leadership pearls for the physician champion
DESCRIPTION
Leadership presentation given at Epic System's 2009 National User Group Meeting, September 2009TRANSCRIPT
Leadership “Pearls” for the Physician Champion
Jon Zlabek, MD, FACPGundersen Lutheran Medical Center
La Crosse, WI
Learning Objectives
• Learn the components of strong vision casting
• Improve your understanding of organizational change
• Understand the importance of strategic team structures
• Learn the importance of your leadership development
Gundersen LutheranService Area
• Clinic founded in 1891; Hospital in 1902
• 7,009 Employees ◊ 693 providers employed/434 medical staff
• 325 Bed Tertiary Medical Center
• Service area covers 19 counties in Wisconsin, Minnesota, and Iowa with 45 clinic locations
• Western Campus of the University of Wisconsin Medical and Nursing Schools
• Five Residency Programs• Minimally invasive surgery fellowship
Gundersen Lutheran Health System
Warning!Warning!Your Organization is
Unique!
Our Go-Live
• Went live on November 1, 2008: EpicCare Inpatient Spring 2008
◊ Including provider documentation
ASAP Pharmacy ADT, Registration, HIM and Billing
• Went live with CPOE February 4, 2009• Have a home-grown ambulatory system
Your Role: The Leadership Pyramid
Develop Yourself As A Leader
Lead Others
DevelopOther
Leaders
The Power of Effective Vision Casting
The Power of Vision
• Ways to “lead”: Authoritarian decree Micromanagement Through Vision
Leading Change – John P. Kotter
The Power of Vision
• Vision is a clear mental picture of what could be, fueled by the conviction that it should be
• Vision is a view of the preferred future
Visioneering – Andy Stanley
The Power of Vision
• It always stands in contrast to the world as it is
• Vision demands change
Visioneering – Andy Stanley
The Power of Vision
• Vision creates change by directing, aligning, and inspiring action
• It gives focus
• It guides and simplifies decision making
Leading Change – John P. Kotter
The Power of Vision
• Vision motivates to action, even if the initial steps are painful and require sacrifice
• A good vision has the “Eye of the Tiger” Ambitious, but attainable goals
Leading Change – John P. Kotter
The Power of Vision
• A clear, focused vision allows us to experience ahead of time the emotions associated with our anticipated future
• These emotions reinforce our commitment to the vision
Visioneering – Andy Stanley
Communicating the Change Vision
How to cast a compelling vision:
1. Define the problem – What problem is my vision designed to solve?
2. Offer a solution – Your vision is the solution to the problem.
3. Tell them why to act.
4. Tell them why to act NOW. Visioneering – Andy Stanley
Communicating the Change Vision
• Simple and clear• Stories and examples• Multiple forums• Give-and-take communication• Explain perceived inconsistencies• Repetition – let them chew on it
Leading Change – John P. Kotter
Communicating the Change Vision
• If you and those around you cannot describe the vision driving the change in less than 5 minutes AND elicit understanding and passion in the person you are talking with, you have a vision problem The elevator talk
Communicating the Change Vision
• Vision leaks!
• You must recast vision once a month or when there is a bump in the road, whichever comes first
Who Can I Blame?
• “ . . . if the followers don’t get it, it’s because the leader hasn’t delivered it. And if the followers don’t own it, it’s because we’ve not made it accessible enough to own it . . .”
• “. . . as much as we want to blame the followers, the buck stops right here . . .”
Making Vision Stick - Andy Stanley
Recommended Reading
VisioneeringPastor Andy Stanley
Selected Principles of Organizational Change
“If you don’t like change, you’re going to like irrelevance even less.”
General Eric ShinsekiU.S. Army Chief of Staff
The Basics of Change
• Change is unavoidable • The pace of change will only get
faster• Resistance to change is universal
• A quick poll . . .
Developing the Leader Within You – John C. Maxwell
The Basics of Change
You need to know:
• The technical requirements of change
• The attitude and motivational demands that bring it about Don’t blow off the psychology of change!
