by ACHE SoCal | Sep 30, 2020 | Blog, News
The last several months have been stressful with world, US and West Coast events. COVID, racial disparities and fires raging have caused me to reflect on my resilience as a leader and how I cope with devastating events. I’ve had colleagues who have been affected by tragedies, and their stories of how their communities have rallied around them have been heartwarming. Stories about healthcare workers who day in and day out have sacrificed their lives to care for others are inspiring. My oldest son graduated from college in 2020 and began a job in Wisconsin. He took his first paycheck to contribute to black lives matter. He is insistent his generation will be the vehicle for change.
Finally, I believe climate change, dry weather and human negligence in California have contributed to the massive fires. Yet, we have learned the importance of emergency management services and how we must be continually proactive with anticipating hazard vulnerabilities.
As leaders, we have a duty to model the behaviors we expect from others. As I pause to reflect on my own behaviors, I realize the importance of vulnerability, authenticity and empathy. Every night I think about all I am grateful. We were called to an incredible profession to serve others. We can affect change through relationships – one conversation at a time.
As Maya Angelou said:
“If you don’t like something change it. If you can’t change it, change your attitude”.
“Nothing will work unless you do”.
“Courage is the most important of all the virtues because without courage you can’t practice any other virtue consistently. You can practice any virtue erratically, but nothing consistently without courage”.
Finally, “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel”.
Words to live by….
Dr. Tricia Kassab, EdD., RN, FACHE, CPHQ, HACP
by ACHE SoCal | Sep 30, 2020 | Blog, News
“OK, Let’s roll…and hey! let’s be careful out there.”
-Sgt. Phil Esterhaus, played by Michael Conrad, Hill Street Blues
At the morning roll call, Sgt Phil outlined the priorities for the next shift. He was briefing a group of police officers in the fictional Hill Street precinct on the challenges they would face. Like a coach, he fired them up, and like a benevolent parent, he reminded them to take care of themselves and each other.
The last few months have given all of us the opportunity to both encourage and protect our colleagues. Health care providers that choose to be in direct patient care do so with the understanding that they are provided an incredible opportunity to touch and heal their fellow human. At the same time, the closeness can be dangerous, both physically and emotionally.
How do we look to the past to gain understanding going forward? How do we protect our workers while meeting our moral obligation to our patients? How do we grow comfortable with the concept that the world will never be risk-free?
I was a Surgery resident during the 1980s, newly married, and with a child on the way. We were seeing increasing numbers of IV drug abusers and young gay men with a puzzling array of symptoms, including atypical lung findings. Open lung biopsy was the standard of care. I had already been exposed to Hepatitis from a needle stick, and at that point, we didn’t know HIV was transmitted. But we adapted – we limited the use of blades, employed staplers instead of sutures, and developed clear cut protocols for how instruments were passed. We recognized that with the privilege of caring for patients, we accepted and, in fact, embraced the management of risk. Patient care improved because we took that challenge.
COVID-19 feels strangely similar and yet also quite different. Early on, we didn’t fully understand transmission, optimal treatment, or slope of the curve. We responded based on the horrors we saw in New York City, moving rapidly to remote work, throttling back on elective surgeries, and appropriately protecting the payroll of employees. We paid whatever was necessary to have basic levels of PPE. Sadly, early on, some of our colleagues contracted the disease and died.
But we didn’t stop caring for our patients.
Over time, and with understanding, we realized that masking, social distancing and rational judicious use of testing would allow us to open services to all in need. The nosocomial transmission was rare. We saw that deferring care for non-COVID-19 patients led to the progression of the disease and poorer outcomes. We needed to bring the staff back and help them feel safe.
Transparency, along with frequent communication of new data and protocols are vital. While our colleagues can be given the option to work from home when possible, they must also be required to come to work when it is safe, and their skills are needed on site. As leaders, we should be seen walking the floors, shoulder to shoulder with our staff. We need to get out the message and demonstrate with our behavior that risk can be managed, even if never eliminated. Living with risk is living life.
“It is not because things are difficult that we dare not to venture. It’s because we dare not to venture that they are difficult.” -Seneca
Be safe – but don’t be scared.
Harry C. Sax, MD, FACHE
Regent for California – Southern
harry.sax@cshs.org
by ACHE SoCal | Jun 29, 2020 | Blog, News
Undesignated Leaders
I knew the call was coming. All day there were reports of a large demonstration moving toward our hospital. There had been significant looting with the previous night’s protests, and we expected that clashes would ensue between police, protestors and outside agitators.
