What the “org chart” can reveal about physician culture 

https://mailchi.mp/ce4d4e40f714/the-weekly-gist-june-10-2022?e=d1e747d2d8

A consultant colleague recently recounted a call from a health system looking for support in physician alignment. He mused, “It’s never a good sign when I hear that the medical group reports to the system CFO [chief financial officer].” We agree. It’s not that CFOs are necessarily bad managers of physician networks, or aren’t collaborative with doctors—as you’d expect from any group of leaders, there are CFOs who excel at these capabilities, and ones that don’t. 

The reporting relationship reveals less about the individual executive, and more about how the system views its medical group: less as a strategic partner, and more as “an asset to feed the [hospital] mothership.” Or worse, as a high-cost asset that is underperforming, with the CFO brought in as a “fixer”, taking over management of the physician group to “stop the bleed.”

Ideally the medical group would be led by a senior physician leader, often with the title of chief clinical officer or chief physician executive, who has oversight of all of the system’s physician network relationships, and can coordinate work across all these entities, sitting at the highest level of the executive team, reporting to the CEO. Of course, these kinds of physician leaders—with executive presence, management acumen, respected by physician and executive peers—can be difficult to find. 

Having a respected physician leader at the helm is even more important in a time of crisis, whether they lead alone or are paired with the CFO or another executive. Systems should have a plan to build the leadership talent needed to guide doctors through the coming clinical, generational, and strategic shifts in practice. 

Former patient kills his surgeon and three others at a Tulsa hospital

https://mailchi.mp/31b9e4f5100d/the-weekly-gist-june-03-2022?e=d1e747d2d8

On Wednesday afternoon, an aggrieved patient shot and killed four people, including his orthopedic surgeon and another doctor, at a Saint Francis Hospital outpatient clinic, before killing himself. The gunman, who blamed his surgeon for ongoing pain after a recent back surgery, reportedly purchased his AR-15-style rifle only hours before the mass shooting, which also injured 10 others. The same day as this horrific attack, an inmate receiving care at Miami Valley Hospital in Dayton, OH shot and killed a security guard, and then himself.

The Gist: On the heels of the horrendous mass shootings in Buffalo and Uvalde, we find ourselves grappling with yet more senseless gun violence. Last week, we called on health system leaders to play a greater role in calling for gun law reforms. This week’s events show they must also ensure that their providers, team members, and patients are safe. 

Of course, that’s a tall order, as hospital campuses are open for public access, and strive to be convenient and welcoming to patients. Most health systems already staff armed security guards or police officers, have a limited number of unlocked entrances, and provide active shooter training for staff.

This week’s events remind us that our healthcare workers are not just on the front lines of dealing with the horrific outcomes of gun violence, but may find themselves in the crosshairs—adding to already rising levels of workplace violence sparked by the pandemic.

Something must change.

Gun violence, the leading cause of death among US children, claims more victims

https://mailchi.mp/d73a73774303/the-weekly-gist-may-27-2022?e=d1e747d2d8

Only 10 days after a racially motivated mass shooting that killed 10 in a Buffalo, NY grocery store, 19 children and two teachers were murdered on Tuesday at an elementary school in Uvalde, TX. The Uvalde shooting was the 27th school shooting, and one of over 212 mass shootings, that have occurred this year alone.

Firearms recently overtook car accidents as the leading cause of childhood deaths in the US, and more than 45,000 Americans die from gun violence each year. 

The Gist: Gun violence is, and has long been, a serious public health crisis in this country. It is both important to remember, yet difficult for some to accept, that many mass shootings are preventable. 

Health systems, as stewards of health in their communities, can play a central role in preventing gun violence at its source, both by bolstering mental health services and advocating for the needed legislative actions—supported by a strong majority of American voters—to stem this public health crisis. 

As Northwell Health CEO Michael Dowling said this week, “Our job is to save lives and prevent people from illness and death. Gun violence is not an issue on the outside—it’s a central public health issue for us. Every single hospital leader in the United States should be standing up and screaming about what an abomination this is. If you were hesitant about getting involved the day before…May 24 should have changed your perspective. It’s time.”