Developing the Leader Within You – John C. Maxwell
2% Innovators
10% Early
Adopters
60% Middle Adopters 20%
Late Adopters 8%
Laggards
Developing the Leader Within You – John C. Maxwell
Marc Wright www.simply-communicate.com
The Kubler-Ross Model
Why People Resist Change
• They didn’t initiate it and aren’t involved with the process Changing vs “being” changed
• Habits and routines are threatened
• Fear of the unknown
Developing the Leader Within You – John C. Maxwell
Why People Resist Change
• Satisfaction with the status quo
• The purpose of the change is unclear
• Change creates fear of failure
• Lack of respect for the leader They view the change according to the
way they view the “change agent”
Developing the Leader Within You – John C. Maxwell
When Do People Change?
• Leaders create an atmosphere that causes at least one of these to occur: People hurt enough that they have to
change People learn enough that they want to
change People receive enough that they are
able to change
Developing the Leader Within You – John C. Maxwell
Creating a Change Climate
• Understand the history of your organization
• Develop trust with those you are leading
• Place influencers in leadership positions and get them on board early in the process
Developing the Leader Within You – John C. Maxwell
Creating a Change Climate
• Show people how the change will benefit them
• Give people ownership of the change Ask those affected to be involved Decisions should be made at the
“lowest” level possible – those in the trenches
Developing the Leader Within You – John C. Maxwell
When Change Doesn’t Work
• It’s a bad idea• It’s not accepted by the influencers• It’s not presented well• It’s self-serving to the leaders• Too much change is happening too
quickly
Developing the Leader Within You – John C. Maxwell
Errors of Change
• Making an error of change can have serious consequences: Creation of unnecessary resistance Employee frustration Poor implementations
◊ Too long and too expensive
Failing to deliver and sustain expected results
Leading Change – John P. Kotter
Error: Allowing Too Much Complacency
• Failure to create sufficient urgency is fatal for a change process
• Leaders underestimate how hard it is to drive people out of their comfort zones
Leading Change – John P. Kotter
Error: Allowing Too Much Complacency
• Reasons for high complacency: Past success Lack of a visible “crisis”
◊ “Things aren’t that bad” Low performance standards
Leading Change – John P. Kotter
• Leaders tend to: Skip creation of urgency due to lack of
patience Underestimate the power of the status
quo Confuse creating urgency with creating
anxiety and make things worse
Leading Change – John P. Kotter
Error: Allowing Too Much Complacency
Establish a Sense of Urgency
• “Problem-Cast” – tell them why the current situation is bad Use hard data about your current clinical
shortcomings – publicize the problems ARRA HIT dollars and timelines are important,
but don’t make it the central reason
• “Vision-Cast” - bombard them with the great future, but tell them they can’t capitalize on it with the status quo
Is This Your Guiding Coalition?
