BUZZ! e-Newsletter: April 2016
We are pleased to present the April 2016 edition of TLD Group Buzz, a free e-newsletter for our clients and consultants, distributed to subscribers quarterly. This edition includes TLD Group News, a Partner Spotlight, as well as brief summaries of cutting-edge issues and trends impacting executive assessment, development and organizational transformation.
As organization development consultants, seasoned executive coaches and academicians, TLD Group’s team strives to weave the latest trends in OD and HR into our customized client solutions.
Should it be considered a problem if 30-50 % of physicians are experiencing signs of burnout? What if I said 30-50% of airline pilots were experiencing angina and, given what we know about heart disease, if untreated, a majority of them will have heart attacks while working?
As reported by Medscape, that’s exactly the state of the burnout epidemic in healthcare today. Unfortunately, the prevailing approach to burnout is rooted in traditional stress management, focusing only on individuals modifying their stress reaction, i.e. their “coping.” I believe a radically new two-pronged approach is needed. The first prong is geared toward helping the physician not only manage their stress response better but also systematically identify what they can work on changing within their own world. The second prong is geared toward helping groups and entire organizations both incorporate “stressee management” and introduce collaborative focused problem-solving and systematize this into a comprehensive “total stress management” approach.
Approaching Stress from a "Human Systems" Perspective
When 30% of a functional segment of an organization has problems, whether designated by their particular role (e.g. ICU nurses) or by the work focus (e.g. all those who take care of severe trauma in the ER), it is necessary to look at what is causing that problem for those 30% and recognize that this is not simply a “coping deficiency” problem.
Stress overload leads to burnout because the jumble of stressors and the accumulated toxic load of negative emotions (e.g. anger; worry; pain; sadness; shame) become so overwhelming that one doesn’t have enough psychological energy or “mental RAM space” to sort it all out. We tend to approach the stress storm as though it is one big black cloud. The more high-intensity and high-stakes outcome the job is, the more susceptible one is to burnout. Fair to say, it doesn’t get higher stakes than dealing with treating people’s illnesses and injuries and working to save their lives.
It’s also vital to understand that burnout is not a binary phenomenon. Comparable to illness, it exists on a continuum of severity from “doing okay” to “wear-down” to “burnout” and even to a state beyond burnout I call “meltdown,” depending on the intensity of each of the three indicators: fatigue, detachment and reduced accomplishment.
Why Does This Matter?
Burnout erodes our body’s and mind’s coping reserves and bankrupts our emotional bank account. Of course, burnout is a problem for the professional experiencing it. It’s bad for your job and career and for patient care because you’re not performing at the top of your game. It’s debilitating and, like depression, impairs one’s overall quality of life and negatively impacts your relationships, professionally and personally.
But it’s not just an individual problem. In a group setting, as a doc becomes less functional, patient care suﬀers and the quality of the group is impacted, with possible ramifications on the group’s reputation. The physician is not as reliable, and as he or she becomes less functional, may become a liability to the group. Burnout could become so severe that the physician may not be able to be on call and could even be compelled to drop out of the group, leaving the group hanging for call and necessitating emergency replacement.
Further, a physician’s burnout is a huge problem for the organization. That physician becomes less functional as a part of the healthcare team; the quality of the team is impacted, with possible ramifications on overall team’s function. Patient care may suﬀer and cause a significant liability. As a key member of a healthcare team, the physician could be compelled to take leave and require the team to re-train and re-enculture a new physician leader. Burnout does little for team morale and impedes a team or department’s best work. And there is considerable lost productivity and the concern about ongoing sub-par performance.
And, obviously, burnout a problem for society as a whole. The costs of training a physician are immense and there is a chronic shortage of professional medical resources. A burned out doc is a loss to one’s entire patient population.
The Remedy Is Decidedly Not "Stress Management" Per Se
The early approach to burnout like that of stress management was that it approached burnout as an individual stress coping problem – some incapacity to deal with the stress that others in similar circumstances apparently could handle. In other words, burnout was predominantly seen as indicative of individuals’ coping mechanisms, i.e., falsely implying that they simply had some deficiency in the means by which they handle stress that everyone else was apparently handling quite fine. Therefore, as the stress management industry grew, its exclusive focus was in teaching these presumably deficient individuals how to better manage their stress, i.e. learn better “coping” mechanisms. This was then extended prophylactically to all employees for them to learn how to cope with their stress in general so as to prevent the meltdowns that were occurring in these select few. There seemed to be a mistaken assumption implicit here that one can’t really change the external causes of stress; that one had to accept these as a given, and therefore the only thing you have control over (if that) is your own reaction to stress.
But, if burnout is aﬀecting 30% of a segment of your workforce, is it really a failure of coping? When the incidence of a disabling stress syndrome like burnout rises to 30% to 50% of a segment of the workforce – whether it be ER physicians, nurses, social workers, internists, teachers or ministers – one begins to realize that this is not a matter of “insuﬃcient coping” but rather an indication of significant stressor overload particularly aﬀecting certain segments of the work population.
