Kendall L. Stewart, M.D. 

Why are physician leaders hesitant to do this?

We physicians are a fairly opinionated lot. We have invested many years convincing ourselves and others that we are special. We know what’s best. We are all above average. We are the experts. If we don’t know it, it’s not worth knowing. We rarely make mistakes. When a mistake occurs, it is almost always someone else’s fault. And we feel very strongly about all of this. If you don’t believe it, just question us and watch now arrogantly most of us will respond.

What is the case for doing it anyway?

Emotional arousal is blinding. It is hard to think clearly when you are angry, fearful, hurt or embarrassed. Moreover, people pick up on how you feel. You cannot hide your feelings. And the people around you will react instinctively to how you feel. They may attack, defend or retreat into stony silence, but they will not take risks or offer creative solutions. If you remain emotionally detached and genuinely curious, they are much more likely to speak to you honestly about what they think and feel. The pool of available options will deepen as a result.

How can you do it?

1. Recognize the problem. Most leaders believe that their negative emotional arousal is both justified and motivating. It is neither. It is a leadership failure.

2. Recognize your own arousal. This is not as easy as it sounds. Strong feelings erupt without warning and trigger problematic behaviors before we even realize we are aroused.

3. Do not act on your feelings. Keep your mouth shut until you calm down. Never click “Send” while you are still upset.

4. Help others recognize their arousal. They are no better at seeing themselves objectively than you are. Offer to consult with them about their arousal if they will do the same for you.

5. Ask clarifying questions. “Might we be overreacting?” “Should we sleep on this?” “Are we allowing our emotions to blind us to other options?”

How have you observed physician leaders improve the decision-making process by remaining detached and curious?

Kendall L. Stewart, M.D. 

Why are physician leaders hesitant to do this?

Once leaders decide what they want to do, they naturally switch to the selling mode. They want to hear from those who agree with them—from those who disagree, not so much. Leaders with made-up minds are reluctant to wake sleeping dogs. Like every other committed leader, they want to achieve their objective with the least effort required. They don’t want to take heat. Partisans do not welcome dissent. Soliciting feedback is hard work. It takes time. And inviting others to criticized your proposals is unpleasant.

What is the case for doing it anyway?

Most people want to express their opinions or at least be invited to do so. Not everyone will contribute. Those who do would prefer that you do exactly what they say, but everyone recognizes that decisions must eventually be made. They understand they will not always be happy with the result, but they will be a lot less unhappy if they are consulted before the final decision is made. Real leaders welcome dissent, respect it and use it to achieve their goals.

How can you do it?

1. Decide who the stakeholders are. Every decision affects someone. Take a few moments to figure out who will be affected and who might like to participate in the decision-making process. Even those who have no real interest in offering an opinion are usually pleased to be invited to participate in the process.

2. Invite input appropriately. Present the issue in a way that invites stakeholders to consider the case for and against their point of view. This even-handed approach will remind even the most opinionated to respect contrary perspectives.

3. Value data over emotion. Make it clear that while you welcome any and all opinions, you will give preference to evidence-based recommendations when making the final decision.

4. Clarify who is opining and who is deciding. This is not a mystery. The people who are signing the checks are deciding. Everyone else is opining.

5. Set a deadline. Do not let the arguments go on forever. Endless discussions always turn repetitive and personal. You can never know everything you need to know.

6. Make the best decision and move on. Whatever you decide will sometimes turn out to have been a mistake. When that happens, make another decision and move on again.

How have you observed physician leaders solicit input from stakeholders effectively?

Kendall L. Stewart, M.D. 

Why are physician leaders hesitant to do this?

Confrontation is hard. Because it is so unpleasant, most of us avoid it. Because we avoid it, we allow ourselves few opportunities to get better at it. And because it is hard and we are not very good at it, we avoid it. And so it goes. Like everyone else, we leaders spend most of our lives avoiding discomfort.

What is the case for doing it anyway?

If everyone read your mind and automatically did exactly what needed to be done while behaving respectfully and responsibly, you would never need to confront others. Has that been your experience in life? Inappropriate behavior is inevitable. Conflict is the result. Confrontation is the only way to deal effectively with these challenges while pursuing exceptional organizational results.

How can you do it?

1. Set realistic goals. No amount of confrontation will transform jerks into nice people. Focus on the one or two behaviors that must change.