Error: Failing to Create a Sufficiently Powerful Guiding Coalition
• Individuals and weak committees don’t have enough power to overcome the massive sources of inertia
• They may get it off the ground, but it quickly fizzles away
Leading Change – John P. Kotter
Error: Failing to Create a Sufficiently Powerful Guiding Coalition
• A weak committee will fail: Not enough credibility Wrong composition
◊ Too many managers, not enough leaders
• People “smell” lack of long term success and then disengage
Leading Change – John P. Kotter
Error: Failing to Create a Sufficiently Powerful Guiding Coalition
• No one individual can: Develop the right vision Communicate it broadly and effectively Remove the key roadblocks Generate short-term wins Lead and manage all the sub-projects Anchor changes in the culture
Leading Change – John P. Kotter
Create the Guiding Coalition
• The coalition needs to be powerful: Reputations and relationships Expertise Titles
◊ Assuming those with the title are strong leaders
Proven leadership capacity
Leading Change – John P. Kotter
Highly Recommended Reading
Leading ChangeJohn P. Kotter
Developing the Leader Within YouJohn C. Maxwell
The Importance of Strategic Team Structures
Physician Leadership Team
• A group of 5 specialty-diverse physician leaders who were my “Guiding Coalition”
• My “go-to” group for decisions that were too big for me to make alone; my trusted advisors
Physician Leadership Team
• I spent lots of time and asked a lot of advice from others before choosing and making the “pitch” to them
• Our group: Emergency Department Physician– 0.3 FTE General Medicine Section Chair – 0.1 FTE Hospitalist/Assoc. Director of Residency – 0.1 FTE OB/GYN Physician– 0.1 FTE Myself (Internal Med/Vascular Med) 0.5 FTE
Physician Leadership Team
Develop Yourself As A Leader
Lead Others
DevelopOther
Leaders
Physician Leadership Team
• I poured lots of leadership development time and energy into them: Read several leadership books together Discussed difficult leadership decisions Discussed potential “fires” and how to
handle them Openly discussed our leadership
strengths and weaknesses
Recommended Reading
Developing the Leaders Around YouJohn C. Maxwell
Advisory Team
• Multidisciplinary group representing Physicians and Associate Providers in every inpatient specialty
• At least one per specialty• Total of 35 people
Advisory Team
• My “go-to” group for decisions that were too big and far-reaching for the Physician Leadership Team: New Same Day Surgery flow Navigator build Smart Text content
• Most functioned as their department’s Super Users
Advisory Team
• They must be committed to the project’s success in relation to their department and the organization
• They need to have your “back” and the project’s “back” when challenged
• They will take a lot of hits for you, so be very appreciative!
Advisory Team
• We “funneled” all communication to and from their department through them Able to answer most questions in a way
their department could best understand
MD Champion sanity: 35 people asking me questions instead of several hundred
The slides that follow are some of what I presented to the Advisory Team at our first meeting . . .
Advisory Team Roles
• You must give us your input!• This is one of the high-risk areas of the
project.• Represent your department . . . they are
depending on you!
Communicate with the Implementation Team
Advisory Team Roles
• You need to tell those around you how the project is going: Must keep abreast with what is happening Plan an update at every department meeting Ask us clarifying questions as they occur
Communicate with Those You Represent
Lead By Example
• Maintain a positive attitude, even when things get rough . . . your colleagues are watching you closely
• You will be asked to be in the first wave of training and be “Super Users” so you can dispel myths and fears of your colleagues
Advisory Team Roles
Epic Super UserEpic Super User
Picture YourselfPicture Yourself
Executive Leadership
• It is critical to have Executive Leadership 110% behind the project Thankfully, ours was and still is
• In your interactions with them, remember a few important things . . .
Executive Leadership
• “Don’t surprise us” Let them know of controversial decisions
well in advance to avoid the hallway ambush
• Present likely scenarios in advance so they can process their responses What if “Dr. Jones” refuses to do XYZ?
Executive Leadership
• Full disclosure Don’t even consider anything less than
total honesty and transparency Trust is a vital commodity Your CEO should not lose sleep over
your management of this project
Executive Leadership
• Escalate issues appropriately Find your organization’s balance
between “hands off” and “micromanagement”
• Allow them to help you Present issues in such as way to allow
them to help you make the project succeed
The slides that follow are some of what I presented to Executive Leadership when requesting Physician and Associate Staff time to be Super Users . . .
