Rural Physician Leadership Curriculum

1. Rural Physician Leadership Curriculum West Virginia University Rural Family Medicine Residency Program

2. Rural Physician Leadership Curriculum Module 4 Hospital Committees,Teams & Meetings

3. Rural Physician Leadership Curriculum Description • Funded by HRSA Grant D22HP00306 • Objective 1 • Develop a competency based longitudinal curriculum in Rural Physician Leadership Konrad C. Nau, MD Principle Investigator Chair, Dept of Family Medicine-Eastern Division WVU Rural Family Medicine Residency Program

4. Rural Physician Leadership Curriculum Learning Objectives : Module 4 • Understand the differences between hospital committees and teams • Identify factors to consider when participating on a committee • Understand meeting types and etiquette • Identify signs that it may be time to leave a committee

5. Functions Crayton Fargason,MD Curbside Consult on Hospital Committees and Teams , 2001, American College of Physician Executives.

6. Committees and Team Interactions • Committees delegate work to Teams • But not visa versa • Usually process focused work example • Credentials Committee appoints team to recommend critical care credentialing criteria

7. Committees and Team Interactions • Committees delegate work to Teams • But not visa versa • Usually process focused work example • Credentials Committee appoints team to recommend critical care credentialing criteria

8. Committees and Team Interactions • Teams report to Committees • But not visa versa • Usually for policy recommendations example • Alcohol Detoxification Team recommends standing orders for identifying, preventing, and treating alcohol withdrawal in hospitalized acute care medical and surgical patients

9. Don’t Confuse Your Teams • Patient Care Teams • Focus on individual patients • Care for one patient at a time • Hospital Committees/Teams • Focus on groups of patients • Care for the organization • Care for the processes of the organization

10. Group Decision-Making • Applies to Teams and Committees • Best for 2 types of decisions • Information-Dense Decisions • Decisions that Require Team Implementation • Power Source • Ability to consider multiple potentially competing perspectives

11. Group Decision-Making • Address complex decisions • Make decisions where diffusion of responsibility is appropriate • CEO / Committee relationship vs • Attending /consultant relationship • Make decisions over a period of time

12. Strengths : Group Decision Making • Information-Dense Decisions • Information from multiple parties required • Take time to seat the right people • Promote dynamics that will allow all relevant information to be • extracted • incorporated

13. Strengths : Group Decision Making • Implementation Requiring Cooperation • Seat all key participants in the process • Facilitates initial buy-in • Participants can sculpt decisions that they will have to implement • Participants can vent negative feelings and put them in perspective • Best done BEFORE the work is to be done

14. Weakness : Group Decision Making • Passing the Buck - Tendency to decrease amount of work done by any one individual • False assumption that group decisions are more balanced • Dominant physician decides on end result of committee without eliciting relevant information from team members. • Team feels that they have no real input or authority

15. Weakness : Group Decision Making • Team asked to make decision that is clearly a management responsibility • Team composition can be stacked in favor of only one side of an issue or lack key operational leaders • Creativity requires at least some individual work effort for maximal option creation

16. When asked to serve on a Committee • Why me ? • Why the Committee ? • What is the Time commitment ? • What is my Role ?

17. Why me ? • Expertise • Power • Personality • JCAHO Mandated • Potential • Problem

18. Why me ? Expertise • Unique operational perspective of physicians • Quality of Care knowledge • “Power of Persuasion”

19. Why me ? Power • Income contribution to the hospital • “Mission Critical” services • Expense contribution to the hospital • DANGER : Your comments will tend to be interpreted as self-serving • ADVICE : Focus on the interests of the other committee members (Servant Leadership)

20. Why me ? Personality • Your ability to contribute to the group maintenance activity of the committee • High Emotional IQ physicians are valuable • Self-aware • Motivated • Self-regulated • Empathic • Adept in relationships

21. Why me ? Personality “And when we do not know, or when we do not know enough, we tend always to substitute emotions for thoughts.” T.S. Eliot The Sacred Wood

22. Why me ? Mandate • Executive Committee • Department or Service Chairs • Medical Staff Officers • Credentials Committee • Quality Assurance/Performance Improvement/Peer Review

23. Why me ? Potential • Organizations must develop their human capital • Management can evaluate and develop your non-clinical decision making abilities • Opportunity for you to develop skills and create a reputation beyond your clinical competencies

24. Why me ? Problem • Bombastic and obstructionist physicians can be appointed to a committee as a means of managing their unpleasantness • Unproductive and powerless physicians have lots of spare time to serve on committees

25. Why the Committee ? • Who initiated the committee/team • Authority boundaries • Resources • Probability of Success • Clarity of goals • Political factors

26. Time Commitment ? • All other businesses readily accept this professional imperative • Build in in your schedule • How often , how long • Preparation time needed • Committee service builds valuable long term relationship capital for your practice

