Sunday, June 22, 2014

How to Develop the Skills to Lead and Succeed

Someone sent me a review about "Enhancing Your Executive Edge" by Kim Zoller and Kerry Preston. I'm not sure it's source but It's worth putting here in total. Some great thoughts about just the behaviors that have been plaguing our system lately.

It would be wonderful if everyone were nice to each other and had each other's best interest at heart. But the reality is, many people are out for themselves. Sometimes it is a personality issue, and sometimes it is the way the corporate structure is set up.
[Such is the reality of medicine.]
Our goal should be "lead and succeed". To do so you have to see the big picture and realize that a leader is only a leader when there are followers.  You have to be above all the petty behaviors. Although difficult, it is critical for your future to learn how to deal with these kinds of behaviors. 
All these behaviors come from ego. While some ego is important, having an inflated ego can hurt you.
If you do not have humility, as a leader it is something you must learn. Humility allows you to keep your ego in check and makes you think before you act.

Posturing and extreme one-upmanship
Have you ever worked with people who are obsessed with competing and making themselves look good? This is the definition of posturing in a nutshell. The person is constantly asking, "Who is the better one? Who can run the race the fastest?" Keep in mind that posturing is more than being competitive with others; it is a high level of "oneupping" another person. Posturing comes from a need to win and be known for winning. It may come from insecurity or jealousy of others. This behavior does not bode well for building relationships, nor does it reflect well on the person one-upping.

Unfortunately, there are people who will try to sabotage what we are doing to make themselves look and feel better. Sabotage is really a form of insecurity. There are so many clients who say, "I cannot seem to get my ideas known by anyone around me except my boss." Or "My boss takes credit for everything I do." Not giving or sharing credit is the behavior of a person who is sabotaging another person. The saboteur is trying to make the other person not look as smart as or as effective as he or she really is. What people don't realize is that by making someone look good, we make ourselves look good.

Some people think sarcasm is funny and do not realize how much it hurts other people's feelings. There is always a hint of truth in sarcasm, which is what makes it hurtful. If you have something to say to someone, say it. Using sarcastic comments will only harm your edge and lessen respect others have for you. Keep in mind that sarcasm may be in your partially blind area. You may know that you use sarcasm, but you may not know the ramifications of it and what other people think and feel because of your sarcasm.

Some things to consider:
  • Do not put other people down to make yourself look good.
  • Raise your empathy level and always keep others' feelings in mind — increase your emotional intelligence.
  • You may say that there are plenty of leaders who exhibit these personality blockers, and, yes, there are. 
  • Do people work because of you or in spite of you?
  • If you have people who work for you, will they go the extra mile for you?
  • Will they stay late?
  • Will others take on an extra project just because you asked them to?
  • Do not "one-up" people.
  • Be collaborative.
  • Listen — engagement does not mean having the best idea or best story to tell.
  • Do not be the subject-matter expert on every topic.
  • Do not try to one-up them — you will never win.
  • Do not get off ended; it is their way of feeling important.
  • Smile and say things like, "That's great," and keep the conversation going.
  • Are you excited for people when they are successful?
  • Do you let others take credit for work they produce even when they are not in the room
  • Give people credit for their work.
  • When someone else's idea is chosen over yours, congratulate him or her.
  • Say nice things about other people and their work.
  • Realize that when you sabotage other people's work, you will lose all respect from others.
  • Take comfort in the fact that people always find out who really did the work.
  • Try to include others on e-mails so that they are aware of your work.
  • Do not speak badly about saboteurs. That will only hurt you—especially if they have any degree of influence.
  • Try to get included in meetings where the work will be discussed.
  • Speak up in meetings; do not fade into the background.
  • When the saboteur tells about the work that "he" had done during a meeting, use statements like, "Yes, and what I'd like to add was that when I was working on the project, I found . . ."
  • If appropriate, go to the saboteur and say, "I respect everything that you are doing. I would really like to be included in the reports so that others know what I am doing at the moment."
  • Aren't you just a ray of sunshine.
  • Did you take your medication today?
  • Do I look like a people person?
  • Not the brightest crayon in the box.
  • Don't worry. I forgot your name, too!
  • Nice perfume. Did you use the bottle?
  • When it involves trying to get a laugh at someone else's expense, it is sarcasm — do not take part in it.
  • If you have said something sarcastic, immediately apologize.
  • When you have said something sarcastic to someone in front of other people, apologize publicly.
  • Even if people tell you that your sarcasm is not hurtful, do not believe them. They are not sarcastic and do not want to hurt your feelings.
  • Stop doing it and learn some real jokes if you are trying to be funny.
  • Do not laugh when they make the joke; your laughter tells them it is all right to keep doing it.
  • In private, say to them, "I know you may not realize it, but when you make those sarcastic jokes, they are hurtful. I know you would not want to hurt anyone's feelings, and so I wanted to let you know.  If you are comfortable, say to them, "That's not really funny."
I hope one or more of my esteemed colleagues reads my blog. But I bet ego won't let them.

