Executive Coach Helps Physician Adjust to Life as Medical
Director
The skills that had served Dr. Adler so well in his medical practice
didn't help him much in the managed care business world.
By Alan G. Adler, MD, MS
(from Managed Care Magazine)
Sometimes you don't know what you don't know. In the mid-1990s, I
left my job as division director of general internal medicine at Hahnemann
University School of Medicine in Philadelphia. I welcomed the challenges
that would come with my new position as medical director (currently,
I'm interim chief medical officer) at Horizon/Mercy, an HMO for the
publicly insured in New Jersey.
Executives
have often used coaches
to extend their skills
By Val Williams
The way that physicians are trained
is very effective for many environments: private practice,
hospitals, interactions with students and patients.
However, once a physician joins the staff of a managed
care organization as a medical director or chief medical
officer, he may find that his personal "winning
formula" doesn't work anymore. Corporations have
hundreds or even thousands of employees, and the physician
may find himself dealing with policies and procedures,
competitive peers, office politics, negotiations, and
downsizing.
Business coaching has been an
important tool for senior corporate executives for
a long time.
Typically, "business coaches" or "executive
coaches" work with high-level executives to develop
leadership skills that focus on such things as strategic
planning, conflict management, and staff performance.
A business coach teaches a physician
how to play the game of being a successful corporate
executive. Physicians are used to being the final authority
with their patients. They are trained to be confident
and take responsibility for decisions. Corporate executives
also value authority, but it is often based on title,
power, or influence.
So how does a physician master
the business skills required for corporate success?
Coaching is about skill development, so the physician
creates specific goals and, with the coach's help,
actually practices new skills on the job so that results
are measurable.
Typical skills that physicians
learn include strategy development, conflict management,
staff oversight, time and stress control, performance
evaluation, alliance building, power leveraging, and
executive presentation skills. These skills allow physicians
to contribute better to managed care organizations
as they become successful corporate executives. |
Yet I had little inkling of what some of those challenges would be
and how my medical training had left me unsuited to respond to them.
This became evident from the moment I sat in on my first business
meeting in 1995, where the focus was on reviewing financial reports,
profit and loss statements, balance sheets, strategic plans, and quality
programs.
When I expressed my point of view, I didn't just leave it at that.
I explained it, rephrased it, then explained it again just to make
sure that everybody really understood.
This, of course, is the way many good physicians deal with patients
because we know that people often don't hear things the first time.
My CEO at the time took me aside and
said: "We heard what you
said the first time. We heard it the second time. We even heard
it the third time."
He said he wanted clear, concise, "lasered" presentations
-- right to the point. The assumption was that you had done your
homework -- long explanations were generally not required.
Many physicians who are considering
career moves into the business arena mistakenly believe that, compared
to clinical medicine, being an executive will be "easy."
While clinical medicine is certainly difficult and challenging, large
numbers of physicians have failed to make the transition to the business
world due to a fundamental lack of skills -- and they are truly shocked
by the difference between the reality and their preconceptions.
My CEO was aware of this disconnect, and he suggested that I could
use some executive coaching. I welcomed the help. The way I saw it,
even the best tennis player in the world has a coach. No matter how
good you are at something, you could still benefit from the objective
advice of an expert.
The higher up you are, the fewer people
you have to really talk to, whereas in clinical practice, "sidewalk consults" with
peers about a difficult decision, case, or issue are common. Objective
expertise may not be as readily available in a business hierarchy.
Every other Tuesday
Every two weeks, usually on Tuesdays at 2 p.m., I speak to Val Williams,
my executive coach. During our first conversation (in person, other
meetings via telephone) we conducted an inventory of areas where I
could benefit from coaching.
These included business skills such as how to do proper and useful
performance reviews; approaches and language to deal with difficult
issues with a boss or someone who reports to me; and getting buy-in
without being repetitive. She also taught me how to get important feedback,
run a successful committee meeting, and use conflict-resolution skills.