2. Prepare. Do not confront others by the seat of your pants or when you are angry or poorly prepared. Take the time to think through exactly what you intend to say, how you intend to say it and what you expect to accomplish.

3. Make notes. Effective leaders do not attempt to wing these crucial conversations. Explain that you have made notes because this conversation is important and you want to make sure that you cover all of the important points.

4. Do not argue or get sidetracked. Ask the person you are confronting to listen without comment until you are finished. Promise him the same courtesy when you are finished. Deliver on that promise.

5. Document the confrontation. We all hear and remember what we want to hear and remember. Clarify your position in a letter.

6. Proceed to the next step. Confrontation is just one step in the process of holding others accountable. Painful as it is, you must follow confrontation with continued accountability or your efforts will have been wasted.

How have you observed physician leaders confront their colleagues successfully?

Kendall L. Stewart, M.D. 

Why are physician leaders hesitant to do this?

There are a number of barriers to reaching the best-possible decisions. The data needed to make decisions is seldom perfect or complete. Emotionally aroused leaders are inclined to jump to conclusions before considering all of the alternatives. Just like everyone else, leaders are strongly inclined to take the easy way out and go along with the crowd. Faced with painful options, leaders may be paralyzed by the fear that their decision will be unpopular. But the most common reason leaders are hesitant to make the best decision is that they have not followed a thoughtful and rigorous decision-making process.

What is the case for doing it anyway?

You cannot avoid making a decision forever. You will never have all the data you need. You will never be able to fully trust the data. No matter what you decide, someone will criticize you. The only reasonable approach is to make the best-possible decision you can and then move on. If your decision turns out to be wrong, just make another decision. Leaders don’t have to be perfect. They just need to learn and improve. That may sound easy. It’s not.

How can you do it?

1. Take time to figure out what the problem actually is. The issue everyone is upset about is frequently not the real problem at all. When it’s time to make a decision, ask yourself what problem you are trying to solve. Ask whether this is the real problem. Making the right decision about the wrong problem is not that helpful.

2. Consider your options. Remind yourself and your colleagues that emotions are blinding. People who are aroused cannot see all of their options. Ask detached observers to help you identify your options. These dispassionate consultants will invariably think of options you failed to see.

3. Examine the pros and cons for each option. Leaders skip this critical step all the time. It is tempting to rush to judgment. Impulsive leaders just want to do something, anything. Going with your gut is overrated. Other leaders prefer to discuss options endlessly, fearful of doing the wrong thing, inviting criticism or not being liked.

4. Invite all interested parties to weigh in. Giving people a chance to express their opinions is never a problem and sometimes produces ideas or solutions you would have otherwise overlooked.

5. Announce your decision and get on with it. If new information arises, you can always reconsider and decide something else.

How do you make the best-possible decisions?

Kendall L. Stewart, M.D. 

Why are physician leaders hesitant to do this?

Every leader admits that building and maintaining an organizational culture of integrity is essential in theory, but the emotional price is steep. You have to tell the truth. You have to take the same position publicly and privately. You have to do what you say you will do and admit it when you are wrong. It is much easier to tell people what they want to hear, to enter into secret agreements and to avoid speaking on the record. It is easier to blame others. It is easier to hold your cards close to the vest. It is easier to cut secret deals while reassuring yourself that’s what everyone does. Every leader aspires to be a person of integrity. Not every leader is willing to pay the painful price on which that reputation is built.

What is the case for doing it anyway?

The people you serve will figure out pretty quickly whether you are a person of integrity or not. If they conclude you are not, you are finished as an effective leader. You may hold on to your leadership title for a time, but no one will take you seriously. You will not be a player. Few of us intentionally aspire to be empty suits, but there are more than a few of those around. Is that the way you want your professional life to turn out?

How can you do it?

1. Choose the reputation you want to build. Look around. There are real life examples of reputable and disreputable leaders in your own work environment. You know who they are. Choose your role models carefully. You will likely turn out to be the kind of leader you look up to.

2. Make a list. Do some practical research on integrity. Write down how leaders with integrity behave. Be specific and detailed. Post your list of requisite behaviors so you will see it every day.

3. Listen critically to all sides before taking a position. The urge to jump to accommodating conclusions when powerful complainers come calling is strong. Resist it.

