After reading Christopher Cornue's Hospital Impact post last week on creating collaborative environments for success, I was inspired to write my own post on how to best breed success. I agree with Mr. Cornue's assessment that "safe environments where everyone's ideas are respected and encouraged" are essential for sustainable leadership, and ultimately believe that culture reflects a shared view of the world and of methods for effective problem solving. A strong physician-hospital culture allows people to feel empowered, knowing that outcomes will remain consistently beneficial and that their efforts will be appreciated
Overall, active listening makes people feel affirmed that their opinions matter even when they do not get their way. Here is what I offer as a three-step strategy for creating a culture of collaboration:
Step 1: Engage your physician champions, the top clinicians who have earned their colleagues' respect, regardless of their irascibility; possible roles for these doctors include:
- Presenting and discussing clinical data with fellow physicians.
- Minimizing physician-hospital battles.
- Creating a safe environment for learning.
- Helping to build transparency and trust.
Step 2: Re-frame physician anger as pain. Nobody formally taught me communication skills in medical school, residency, or fellowship training, except a few nurses who thought that I might be trainable. Yet, nurses where I worked unanimously felt that the primary purpose of a surgical residency should be to teach and learn communication skills (Cohn K, et. al. The odyssey of residency education in surgery: Experience with a total quality management approach. Current Surgery, 1997; 54:218-224).
It is very challenging to convince yourself that you have an opportunity to engage a physician to improve care when a disgruntled doctor starts a conversation with, "I'm surrounded by idiots!" However, allowing a physician to vent and then talk about what we can do together to solve the problem, respects a physician's time and makes the physician feel respected. It is tantamount to pulling a sliver from a lion's paw.
Step 3: Embrace coaching, democratic and affiliative leadership styles. The problem with command-and-control and pacesetting leadership styles is that they diminish group cohesion. In "Surgeon frustration: Contemporary problems, practical solutions," I quoted Daniel Goleman as saying that coaching leaders who develop people's skills for the future; democratic leaders who build consensus through participation; and affiliative leaders who build emotional bonds and harmony; all have a positive effect on group cohesion. Those of us who display alpha-male tendencies may need to get in touch with the 23 chromosomes that come from our mothers. The most effective leaders use multiple styles seamlessly (Goleman D. Leadership that gets results. Harvard Business Review. March 2000, 78-90.)
If any of what I advocated was easy, readers would already be doing it. Exemplary hospital leaders with whom I have had the privilege of working make an effort to live daily by the three steps mentioned above, and listen to the courageous few who tell them when they have fallen back into command-and-control responses. As for you, what do you see as the critical steps in forming a culture of collaboration? How do you collaborate at your organization? What benefits have you experienced as a result of collaboration?
As always, I value your input.
Ken is a practicing general surgeon/MBA and CEO of HealthcareCollaboration.com and will be presenting at the ACHE Congress on Healthcare Leadership, March 24, on "Cutting-Edge Physician Recruiting, Contracting, and Recruiting Strategies."