Val keeps me focused on the fact that every clinical issue also has
a business side. If I want to start some program, I have to make a
business argument for it.
Whenever we discuss an issue, Val
redirects me with the questions: "What
is the business issue here? How does this have an impact on the
business?"
We also talk about specific problems
that I might be having with specific people. Then the question is: "What's
the best way to handle this?"
Again, medical training can't help here. Physicians manage themselves
well but manage people poorly. They're deficient in giving feedback
and tend to ignore bad behavior.
Of course, this is not unique to physicians -- many, if not most people
who are promoted to managerial positions due to their technical or
clinical expertise, face the same difficulty.
Val and I go over various options and strategies. Then, the next time
we talk, I tell her how the specific strategies had worked out.
Performance reviews
Executive coaching probably has helped me the most relative to doing
performance evaluations. I believe they present some serious challenges
to physician executives. Doctors like to be liked; they want to be
patted on the back. They enjoy recognition and try to avoid giving
critical feedback. They have not been trained to do evaluations. Again,
this is true of many professionals, not just physicians.
Executive coaching has helped me develop the skills to do performance
reviews. I have come to realize how crucial it is to provide fair coaching
and feedback to people who report to you, so that they can improve
their skills, and be more productive, which also benefits the company.
Part of this is structuring a development plan for each individual.
Expectations need to be clearly understood. This needs to be done on
an ongoing basis, not just once a year -- the review should never come
as a surprise.
I have sat in on innumerable medical departmental or staff meetings
where the same issues were complained about and rehashed for months
or years, without any attempt to establish a plan to deal with them.
Now, I identify specific issues, establish action plans, and set deadlines
for improvement. This is something that I had always been weak at and
that, I believe, physicians in general do poorly. Those kinds of things
never got done in my whole experience in an academic center.
Another big area where executive coaching paid off for me is in running
committees. That's a challenge because you have different people with
different agendas. You always have some people who are more vocal.
How do you keep them from drowning out the less vocal members? The
challenge often is to get some people to listen more. Another strategy
here is to ask specific committee members to give feedback to an individual.
I've also learned that good managers manage those above, as well as
below, them. If I'm not happy with something my boss has done, how
do I handle that? There's a whole lexicon that I needed to familiarize
myself with.
For instance, I learned to avoid "you" language. Val told
me that too many people barge into somebody's office and start saying "You
did this" and "You did that."
Of course, the other person immediately gets defensive. If you're
managing people that way, you're going to have a lot of unhappy employees.
In addition, if you use that language with your boss, you may find
yourself out of a job.
There are better ways of expressing
dissatisfaction. For instance, you can say, "At the meeting I felt that my voice wasn't really
heard. Can you suggest how I can present myself better at a meeting?" Or, "I
think you run the meetings very well, but this situation came
up. I felt a bit uncomfortable. I'd like to discuss it with you. Maybe
you can help me work through this."
Just the phrasing helps you to manage
somebody higher up when you're unhappy. As opposed to "I want to do this" and "I want
to do that," the business rationale must be presented. It may
be of individual benefit, but ultimately it has to make business
sense.
It doesn't come easy.
Because most doctors tend to be Type A personalities, they are generally
quite compulsive, work extremely hard, and strive to become efficient.
Even so, they have not learned how to manage people. They tend to work
much better alone than in a large, hierarchical organization.
Moreover, the many management courses that are available do not, for
the most part, prepare someone for the day-to-day issues that will
come up. I have been quite fortunate to work for a company and chief
executive officers that have recognized the importance of management
and leadership training.
Having an outstanding coach has been invaluable in learning to solve
problems and deal with some very difficult situations. She is a person
I can count on to be supportive and help me look at complex problems
from different points of view. Most importantly, I believe that our
company has derived substantial benefit as a result.
Alan G. Adler, MD, MS, is the interim chief medical officer at Horizon
Mercy and a member of Managed Care's editorial advisory board.