4. Beware the secrecy trap. When people ask you to hold something they are about to say in confidence, stop them right there. Make it clear that you cannot agree to confidentiality beforehand. Actually, nothing a leader says or does is secret for long.

5. Do the right thing. You will usually know right away what the right thing is. It’s the hard option that you would rather avoid.

What exactly do you do to build and sustain a culture of integrity?

Kendall L. Stewart, M.D. 

Why are physician leaders hesitant to do this?

We all want people to feel, act and behave the way we want them to. If they would only do that, we would feel better about them—and ourselves. People not only disagree, they are sometimes disagreeable too. The leader’s first impulse is to change them. We often persist in these futile efforts while knowing we have no chance for success. And to make matters worse, we allow ourselves to become frustrated when we fail. Many leaders view frustration as both an entitlement and a gift. It is neither.

What is the case for doing it anyway?

If you focus on understanding and accepting others instead of trying to change them, they will be much more open to your point of view. And you will likely discover some unexpected common ground. That will provide a foundation for further discussion and compromise. And you will be a lot less frustrated in your work.

How can you do it?

1. View your rising frustration as evidence that you have missed the point. When you are focused on accepting others as they are, curiosity replaces frustration as the accompanying feeling.

2. Ask clarifying questions. Avoid the inclination to confront, challenge and openly disagree. Resist the urge to make pronouncements and sweeping generalizations.

3. Acknowledge the reasonableness of others’ positions. After all, if you were in their shoes, you would think and act exactly as they do.

4. Ask them to identify the weaknesses in their cases. Most physicians are critics by nature and cannot resist the challenge to attack the prevailing wisdom even when it is their own.

What strategies have worked for you in accepting others as they are?

Kendall L. Stewart, M.D. 

Why are physician leaders hesitant to do this?

We are all the same. We tend to focus on weaknesses and take strengths for granted. If you received 20 positive comments during your evaluation and two negative ones, you will find yourself ruminating about your perceived shortcomings. That’s because you want to be perfect and you want everyone to love you. While you recognize this is patently ridiculous, you can’t help yourself. It’s the way human beings are wired.

What is the case for doing it anyway?

The effort you and others expend in trying to overcome obvious weaknesses is mostly wasted. The time and energy you spend in improving your strengths will pay much better dividends. If you discover weaknesses that actually interfere with getting the job done, these things will have to change, but most personal shortcomings are more annoying than disabling. Simply admitting these quirks openly, asking for others’ patience and finding colleagues whose strengths can compensate for your weaknesses is enough. When you think about it, changing your entire personality to suit every person you interact with is an unrealistic goal anyway.

How can you do it?

1. Figure out what your strengths and weaknesses are. Ask your immediate superior to conduct a facilitated 360-degree evaluation of you. She will invite the twenty or so people you work most closely with to tell her what they perceive as your key assets and shortcomings at work. It would be nice if people would be honest with you themselves, but they won’t.

2. Look hard at the recurring perceptions in this evaluation. They won’t surprise you. You may be surprised that your colleagues see through you so clearly.

3. Admit your weaknesses freely. Always begin your efforts to persuade your colleagues with a frank admission of your perceived shortcomings and ask them to look beyond those. Everybody appreciates honesty.

4. Stop ruminating about your shortcomings. This mental tendency to fret pointlessly and destructively will sap precious time and energy that would be better invested in productive mental effort.

5. Focus most of your energy on your strengths. This approach will allow you to become even better at what you already good at. And it will offer a healthy distraction from the rumination that cripples so many leaders.

How have you successfully encouraged your colleagues to focus on their strengths instead of their weaknesses?

Kendall L. Stewart, M.D. 

Why are physician leaders hesitant to do this?

First, we think we already know what others expect. Second, if they don’t expect that, we believe they should. Third, we are much more concerned about what we expect than what others expect anyway. Such arrogance is not confined to physicians, but we have taken it to a new level. These baseless assumptions are at the root of most failed communications. Here is the simple truth. We cannot read our colleagues’ minds very well. We should stop trying.

What is the case for doing it anyway?

Taking the time to complete this step in your conversations with others will increase your odds of communicating successfully and persuading your colleagues to join your cause. Instead of listening dispassionately, many physicians are thinking about how ignorant, selfish or wrong the other speaker is. Resisting your natural tendency to devalue any view that is different than your own will not be easy. After all, you are certain that you are right. Thankfully, this defensive certitude diminishes a bit as you get older. The only thing you will be sure of later in your life is that you are not sure.

