And what you can do to be a better one yourself I've interviewed more than 35 physicians who were referred to me as "good doctors." Nearly all of them said they went into medicine because they like science and want to help people. None of them told me, "I want to be a successful businessperson." Medicine is big business, in a transformational mode, with metrics-as-proof. Patient safety, quality of care, and teamwork are all on the productivity and performance "control panel." My observation from coaching more than 140 physician executives is that communication, feedback, trust, and psychological safety among patient care team members make the difference between high-performing and not-so-high performing teams and lead to fewer patient deaths and errors. Communication Patient handoffs are a dangerous time. One study published in the New England Journal of Medicine says 30% of medical errors can be reduced by more effective oral and written communication. The authors recommended an oral handoff process, such as I-PASS (Illness severity, Patient summary, Action list, Situational awareness and contingency planning, and Synthesis by receiver). Based on my observations, three factors get in the way of effective communication. First, there's hierarchy. Medicine is built around increasing status with age and experience. Attending physicians may be unavailable to oversee handoffs. Residents, interns, and medical students all have their places in the hierarchy. Second, we don't know what we don't know. One example is intent and impact. The two members of a physician-administrator leadership dyad I coached didn't communicate with each other. This toxic relationship affected the entire organization, resulting in workarounds and missed opportunities. As I coached both of them, separately and together, I learned the "bad blood" between them went all the way to their first meeting, when one had a positive intent in speaking to the other, who interpreted it as a criticism. I asked for permission to share this in our group coaching session. They were both surprised, and that was the start of a more functional relationship. Third, as physicians, we're focused on getting to the answer. We're "fix-it" people, not trained in systems thinking. One of the hardest lessons for me to learn was that not everyone appreciated my "brilliant" solution. In working with others, it's often more effective to wait until you're asked to help. Feedback Most of the feedback we give and get in medicine is the "gotcha" type: blame and shame. Most of the errors are from systems failures, and it's hard to move to systems analyses when we're pointing fingers at others. What's necessary is a clear-eye, non-judgmental assessment. For example, Navy SEALs after-action reviews ask five questions: What were our intended results? What were our actual results? What caused our results? What would we do the same next time? What will we do differently? One of the surgical teams I coach asked this same litany of question reviews after each surgery, in a safe, non-blaming environment. It took some work and gentle facilitation. But they found it useful, and now all the surgeons in this organization use it. What would your specialty group, operating team, or small practice gain from consistent use of after action reviews? Collective Intelligence It turns out that two (or more) heads really are better than one -- but only under certain conditions. Researchers at Carnegie Mellon and the Massachusetts Institute of Technology found that a group's collective intelligence (the ability of the group to perform a wide variety of tasks, or the c-factor) correlates with the average social sensitivity (individuals' ability to perceive, understand, and respect the feelings and viewpoints of other group members), distribution in taking turns to speak (more evenly distributed = higher collective intelligence), and the proportion of females in the group. The c-factor is NOT strongly correlated with average or maximum intelligence of group members. Higher social sensitivity leads to increased trust and psychological safety -- critical for high-functioning teams. I've observed in my coaching work that when working in groups, physicians and others are more open with each other about their real feelings, communicate openly and listen effectively, and have more satisfied team members, resulting in fewer medical errors. What Can You Do? First, be curious about how skills outside diagnosis and treatment affect your group, your patients, and yourself. Second, take a course on effective listening and ask for feedback. Third, ask your colleagues specific questions about becoming a more effective leader and follower. What could you do more of, less of, start doing and stop doing? And always remember the patient. The surgical "time out" is the last step in the Universal Protocol, occurring just before the incision is made, to confirm patient identity, surgical site, and the planned procedure. During a recent surgery, I heard the anesthesiologist say "Sweet dreams," followed by "Time out" from the surgeon, then a team member saying her name. The next I knew I was in recovery. Hearing "Time out" for me, a physician, reassured me the surgical team was following safety procedures, as I was being given a general anesthetic for my first-ever surgery. Finally, follow the advice of Atul Gawande, MD, and get a coach. Source