We activated the command center around 4:00 pm. I put on my scrubs and headed in from the west, judging my route by the position of the police and news helicopters in the distance. The hospital parking lot was eerily quiet and as I walked in, there was a sense of anticipation…and readiness.
The nurses and staff in the center were assessing staffing and receiving reports of employees unable to get to the hospital due to street closures. As I walked to the Emergency Department, it was already busy with acute surgical emergencies, heart attacks and elderly patients who had fallen, with fractures. I was pleasantly surprised to see not one, but three chief residents there, along with a similar number of Trauma attendings. Normally, we have one of each. No one had to say anything, they just came in.
I made it a point to walk through the floors and the ICUs. At the stations, the nurses were a bit surprised to see me there on a Saturday evening. They expressed concern for their staff – both those coming in and leaving. One of them was on Facetime with a colleague caught in her car in the middle of a protest. She was clearly terrified, but fortunately had her hospital ID and scrubs on. She wasn’t injured and made it in. By the same token, we hesitated to send one of our Fellows home. He is African American and we had concerns about him being stopped. We worked with a local hotel to provide housing for any employees who were concerned about their safety after completing their shift. Some just asked to keep working and helping.
The Trauma pager went off. A steady stream of injuries began to flow into the Emergency Department. I watched as a multidisciplinary, multiracial team stabilized and evaluated the patients. I knew some that were active in LGBTQ issues, others that had been discriminated against in their native countries, many for whom English was their second language. They worked with a flow and beauty that seems at odds with one’s images of a trauma unit.
Three bays apart laid an LAPD officer and a protestor. Both had been struck with projectiles – both would soon be in our operating room, having bleeding stopped and fractures repaired. Both survived.
The surgical suites had a limited number of staff. We coordinated and triaged, not just for injuries related to the protests, but also for other life-saving care. A kidney would be arriving for a transplant around 1:00 am. Another family was mourning the death of their loved one, yet had consented to organ donation – this too needed to be arranged, including safely bringing the transplant teams in from outside hospitals.
I walked into a case of a gunshot wound to the abdomen. The young trauma attending was working with our chief resident. Her two fellow Chiefs were in the room providing support and being available to help with other cases. The anesthesiologists were doing a masterful job keeping up with blood loss. Once again, many genders, many races, many ages. At 63, I was the oldest person in the room. Gazing over the ether screen, I could appreciate the path of the bullet – have been there far too often. We talked about other potential injuries and developed a plan to temporize and come back in a day for definitive treatment. That patient, too, is alive and recovering.
My office is on the 8th floor, with a normally beautiful view of the Hollywood sign and the lights of the city. Tonight, there was smoke in the air and the reflection of emergency vehicles on the windows below.
By 1:00 am the riots had burned themselves out. A curfew was declared, and the streets began to quiet. We felt it was safe to send some residents and attendings home to rest for the next day’s battle. I drove by broken glass and dumpsters in the street.
At 7:30 Sunday morning, we had a WebEx with other operational leaders. In appropriate tones, we discussed security, staff morale and what we, as the appointed leaders, could do.
I smiled to myself – the true leaders that night didn’t have formal titles. The were nurses, techs, residents, attendings, security and housekeepers. They maintained equanimity in the face of chaos. They did their jobs not because they were asked, but because it was in their hearts.
They are all of us.
Harry C. Sax, MD, FACS, FACHE
ACHE Regent – Southern California
Professor and Executive Vice Chair
Department of Surgery
Senior Physician Liaison
Cedars Sinai Medicine Clinical Transformation Initiative
by ACHE SoCal | Jun 29, 2020 | Blog, News
Dear Colleagues,
Over the last several weeks we have come together for our patients, family, friends and community in extraordinary ways to learn how to be safe during the COVID-19 pandemic. As we practice social distancing in a new way, we are seeing the benefits of preparation and collaboration. We count on our many talented leaders, colleagues and national experts in emergency planning, clinical care, research and operations to help guide our roadmap.
This pandemic is precipitating a set of events unprecedented in our lifetime. The American College of Healthcare Executives (ACHE) and Healthcare Executives Southern California (HCE So Cal) have changed how we provide education and networking events by offering virtual webinars. Our goal is to stay connected and to collaborate together.
As I ponder how healthcare organizations may change from the pandemic, several things come to mind. First, organizations will need to address brand strategy and marketing messaging to ensure how we communicate safety and security and deliver on our core values.