 The MacArthur Tenets

https://www.leadershipnow.com/macarthurprinciples.html

Douglas MacArthur was one of the finest military leaders the United States ever produced. John Gardner, in his book On Leadership described him as a brilliant strategist, a farsighted administrator, and flamboyant to his fingertips. MacArthur’s discipline and principled leadership transcended the military. He was an effective general, statesman, administrator and corporate leader.

William Addleman Ganoe recalled in his 1962 book, MacArthur Close-up: An Unauthorized Portrait, his service to MacArthur at West Point. During World War II, he created a list of questions with General Jacob Devers, they called The MacArthur Tenets. They reflect the people-management traits he had observed in MacArthur. Widely applicable, he wrote, “I found all those who had no troubles from their charges, from General Sun Tzu in China long ago to George Eastman of Kodak fame, followed the same pattern almost to the letter.

  Do I heckle my subordinates or strengthen and encourage them?

  Do I use moral courage in getting rid of subordinates who have proven themselves beyond doubt to be unfit?

  Have I done all in my power by encouragement, incentive and spur to salvage the weak and erring?

  Do I know by NAME and CHARACTER a maximum number of subordinates for whom I am responsible? Do I know them intimately?

  Am I thoroughly familiar with the technique, necessities, objectives and administration of my job?

  Do I lose my temper at individuals?

  Do I act in such a way as to make my subordinates WANT to follow me?

  Do I delegate tasks that should be mine?

  Do I arrogate everything to myself and delegate nothing?

  Do I develop my subordinates by placing on each one as much responsibility as he can stand?

  Am I interested in the personal welfare of each of my subordinates, as if he were a member of my family?

  Have I the calmness of voice and manner to inspire confidence, or am I inclined to irascibility and excitability?

  Am I a constant example to my subordinates in character, dress, deportment and courtesy?

  Am I inclined to be nice to my superiors and mean to my subordinates?

  Is my door open to my subordinates?

  Do I think more of POSITION than JOB?

  Do I correct a subordinate in the presence of others?

Patton’s Principles of Leadership

https://mailchi.mp/8ae5c9ccdfaf/leading-blog-unsafe-thinking-how-to-get-out-of-your-rut-13659212?e=89386aa055

BORN in San Gabriel, California, in 1885, George S. Patton, Jr. was the general deemed most dangerous by the German High Command in World War II. Known for his bombastic style, it was mostly done to show confidence in himself and his troops, says author Owen Connelly.

On December 21, 1945, Patton died in Heidelberg, Germany. The following day the New York Times wrote the following editorial:

History has reached out and embraced General George Patton. His place is secure. He will be ranked in the forefront of America’s great military leaders.

Long before the war ended, Patton was a legend. Spectacular, swaggering, pistol-packing, deeply religious, and violently profane, easily moved to anger because he was first of all a fighting man, easily moved to tears because, underneath all his mannered irascibility, he had a kind heart, he was a strange combination of fire and ice. Hot in battle and ruthless, too. He was icy in his inflexibility of purpose. He was no mere hell-for-leather tank commander but a profound and thoughtful military student.

star   Everyone is to lead in person.

star   Commanders and staff members are to visit the front daily to observe, not to meddle. Praise is more valuable than blame. Your primary mission as a leader is to see with your own eyes and be seen by your troops while engaged in personal reconnaissance.

star   Issuing an order is worth only about 10 percent. The remaining 90 percent consists in assuring proper and vigorous execution of the order.

star   Plans should be simple and flexible. They should be made by the people who are going to execute them.

star   Information is like eggs. The fresher the better.

star   Every means must be used before and after combats to tell the troops what they are going to do and what they have done.

star   Fatigue makes cowards of us all. Men in condition do not tire.

star   Courage. Do not take counsel of your fears.

star   A diffident manner will never inspire confidence. A cold reserve cannot beget enthusiasm. There must be an outward and visible sign of the inward and spiritual grace.

star   Discipline is based on pride in the profession of arms, on meticulous attention to details, and on mutual respect and confidence. Discipline must be a habit so ingrained that it is stronger than the excitement of battle or the fear of death.

star   A good solution applied with vigor now is better than a perfect solution ten minutes later.