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 first in a five-part series.

What are some reasons a physician might benefit from a coaching relationship?

Physician leadership is a role where people have a lot of responsibility without, generally, adequate preparation or learning. Our healthcare systems are really doing a disservice here by saying, “you’re a really good doctor and you seem to have good skills, so we’re going to promote you to a leadership position.” We assume (usually erroneously) that, because they’re the “A” students—smart, gifted, high-achievers—they can just figure it out on their own. Many of them continue with their own clinical practices while taking on additional responsibilities related to their new leadership roles and, typically, there’s not a lot conversation around what they aspire to be or what leadership means to them. Pile on lack of role clarity and inefficient processes and procedures, and we end up with high-performing individuals who genuinely want to be good leaders but don’t have the tools or the support they need to succeed.

Physician leaders have to forge good relationships with everybody—they might even be asked to manage their peers. What they’ve been taught to do well—taking care of patients—is really different from leading colleagues. So these folks need help learning how to lead.

What, exactly, do you teach them?

One important thing I teach them is to become aware of their audience (whether it’s frontline staff, a colleague, a patient, or an executive above them in the hierarchy)—to know who they’re communicating with, for what reasons—and frame their messaging and behavior accordingly. I help them build awareness around c-suite/executive world politics: how do they manage themselves within that environment without getting sucked into the dynamics?

A little diplomacy, maybe?

Definitely. Because they naturally tend to be resistant to the politics, and that’s actually where they can get themselves into trouble. I think it’s acculturated in the healthcare world. It’s always been that way, right?  “I’m the physician and you can’t have a hospital without me. Yet I’m not really your partner.” In my opinion, most healthcare systems don’t truly believe that their physicians are their partners— yet. But there’s an evolution underway. Doctors are more than just employees—they’re inherently partners. As a hospital, you can’t exist without them. They’re doing the work that allows you to generate revenue and be reimbursed. And physicians don’t want to be treated like employees; they want to be engaged, respected, and they want to contribute and do a really good job. They have high expectations for themselves and they don’t fail well, frankly. We have to help them succeed.

Most physicians simply don’t have the skills to or may not be empowered to manage each other. Currently, in many hospitals, the structure to manage a physician who is struggling from either a behavior or a quality of care perspective is through the Medical Executive Committee. Hospitals have created a structure that manages physician behavior from inside the walls of the hospital. But, usually, there’s nobody there to help support and teach those physicians how to show up differently.

How effective are those committees?

It totally depends on the hospital or the system. Some have built in coaching and teaching programs that are effective. But traditional internal Med Exec Committees are fairly punitive. They say, “you do this or else,” and they hold the strings. Which isn’t all that helpful in creating collaborative relationships or lasting behavior modifications.

The reality is that, for many years, physicians have been held accountable from a practice lens by the Med Exec Committee. They haven’t had to be accountable to people outside of that for their behavior. What we’re starting to see now, with chief medical officers and medical directors being put into place—now people are becoming more responsible for trying to help them learn better behavior. The Med Exec Committee hasn’t developed physician leaders or given them the opportunity to coach and teach each other. This is new: physicians are just learning how to hold each other accountable at a behavior level. We haven’t made them do that in the past.

This is not on the curriculum in medical school.

No, it’s not. And now, all of a sudden, we expect them to know how do it. But you can’t just say, “be a leader and manage your colleagues.” It’s not that simple. When frontline physicians become disruptive, there’s really nobody to help them.

That’s where we come in.

In our next issue, Pat will describe our Observation Coaching process and explain how Innovative Connections can help to address this critical gap in physician development.