How Can We Best Approach It?
We need to address and modify what’s causing burnout. In attempting to understand what causes burnout, you’re going to discover that there is seldom a single root cause but rather a matrix of causality, unique to each individual. Therefore, one has to ask “if it is not the deficiency of the individual, why is this happening?” In regards to professional “people work” fields like healthcare, there is a unique array of particular stressors which aﬀect each individual, some of which may be shared stressors impacting the larger group.
The Stress Biopsy
I invite people to do their own “stress biopsy” which is essentially an inventory of all the things that are causing them stress – both professional and personal.
For example, a stress biopsy might include an amalgam of many stressors such as: work overload; demanding patients; pending litigation; giving bad news to patients; bureaucratic tasks tying up so much time; unrealistic administration expectations (e.g. emphasis on patient satisfaction scores); inappropriate intrusion into clinical matters by administrator or by insurer – the list goes on.
If you were to do an “aﬀect load” for each of these, you’d see that each is laden with multiple negative emotions (e.g. anger, sadness, worry, shame, pain) which drain the emotional bank account. Stressee management practices help stop the hemorrhage and serve to replenish that bank account. While each stressor is “manageable,” both in terms of “coping with” and solving, when all jumbled together and packed tightly, they become both emotionally depleting and immobilizing. We then have a tendency to experience these as one giant unmanageable entity. This is why detailed problem disarticulation is so important. It’s vital for us to “tease apart” this stress storm in the same way that a surgeon must patiently tease apart tissue.
By doing this sort of “stress biopsy” and clustering the stressors in smaller chunks, one now has a concrete way of focusing on one – or a common cluster – of stressors and developing a strategy to actually resolve the problem itself, not simply settle for a better way to “cope.”
The Solution: Organizational "Stress Biopsy" and Stressor Management
I believe that what’s called for is a triple initiative towards developing a Total Stress Management system:
- Helping physicians (and all other care providers) individually understand stress and burnout and learn how to manage their stress reactions better (“stressee management”) and how to identify and prioritize what they can fix within their own sphere (“stressor management”).
- Bringing it to the group practice/departmental level and designing a program to manage their stress, and developing an approach as a group for conducting their own “stress biopsy” and systematically tackling the key stressors they’ve identified.
- Making it an integral part of organizational functioning by enabling the whole organization to put forth a concerted approach to managing stress, preventing burnout and cooperatively identifying key stressors that the organization can collaboratively work on and resolve.
For those who are inclined to say “a Total Stress Management approach can’t be done, it’s unrealistic,” perhaps they need to understand that such a mindset keeps them and their organization hopelessly mired in an ultimately self-defeating stress quagmire. And it’s clear, the more physicians, nurses, team leaders and managers stay in stress overload and develop burnout, the more hobbled and less productive the organization becomes. It’s not a matter of whether you’re going to develop such a Total Stress Management approach, as there really is no other choice. It’s a matter of when and how to best implement it.
Kernan Manion, MD, is a TLD Group Senior Consultant who specializes in coaching and consulting on career burnout and organizational collaboration in healthcare and other “people services” fields. He is a well-received facilitator and keynote speaker. All initial coaching sessions and consultation discussions are complimentary and provided confidentially and without obligation. He can be reached at firstname.lastname@example.org.
TLD GROUP UPDATES
TLD Group News
APLA™ is TLD Group’s customized leadership development program designed to develop physician leaders who inspire change and improve health system performance. APLA™ is grounded in our research-based physician leadership success model, focusing on development in four leadership clusters: leading self, leading others, leading for results, and leading change. The multidimensional program utilizes our unique experiential learning approach which engages participants to develop their leadership skills through interactive learning modules, assessment and coaching, and on-the-job project work. We are pleased to present the video vignettes with some of our APLA faculty of nationally-renowned experts and thought leaders across the healthcare spectrum. To see more videos, see our Faculty Videos page.
Stephen Beeson, MD
Larry McEvoy, MD, FACEP
Amy Edmondson, Ph.D.
Louellen Essex, Ph.D.
April Video Blog
We are pleased to share our video blog on strategic succession planning in which we describe our work with a client on creating a deliberate and systematic approach to ensure leadership continuity in key positions, retain and develop human capital for the future, and encourage individual advancement.
Our partnership with Palomar Health in Escondido, CA beginning in 2013 is featured in this month’s Frontiers of Health Services Management. Through our customized Applied Physician Leadership Academy© (APLA™), Palomar successfully transitioned to a dyad model of leadership.
