Dr. Joe Siegler's Peak Leadership Blog

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Raising Physician Performance with Coaching

Healthcare Executive Magazine
On Physician Relations
May/June 2016 Issue


In healthcare today, physician excellence is crucial for peak-performing teams. Coaching is one way in which both high-performing and underperforming physicians can reach higher levels of performance.

All physicians have the potential to benefit from coaching. Successful performance outcomes are dependent on an innovative triad of communication:

  • A respectful relationship between the physician client and coach
  • An effective collaboration with ongoing communication between the coach and stakeholders
  • The setting of unified expectations for the physician by stakeholders and the coach based on assessment findings

Respect. Underperforming physicians are frequently referred to as disruptive—but research has shown such labeling is not only damaging, but also may have the unintended effect of fostering underperformance. Therefore, it is vital that healthcare leaders and the physician coach set a tone of respect in which the physician being coached does not feel shamed. When they feel respected, physicians who are coached more easily take ownership of both positive and negative assessment findings, resulting in improved outcomes and lasting positive changes.

Collaboration. Research also has shown that when innovative programming is linked to ongoing communication with stakeholders, the outcomes can be exponentially more successful. When the coach and stakeholders are in regular communication, they become a unified force whose aim is to elevate physician performance. This does not happen without open communication from the beginning of the coaching process.

Establishing Unified Expectations. Each component of the triad of communication is crucial to optimizing physician coaching outcomes. “Through open dialogue and effective collaboration with the physician coach, the organization can frame the engagement at the outset by contextualizing the situation and prioritizing goals and expected behavioral changes,” said Lisa M. Abbott, Senior Vice President of Human Resources at Lifespan Corporation and an ACHE member. “This approach allows us, as partners, to markedly potentiate positive outcomes.”

High and Underperforming Physicians

High-performing physicians already are meeting or exceeding the organization’s expectations with no apparent issues. These physicians have Olympic aspirations and many talents. They either seek coaching themselves or their supervisor wants them to achieve the highest level of performance possible. Supervisors within the organization may find that, at times, they are able to elevate the performance of high performers without outside assistance. However, when an outside coach is engaged, the physician client benefits from a coach who has a comprehensive set of skills in the core areas of leadership, professionalism, boundaries, life, wellness, habits, and addictions, as well as in the specialty areas of healthcare and patient experience. The physician also may benefit from additional modules for coaching such as onboarding, task and time management, minority empowerment, or advanced leadership development. With this practical knowledge, an effective coach can unlock a physician’s previously untapped capabilities.

Underperforming physicians either have a single behavior or a complex set of behaviors that require management. While the physician coach will explore underlying issues, most coaching goals for underperformers have a behavioral focus to optimize team relationships first.

Frequent signs of underlying issues contributing to underperformance include:

  • Irritability or temper outbursts
  • Fatigue, apathy, or other signs of burnout
  • Frequent or serious errors
  • Strained relationships with team members
  • Mental health issues, addictions, or medical symptoms
  • Boundary violations as victim or offender (e.g., bias, bullying, sexual harassment)
  • Absenteeism or tardiness
  • Legal problems
  • Problems in personal life
  • Complaints from staff or patients

In recent years, maladaptive behaviors have begun to be treated as seriously as addictions. “Now we can help physicians raise their performance by managing behaviors that may hinder adequate team functioning and patient care,” says Bonnie Kriescher, vice president of human resources for Advocate Health Care, in the Chicago area.

Three Levels of Performance Elevation through Coaching

When they are engaged in coaching, physicians tend to raise their performance.  Supervisors find they can foster development in some higher-performing physicians without outside coaching assistance. However, more challenging high and underperformers produce higher performance outcomes with the assistance of an experienced physician coach.

Level I: Entering coaching as a high performer. Level I physicians tend to be very disciplined and bright. These are physicians who are masters at mastery—they learn fast and implement strategies for achieving new goals proficiently. These clients usually succeed in raising their performance to even higher levels through collaborative work with their coach and stakeholders.

For example, Steven is a strong CMO at a medical center. He has been selected for a promotion and feels honored. He asks for a year-long onboarding coaching package to help him be successful in his new position, and his supervisor grants his request. Steven and his coach work together, collaborating with stakeholders, to foster Steven’s growth into an Olympic performer in his new position.

Level II: Entering coaching as a focal underperformer. A focal underperformer is a physician with a single behavior that negatively impacts his or her performance and the team. A physician coach will complete an initial evaluation of the focal underperformer to identify strengths as well as signs of underperformance and any underlying issues, and then will create performance goals to be monitored over time. The physician coach and stakeholders should be in regular communication regarding progress and goals. If a client relapses with an addiction or a maladaptive behavior, the physician may be referred to a physician health program or boundary program. If relapses persist, disciplinary action by organizational leaders may be taken.

