the contribution of others

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Size of Meetings 15 - 30

• Good size for
• Information sharing meetings
• Creates feeling of being part of large team
• Warning
• Use smaller ( 7-15) sub-groups that report to
  larger group if problem solving
• Hidden sub-group agendas and win/lose mentality
  can easily emerge

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Size of Meetings over 30

• Good size for
• Lectures, panel discussions
• Voting
• Creates feeling of being part of large team
• Warning
• Clear speaking and voting rules needed
• Hidden sub-group agendas and win/lose mentality
  can easily emerge

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Shapes of Meetings

• Shape Matters

M. Doyle D. Straus
How to Make Meetings Work Jove Books, NY 1982
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Shapes of Meetings

• Shape Matters

M. Doyle D. Straus
How to Make Meetings Work Jove Books, NY 1982
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Shapes of Meetings

• Shape Matters

M. Doyle D. Straus
How to Make Meetings Work Jove Books, NY 1982
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Shapes of Meetings

• Shape Matters

M. Doyle D. Straus
How to Make Meetings Work Jove Books, NY 1982
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Shapes of Meetings

• Shape Matters

M. Doyle D. Straus
How to Make Meetings Work Jove Books, NY 1982
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Shapes of Meetings

• Shape Matters

M. Doyle D. Straus
How to Make Meetings Work Jove Books, NY 1982
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Meeting Etiquette

• Attend regularly
• Come prepared
• Be an active listener
• Dont overuse your status
• Respect group consensus decision making this is
  not clinical medicine

Crayton Fargason Jr MD
Hospital Committees and Teams ACPE, 2001
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Time to Leave

• Change in Interest
• Change in Availability
• Conflicts of Interest
• Detrimental to your relationships
• With physician colleagues
• With hospital staff

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Time to Leave

• Inability for Committee
• to have good meetings
• The hard truth is, bad meetings almost always
  lead to bad decisions, which is the best recipe
  for mediocrity
• Patrick Lencioni
• Death by Meeting

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Hospital Committees,Teams Meetings
While medicine is largely a one-on-one practice
of the healing arts Physicians have a citizenship
duty to contribute to the infrastructure that
enables them to sustain their practice of medicine
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Hospital Committees,Teams Meetings
SummaryYou now know

• the difference between committees and teams
• why physicians should serve on committees
• about the most effective types, size, and shapes
  of meetings
• how to effectively serve or lead a committee