FDIC - Frightening Disseminated Intravascular Coagulation

DIC is a paradoxical event in any patient, particularly in pregnancy. Disseminated (everywhere in the body), Intravascular (in the blood vessels), Coagulation (clotting).

 DIC It is one of the most dangerous conditions that we encounter in the mother/baby realm during pregnancy and can threaten both mother and fetus. It is an extremely paradoxical event; A ballet between clotting and bleeding; Between life and death.

 A "trigger" stimulates activation of the clotting cascade and clotting throughout the body. This activation results in widespread thrombosis (clots). All this clotting leads to depletion of the raw materials of the clot...platelets and coagulation factors. The end result of this process is bleeding into many areas and organs and, ultimately, multi organ failure including fetal demise. In most cases in the pregnant patient, this demands emergency c-section with long, exhaustive NICU stays for the babies who survive.

In a word, frightening.

DIC Cascade

I've Nothing Together

"Pride will keep you from growing, because when you pretend that you’ve got it all together, you won’t make an effort to become more spiritually mature. No one has it all together! Humility leads to happiness because it makes you teachable. - Rick Warren

I've been really observant sensitive to the lack of humility in some clinicians that make them unteachable and, worse, dangerous. There is a disturbing trend I've noticed that people are genuinely unhappy in the medical centers I've worked lately. There is so much stress, whirlwind activity and demand of time. I hear so much grumbling through the day (and night) from otherwise nice people.

 The exception to the "nice" rule is the clinician who comes believing that they have it all together and that nobody else does. The lack of teachability, compassion for the team that makes them look good and general sense of untouchability is a dangerous recipe. When those below are unwilling or unable to speak their minds, patient safety suffers tremendously. But more importantly, it unnecessarily creates an environment that nobody feels comfortable in, including the patient.

 Medical education and administration has lost the ability to breed into and maintain a sense of humility in providers. The system is so broken, so lost. There is absolutely no recovery from a system that allows such behaviors to continue and, in many case, flourish. I, on the other hand, become more humbled by witnessing such aberrant behaviors and know for a fact, I don't have anything "together".

Saturday, June 7, 2014

Stop the Bullies

"You suck!" That's what he said. I've certainly had good days and off days, but this was a mostly innocuous event in surgery that had no ramification to the success or failure of the procedure. It was a hand movement that provoked it. A totally over the top comment on a minor event. Did he think it would make be better?

I've really become sensitive to bad behavior in medicine today. I'm really tired of how we treat each other in the hospital and the effect it has on morale, work productivity and potentially, patient safety and care. 

"He comes to the operating room late, greets no one, and berates the nurse for not setting up the stepstools the way he likes. He tells the [assistant] he doesn’t know the anatomy and sighs when she adjusts her grip on a surgical tool. He slaps the hand of the [surgical tech] when she reaches for the retractor to pull back skin for a clearer view. The operating room is [quiet and] tense for hours."

There is a profound disrespect that abounds in the medical setting, particularly where new or student providers are present. The bullying culture of medicine is well, well known. If you haven't experienced mistreatment, you've seen it regularly. There becomes a subculture of talk about the "crazy" surgeon, who you like and don't like to work with, and the effects of such behavior on colleagues and staff.

"For the most part, I’ve been pleasantly surprised. The majority of doctors, nurses, and other health care professionals I’ve worked with have been courteous and respectful: strong teachers and compassionate caregivers. I have met colleagues whom I would feel honored to work alongside in the future and mentors whom I’d want to treat my own family should they become ill."

 But the mood and atmosphere created by the bellyaching, angry, terse talking surgeon is at least demoralizing to a surgical team. At worst, dangerous to patient care.  The psychological effect of being called out affect our state of mind in "small but cumulative ways. This is the stuff that creates a culture." And I must say that after these many years, I don't like the culture.