27. What is my Role ? • Active Participant • Regularly attends • Respectful communicator • Follows group agenda • Group Leader • Attend to group cohesion • Help set agenda and maintain focus • Ready to assume Risk

28. What is my Role ? • Group Leader Roles • Opinion leader • Facilitator • Arbitrator/Negotiator • Keeper of the Discussion Rules • Devils Advocate • Keeper of the Voting Rules

29. Types of Meetings • “Bad meetings, and what they indicate and provoke in an organization, generate real human suffering in the form of anger, lethargy, and cynicism…it impacts people’s self esteem, their families, and their outlook on life.” Patrick Lencioni Death by Meeting : A leadership fable about solving the most painful problem in business Jossey-Bass, 2004

30. Types of Meetings • Daily Check-In • Weekly Tactical • Monthly (or Ad Hoc) Strategic • Quarterly Off-Site Review

31. Types of Meetings : Daily Check-In • Time: 5 minutes • Purpose/Format: • Share daily schedules and activities • Keys to Success • Don’t sit down • Keep it administrative • Don’t cancel even when some people can’t attend

32. Types of Meetings : Weekly Tactical • Time: 45 - 90 minutes • Purpose/Format: • Review weekly activities and metrics • Resolve tactical obstacles and issues • Keys to Success • Set agenda after initial reporting • Postpone strategic discussions

33. Types of Meetings : Monthly Strategic • Time: 1-4 hours • Purpose/Format: • Discuss, analyze, brainstorm • Decide on Critical Issues affecting long term success • Keys to Success • Limit agenda to one or two topics • Prepare and do research • Engage in good conflict

34. Types of Meetings : Quarterly Review • Time: ½ - 2 days • Purpose/Format: • Review strategy, industry trends, competitive landscape, team development • Decide on Critical Issues affecting long term success • Keys to Success • Get out of the office • Focus on work • Don’t overburden the schedule

35. Types of Meetings : Medical Mixup • All four types are separately held in the most successful private/group practices • Hospital administration and management tend to hold all four meeting types separately • Hospital/Medical Staff Committees tend to mix all 4 types into once a month meetings

36. Types of Meetings : Medical Mixup Results of the Medical Meeting Mix • tactical > strategic • acute problems > chronic problems • fatigued participants leave meeting towards the end • right when most decisions get made

37. Types of Meetings : Medical Mixup If several meeting types must be held in one sitting • Strictly allocate time for each type/function • Agenda setting and adherence is critical • Try not to mix more than 2 meeting types

38. Meetings : Prepare/Prepare/Prepare • Agenda • Start with specific goals/objectives • When • Where • Who

39. Size of Meetings • “Size Matters” • Group dynamics change at various sizes • 2 – 7 participants • 7 – 15 participants • 15 – 30 participants • Over 30 participants M. Doyle & D. Straus How to Make Meetings Work Jove Books, NY: 1982

40. Size of Meetings : 2 –7 • everyone can play multiple roles • Facilitator - Recorder • Chair - Group Member • Good size for • All types of meetings esp. process detail • Detractors • ? Critical mass for best creativity • Decision quality may be questioned

41. Size of Meetings : 7 - 15 • Good size for • Problem solving meetings • Decision making meetings • Best size for creative synergy • Warning • Need separate Facilitator and Recorder • Complexity requires attention to structure and agenda

42. Size of Meetings :Restaurant Lessons • “Groups of 6 or more will have an automatic gratuity of 15% applied to the bill” • Everyone feels they overpaid • Nega-synergy • The probability is high that 1 or 2 “low tippers” will adversely effect the contribution of others

43. Size of Meetings : 15 - 30 • Good size for • Information sharing meetings • Creates feeling of being part of large team • Warning • Use smaller ( 7-15) sub-groups that report to larger group if problem solving • Hidden sub-group agendas and win/lose mentality can easily emerge

44. Size of Meetings : over 30 • Good size for • Lectures, panel discussions • Voting • Creates feeling of being part of large team • Warning • Clear speaking and voting rules needed • Hidden sub-group agendas and win/lose mentality can easily emerge

45. Shapes of Meetings • “Shape Matters” M. Doyle & D. Straus How to Make Meetings Work Jove Books, NY: 1982

46. Shapes of Meetings • “Shape Matters” M. Doyle & D. Straus How to Make Meetings Work Jove Books, NY: 1982

47. Shapes of Meetings • “Shape Matters” M. Doyle & D. Straus How to Make Meetings Work Jove Books, NY: 1982

48. Shapes of Meetings • “Shape Matters” M. Doyle & D. Straus How to Make Meetings Work Jove Books, NY: 1982

49. Shapes of Meetings • “Shape Matters” M. Doyle & D. Straus How to Make Meetings Work Jove Books, NY: 1982

50. Shapes of Meetings • “Shape Matters” M. Doyle & D. Straus How to Make Meetings Work Jove Books, NY: 1982