Things Unique to Physicians #1
• Unlike other hospital employees, due to rotation schedules, some physicians may not set foot in the hospital for months Internal Medicine clinic-hospital docs Rheumatologists Dermatologists, etc
Things Unique to Physicians #1
• The 2 week Go-Live “Blast” of support when Epic is onsite, or even the lower level support intensity the month after Go-Live won’t help some of them
• Therefore, they are at higher risk for troubles
Things Unique to Physicians #2
• Most physicians and associate providers will use Epic only sporadically throughout the day, and in “bursts”, unlike nurses Morning rounds Afternoon rounds
• The rest of the day they live in the clinic or operating room
Things Unique to Physicians #3
• Physicians will have questions not only when they are in the hospital, but also at their “home base” – usually in clinic This is a less chaotic environment to get
more Epic support A local knowledgeable person from their
department/section is important
Things Unique to Physicians #4
• By far, physicians have been the group that struggles the most with change of this type
• A struggling physician group trickles down to negatively impact others around them (Nurses, HUCs, etc)
Creative Use of Physician and Associate Staff Super Users
• So, support for physicians and associate providers needs to: Be available for a longer period of time Be timed correctly for when they are
using Epic (rounding) Be locally available for questions when
they are not in the hospital (in their clinic)
Tips For the Physician Champion
Interactions with the Implementation Team
• You are the bridge/translator between the Implementation Team and end users You understand the clinical side already You must also have an understanding of
the technical side
Interactions with the Implementation Team
• Consider taking full Clinical Documentation and Orders training Understand the build process Feel their pain
• Be intimately involved with the build You will understand and see things the
builders won’t and vice-versa
Interactions with the Implementation Team
• Keep track of how the teams are doing to appropriately “time” your requests
• Don’t overburden them
• Give them what they can handle, when they can handle it
Interactions with the Implementation Team
• Review training materials in detail and attend several early sessions to ensure the wrinkles are ironed out Identify workflows that will be difficult
• Give the training team tips on how to handle difficult providers Setting ground rules for the classroom How to relate with “Dr. Jones”
Interactions with the Implementation Team
• Be a “thanking” machine! They are working like crazy and can’t
hear it enough
• Publically praise them whenever you can
• If a particular team is struggling, pour more into them
Interactions with the Implementation Team
• Protect your Implementation Team. Call out providers being unkind to them
• Maintain an eternally positive attitude – there will be plenty negative thoughts and fears floating around
Implementation Team
Develop Yourself As A Leader
Lead Others
DevelopOther
Leaders
Interactions with the Implementation Team
• You have a captive audience of leaders who are likely embarking on the biggest challenge of their lives
• Use this opportunity to develop them as leaders: Leadership material recommendations Large group teaching One-on-one interactions
Pure GoldLeadership Nuggets
Illustrating Principles of Organizational Leadership through the Epic Project
Jon Zlabek
Interactions with the Implementation Team
• Large Group Leadership Topics: Understanding organizational change Basic and advanced conflict resolution “Your potential exceeds your
expectations” The approach to “critics” Relating with difficult providers
Strong Relationships with End Users
• It’s culturally important to be a physician first Be in the trenches with them Know the local culture and workflows
• You must know the personalities and how they will react to changes Communicate uniquely with each person
Strong Relationships with End Users
• Listen before you react Even if you have the answer right away,
they need to be heard
• Empathize with them
• Have a contagious positive attitude Your attitude leads the way
Strong Relationships with End Users
Under-Promiseand
Over-Deliver
Communication
Don’t rely on:
• Cascading (trickle-down) communication Example – talking only at Department
Chair Meetings
• Email While efficient, it isn’t enough
Communication
• Get in front of them face-to-face in small groups at their department meetings We went to each department 5 times
Communication
• Tell them the expected “Wins” early and often (every time you present)
• Our big expected wins: Best Patient Care
◊ Safety, satisfaction, and quality
High Employee Engagement◊ Efficiency, recruitment, and retention
Decreased Cost of Healthcare
Communication
• Inform them early and often that this is an “all in” type of project – training and use. No one is exempt.
• Proactively address every excuse! Computer skills training Typing training Tons of computers for access “Page me” if you get stuck – don’t struggle
Communication
• After Go-Live, get in front of the departments again: Thank everyone for their help Focus thanks on the Advisory Team
member in front of their peers Ask for optimization requests Report on the pre/post metrics to anchor
the change in the culture
Anchoring Change in Culture
• “Culture changes only after you have successfully altered people’s actions, after the new behavior produces some group benefit for a period of time, and after people see the connection between the new actions and the performance improvement. Thus, most cultural change happens [at the end, not at the beginning].”