So I've learned to deal with the daily mistreatment. It seems to be the way it goes and has to be done. I've done the blow off explanation of that's "how he (or she) is" or "he's having a bad day" or "his mother is in the hospital". I've bonded with other staff over these incidents ('looks like you need a hug") and had conversations of "solidarity" with staff and colleagues about it. Worst, I've trained myself to ignore it, take it, swallow it, and (hopefully) get over it.

I often wonder thought what we aren't doing, what we miss and what we do in error from the effects of the fear and trepidation created in such environments. I think we rush to do things "more" right, more quickly and more expertly when we are chastised and often to the neglect of good procedure that really shouldn't be rushed. Is the environment created by these bullies making people so nervous that they can't really do their job correctly? I think so. And unfortunately I've seen evidence of that recently in the OR.

I can't remember a time in medicine when cooperation, respect, and relationship among colleagues and staff was more important. It takes a team to make medicine happen, particularly in surgery.

"Now, enter the culture of disrespect. Suppose an attending physician makes withering critiques or unreasonable requests. A resident, hoping to avoid such abuse, slowly but surely starts to hold back. She holds back some questions for fear of burdening and, under the constant stress of being scolded, becomes immersed in details of efficiency."

"A substantial body of data attributes medical errors to interactions among hospital workers. Calls for improved patient safety gained traction from the late 1980s through the early ’90s, when Australian researchers reported a shocking find: the vast majority of medical errors, some 7080 per cent, are related to interactions within the health care team." If that is the case, then bullies create environments that have the potential to create error.

"The link between harsh words and medical errors was reignited in 2012 when Lucian Leape, professor of health policy at the Harvard School of Pub­lic Health, published a two-part series in Academic Medicine. ‘A substantial barrier to progress in patient safety is a dysfunctional culture rooted in widespread disrespect,’ Leape and his co-authors asserted. ‘Disrespect is a threat to patient safety because it inhibits collegiality and co-operation essential to teamwork, cuts off communication, undermines morale, and inhibits compliance with and implementation of new practices.’"

"When anger and intimidation flow down, information stops flowing up. The chain of communication becomes clogged."  Some of the most popular reasons for lac of communication in the hospital setting, according to research: Intimidation. Fear of confrontation. Concerns about retaliation.

"When someone is unpleasant or demeaning, something switches in the minds of those on the receiving end: they sacrifice honest communication to save face. I’ve seen it in action so many times that the pattern has become predictable. Preoccupied with fear of appearing incompetent, team members keep uncertainties under wraps."

"Many in medicine actively protect the culture of disrespect because they hold a fundamentally flawed idea: that harshness creates competence". I am experiencing such a shameful experience now. No new competence comes from harsh, disrespectful communication.  "Brutality doesn’t make better doctors; it just makes crankier doctors. And shame doesn’t foster improvement; it fosters more mistakes and more near-misses. We know now that clinicians working in a culture of blame and punishment report their errors less often, pointing to fear of repercussion. Meanwhile, when blame is abolished, reporting of all types of errors increases."

"Bad cultures lead to bad outcomes. Jerks do not make good medicine. They foster a backwards atmosphere that degrades trust, tarnishes open communication, and promotes cover-ups."

I wish I knew how to stop disruptive behavior. But likely if I speak out about it, I'll be dismissed so that the disruptive surgeon bringing in financial benefit to the hospital can continue to rant and rave. Thus facilitating the behavior it hopes to eliminate.

"We can’t ignore a system that takes loads of formerly ‘nice’ people and churns out jaded, bitter, and gruff ones" I yearn for a hospital culture that shames bullying making the bully look like the bad guy, rather than making the recipient look weak. 

There is not quick fix, but I for one, am beat up enough for a lifetime. And I don't think I'm a better provider for it. Maybe I just suck.

Wednesday, June 4, 2014

Time Flies

Time flies when you are having fun or busy putting people back together again. It's no excuse, but writing superflous wordage about next to nothing take back seat to patient care. Now I know how all the King's men felt. It's been a busy time with leaving internship and going to work.

It's been a great learning experience on many fronts. I don't think like a medicine people and being back in surgery is wonderful. Those who can't memorize, operate.

 Quote of the past few months: "Can you imagine what a great surgeon I would be if I could find help who were as good as me?" - Anonymous, M.D.

I continue to strive. Per chance to dream.