“We were so fortunate to find The Leadership Development Group (TLD Group) to help us on our journey to design and launch a customized leadership academy for physicians, nurse leaders, and administrators. TLD Group worked with us to align our efforts with best practices in the field, provided consultation that enriched the overall and design, and connected us with fantastic speakers. In fact, we decided to incorporate TLD Group’s physician leadership competency model and Applied Physician Leadership Academy© (APLA™) components in our design (including learning modules, coaching and assessment, and experiential learning through project work). It’s not often that consultants really appreciate the nuances of organizational culture; TLD Group was able to align with our culture and organizational readiness to help us design a customized high value, high impact program.” -- Leslie Solomon, VP, Culture and Talent Planning, Palomar Health System.
On June 23, 2016, TLD Group APLA Advisory Board Member, Larry McEvoy, MD, and TLD Group President & CEO Tracy Duberman, PhD will be presenting a webinar for AHA’s Physician Leadership Forum, entitled “The Impact of Emotional Intelligence and Resiliency on Health Care Performance.” Attendees of this webinar will learn the essential link between emotional intelligence and resiliency on sustainability and leadership and organizational performance. The webinar will also share key skills required for building resiliency amid our complex healthcare environment. Click here to register for the webinar.
TLD Group President & CEO Tracy Duberman and TLD Group Senior Consultant Kathy Bernhard presented a webinar entitled “A New Rx for Board Succession” for the New Jersey Hospital Association (NJHA) trustees on April 14th. Trustees learned how to assess their Board’s composition strengths and risks and were provided with best practice strategies for effective Board succession. Click here for a link to the presentation.
LEADERSHIP DEVELOPMENT TRENDS
How refreshing it is to see the recent positive shift toward filling CEO openings with internal candidates rather than external hires. The Wall Street Journal recently reported that in 2015, 4 out of 5 S&P 500 companies promoted internally – a major increase since 2012. The question regarding whether to hire an insider or search externally has been a long-standing issue for companies for quite some time. Yet in his Harvard Business Review article, “More Insiders Are Becoming CEOs, and That’s a Good Thing,” Joseph Bower notes what many of us always suspected. Internally-promoted candidates are more successful than external hires.
When an external candidate is hired for a CEO position, he/she essentially enters the company blind with little knowledge of the company’s daily operations and is not familiar with the strengths and capabilities of their new workforce. Outsiders tend to impose their own beliefs about what is “best” for the company without truly understanding its culture, often leading to lower employee morale. Furthermore, much of the organization’s time, money, and resources is then spent on training and development to get the new hire “up to speed” on how the business is run. On the other hand, when an insider is promoted, he/she has intimate knowledge of the organization’s internal workings and have first-hand experience with how the company deals with challenges in the industry.
Why have companies in the past failed to promote from within? Often it is because they have felt their workforce lacked strong internal candidates. However, a lack of candidates may be due to a more deep-seated issue: these companies may not have invested the time or effort to develop high-potentials to one day lead the company. The best thing an organization can do to ensure strong successors is to identify internal candidates who have a well-grounded understanding of the company’s ins and outs, and who also demonstrates the potential to fill the CEO role through targeted development.
Please contact us for more information about how TLD Group incorporates these strategies in our succession planning services.
“Soft skills” are often under-appreciated in leadership development, however, emotional intelligence has emerged as an increasingly important skill to be successful in today’s modern workplace. People with high emotional intelligence have an acute awareness and understanding of the emotions manifesting both within themselves and others. By definition, emotional intelligence is the ability to use and manage emotions, which is particularly important in interpersonal situations.
John Rampton, in his article featured on Inc.com, outlines 10 qualities that are relatively consistent across highly emotionally intelligent individuals. These qualities can be developed through focused attention (see next article “Simple Steps to Make Positive Change). They include:
- Flexibility. While many people have perfectionist tendencies and feel the need to make sure tasks are done precisely and in a particular manner, this could lead to set-backs and hinder progress. Emotionally intelligent individuals understand that things don’t always go as planned and are able to adjust their behavior in the face of obstacles.
- Work-Life Balance. All work and no play leads to high stress and low health. People with high emotional intelligence know that the most effective way to be productive at work is to take care of your personal and emotional well-being. When you take time to take care of yourself, you’ll find you’re more refreshed and eager to put your mind back to work.
- Embrace change. People often have the tendency to shy away from change, which undeniably hinders progress. The workplace is ever-changing and emotionally intelligent people know how to flexibly adapt to change.
- Empathy. This is a critical component of emotional intelligence. Empathy is the ability to relate to others, which becomes useful when interacting and working with others.
- Positivity. Emotionally intelligent people don’t get hung up things that have passed that they no longer have the power to change. Instead of focusing on what went wrong in the past or blaming others for getting in their way, these people choose to see the positive. This allows them to be more constructive and objective rather than pessimistic.
