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Goals for a Strong Heart in the Fall and Winter Seasons

In 2010, experts from the American Heart Association identified seven key behaviors that can optimize and protect heart health:

  1. Exercise
  2. Eat right
  3. Lower blood pressure
  4. Lower your cholesterol
  5. Know your blood sugar
  6. Maintain a healthy weight
  7. Don’t smoke

Dr. Donald Lloyd-Jones, representing the American Heart Association, says this list of 7 actions above is the closest medicine we have to achieving the mythical “Fountain of Youth.”

He emphasizes the following tips:

  • Get regular exercise – Both aerobic and resistance training and even short workouts help (i.e. calisthenics, push ups and sit-ups, walking stairs at work, walking around the neighborhood).
  • Avoid high blood pressure – Lose weight, watch salt and sugar intake, etc.
  • Know and lower your cholesterol levels (HDL, LDL, and triglycerides) – Eat fatty fish, nuts, tofu, fruit, olive oil, beans, vegetables, and reduce carbohydrate intake.
  • Lower blood sugar – Get a good night’s sleep, reduce extra pounds, lower alcohol intake, and follow your fasting blood sugar with your PCP, etc.
  • Eat healthy food – Eat fruits, vegetables, seafood, yogurt, organic foods, olive oil, etc. and avoid sodas, fruit juices, pasta, bread, processed meats, and trans fats, etc.
  • Don’t smoke – Quitting will immediately lower your risk of heart disease by up to 50 percent
  • Get a dog –It keeps you moving while you are loving and being loved.
  • Reduce stress in your life and work – Chronic mental and emotional stress takes a major toll on your heart.
  • Meditate – Evidence shows that meditating can blunt the body’s maladaptive response to stress.
  • Go regularly to your dentist – Studies have found that gum disease increases the risk of heart disease by 24 to 34 percent.
  • Lower alcohol intake – If going to drink alcohol, drink red wine in moderation – it raises HDL cholesterol, the healthy kind.
  • Walk in nature – Studies show that walking in nature can lead to benefits such as lower blood pressure and lower stress hormones.


Based on the heart-healthy conclusions above from the American Heart Association, which ones are you willing to include in your wellness regimen?  You might want to tape this on your fridge!

Enjoy the day!


7 Habits for a Healthy Heart by Anahad O’Connor, New York Times, Well Column, September 28, 2017.



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).


Future Leaders in Peak Performance: A new hybrid of competency, authenticity, and inclusiveness

Physician Executives Forum Newsletter
January 24, 2014

Professional Pointers:

Future Leaders in Peak Performance: A new hybrid of competency, authenticity and inclusiveness

Joe Siegler, MD
President and Founder
Full Life
Spheres Executive and Physician Performance Coaching

Healthcare has grown increasingly competitive, and the companies that will flourish in this fast-moving, ever-evolving marketplace will have to promote a new form of leadership that addresses emerging priorities. A review of current business trends in healthcare reveals that the traditional task-driven, hierarchical-based models of operating systems do not account for sufficient speed, innovation and flexibility required to face fierce competition. John Kotter’s writings on the need for an additional nontraditional operating system have invited organizations to add a ”second operating system” to address these new nontraditional functions. Leaders of the future will need to successfully oversee or participate in both operating systems. The second operating system components must be seen as vital as the traditional.

It is clear that there is an opportunity for a new leader, one who has the skillsets, values and personality to adequately inspire their organization into a greatness that produces high-performing individuals, teams, senior leaders and even the staff-as-a-whole. This new prototype of a leader understands that success of the organization will depend on applying multiple innovations to the patient experience as well as to staff engagement in ways that are earthshattering and not simply talk. Inclusiveness and diversity will surely play a big role in the success of boards, clinical and administrative team productivity, and culturally sensitive patient care potentiating clinical outcomes. In order to produce this degree of effective innovation, each leader must bring diverse team members together to work toward common goals. The end game will be to inspire teams of clinicians, executives, senior leaders and staff to create new inventive programs that optimize patient experience—the ultimate metric outcome of the future.

Therefore, new leaders will promote achievement of clinical indicators for ACO relationships, traditional key performance indicators (i.e., productivity) and also introduce the vital emphasis of broad positive experience of both knowledge workers (highly trained physicians, executives and medical personnel) and customers (patients)—beyond anything we have seen up to this point in the evolution of healthcare systems. Medical care is steadily shifting away from a hospital/specialty and doctor-focused enterprise, and is moving towards a patient-oriented focus. Therefore, in the emerging paradigm, customer care is paramount to all else. This has been a long time coming, and is probably happening now because of the emphasis on metric clinical results and new cultural standards of covering most Americans with insurance. Shortages of primary care physicians also necessitate multi-disciplinary team approaches for handling potentially huge numbers of newly enrolled patients. Therefore, multi-facility and multi-disciplinary approaches will become the norm for each individual patient. For example, using a single specialist will no longer be sufficient as healthcare will increasingly utilize a multi-modal approach provided by high-performing leaders, teams and the entire staff.

