Interview with Pat Samples by Holly LeMaster

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.

Innovative Connections offers support and inspiration through our experience and expertise in culture, leadership, and organizational development. We know that highly effective organizations exhibit strengths across five areas: leadership, decision-making and structure, people, work processes and systems, and culture. Organizational effectiveness is about each individual doing everything they know how to do and doing it well; in other words, organizational efficiency is the capacity of a team to produce the desired results. This pyramid reflects the importance of the foundation of relationships, building to the mission of the organization, to achieve organizational effectiveness.

David Quiqley, M.S.W, PHR, Board-Certified Coach

By David Quigley

While running errands recently I had the opportunity to be in and out of several local businesses. I was greeted as I entered the bank, then the tire shop, again in the coffee shop, and the convenience store. This is a common experience nowadays, as most businesses make it a point to greet customers as a routine part of their sales or service approach. In your personal experience, is that personal greeting effective, or not?

I’ve spent much of my career in customer service, focusing the past several years in the healthcare world (where customer service is referred to as “patient satisfaction” or “patient experience”). In high-performing healthcare organizations there is an evidence-based practice which, in my view, other businesses (including retail) could emulate to up their games significantly. I refer to this approach as “connect, then sell (or serve, or provide care).” Let me explain.

A colleague referred me to an article titled “Connect, Then Lead” which, among other things, documents the merits of making a genuine human connection before proceeding with the business at hand.¹ This approach can have many benefits, including:

• Reinforce the importance of the relationship between staff and leader
• Move away from “command and control” leadership to more of a “collaboration and communication” style, thus increasing involvement, engagement, and productivity
• Develop staff members’ thinking from renter to owner mentality

One of the key ideas I took away from this article is the opportunity to expand the concepts beyond a leadership model to a broader customer service model:

• Connect, then sell (in a retail setting)
• Connect, then serve (in a service setting)
• Connect, then provide care (in healthcare)

Here’s a great example. In the tire shop, they hollered my name from across the showroom: “Mr. Quigley your car is ready!” It was polite and effective. Yet, how much more pleasing would my experience as a customer have been if the technician had "closed the gap" by walking across the room to me, making eye contact, and telling me, “Mr. Quigley, your tire service is complete and you can get back on the road safely and with confidence again.”

This technique of closing the gap, making eye contact, and using key words is something my physician’s office does well. They look me in the eye, greet me warmly, then walk with me—not ahead of me—down the hallway to the exam room. This approach is intended to acknowledge the person, make a connection, and inform with relevant information, all of which is aimed at building trust and reducing anxiety.

Patient experience survey data has proven that these simple steps make a difference in customer satisfaction (i.e., patient experience). National surveys and research demonstrate that, in addition to clinical competence, patients (healthcare customers) appreciate compassion, empathy, and being treated as individuals. These practices, when carried out sincerely and effectively, raise the level of service that the patient/ customer experiences. Thus the “connect first” concept has merit.

I really, really enjoy, appreciate and am alert for good customer service. I tip accordingly, give compliments, and send notes of appreciation when appropriate. So I would be a huge fan of other industries embracing the “patient/customer centered care” model that my doctor’s office team has learned to execute so well.

¹Cuddy, Amy J.C., Matthew Kohut, and John Neffinger. "Connect, Then Lead." Harvard Business Review 91, nos. 7/8 (July–August 2013): 54–61.

Martin Luther King, Jr., said, “I have also decided to stick with love…Hate is too great a burden to bear.”

Why is hate so harmful?  I think all of us know the answer, but do we realize that hate actually causes physiological and mental harm? Neuroscience in the last 20 years has made amazing discoveries by studying the brain and how it functions. By watching different reactions while using the fMRI, they have discovered the neuropathways that flow to different parts of the brain and how those pathways create our reactions and responses to the world around us and the world within us.