For example, Susan, a surgeon, was in the operating room when she asked for scalpel “A” but was handed scalpel “B” by a nurse. Susan became hostile with the nurse, who filed a formal complaint against Susan. The organization decided to refer the physician to coaching. Here, Susan is learning that her threshold for becoming irritable—the underlying issue—is low and needs to be raised. Susan successfully works to utilize more adaptive coping methods for her triggers of irritability while in the operating room, thus avoiding further team conflict.

Level III: Entering coaching as a complicated underperformer. A complicated underperformer has multiple behaviors that negatively impact physician performance—and these behaviors, in turn, can affect the team and even patients. This physician usually requires the attention and expertise of a coach experienced in dealing with multiple issues and behaviors.

Physicians who fall under this category can require intensive evaluation with referral to a local multidisciplinary assessment, addiction or boundary program, physician health program, and/or a physician coach who can begin to raise the performance of the Level III physician by helping the client begin to manage maladaptive behaviors while simultaneously enrolled in treatment programs. Often, the referral to coaching happens after discharge from a treatment program as part of the continuing care plan.  Using the triad of respect, collaboration and unified expectations, the coach is able to communicate with both the stakeholders and the physician to develop an overall plan that all parties can embrace.  Disciplinary action may be averted if the physician is compliant with key goals and minimizes relapse.

For example, Barry, a dermatologist, was arrested for allegedly inappropriately touching a patient. He also had high levels of alcohol in his system upon testing. He was referred to a local multidisciplinary assessment, alcohol and boundary treatment programs, and a physician coach. Barry’s coaching targets compliance with recovery goals such as being free of substance and boundary violation relapses.  Barry will remain engaged in coaching to prevent future relapse.

Communication That Supports Performance Excellence

All physicians in coaching can benefit from the triad of respect, collaboration, and unified expectations.  The physician client implements key goals generated by the coach and stakeholders to catalyze higher performance.

High performers can rise to Olympic levels with proper supervisory and coaching support. Underperforming physicians can be elevated to higher performance levels with effective coaching. Physician clients are able to own their persistent challenges while developing into more effective team members and sustaining positive progress. Optimized physician performance benefits organizations, stakeholders, teams and, most important, patients.

Joe Siegler, MD, is a board-certified physician, president of Full Life, and creator of Spheres® Leadership Coaching (joesieglermd@spherescoaching.com).


Accurate Predictors of Success

Tags: Leadership, Performance, Equity

Christopher Chabris and Joshua Hart demonstrate the importance of rigorous study design when asking complex social questions such as what are the predictive factors of successful people? Chabris and Hart re-examined the findings of Amy Chua and Jed Rubenfeld who proposed that certain ethnic and religious minority groups (among them Cubans, Jews, Asians, and Indians) achieve higher success than other groups. Chua and Rubenfeld claimed this is caused by:

1. A belief of superiority
2. Personal insecurity
3. A high degree of impulse control

What I find interesting about this story is how the first authors presented their opinion about the three factors above as fact. I wonder what this reveals about their own discomfort with success. This is also a negative approach to viewing success. They do, however, list impulse control which does get validated in the follow-up study below.

Researchers Chabris and Hart reviewed the methods of Chua and Rubenfeld and found a significant amount of subjective circumstantial evidence. Chabris and Hart went on to survey 1,258 adults and rated impulsiveness, ethnocentrism, and personal insecurity. They also tested cognitive abilities and examined income, occupation, education, and awards of achievement (artistic, athletic, or leadership). Participants also gave their age, sex, and parents’ levels of education.

Interestingly, the most successful participants reported a higher cognitive ability and had more educated parents, a higher socioeconomic background, and better impulse control. So Chua and Rubenfeld had only identified higher impulse control accurately as a predictive factor for success. In addition, Hart and Chabris replaced Chua and Rubenfeld’s findings of superiority and insecurity as a predictor of success with intelligence and a higher socioeconomic family background – a more strengths-based and positive approach to viewing success.

For whatever reason, Chua and Rubenfield were erroneously stating that one’s superiority and insecurity were predictors of success. Thankfully, Chabris and Hart concluded that Chua and Rubenfeld needed to apply empirical inquiry into the studying of the minority groups. They clarified that higher cognitive ability, more educated parents, and higher socioeconomic background, as well as better impulse control, all surfaced to accurately predict success. Therefore Chabris and Hart have proven their point –  study design is everything in producing accurate research outcomes.