Leading Change – John P. Kotter
How We “Connected” the Change to the Improvement
• Mortality• Length of Stay• ED Throughput• OR Start Time• Patient Satisfaction• Documentation Audits• Medication Events
• Lab and Radiology Utilization
• Professional Charges• Paper Savings• Transcription Savings• Implementation
Savings
Don’t forget the “Soft Wins”!
The slides that follow are some of what I presented to departments before Go-Live . . .
DeepDeepThoughtThoughtss
bybyJON ZLABEKJON ZLABEK
Go-Live Expectations
• The Go-Live process will be a HUGE thing Get ready for a wild ride, baby
• All of the benefits from this project WILL NOT be seen in the first few weeks-months
Go-Live Expectations
• There will be bugs to work out
• Believe it or not, we’re not going to catch everything in the thousands and thousands of decisions we have to make
Please be patient!
We Are ALL Leaders . . .
Leading By Example
• Maintain a positive attitude, even when things get rough Go-Lives of this magnitude can get
“bumpy” . . . expect some difficulty Medical and non-medical staff are watching
you closely and taking cues from your reactions to change
Whether you like it or not, you are a role-model
We Are ALL Leaders . . .
Communication is KEY!
• Please read and keep abreast with what is happening Department meeting updates Talking with your Advisory Team Rep Bridges (our weekly newspaper) Medical and Associate Staff E-Newsletter GLadiator Link (our intranet)
• Ask us clarifying questions as they occur
A Normal Part of Big Change
• People tend to experience different emotions at this stage of change in a big project like this . . . Excitement Concern, worry, fear . . .
• These are normal!
Keep Perspective . . .
• Thousands of organizations are using electronic health systems
• Hundreds of organizations are using Epic• They succeeded.
• Some of the reasons we’re in great shape . . .
Keep Perspective . . .
• Epic’s inpatient system has been consistently rated #1 by customers Many other hospitals are working with
lesser-rated vendors
• The Epic Inpatient 2008 version has many new features to streamline care and make our lives better Other hospitals using Epic have paved the way
for improvement to our benefit
Keep Perspective . . .
• We will be the first hospital to Go-Live with “partial dictation” Other hospital’s MD/PA/NPs need to type a lot,
or else dictate all the notes
• We have been using an electronic medical record for over 10 years in the clinic A lot of other places were still on paper when
their hospitals went live
We Will Prevail
• There is absolutely no doubt in our minds that we will have overwhelming success during Go-Live
We Will Prevail
• However, we need to stay on track and work together: You will need to be focused during
training There will be a learning curve There will be tweaks to make along the
way Patience please . . .
Engaging Everyone
• Everyone who “touches” hospital and Emergency Department patients must participate for success
• Administration is 100% behind the policy of everyone being engaged
Training
• Training details: Please arrive on time and be free of
patient care duties (ideally “pager off”) Training is not the time to question or
challenge workflows ◊ Write down your questions and ask me after
class
Please be respectful to your trainers!
Physician Champion Tips At Go-Live
Physician Champion Tips At Go-Live
• Lots and lots of caffeine• Lots and lots of sugar
You should easily burn off more than you can ever consume!
• Have a fresh pager battery at all times!