- Knowing your limits. People in the workplace very often become overwhelmed with work, typically resulting from putting too much on their plate at once. Emotionally intelligent people know what they’re capable of and know when enough is enough. It’s okay to say “no” if you’re beginning to feel burnt out.
Please contact us for more information about how TLD Group incorporates these strategies in our coaching and assessment services.
Why is it that change is so hard? Time and time again, whenever people make an attempt to make a positive behavior change, they often fall short. In his article in Talent Management Magazine entitled “How to Initiate Positive Behavior Change,” Marshall Goldsmith outlines four approaches to help make proactive steps toward effective behavior change:
- Behavior change will not occur instantaneously. It takes conscious self-driven effort. This may sound daunting, but the best way to approach behavior change is to think of it as an opportunity to embark on a journey of self-invention. Who do you want to be? Keep an end goal in mind as you take marginal steps toward becoming that person.
- Making a behavior change does not mean you have to change everything about yourself. Take some time to dig deep and consider what aspects about your behavior you feel proud of and believe you are doing well. Find ways to maintain these behaviors, but be careful not to become stagnant. Even if your goal is to become a “better you” it’s important to praise yourself for valuable aspects of your current self that are worth holding on to.
- The opposite of preservation of behaviors is elimination. There are undoubtedly a number of behaviors you could stand to lose. Start by identifying some behaviors that are either holding you back from further improvement or are hindering your progress. By eliminating these behaviors and preserving those which serve to your benefit, you’ll be well on your way to making steps in a positive direction.
- Certainly creating, preserving, and eliminating feel like active steps towards positive behavior change, but another crucial step is to be accepting of the times when we are unable to make the change we had hoped for. Goldsmith appropriately notes that “business people can’t help equating ‘acceptance’ with ‘acquiescence’” but it’s important to remember that acceptance of that which we cannot change is a crucial step to behavior improvement. If we become caught up trying to fix things that we simply are not able to, we will quickly become discouraged from trying to make changes in ways of which we are capable.
Please contact us for more information about how TLD Group incorporates these strategies in our coaching services.
Best in class talent development is anchored in job specific competency models based on the characteristics required for high-performing employees. Competency models go beyond a simple job description and include the essential skills, knowledge, experiences, and behaviors required for success in a particular job/role. A well-conceived competency model sets the standard to make objective talent decisions and development plans for the position(s) for which it is built.
According to Jim Graber’s article in Talent Management, “The Case for Competency Models” there are three classes of competencies that must be considered when building your competency model: core-level, functional, and job-families (the abilities, skills, and proficiencies that are required for success on the job).
A competency model should be customized based on the organization’s needs and values. When designing your competency model, consider the following:
- What are your organization’s goals, and how can the competency model be designed to be aligned with those goals?
- What is the purpose of the model, and how will it be used? Will it be used for hiring, promotions, training, or otherwise?
- What competencies are most important to your organization? Behavioral, technical, and interpersonal competencies are just a few of the many examples.
- How will the competency model be communicated to employees upon its development? Your employees should be informed about what is expected.
Competency models are an outstanding tool to drive strategic talent management decisions. These models help define what is most important for job performance, and reduces ambiguity about what your company is looking for from its employees.
Please click here for more information about how TLD Group can help your organization design competency models through our organizational development consulting services.
What determines whether or not we will trust someone? Business consultant Cynthia Olmstead outlines the “ABCD” aspects of trust:
- Able: Whether the person is capable of delivering on the results that they purport to provide.
- Believable: Our confidence in the person’s sincerity.
- Connected: How well the person relates to and works with others.
- Dependable: Whether the person demonstrates that he/she has followed through on promises and commitments.
Strategic management professor at Utah State University James Davis adds two other drivers of trust to this list: benevolence and integrity. Benevolence is the degree to which we feel that the other person actually cares about us and is not making promises driven by self-serving motives. Integrity is the degree to which this person shares similar values.
Even when a leader has demonstrated all these drivers of trust, he/she may still have difficulty gaining the trust of some of his/her team members. Why might this be? Plain and simple, trust is a two-way street. Even if a person has clearly demonstrated that he/she is trustworthy, others must be willing to accept the trust. This can be very difficult because trusting someone means allowing oneself to become vulnerable.
What can be done to win over those who are resistant to trusting a leader? Hoff suggests that creating a culture of risk-taking within the organization is an effective strategy. Taking risks on low-stakes opportunities (i.e. encouraging team members to voice their opinions during team meetings) helps to desensitize people and make them more willing to take larger leaps. . Trust can then be built by providing praise, when appropriate, to demonstrate that their opinion has been heard and appreciated. Small steps such as these will lead even the most defensible employees in the direction of trust, so long as the leader continues to demonstrate that they have deserved it.
An organization built on a culture of trust undoubtedly will realize great success because decisions will be made based on mutual respect and interdependence.
Please contact us for more information about how TLD Group incorporates these strategies, in our coaching and team building services.