One of the biggest takeaways for me, from a purely beginner’s perspective, is that we all have a first response that is usually negative. There are reasons for that and mostly it’s because it helped us survive in prehistoric times. I’ve heard that we are using prehistoric brains in modern times. What this creates is a tendency to stick with beliefs even when the scientific data clearly proves differently.

How do we live our highest values and become better than we’ve ever been before? It is simple, but it won’t be easy. We will have to make a concerted effort from the inside out. We will have to be willing to change our minds about many things that come easy to us. All too often, they are supported by our negativity bias and the way it’s been done for a long time.

Some suggest breathing and coming back to the present moment as a cure. I concur. A process that I have used and often teach, formulated by Elisha Goldstein, PhD, co-founder of The Center for Mindful Living, is called STOP. I use it when my thoughts and emotions start spiraling to a place of negativity bias and my old way of reaction takes hold. This can be the path of least resistance, but it usually leads to the burden of hate/disconnection/ fear, etc.

Consider STOP

S- Stop and recognize that something is occurring. This sometimes takes a mindful awareness.

T- Take a deep breath--maybe 2 or 3 deep breaths. This can ground you to this moment, move you from the sympathetic nervous system response of “fight/flight/freeze” to the parasympathetic nervous system response of “tend and befriend.” It helps unwind the nervous tension.

O- Observe what is going on in your body.  Where are you feeling the physiological response?  Now what are your Options. You get to decide at this moment if you will react or respond.

P- Pause and consider: is this the best time to react? Would it escalate and perhaps create regret or get the results you are hoping for? Maybe you need time to let go. Or Proceed, realizing you have it under control and you can respond in a way that represents your highest choice and desired outcomes.

We are in a time of choice and change worldwide, as well as personally.  We are all holding our own ticket for the way we will go. I am convinced it all starts from within. Where do our values and heart lead us? Can we stick with love and translate it into the world around us? Of course, we can. As Gandhi says, “We must be the change we want to see in the world.” And as I say, it must start from within. We really can change our minds.

It is that time of the year that many of us will review the year that is ending.  This year I choose to do it with a gentle touch of non-judgment of my own foibles and those of others.

It is also a time of looking forward, to imagine what the path of the new year will be. Last year my word, work and theme was “Courage”.   I was embarking on many new opportunities and quite honestly, I was pretty nervous.  Armed with a mantra of courage, I soon found you gain courage by doing and through experience your expertise emerges.  Thus, competence cures the fear and you no longer need courage because it is only needed when you are afraid.  Not that I still don’t have my fears, but by courageously naming them in confidence, I recognize them and use the energy to move forward.

This year my word, work and theme picked me.  While sitting on the front porch on Christmas morning, as the rising sun slowly illuminated the early morning sky I realized that I choose to see, hear, think and feel beyond the human conditions.  But how?  By INSIGHT.  That “still small voice” within.  That clear channel to my innate wisdom and my guiding light.

I heard one time why it is called the “still small voice”.  It is because by not listening to it, we keep it still  small.  The wisdom beyond understanding is another way to think of it.  But how do we hear it?

In today’s very busy, media focused, over stimulated, full of judgment modern world the only way I can imagine to unplug is by giving myself permission to slow down, be silent and allow a peace to permeate my body and mind.  I do this by spending 20 minutes a day in silent meditation.  My meditations are focused on breathing in and out of my nose and feeling the cool air on the inhale and the warm air on the exhale.  My focus is good for one or two full breaths.  That is an improvement.  A year ago, I couldn’t make it through the first inhale without my mind wandering. The purpose is to notice when you have lost the awareness of your breath and bring it back, no judgment.  There are numerous neurological benefits but simply said, it helps rewire your brain from “fight/flight/freeze” to “tend and befriend”.  It teaches us how unruly our thoughts can be and that we are not our thoughts.  Dan Millman says, “You don’t have to control your thoughts, you just can’t let them control you.”

In my desire to live a wise and loving existence, to lead from the inside out, I am supported by this simple practice.  So, this year my word is INSIGHT.   I need to be quiet enough to hear (that still small voice) and brave enough to live what I hear.