Physician Champion Tips At Go-Live
• Be on the go and in the trenches
• Put out fires immediately
• Go to the command center only: For food To resolve burning issues To check on the Implementation Team
Physician Champion Tips At Go-Live
• Carry candy – the cure for many a stressed-out end user
• Carry relevant tip sheets and other support material with you to hand out
How I Addressed Resistance
• First of all, do your best to prevent resistance: Strong, clear vision communicated
repeatedly Administration that is solidly behind you “Nip it in the bud” when you first hear
about it – Have great spies
How I Addressed Resistance
• Second, LISTEN PATIENTLY Let them fully vent NEVER strike back at this time Top quote from a surgeon:
◊ “His/her behavior stinks, but that’s how a surgeon asks for help”
How I Addressed Resistance
• Third, remember your role (protect your sanity) “Going electronic was a board decision –
I’m just the implementer” “I didn’t invent Epic” “I am not the Epic police – I can’t punish
anyone for bad behavior”
How I Addressed Resistance
• Third, remember your role (protect your sanity) “There is a defined escalation pathway
in place for your concerns. I’ll be happy to guide you if you wish”
Second best quote of the project: ◊ “Epic isn’t meant for the older docs who are
ready to retire, it’s for the next generation of physicians”
How I Addressed Resistance
• Lastly, work your butt off to teach them and fix things Offer help immediately – this resolves
most lower level resistance right away “Under-Promise” and “Over-Deliver” Follow up with them to let them know
you are still working on a solution and/or what the resolution is
The Importance of YOUR Leadership Development
The Leadership Pyramid
Develop Yourself As A Leader
Lead Others
DevelopOther
Leaders
• Success in current and future environments depends on your competitive drive and lifelong learning
• You must intentionally and continually develop yourself as a leader Don’t even consider “winging it”
Leading Change – John P. Kotter
Leadership and Lifelong Learning
Who’s Gonna Pay?
• If you are not willing to pay the price of developing yourself as a leader, your people will pay the price of your poor leadership
• Who is gonna pay the price?
The Way of the Shepherd – Leman & Pentak
Who is ultimately responsible for
YOURYOUR leadership
development?
Foundation of Leadership - Trust
1. Integrity Honesty Congruence – walk the talk Humility - quick to apologize & forgive
2. Intent Pure motives Mutually beneficial agenda Act in the best interest of others
The Speed of Trust – Stephen M.R. Covey
Foundation of Leadership - Trust
3. Capabilities Know and use your talents and skills Keep up to date
4. Results Take responsibility for results, not just
for “trying” Communicate the results “Beginners are many; finishers are few”
The Speed of Trust – Stephen M.R. Covey
Recommended Reading
The Speed of TrustStephen M.R. Covey
speedoftrust.com
A Leadership Development Plan
• Form solid trusting relationships with those around you, then:
1. Lead something2. Read everything you can on leadership
– leaders are readers3. Attend leadership courses/conferences4. Learn from leaders better than you –
get a leadership mentor
Highly Recommended Reading
The 21 Irrefutable Laws of LeadershipJohn C. Maxwell
Epic – Home Life Balance
• Awesome wife and kids!
Epic – Home Life Balance
Your career is a 30+ year marathon, not a sprint
Take a step back and look at the big picture . . . What matters most?
Leave work at work
Family comes first
Epic – Home Life Balance
Movie recommendation about this issue:◊ “Click” with Adam Sandler – stresses the
importance of “Family Comes First”◊ The modern day movie version of the song
“Cats in the Cradle”
Epic – Home Life Balance
• I did my very best to avoid taking work home, and when I was getting crushed, tried to do it early AM or late PM Worked very hard to compartmentalize
my two worlds Personal policy:
“Taking work home will be uncommon”
Epic – Home Life Balance
• Took strategic blocks of time off: After big bursts of project intensity Times that the Implementation Team
needed me less Took more than a day off at a time Pager free – pushed every work thought
out of my mind
Epic – Home Life Balance
• I actually grew in other critical areas of my life that helped keep me going:
Improved my spiritual life◊ One tends to experience the need for divine
intervention more in projects like this
Improved my physical conditioning with a few triathlons last year and now in training for a marathon
My Top Leadership Lessons
• Your career is a 30+ year marathon, not a sprint; Leave work at work – family comes first
• Never rely on cascading communication
• “Under-Promise” and “Over-Deliver”
• Your guiding coalition and initial structure set-up are critical – take your time and get it right
• Your leadership development is the key to your success – be a “student” of leadership
“It ain’t an easy job, but when you bring a couple thousand
Gundersen Lutheran employees through
implementation, and you ain’t lost a one of them . . .
Ain’t a feeling like it in the world.”