Lessons in Leadership from Lincoln Hospital
It is the rare leader who has the depth of self-awareness demonstrated by Marcy Pressman, Associate Executive Director of Ambulatory Care at Lincoln Hospital in New York City. Marcy has worked to redesign the patient visit since 2002. She was an engineer before entering healthcare management, and she exemplifies Michael Hammer’s definition of the perfect redesigner: “A woman engineer who has changed jobs frequently [and has great communication skills]”.
The following article is the consequence of the alchemy between Marcy’s self-awareness and her growing experience in change management. We hope her wisdom helps you from learning these same lessons the hard way.
Lessons in Leadership
by Marcy Pressman, AED Lincoln Hospital
I am an Adrenalin addict. I’ve taken the first step toward recovery – I’ve admitted it. I get “high” from putting out fires – this makes me great at functioning in a chaotic environment. I do my best work under pressure (or so I thought), so I wait until the last minute. Sometimes I create the chaos just to sustain the “habit.” I am also a pusher – I collect and/or create other Adrenalin addicts. This means that when conflict arises, my “team” has no place for all that Adrenalin to go. So, what happens? We become jumpy and unable to concentrate on what others are saying. A typical scenario:
Person A: What happened to the patient?
Adrenalin Addict: It wasn’t me!
Adrenalin addicts are so jumpy, we don’t hear the questions or the answers. We are too caught up in the moment, in the conversations in our heads. This makes us short-tempered, defensive, and not team players, no matter how many times we are told we are a “team.” We don’t have any idea what kinds of conversations real teams have.
I do not like silos – but my actions reinforce them.I keep telling myself I don’t like silos but I divide problems into compartments to be solved by the “expert” in that area. This is healthcare, not the defense industry, where top-secret projects are divided into sub assemblies, and each expert only has enough information to work on his/her part. In healthcare, team expertise is greater than the sum of the parts. We see this over and over again in the best patient outcomes. Why then, do leaders try to divide the expertise? Why do we call meetings with only one part of the team? Why do we put administrative demands on one of the experts, excluding the others and, worse, sacrificing the team time by siphoning off the energy/expertise of one of its members? We say we value team—let’s act like we believe it.
Confront issues, not people.There is a difference. You will get better and more sustainable results if you can make the distinction.For example, a doctor arrives late to clinic every day.
Scenario A: Confront the Doctor
Manager: Dr. X, you come in 15 minutes late every day. You need to be here on time.
Doctor X: My start time is 10 a.m. and that’s what time it is. What are you, my timekeeper?
Scenario B: Confront the Issue
Manager: Dr. X, the clinic starts at 9 a.m. We need you to be here on time for your patients.
Dr. X: Well, my start time is 10 a.m.
Manager: What should we do with your patients who are waiting for you? Do we need to change your start time or would you like us to change your patient schedule?
Beat a dead horse—and make sure it’s really dead.Refer back to #1. Adrenalin addicts are always in a rush. When we bother to have a conversation about a problem, we talk fast and call it “communicating.” We think we solve problems quickly so we can move on to the next one.Make sure the problem is resolved, and when you think it is resolved and everyone is in agreement, review it one more time. I have had to learn to take the time to talk and listen. It is very painful for an Adrenalin addict like me, but I am working on it. Now I’m able to recognize the signs of my addiction rearing its ugly head and pause when I need to remain focused and patient.
To combat the darkness, increase the light.I hate negativity. It makes me feel like I’m choking. When confronted with negativity, as an Adrenalin addict, I want to dismiss it quickly. I am learning to hear it, to really listen and to understand where it is coming from. The most important phrase I’ve learned is “What is it about the issue don’t you like?” Usually, I am able to address the source of the negativity so we can all move on, not just me.
We are passionate about what we do. Separately.We all think we’re the only ones who care about the patients. When someone opposes our viewpoint, we think they don’t have the same commitment to our mission. It isn’t true. They just believe passionately that their way will deliver the best outcome. Have faith in your colleagues. Embrace their passion, even if not always their ideas.I have two managers working together who are very passionate about what they do. They are also Adrenalin addicts. Bad mix. So, we devised a system of what I call “passion distribution” to allow them to work effectively together. One of them has “odd-numbered” days to be passionate; the other has “even-numbered” days. When conflict arises, they recognize who is “allowed” the passion for the day. They don’t always agree, but this allows them to have more meaningful dialogue without the egos in the way.Once, I asked an old woman how she managed to stay married for 60 years. She explained that every once in a while, she and her husband would have a knock-down, drag-out fight about something. She said, “Honey, as long as you’re fighting, it means you still care about something.”
Trust the data. But verify with your gut.Data is very important but no data is objective. It is distorted by the systems designed to collect and analyze the data. When you roll up your sleeves and get involved, sometimes what you experience doesn’t match the data you see. Trust your gut.I have spent a lot of time and energy making sure staff don’t “make up the numbers” because I am very committed to being “real” about progress or lack thereof. I even check the raw data. But, having the raw data in my office and experiencing it live are two different things. I didn’t know why. So, I asked a staff member about the disparity. She replied, “well I know how much you want our cycle time to be at 60 minutes so we take a really large sample and if I think some of the examples will disappoint you, I just use others.”Wow!
Bottom Up is nice. Top Down is necessary. But the best view is from the middle.We all had the warm, fuzzy idea that we should have the line staff drive the changes. But, we excluded the local leadership. For sustainable gains, both levels of staff must be engaged. Why?Staff and leaders come and go. There needs to be enough people in place with the memory, commitment, and energy to sustain the process of change. It doesn’t happen just because we have egalitarian visions of how change should occur in a perfect world. Change requires energy, and energy is distributed among many people. Even an energetic person has “off” days or moments. The rest of the team can “kick in” when this happens. When there is a blackout or brownout in the main power source, the backup generator will kick in. But, remember, even the backup generator needs routine maintenance.
It is not enough to have a vision. Paint the picture.Leaders are supposed to be visionary. I know where I want to be, what success looks like. How do I get others to “buy in”? First, we need to have a common language. Paint the picture. “Success for our team will look like this….. It will feel like this….” Saying our cycle time will be 60 minutes or less doesn’t mean anything to anyone. It’s like describing a circle to someone by talking about the circumference as a function of pi. Draw the picture.
Deliver the goods but be gracious when the recipient doesn’t reciprocate.If you make demands, you must deliver your side of the bargain. Do whatever it takes to make sure everyone gets to lunch on time and knows what it feels like when that happens. Do whatever it takes to share the data daily so people can react to it. Accept the reactions—the good, the bad, the ugly. This goes back to #6. As long as people are reacting, it means they care. Don’t expect anyone to tell you that you’re doing a good job no matter how hard you are working—measure yourself against the picture you painted. Ask for feedback from your patients as well as your staff and know that not everyone benefits from the changes you make.For example, we couldn’t understand why the clerks weren’t excited about the changes we were making during the redesign process. Then we realized that nothing really changed for them. They always went to lunch on time. Now, they had more “coaches” looking over their shoulder. This was not seen as a benefit. But as the weeks wore on, the coaches faded into the background, and the patients were more grateful. Also, there were fewer patients presenting them with problems/challenges.
In our Adrenalin-addicted environment, we expect immediate rewards for making changes. This is not the reality.
Roger Coleman, Editor