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Supporting Disruptive Physicians

Interview with Pat Samples by Holly LeMaster

Pat Samples, MS, RN, CENP

Pat Samples, MS, RN, CENP

I recently sat down with Pat Samples, MS, RN, CENP, to talk about a topic that’s close to her heart: physician coaching. Coming from her background as nurse, and then a nursing executive, Pat has a natural gift for coaching and developing physician leaders. If you’re a physician who’s curious about exploring a coaching relationship, or an administrator who is wondering about the benefits of coaching for members of your medical staff, you’ll want to read all of these interviews.

This is the second  in a five-part series.

When we left off, you were talking about the physician leadership gap in healthcare organizations—about how there’s typically no effective peer support to help a physician who’s struggling with, say, behavioral or quality issues. What, exactly, is it that you do to fill this gap? It’s a process we call Observational Coaching. What I do that’s different is to spend time with them, watching in their natural habitats, and then give them feedback. I might follow them 4 – 6 hours at a time for 4 or 5 sessions, through every environment and practice setting—their offices, the O.R., on the units, with patients and families, with staff, in meetings—to see how they’re showing up in various settings and with various parties. As an objective party, a neutral “outsider,” I can then point out what I’m seeing and perceiving, and ask the physician to explain what’s happening for them. “Okay, here’s how I saw you show up here, and this is how I saw you show up there. Tell me the disconnect.”

Wow. Do other people know who you are and what’s going on? Sort of. The first session we spend one-on-one, just getting to know each other and laying the framework for the rest of the sessions. When I’m observing, we always get the patient’s permission (if there’s one involved) for me to be present. We tell others just that I’m a nurse who’s following the physician, which is factually accurate. They actually don’t know that I’m observing and coaching. It’s usually not until after they’re successful that they tell people, “remember that day in the O.R.? Pat really helped me!” In an O.R. setting, for example, I’m usually at the back of the room so they forget I’m there. I try to position myself behind them until they get comfortable, and then I move around so I can watch their facial expressions.

Under certain circumstances during the process, I might step up next to them and just cue them a few times, but only after I have asked their permission.

What kind of cues would you give? Once when one was sort of yelling and getting really frustrated…Wait, so you’re standing there; he knows you’re there, and he still misbehaved? They honestly forget I’m there, because I’m standing out of the way and they are focused on what they’re doing. I want to watch everybody. I want to see how the staff is showing up prepared or not prepared, take in the layout of the room—especially in the O.R. because it’s so multifaceted. In this particular case, it was the second time I’d followed this doctor into the O.R. And I observed him getting really frustrated, for all the right reasons: not the right equipment, the staff was not paying attention. So I just stepped up next to him and just whispered to him, “you’re yelling. That does not make them smarter.” I just cued him to stop yelling—that’s all I did.

Afterward, when we were debriefing the experience, we referred to his Hogan Personality Assessment (a tool we use that provides powerful insights into personality, behaviors, and values). And based on who he was as a person, it was clear he really derails when he does not have the right equipment in the room. From there, we were able to strategize: what control do you have to make sure that you always have the right equipment? They key is in teaching them to get to know themselves, what they need to be successful, and what they can impact and influence. Instead of allowing other people’s poor choices to negatively impact his surgery, ask what’s within his control and what’s within his influence? And then, own it. Once you’re in that place, you can verbalize your frustrations differently and more productively.

This must have impact way beyond the single physician. Yes. We also organically uncover operational issues as a result of this observation process. When that happens, I can report the problems back to leadership and recommend resolutions. In one case, we ended up doing some extended work with my physician client’s whole team to support them in being more effective overall. It’s never just one thing, is it? No. If we can address those operational barriers that are elevating the frustration, we can improve the dynamics from multiple angles. That’s why physicians appreciate this process so much. They learn to become accountable for their own behaviors while we simultaneously identify and address the areas where they need help from others—their team, their leaders, the organization.

To address the personal dynamics with the coached physician following observation, we use the Hogan Personality and Emotional Intelligence Assessments for self-discovery, and then we really talk about the physician as a human being—how their personality traits, behaviors, and values are serving them and how they’re getting in the way. Who do you want to be? How do you want to grow? What do you want to master? And, I tell them directly, “you actually can’t act like this anymore. We don’t yell at people, we don’t call them names; you can’t create that kind of culture anymore.” We know that the real reason most physicians resort to these kinds of bad behaviors it is that it gets them what they want; it gets somebody’s attention. My job is to teach them to find their voice and express it in a mature way that serves the team and the patient.

Okay, so that accounts for an individual physician and the areas he or she touches. What about the rest of the medical staff and physician leadership. How do you address that next level?  Good question. The physician leaders in that organization might not have the skill sets to help them  integrate the learning and sustain the new  and improved behaviors. Once I’ve done the work with the frontline practicing physician, we go to their leader or medical director together. The physician explains, “here’s what I’ve learned about myself and here’s what I need from you.”  Then we make a plan together to move forward and keep the behaviors in check. This process teaches the medical director how to help and support all of his frontline physicians. They just need the awareness, intention, and skills to be able do that. At the medical director level, I can teach them crucial conversations, addressing behavior in the moment, conflict resolution ability, and how to learn about their colleague as a person (why they are behaving the way they are). To address a colleague’s behavior doesn’t mean they aren’t providing quality care. And that’s a new concept for physicians. It doesn’t mean they are a bad physician or don’t know how to provide the care. But if you don’t have the right behavior in delivering the care, you’re part of the problem in healthcare.

“If you, as my medical director, see me lose my cool and don’t say anything, that silence is affirmation.”

To summarize, why would an organization hire Innovative Connections for physician coaching? Their pain is, more often than not, a physician that’s causing chaos or disruption in an environment that’s having a downstream effect on other people. Physician leadership is a fairly new concept in healthcare at a very disruptive time. Appropriate support, education, and coaching will allow physicians to be more successful with fewer casualties, and have a higher impact quicker to support them, their colleagues and their teams. Trickle down leadership!

We’ve experienced great success with our observational physician coaching, I believe, because it’s really focused and intentional. Because we’re there, watching, we experience firsthand through an objective viewpoint what’s working and what’s not working. Then we create a totally individualized learning plan for the physician based on their specific obstacles and circumstances.

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