The striking need for enhanced metric outcomes in disease management of individual patients also predicts a renaissance of behavioral health services (mental health and addictions) because of the valuable potential impact they can have on optimizing clinical results as well as the organizational bottom line. These rematerializing services provided on-site or locally, will also morph into exciting forms of new approaches and services such as:

  • online or video services
  • new ideas to manage mental health, addiction and recovery success
  • new tools to foster compliance and wellness of patients
  • peak performance coaching of physicians, executives, senior leaders and teams


The smartest system leaders will design and implement second parallel operating systems—those that are flexible, innovative and inclusive. For example:

  • The leaders of the future will need to create an inclusive culture by valuing people for their authentic selves, appreciating knowledge workers (doctors, nurses, technicians, etc.) and demonstrating respect of staff in multiple ways.
  • Team productivity is extremely important in achieving clinical and organizational key performance indicator metrics, more so than the performance of any single individual. Fostering a healthy, respectful work environment will be vital as team productivity becomes the vehicle of success. Research is revealing a fascinating finding that intra-team socialization predicts a higher performing team. Pentland reports that the success of teams is related to spontaneous socializing between team members1. Therefore, socializing teams will perform at higher levels, and as healthcare boards and teams become increasingly diverse, it will become imperative for skilled leaders to creatively breakdown the sense of ”difference” between team members and encourage intra-board and team socialization to foster peak output of each team. If a workplace culture is competent, inclusive and empathetic, then the staff will be more comfortable being themselves with their peers, which would result in greater intra-team socialization leading to higher performance. Services developed in this fashion will be more culturally sensitive and will serve the people from the community better with greater empathy and identification of unique needs. It is vital that all leaders examine their organization and consider the possibility that their strongly held personal beliefs and practices may actually work against the inroads into inclusion and possibly be experienced by patients and staff as imposed beliefs and practices—clearly the very opposite of effective business practices and trends.


Many leaders already claim significant advances in staff engagement and patient satisfaction (much more focal a metric than broader patient experience). That may be the case, but there clearly is a lot further we can go for each health system is a work in progress. For example, some physician and executive leaders who are fairly green are often selected for their ability to manage projects forward. They may be responsible for negotiating with staff and delivering on clinical metrics. Such a leader can make gains in project advancement, but some may have trouble with second operating system goals of innovation, emotional intelligence, transparency and inclusion. Objective ”left brain” skillsets of such leaders are needed by most organizations, but so are warm interpersonal skills of openness, inclusion and respect. According to business trends, in the future, through careful selection and training of leaders, transparency and interpersonal respect have to dominate as cross-system practices. This doesn’t mean that leadership has to agree with everyone. It means discussion has to be on the table and fair. These new peak performance practices have the potential to create a new and positive leadership style that I call humility of position.

It is clear that inclusion and interpersonal respect both need to be a core practice for true organizational success—for culturally sensitive approaches to staff and patients must rule. This clearly pertains to differences of many groups of staff and patients, which cannot all be listed here, such as income, gender, race, orientation, religion, disability, community, citizenship, age, etc.

As healthcare companies shift away from hospital and practitioner-based service and move to a patient-centered approach, there will be a greater need for organizational cultures that simultaneously improve the environment for knowledge workers and all staff, as they continue to revolutionize the patient experience more and more over time. Porter and Lee call this the value agenda: achieving the best outcomes at the lowest cost—that everything is ultimately about the patient2. Maintaining high-performing teams of all types requires the guidance of competent, respectful and humble leadership. Without innovative second operating systems, traditional operating systems alone will not work in future healthcare systems that are measured by the resulting metrics of patient experience, staff engagement, and key performance indicators.

Some of the most interesting ideas in business leadership are coming out of a few highly successful companies like Netflix. We cannot be sure which of these new second operating system approaches will also work in healthcare, but it is vital for leaders to be aware of innovations in other industries that are catalyzing company growth through greater staff and customer engagement.

These are exciting times. We must find, hire and groom the leaders of the future. They will be diverse, kind, smart, innovative, inclusive, fast, humble and able to build the second operating system to achieve key organizational and clinical results. These are lofty goals, but the reward will be exponentially worthwhile. This new paradigm will be appreciated by many and make it cool to be both competent and decent.

I welcome your thoughts and comments at info@flcoaching.com or 773.529.1200.

1 Pentland, A. April 2012. “The New Science of Building Great Teams.” Harvard Business Review.
2 Porter, M., and T. Lee. Oct. 2013. “The Strategy That Will Fix Health Care.” Harvard Business Review.

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