Second, patient access to care will change to offer virtual alternatives. Telehealth can help attract new patients, reduce no-shows, boost revenue by turning on-call hours into billable time, and possibly reduce overhead for physicians who decide to switch to a flexible work-from-home model for part of the week.
Third, physician offices and hospitals will need to reconfigure services and spaces to provide patients a sense of security. Mixing symptomatic and asymptomatic patients in crowded waiting rooms will be a major dissatisfier and threat to people’s safety. Organizations may want to consider redesigning facilities and create separate entrances for the sick and well patients.
Finally, how we come together in different ways will impact the communities we serve. In the words of Walter Payton “Together we are stronger than we are alone.” Thank you for all you are doing during these challenging times.
With deep appreciation,
Tricia Kassab, EdD., RN, FACHE
President, Healthcare Executives So Cal
by ACHE SoCal | Mar 14, 2020 | Blog, News
Health Care Executives of Southern California is positioned for a wonderful year. The Board of Directors of HCE, under the very able leadership of Dr. Tricia Kassab, FACHE, has launched 2020 with exceptional education programs and networking opportunities for its members.
I would like to thank the 2020 HCE Board of Directors, Vice Chairs and committee members for their volunteer leadership. If you are interested in getting more involved in your Chapter, there are many opportunities on committees, so please reach out!
Nationally, ACHE offers many educational and career advancement opportunities as well. I encourage you to take a tour through www.ache.org to access all of the resources that ACHE has to offer. The opportunity to explore advancement to Fellow status in ACHE is available for members who meet specific requirements. Again, the ACHE website offers information about the FACHE process. Please keep an eye out for a Board of Governors study series to be offered by HCE this year.
I would like to introduce Dr. Harry Sax, FACHE, as your newly elected ACHE Regent for Southern California. It has been an honor to serving as your Regent for the past three years and connecting with so many of you. As health care leaders, we do our best working together for the patients and communities we serve.
As always, our industry continues to face many different challenges. It is more important than ever to stay informed and engaged. Stay tuned for many innovative programs at the local level from your HCE Chapter!
Ellen Zaman, FACHE
by ACHE SoCal | Mar 9, 2020 | Blog, News
By Dr. Kevin Nourse
Leading healthcare organizations recognize the value of investing in developing high-potential future leaders in order to establish a pipeline of talent ready to step into future management roles. Proactively developing future leaders can make a big impact on reducing the likelihood of career derailment later in their careers.
Having designed and facilitated several leadership programs to develop high-potential talent in healthcare organizations and related professional associations, there are five common career traps experienced by participants in these programs. In this article, I identify five common developmental challenges faced by emerging leaders in healthcare:
- Perfectionism
- Inability to delegate effectively
- Excessively blunt communication
- Failure to say no or set boundaries with others
- Overly self-critical
The good news is that emerging leaders challenged by these traps can employ strategies to mitigate them before they negatively impact their careers.
Perfectionism
Perfectionism often appears as an overriding need to avoid errors while preparing a work product such as a plan or report. Perfectionists often become fixated on some inconsequential detail and may lose sight of the big picture on a project or initiative. While perfectionism isn’t always a negative quality, for many leaders, it goes to the extreme and leads to analysis paralysis, procrastination, lost career opportunities, and career derailment.
Consider the case of Guadalupe, a new supervisor. She advanced her nursing career to the point of becoming a supervisor in one of her organization’s clinics. She always prided herself on high quality, error-free work. Because the scope of her role has grown substantially, she has a hard time staying on top of her work demands. Her manager has become frustrated with her inability to meet monthly deadlines for reports. Guadalupe struggles with completing these assignments, checking and rechecking her numbers, and report formatting.
What causes perfectionism? In a 2011 study, a team of social science researchers clarified a definition of perfectionism and developed the Measures of Constructs Underlying Perfectionism (M-CUP) instrument that identified nine key components. Of the nine constructs, there are five that frequently challenge my clients:
- Perfectionism toward others, which appears as having excessively high expectations of others and may result in harshly evaluating others’ work.
- Reactivity to mistakes in which an individual experiences stress to real or perceived errors.
- Perceived pressure from others in the form of internal beliefs that others have high expectations or will be overly critical of their work products.
- Dissatisfaction in which a person does not believe they or their work products are never good enough.
- Black and white thinking is the tendency to think that the lack of perfection translates to failure.
