Goals and Expectations
“My expectations were limited initially. I didn't expect anything to happen – we were responding to community excitement. My initial hour was skeptical, but by the end, I had a very different impression.”
“There had been none [i.e., physician leadership effectiveness] before. Not to be over dramatic, but her [Susan's] coaching was amazingly effective. One physician became the key leader in all of this – he had great potential. He came light years.”
“We met formally twice a week. I (a physician) chaired these meetings and gave large presentations. In the first month to six weeks, Susan spent time with us assessing the group process and personalities. We gained insight into group dynamics. My ability to lead and chair a meeting greatly improved.”
“Long-term, the success from the physician or hospital [standpoint] will depend on the level of trust and level of commitment. You have to get people thinking in that mindset. The majority of the new Board will not be Task Force members. The Task Force had seven months to work together and get to know each other. We're concerned that when the baton is passed, they won't have the same ability. They talked last week about having a retreat to make the transition.”
How the Leadership Training Process Differs
“I (administrator) have been involved in many leadership programs. The one thing that was real significant and not done before was the coaching aspect. Dr. McCoy took the leadership and coached them – got them to process differently.”
“One-on-one is the key difference. This was different and very effective. In her specific coaching of leaders and with individuals on how to behave, she did it without being insulting.”
The Process – What Other People Need to Know
“What other people should know is that leadership is something that can be learned and applied in a structure with committees and rounds of discussion. Leadership also involves recognizing different types of personalities and skillfully using them to work together toward a final worthwhile product – rather than divisiveness due to personality differences.”
Group Decision Making Processes
“On the surface, this is the split, but it was not necessarily a consensus. I would have preferred another outcome. In the end, it was fine and through the process I understood it was the right thing to do. We needed to understand marketing – primary care needed a stronger governance role.”
Benefits / Tangible Results
“Susan's biggest contribution was getting the group process to happen. Getting people comfortable with the go-arounds. It was a cumbersome technique at first, but once I saw how well it worked in a large meeting, I'd use it again.”
“The program got people working together and to keep the end in mind – find the common interest. It's win-win, rather than win-lose. Group leadership is very comfortable now, but not for the first year; it was an evolution.”
“More than anything, we needed to work together toward a common goal and we wanted consistency in how we did things. This was a quality group of people who needed to work together rather than separately.”
“The concept of getting everyone's input and involvement in decision making is good; the old ways don't work anymore. People have to change their ways. We should be willing to accept other ways of doing things. I would be enthusiastic about the process.”
“The prior structure was a director and four independent units. The training showed us opportunities to work together as a team. We [i.e., managers] are much less directive and more like teachers or mentors.”
Skills Learned Are Applied in New Settings
"The skills are transferable. This is a major benefit to the organization, not only to our department. We're using it now in Materials Management; Properties has been turned around, and we're working on Engineering. [They are], of course, using it in Managed Care Operations, which consolidated and eliminated smaller departments."
"Were the concepts and techniques transferable? Yes. The medical center asked us to develop a Strategic Plan for the entire organization through 2003, which they have adopted." (Her implication was that they would not have been asked to do this, if it weren't for the training.)
“We worked through a process for consensus and agreed on a vision. We are still doing this, despite the layoffs. The division still held; there is no need to reconstruct it before we can get going.”
“I spend a good part of the day applying the skills I've learned in new ways. Now, I look for areas of mutual gain, rather than 'how can I convince you.'"
Skills Learned Are Applied in New Settings
“The overall bottom line in terms of effectiveness and productivity is that we are much more coordinated than we were before. We have cross-trained and use flexible staffing.”
“Some of us have taken on more leadership responsibility; I will be working with three other departments. They dissolved the old department lines; now we have a Center.”
“We're more effective now. We can reach out and talk with people. We're touching more people across departments and [some] departments are working together for the first time.”
“We prioritized down to a key number of things we wanted to accomplish. In the past, we had way too much on our plate to be realistic.”
The Leader's Day Is Different
“I don't consider it training, per se. It's an educational and learning process. Before, my day was energy-consuming and time-consuming. We were drowning in crisis management. Now, we are managing our time more effectively (the Covey approach). Mentoring is a joy, as opposed to policing behavior. I appreciate more keenly how to translate our long-term goals across the department.”
“I used to think I had to come up with all the answers. Now I look for groups of people to come up with their own answers. I spent a lot of time before trying to convince people or arguing with them. I've learned it's OK to talk with other people about it – I am no longer the sole problem solver.”
