When your Best Doctors Go Quiet – an Ominous Sign: Part One

When your Best Doctors Go Quiet – an Ominous Sign: Part One

Sometimes a confluence of events comes together in a strange way. This was one of those weeks.

Author: Robert A Felberg MD

Topic: Conflict management, Negotiation, Physician leadership

Keywords: difficult discussion in the workplace, how to manage a team, employee silence, medical leadership.

First–  Richard Thaler wins the Nobel Prize in economics. Richard Thaler has long been a hero of mine. If you don’t know his work, he basically showed that humans are not rational economic agents, in opposition to what was first proposed by Adam Smith. It’s his work that led to the change in retirement funding where people are automatically signed up into their 401ks and have to opt out. I’ve been advocating the findings of Thaler and others like him as a leadership and marketing model for years.

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[Editor Note: physician leadership is a complex skillset. This post is part of a series produced by physician advocates LLC and Medical Success Central discussing physician professional and business skills– the things you weren’t taught in medical school, but define your career success. Please sign up for our newsletter to be kept informed.]

Second- I hear about a disappointing interaction from one of my colleagues with the upper leadership at their institution. My friend tells me they are implementing a new Antibiotic Use policy. There is mandated educational class prior to implementation.  An email goes out to the staff, “Everyone must sign up for a class. So far, only 15% have signed up. If you don’t sign up, you’ll be suspended, etc.” Knowing the findings of Thaler, my friend sent an email recommending that everyone be assigned a date for training with the option to reschedule. That will get everyone past the first step and have 100% assigned. After a professional exchange discussing Thaler’s work in education, finance, and medicine she got a disheartening response: “I’ve launched five Antibiotic Programs. How many have you launched? We’ll ask you for advice when we want it.” Can you believe it? And yet, so typical of the poor leadership that dominates the field of medicine, even at the highest levels.

Third- This article on candor in the workplace is published in the WSJ. Being able to be honest without being penalty is one of the most pressing problems in medicine. Jack Welch, the former CEO of GE was one of the leading proponents. What do we mean by candor? The ability to honestly discuss failures, problems, and even personality issues- in a professional manner-

without facing backlash or career harm.   In medicine, it’s often the case that the we are silent over the big glaring problems and verbose about the meaningless ones. The honest are usually “whacked”, while the meek get promoted. Physician leaders are especially guilty of this- the people below you are discussing problems they have with current policies. Since the leaders set the policies, they are in the firing line. If their egos are bruised easily, they respond with oppression rather than discussion.

Which gets me to my point. How you deal with your thought leaders and change agents defines your success.  Maybe, you weren’t interested in an idea sent your way. The smart reply would be along the lines of “Thanks for your input. You raise some great ideas. It’s too late to use them now, but I could really use somebody with your interests on the Antibiotic stewardship committee.”  Now the ball is in my court. If I was talented and motivated, this would be a big break for me and the leadership could add an interested and vested team player. If I’m not competent, I’d screen myself out. Instead, I have now gone silent. I will not offer any new innovations, even if directly asked. I ‘ve learned the penalty of giving advice- I get “whacked”.  When your best people go silent, you’re in trouble. My friend called me looking for a reference- she knows that she is smarter, works harder, and can get treated better somewhere else, all with a bigger paycheck. The administrator who sent the email reply described above probably thought himself witty, but it was a very costly response. Chance are, if you lose a top-performing employee it’s because of poor leadership.

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In part two, I’ll discuss what I call my Physician Leadership Credo.  Certainly, there are a lot of excellent books, courses, and seminars on Physician Leadership- I’ll just share my own style. In the meanwhile, consider the role of employee silence in the harm of your healthcare organization’s success, how well your organization encourages candor, and consider joining us for the Negotiation and Professional Skills for Physician Seminar.

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What do you think? Have you left a good job because of poor leadership? Do you work someplace where you can be honest without fear of reprisal? What is your leadership credo? Share your thoughts in the comment section below.

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