Coaching in the Upside Down World of Health Care

Understanding Team

Understanding and leading clinical and research teams is very different than leading organizational teams. Hierarchy and command and control are integral elements of medical school, residency, and medicine. Medical students learn from and are told what to do by their interns, the interns by the residents, the senior residents by the chief resident, and everyone marches to the orders and teaching of their attending. The doctors write the medical orders and the nurse’s carry out those orders. Sometimes, the attending is wonderful and a natural teacher. Sometimes, they can be rough taskmasters. Both impact the team profoundly. I vividly remember all six years of surgical trainees and all their medical students gathered in a room for a lecture by a famous and intimidating surgeon. He called on people randomly and grilled them to within an inch of their life. No one was spared and no one survived without being shamed, myself included after having gotten only half an answer right.

Hospitals are laser focused on how to re-build systems and deliver care to create greater efficiency and cut costs. As coaches know, giving commands no longer engenders willing participants, especially when those commands mean doing something differently. In teaching change leadership to physician Executive MBA students at Brandeis University, I often have to remind them that the best idea in the world will come to a grinding halt if the people doing the work don’t agree with the change. This means that to lead change, they have to build the right team with the right people and understand how to bring people along.

If you want to improve the time it takes to turnover an OR suite between surgeries, you need to think beyond the surgeon, anesthesiologist, and head nurse.  What about the OR scheduler, the environmental staff who clean the room, the techs who set-up the trays for the next surgery, and the recovery room nurse who has to be ready to take on the patient? They are all part of the process from when a surgery is completed to the room being ready for the next patient. All too often physician leaders will gather their colleagues, design a new workflow, and then be surprised when the roll out does not succeed.

Coaching physician leaders involves helping them understand the importance of engaging key stakeholders and taking the time to get buy-in. It involves coaching them to go the “Gemba” (the place where work is done); to be curious, respectful, and ask questions; and to value the collaboration of all those who are impacted by an initiative. A client once said, “I really think I need to slow down in order to go faster.” Sometimes they are overly focused on getting results and don’t pay attention to the process involved in getting there.