If you struggle with perfectionism, there are some strategies you can use to reduce your perfectionistic tendencies:
- Build awareness of situations that trigger you to become excessively perfectionistic
- Assess the benefits and costs of perfectionism – are there situations when it is warranted or instances when the opportunity costs are too high?
- Clarify both the time allowed to complete a work product and the need for perfection with your key stakeholders.
- Ask for feedback from others including peers and subordinates about the level of achievement you expect.
- Experiment on low-risk assignments by setting a time limit on the amount of checking and review you perform.
Inability to Delegate Effectively
One of the most significant barriers to the ability of emerging leaders to advance their leadership careers is the ability to delegate effectively. Symptoms of faulty delegation include:
- Holding onto tasks for which others could complete more effectively.
- Micromanaging subordinates when delegation occurs.
- Miscommunicating expectations to subordinates.
- Not willing to invest time in developing direct reports to be able to delegate downward.
- Fear of having to share constructive negative feedback subordinates if their performance does not meet expectations.
The negative impacts of poor delegation can be substantial. Past participants in high-potential development programs describe how an inability to delegate leads to a sense of overwhelm, adverse effects on work-life balance, diminished growth of subordinates, inefficiency, and limited opportunities to work at the highest level of ones’ abilities.
In this book Leadership Agility: Five Levels of Mastery for Anticipating and Initiating Change, leadership experts Joiner and Josephs argue that one of the most critical shifts in the development of leaders in the evolution from heroic to post-heroic stages. Heroic leaders derive their power from their achievements and knowledge, not recognizing the need to leverage the skills other others. As a result, it is increasingly difficult for them to play a bigger game in their role since their skills and capacity constrain them. The ability to delegate is one critical skill associated with successful leader growth and evolution.
Susan, a new supervisor with three direct reports, was excited when she received her promotion but is quickly growing frustrated with her inability to focus on critical priorities. Susan initially believed that “if I want something done right, I do it myself.” In the last few months, she has tentatively attempted to delegate more. However, when she reviews the work products of her subordinates, they completely miss the mark. As a result, she feels compelled to rework their work products in addition to her tasks. Since she does not provide developmental feedback to her team, they never learn how to improve, and the pattern continues.
Strategies you can use to better delegate include:
- Review your and prioritize them using this schema: (1) mission-critical tasks or projects that only I can complete, (2) essential tasks or projects that others have skills to achieve, and (3) tasks or projects that are not critical and others could complete.
- Experiment with delegation by assigning two of the least essential tasks.
- Interview a colleague that is skilled in delegation to find out their insights.
- Interview your direct reports to understand better their interests and skills that you might consider in your efforts to delegate.
- Ask one of your direct reports for feedback about your effectiveness as a delegator.
Excessively Blunt Communication
Authentic communication that is direct and unambiguous is an essential leadership competency. However, leaders that communicate with a harsh tone without consideration for others can seriously damage their reputation and relationships with others. Symptoms of excessively blunt communication include:
- Questioning others competence in a group setting
- Using an accusatory tone
- Cutting people off in conversations
- Harshly worded emails that are copied to multiple recipients
- Using the same approach to communication regardless of the audience
Leaders that are excessively blunt when they communicate may be overusing a strength for task-oriented communication, talking when they are emotionally triggered and are unconscious of their behavior, or lacking empathy and awareness of others’ feelings. The impacts of this communication style include damaging relationships with others, destroying trust, and stifling creativity and innovation. A clinical supervisor in a high-potential development program I facilitated suggested, “the negative impact of my blunt communication style is a reduction or loss of credibility, respect, morale, and staff productivity…I could lose forward-progress or even my job.”
Consider the case of Steve. As a highly experienced healthcare finance manager, he prides himself on speaking truthfully and directly to others. However, Steve tends to overuse this skill or use it in inappropriate situations – both interpersonally and through email. During a recent meeting, he became defensive and used excessively harsh language with a new manager, putting him on the spot in a meeting with his peers. While he apologized afterward, he quickly developed a negative reputation as being easily triggered and lacking leadership presence.
There are several strategies to use if you struggle with your communication style:
- Identify your patterns for being overly blunt – do you demonstrate this with specific individuals or situations?
- Take three deep breaths when you are triggered to speak harshly.
- Proactively build relationships with others, so you have established a trusting foundation as a way to counteract future episodes of harsh communication.
- Communicate your expectations to others in advance, so you are not triggered if they don’t hit the mark.