I find this scenario important because it shows how inadequate research design can foster wrong information being disseminated. In this case, we were being told by Chua and Rubenfeld that minorities are both insecure and superior, accusations that are frequently hurled at minorities. The more skilled team of Chabris and Hart clarified that successful people are actually more likely to be produced by families with more money, more education, and greater intelligence. At least Chua and Rubenfeld accurately stated that better impulse control predicted success. Even though the famous marshmallow study established that previously.

The follow-up question I raise after reading about the findings of Chabris and Hart is how can we help young people produced by parents with less money, education, and intelligence to be more successful – against the odds?

What are your thoughts?



Inspiring Your Team to Complete Key Projects

Tags: Leadership, Performance

I find that many executives need a brief refresher course in order to inspire their team to take a project from conception to completion. A project is about getting something complex, with multiple steps, completed. It can be a new concept or a familiar one. Today we will look at two different styles of project planning and execution.

Juana Craig in Project Management Lite states that a project:

  • Has a beginning and an end (“plan, work, close it out”)
  • Achieves an outcome resulting from a series of steps
  • May involve a budget
  • Usually involves a team

Craig adds that leaders need to:

  • Define the project
  • List desired outcomes and utilize a completion checklist
  • Fill out a worksheet for the project including goals, tasks, and assignments with due dates
  • Devise a plan and budget, if needed
  • Implement the plan and keep written agendas and minutes of meetings (many find minutes are a great generator of next-step goals)
  • Utilize mind-mapping tools and applications
  • Keep everyone informed
  • Review progress at set intervals
  • Solve any problems that may arise
  • Complete the project
  • Determine the metrics of success using the completion checklist
  • Celebrate completion with all participants

I like that Juana Craig gives many specific examples in her book. I also want to refer to David Allen’s classic book on productivity, Getting Things Done. In his book, Allen outlines several processes and ideas for maximizing productivity and completing projects.

Allen outlines the key ingredients for starting a project:

  • Clear outcomes and next actions (Vertical focus).
  • Reminders to review tasks on a daily basis (Horizontal personal focus).

Allen says first to create a basic outline with your team. However, be sure the outline emerges from the team’s relaxed and casual discussions. I find that sketching out a ‘backbone’ plan is then quite simple, and is vital in giving the project forward momentum. Without this clarity the project usually becomes unfocused and slows down.

A pen and a piece of paper is all you need to get started on the vertical plan of a project. Remember Allen believes the casual chatting about why a project is important and about the positive difference it can make is key in the early stages of process design. He adds that visioning, brainstorming, and organizing are also important. Once the vertical plan is clear in an outline, then horizontal “next-step” goals can be pursued by task and time frame priorities. Many companies offer software programs to assist with this, as well.

Below is my own interpretation of Allen’s five-step project plan. I have added a sixth step that I feel is also important.

Six-step Project Plan:

  1. Define the purpose – Why is this project important?
  2. Visualize the outcomes – Constantly revise and create clear goals
  3. Brainstorm – A great example of this is to “mind-map” a project where the name is in the center and aspects of the project come off like branches of a tree
  4. Begin to organize – Start to order ideas and tasks
  5. Identify next actions – Put deliverables, due dates, and goals on a tracking tool and put key meetings and deadlines on a calendar
  6. Follow-up and sustain progress – After project completion, check to ensure the result is working as planned

With early, casual, and relaxing discussions, we begin to visualize potential paths to achieve project outcomes. By brainstorming and collaborating, we calendar goals, record next-step actions, and log task completion. Remember from a previous blog  that two research projects demonstrated that groups who socialize more combined with respectful interactions are most productive. Clearly social interaction also leads to optimal organization and eventual project completion.

Good luck on your next project!



Mindfulness – Segment II

Tags: Leadership, Performance

Today, for the second part in our examination of mindfulness, we will look at a few easy steps in learning to master one’s mind as discussed in the book One Second Ahead by Hougaard, Carter, and Coutts.

Managing your thoughts is more important now than in any time in history. Work used to be an uncomplicated chore that took place in a set period of time. Today, work is often fluid and without the boundaries of geography or clearly defined tasks.