“My day is very much different now: much less directive and more as a teacher or mentor. I am empowering people to do it themselves. More of my day is spent doing planning and long term rather than crisis management. Both personally and professionally, the training has carried over.”
How the Training Process Differs
“There's so much value in what she [Susan] teaches, but you can't put a cost on it.”
“When you come out on the other side, you're going to change. You won't be the same person coming out as when you went in.”
“Another difference is that it's customized. This wasn't obvious up front.”
“She [Susan] doesn't have the benefits of anyone person in mind. Her client is the organization. Initially, there was a basic conflict between the organization and the individual physicians. Through the training we have opened the lines of communication with other physician leaders in the Medical Center as a whole. What we've tried to instill is the idea that the larger organization benefits the individual.”
“The difference is that it's not didactic. We used it as we did it, learned and applied it as we went along. It could have been done in less time, but the quality would have suffered. It takes 6-9 months to change human behavior. It's perhaps too intense or too long for some people – it's enormously intense.”
“Up front there needs to be buy-off on the goal of the consult. I wanted to develop a trust with the other four managers. People need to understand the time commitment; and they need to want to work together, otherwise it won't be productive.”
"It takes effort and focus. Other programs I have done are large group training processes – ten hours would be a lot. Susan's is focused on the department and the individual. The most unique aspect of her program is the one-on-one time – it's absolutely essential.”
“Up front, people need an open mind. Things are changing – people must be willing to change. It will be a lot of work, a lot of reading. I was aware of this going in. I would have liked an overview of the process and where we were going, but you need to trust Susan.”
Tangible Benefits / Results / Cost Benefits
“One of the physician leaders identified four areas in which the training program will have an impact on cost (i.e., promote cost reduction):
1) ability to problem solve
2)better use of staff
3)improved management structure and communication
4)empower people to do what needs to be done.”
“Better quality of decision-making and spending less time arriving at certain decisions has saved us money in terms of productivity: as much as one-third less or even 50% less time in some cases.”
“The training has made a quality improvement impact. I expect quantifiable results in the future from this.”
“We are looking at long- and short-term processes to save patients and the organization money – what to purchase, how to implement it, and patient care practices. Now, we can go back and always measure against the vision so we're not going off on a tangent. We're doing our work quietly and adding to the bottom line of the organization.”
Other Tangible Benefits
"Our department, for the first time, has a clear vision of where it's going and a general idea of how to get there."
"Structure of the department changed from a hierarchy to empowered teams," bringing with it benefits for all involved."
"From the organization's standpoint, there is a better understanding of what we are about."
"Trust and validity are key between administrators and physicians. We now appreciate each other's differences in expression."
"The training creates accountability: this is what we say we're going to do; let's make sure it actually happens."
"The training has made a significant, measurable difference in how they go about hiring/recruiting new people (physicians, nurse, successor to department head). It enabled them to focus and agree on what they were looking for. They have been extremely pleased with the results."
"Two key processes we've developed:
"[One of the other physician leaders] and I didn't communicate at all before Susan's training. Now we have mutual recognition and esteem for each other which shows the value of communicating."
"Our development of a long-term planning document is a tangible result."
"Identifying the preferred styles of interaction – in myself and others – has helped me immensely in collaborative efforts with physicians, who are really the ones who control costs."
"The department had a vision of developing a new practice model, but it needs to come from the staff up, not from the top down. This allows the staff to be active participants in collaboration with other departments and health care professionals."
Key Issues in Health Care Reform
“In today's environment we no longer can look at outpatient and inpatient care as completely different." The total restructuring of the medical center has blended outpatient and inpatient.”
“We're going to be manufacturing health care with groups organized to do just that.”
Physicians as Leaders
“There is a distinct advantage in having an integrated group. Our physician leaders are fine. In approaching communication with physicians [such as problem-solving], you need to use a medical model showing data and options," as though you were diagnosing what is wrong with a patient. The physicians now accept our department as consultants, not lackeys.”
“The focus and loyalty of our physicians is not only to the group, but to the organization. They are able now to deal constructively with change.”
“Physicians as leaders are able to say, 'we need to change our thought process. Change is not so bad; it doesn't assault our medical training.”
“Short-term crisis decision-making is being made by a narrower group with not much networking below the Board level. They're afraid to widen the discussion. However, as a result of restructuring, communication channels are opening. Long-term, they are more open to collaborative action.”