- Leverage the talents of others on your team to diplomatically communicate in sensitive situations.
- Enlist others to support to review your tersely worded emails before you send them.
Failure to Say No or Set Boundaries with Others
Supporting others and going above and beyond the call can make a positive impression on others. However, emerging leaders who are unable to say no or set appropriate boundaries may find others taking advantage of their helpfulness. Symptoms of an inability to set proper boundaries and limits with others include:
- Feeling taken advantage of by others
- Unable to complete your core duties and tasks
- Feeling stressed and overwhelmed
- Afraid of the conflict that might result from saying no
- People-pleasing tendencies
Leaders that are unwilling to set appropriate boundaries and limits may do so because they are overusing a strength of building relationships, don’t believe they have the power or authority to say no, or lack assertiveness skills. Others struggle with this because they inaccurately assume others know their limits. In essence, they teach others through their actions that they will continue to take on more and more. One participant described how she “feels a responsibility to do what I can when I can, even if that makes it personally challenging for me. I feel guilty if I say no to something I could have completed even if it would have overloaded me substantially.”
Barbara is a new manager who struggles with setting limits and boundaries. When asked by colleagues to take on specific tasks, she does so without hesitation. Barbara prides herself on having an open-door policy. As a result, colleagues and direct reports stop by to ask her “quick” questions that result in much more extended conversations. As a result, she works overtime on nights and weekends to catch-up creating negative impacts on her work-life balance. She is growing frustrated and angry. Because of her pattern, she has little time to proactively build relationships throughout her organization, including her boss – a strategic career mistake.
What can you do if you struggle with an inability to say no?
- Before committing to taking on tasks from others, wait 30 minutes and reflect on the opportunity costs of taking on the additional work.
- Proactively communicate to key stakeholders when you are not accessible except in emergencies.
- Pay attention to your patterns associated with people-pleasing – do you do this with certain people or situations? Do you tend to say yes at the end of the day when you are exhausted?
- Interview a colleague who is skilled at boundary setting to find out their approach.
- Enlist your boss to help in setting boundaries on requests from peers or other departments.
- Learn negotiation skills and the art of exchange – if you take on someone’s task, what are they willing to do in exchange.
Overly Self-Critical
Effective leaders pay attention to their performance and development, periodically critiquing their effectiveness to improve their skills. However, some leaders go to an extreme when critiquing themselves, resulting in several symptoms:
- Unable to take action for fear of making mistakes.
- Missed opportunities to contribute their ideas.
- Catastrophizing and expecting the worst.
- Lack of confidence.
- Negative self-talk that focuses more on failures and mistakes versus successes.
- Obsessed with a need to prove themselves to others.
Why are some leaders overly self-critical? In some cases, these leaders set excessively ambitious goals that are likely unattainable. Others experience an imposter syndrome anchored in a fundamental lack of self-regard, causing them to doubt themselves. Regardless of the cause, negative self-talk tends to persist unless leaders recognize the patterns of self-talk and unproductive rumination.
Carol is a supervisor who excelled as an individual contributor. With her promotion into her first management role, Carol’s boss expects her to speak about the performance of her team in leadership meetings. Before attending these meetings, Carol is obsessed with critiquing herself and consistently overprepares. When she shares her ideas in leadership meetings, she unconsciously apologizes to the group. As a result, many of her ideas get little traction with her supervisor and other stakeholders.
There are several strategies you can use to mitigate being excessively self-critical:
- Evaluate the factors that trigger your tendency to become overly self-critical.
- Create and periodically review a journal of accomplishments and accolades received from others.
- Ask trusted colleagues for feedback on your strengths and weaknesses.
- Practice mindfulness to build practical self-awareness skills for noticing negative self-talk.
- Focus on self-care and wellness including adequate sleep, exercise, and diet.
Emerging leaders in healthcare may experience these five common challenges, including perfectionism, an inability to delegate, overly blunt communication, saying no, and being excessively self-critical. These challenges can limit your career progression. By building awareness, experimenting with new behavior, and enlisting the support of others, you can eliminate these potential career traps and prepare yourself for a successful leadership journey.
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Dr. Kevin Nourse is a member of HCE-SOCAL and has more than 25 years of experience developing resilient change leaders in healthcare. He is the founder of Nourse Leadership Strategies, a coaching and leadership development firm based in Palm Springs. For more information, contact Kevin at 310.715.8315 or kevin@nourseleadership.com
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