Leadership Case Study

[David Joyce MD, MBA]

Good Morning everyone on this sunny Sunday here in Maryland.
I sent you a leadership case study last week and wanted to provide some follow up. The clinic in question has added screening outside the facility that includes temp measurement. It is being preformed by a med tech, not a nurse but they are using a script as a basis for the screening. . The nurse practitioners have been pulled to await the projected surge of COVID cases in the main facility. The in person and telemedicine volumes have not been reduced and will be absorbed by the physician staff. No schedule changes, they are double booking appointments.
I wanted to address a question on the leadership pretest that seems to be very commonly answered incorrectly. The incorrect answer, I listened carefully to my employees and then I made the decision. The correct answer, They do the work and I let make them make the decision. Understandably you would not follow this lead for major strategy or capital budgeting decisions. But even those decisions should be made in a democratic team environment with stakeholders representing the decision itself. The point, is that when you have an opportunity to decentralize decision making, productivity will increase. In a business sense, productivity doesn’t just mean more work happens. It is all about efficiency, quality, safety, and engagement. You get many gifts with a decentralized decision process. The Ritz Carlton, the leader in leadership process, allows each worker a $3000 budget to improve the work process without pre-approval. The result is the most engaged work force in the hospitality industry. I encourage you to read the Harvard Business Review article in the reference section of “Quality Leadership”. It describes what is so often the case in healthcare practice and what happens when quality leadership is used. It was game changing so me.
That is it today, short and sweet. You will find this case in the discussion forum if you would like to comment.
Take Care everyone, thanks so much for the time you spend with us. If you appreciate what you are learning invite a friend or colleague. Physicians controlling how the work gets done is the key to good care. But you need as many in the game with the right skills to make a difference.
Take Care
Dr. J

[David Joyce MD, MBA]

Katie Humphries

Participant

This chain of events likely led to SO much more fear and uncertainty, followed by distrust and discontent, than it needed to.  Though the crisis lends itself to an ever-changing protocol when it comes to clinical management (I think most of us can attest to this!), the way the decisions were being made, and those who were directly affected and responsible for implementing said decisions were being informed is simply poor management.  What I have learned from living through this crisis as a PRN urgent care physician, is that those IN the clinic: the providers, the MAs, the administrative staff, are the only ones who truly know how things function normally.  In this situation, time was/is of the essence, so governance by committee may not be a viable option.  However, the people making the decisions need to be those who are directly involved in implementing the changes.  This gives ownership of the protocol to the right people and reduces discontent, distrust, uncretainty and fear.

[Katie Humphries]

This chain of events likely led to SO much more fear and uncertainty, followed by distrust and discontent, than it needed to.  Though the crisis lends itself to an ever-changing protocol when it comes to clinical management (I think most of us can attest to this!), the way the decisions were being made, and those who were directly affected and responsible for implementing said decisions were being informed is simply poor management.  What I have learned from living through this crisis as a PRN urgent care physician, is that those IN the clinic: the providers, the MAs, the administrative staff, are the only ones who truly know how things function normally.  In this situation, time was/is of the essence, so governance by committee may not be a viable option.  However, the people making the decisions need to be those who are directly involved in implementing the changes.  This gives ownership of the protocol to the right people and reduces discontent, distrust, uncretainty and fear.

[David Joyce MD, MBA]

Donna Aiudi

Participant

I am the co- owner of a private practice in Dermatology. I must say this was a very trying time. I was in conflict with my partner at the beginning. She wanted business as usual. I was very concerned early on in the pandemic when it hit Italy. It was a very confusing time. We were not getting very much input form federal, local authorities or The American Academy. Many of my front staff had experience working in institutions during the SARS epidemic. I feel there I did a good job and listened to their concerns and implemented some of the processes. It became very clear as I am close to NYC that the epidemic was progressing and we decided to close for 2 weeks. Some of the midlevel providers and our aesthetician were very upset and walked out angry. Within a week it was clear that this was the right thing to do. Financially this was a tough decision but we had to stop the financial bleeding with no revenue coming in. Currently It is just my partner and I seeing most patients by telemed. I have done a few essential surgeries. Certainly not nearly keeping up with our costs. I am currently not drawing a salary. We have 2 essential admin on staff. We are continuing to cover health care. Now much of my staff is afraid to return. I am trying to slowly open up to see only essential visits in person. Very stressful time. Many sleepless nights.

[Donna Aiudi]

I am the co- owner of a private practice in Dermatology. I must say this was a very trying time. I was in conflict with my partner at the beginning. She wanted business as usual. I was very concerned early on in the pandemic when it hit Italy. It was a very confusing time. We were not getting very much input form federal, local authorities or The American Academy. Many of my front staff had experience working in institutions during the SARS epidemic. I feel there I did a good job and listened to their concerns and implemented some of the processes. It became very clear as I am close to NYC that the epidemic was progressing and we decided to close for 2 weeks. Some of the midlevel providers and our aesthetician were very upset and walked out angry. Within a week it was clear that this was the right thing to do. Financially this was a tough decision but we had to stop the financial bleeding with no revenue coming in. Currently It is just my partner and I seeing most patients by telemed. I have done a few essential surgeries. Certainly not nearly keeping up with our costs. I am currently not drawing a salary. We have 2 essential admin on staff. We are continuing to cover health care. Now much of my staff is afraid to return. I am trying to slowly open up to see only essential visits in person. Very stressful time. Many sleepless nights.

[David Joyce MD, MBA]

The solutions you suggest here have “Quality Leadership” written all overt them.  Candor and transparency should be embraced.  Decisional teams should be small but representative and if given the chance can be very nimble in response to a rapidly changing environment.  Granted there will be some delay but a decision coming from the team will have greater buy in which is ultimately what is important.  Decisions that are centrally created  are fraught with variation and work arounds are destructive.

[David Joyce MD, MBA]

Was the  decision to  close for 2 weeks made between you and your partner or was it the product of a team that had access to all of the same information as you?  What is the decision making process now and who is represented?

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