A few examples of workplace techniques that can help improve your cognitive discipline include:

  • Waiting a second when you are faced with a decision before you react. Use that second to decide what you want to do, if anything. You will feel like you slowed time itself, you will be one second ahead.
  • Realizing thoughts lead to choices, choices to actions, and actions to results. The mind needs to focus and minimize distraction, which is becoming increasingly difficult in modern society with the constant stimulation from the internet, emails, texts, marketing, and endless movie and television selections. Remember that multi-tasking is toxic to our productivity. Keep in mind, we can become addicted to it, due to the release of dopamine in the brain that occurs when we do two or more things at the same time. The goal is to increase focus and effectiveness, not to decrease these objectives.
  • Improving focus by training our minds is about becoming the best person we can be. Research from Singapore Management University demonstrates that nine weeks of mindfulness training elevates focus, awareness, memory, job performance, and overall job satisfaction. Other research revealed increased creativity, improved employee to employer relations, reduced absenteeism, and improved ethical decision-making following mindfulness training.
  • Neuroplasticity allows each of us to train our mind throughout our lifespan by adding new neural pathways through practice and repetition. A great way to do this is to learn a new skill (like skiing or painting) or to practice mindfulness.

The ultimate goal of mindfulness training is sharp focus and open awareness. Let’s look at two steps that can help you begin to achieve greater effectiveness:

Step 1: Focus on What You Choose. You can focus on a task while avoiding distraction until the task is done. Distractions might include talking, unrelated thoughts, street noises, the internet, or television.

Step 2: Choose Your Distractions Mindfully.  You can consciously decide for each distraction whether you will take action or not. Then you are able to sharply focus on your chosen task.

So today after reading this blog, choose one new unfamiliar task or activity and do it. You will lay down a new neural pathway by completing something new.

In the next mindfulness segment we will begin to look at more mindfulness techniques. Until then, reduce your distractions and manage your thoughts. Stop yourself when you find you are starting to multi-task. Purge your distractions with intention. Enjoy training your mind by staying a second ahead of your responses and managing thoughts leading to desired actions and results.

Check out Mindfulness – Segment I



People of Low Income have Hope for Achieving Longevity

Tags: Leadership, Equity

New research reveals that lower income people may not be doomed to a shorter life as prior studies have implied. Reporters Neil Irwin and Quoctrung Buil share their hopeful findings that some locations in the U.S. seem to foster greater longevity for the less fortunate. This opens up an exciting discussion in healthcare regarding a mix of positive habits and public health variables that may buffer the negative effects of poverty. Surprisingly, some large cities like New York and Los Angeles and some small cities like Birmingham are experiencing increased life expectancy in lower income individuals. However, many areas in the U.S. are showing decreased longevity in the same group.

A large concern is that the gap in life expectancy in the U.S. between rich and poor markedly increased from 2001 to 2014.  Men in the top one percent of income lived fifteen years longer than the poorest one percent. In women, the same gap differs by ten years.

I found it particularly interesting that the wealthy benefit from longevity no matter where they live — gaining three additional years in the past fifteen years alone. In contrast, for low income Americans, the results and lifespan vary greatly according to geographic location.

So what’s the big deal about this research? Well, for the first time there is evidence that longevity can be elongated without fixing the more challenging income disparity problem. It is now clear that some geographic locations foster some healthy behaviors that catalyze longevity. In Dr. Raj Chetty’s research he concludes that differences in life expectancy were correlated with health behaviors and local area characteristics.

When I look at the actual journal research report, Chetty found some interesting results such as:

  • In whites across all income levels, mortality rates increased most rapidly for people with low levels of education.
  • In looking at geographic locations, some fostered a lower life expectancy than others. These locations included Oklahoma City, Gary-Indiana, and Toledo-Ohio. In these areas, lower length of life was correlated with smoking, obesity, and exercise; as well as differences in medical care. Therefore I am struck by how health behaviors surface as key factors in life span.
  • Lack of access to care did not appear to be as strong a predictor as health habits.
  • Low income people lived longer if they lived in a city with inhabitants who were highly educated, had large incomes, and had high levels of government expenditures. Examples include New York City and San Francisco. My thought it that there is some mysterious spillover effect from wealthy to low income residents of the same city.

Raj Chetty and colleagues stated that these findings are rough and recent. In the future there will need to be a better designed study with validation and expansion of these findings. So health care initiatives can begin to target the low scoring cities with efforts to improve healthy behaviors among low income residents. As an example, New York City has a trans fat ban and an aggressive anti-tobacco campaign. Cigarette prices rose to more than $12 for a single pack and subsequently the smoking rate plummeted in the last fifteen years.

It is clear we need to identify the elusive health and social variables that foster living a long and healthy life. Trying to identify the keys for longevity will be the goal of future research. It appears that improving access to health care may not have the effect that people had hoped. The preliminary findings reveal that targeting behaviors or disease groups on a population level may be the way to go instead of improving direct care. Targeting behaviors and disease groups is how large health systems are attempting to improve how people manage and prevent disease.

It will be exciting to follow how future research continues to identify key variables in living and a long and healthy life.



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