How can you do it?

1. Face the reality that you cannot read other people’s minds. Every leader makes this mistake. You will too. Recognizing this tendency will give you a chance to overcome it. If you realize that clarifying others’ expectations is an essential step in every communication, you will remember to do this at least some of the time.

2. Create a simple communication checklist. Post it in plain sight. Refer to it or repeat the steps silently to yourself during your listening phase. We physicians don’t tend to listen to others very long before we burst in with our questions and pronouncements. One study concluded that physicians listen to their patients only 23 seconds before redirecting the conversation.

3. Ask clarifying questions to make sure you understand. Even when you are certain you know what your patient or colleague expects, take time to make sure. They will appreciate the effort.

4. Ask them whether you understand their position correctly. Summarize what you’ve heard. Ask whether there is anything else they want you to consider before you take a position or make a decision.

5. If possible, resist the tendency to respond on the spot. Ask for time to reflect and consider. This will decrease the odds that they will conclude your mind was already made up and that you were just going through the motions when you sought their point of view.

How do you clarify others’ expectations?

Kendall L. Stewart, M.D. 

Why are physician leaders hesitant to do this?

We don’t like checklists. We think they are dumb. We are smart people and we know what to do. We are special. We should be able to do whatever we feel like doing. Sure, we sometimes forget things and make stupid mistakes, but the people who support us are supposed to catch those. Genius cannot be bothered with details. And after all, perfection is God’s business. We all want to feel special and we will believe and do almost anything to convince ourselves that we are. But comforting delusions can be deadly.

What is the case for doing it anyway?

Check lists are not dumb. They are smart precisely because they are simple. Checklists are not designed to cover every action the leader needs to take, just the essential ones. Smart leaders use checklists because they recognize their value at keeping everyone focused on the critical steps in the process even when distractions abound. And distractions abound everywhere and all the time.

How can you do it?

1. Educate yourself about the science behind checklists. Read The Checklist Manifesto: How to Get Things Right, by Atul Gawande. You can get this book here.

2. Identify the checklists that have made the biggest difference in your organization. The smartest leaders have already put checklists to good use. Find these leaders and their lists. Learn from them.

3. Promote the use of evidence-based order sets. All physicians have created a set of mental templates to fall back on for the routine things they must do to respond to a particular diagnosis. Recognizing that they cannot possibly keep up with the emerging evidence for the best treatment for the disorders they treat, the exceptional physicians have long since adopted computer-generated order sets based on the latest scientific findings. These are nothing more than sophisticated checklists.

4. When you come across a process improvement opportunity ask yourself and others whether a checklist might be a part of the solution to the problem. Put “consider a checklist” on your problem-solving checklist.

How have you used checklists to decrease errors in your organization?

Kendall L. Stewart, M.D. 

Why do physician leaders find this hard to do?

Every physician leader believes she communicates effectively. And everyone else disagrees. It’s not that leaders don’t wish to communicate effectively. It’s that communication is so dependent on needs and perceptions. If the people you are trying to communicate with have no interest in hearing you at the moment, they just ignore your message. Don’t take this personally. You do the same thing. There is no other way to cut through the message clutter and get through your day. And a lot of people ignore their email and expect an individual conversation at their convenience. Then there is the need for repetition. You talk until you are sick of hearing yourself talk. You are convinced you have communicated to every stakeholder twice. But you missed more than a few important folks. And they feel left out because—they were.

What is the case for doing it anyway?

Effective communication is critical to your mission. Good intentions are not enough. The failure to communicate is the most common grudge people hold against their leaders. While you may be better than most, you are far from perfect and you still have a huge opportunity to improve. Just accept this as a fact. Keep trying harder.   

How can you do it?

1. Get your message down. Cut the verbiage to the bone. Concentrate on telling people only what they need to know, not everything you want them to know. Speak to their needs, not from yours. Find an emotional hook if you can.

2. Design a comprehensive personal communication process. Decide when you will call, when you will meet, when you will send an email message. Send text messages. Use social media. Write letters and notes. Generally speaking, the way people communicate with you is the way they want you to communicate with them. Make rounds. Make communication individual.

3. Stick to a schedule. Decide who you will communicate with every day, every week and every month. Inform everyone of this schedule and then do it.

4. Welcome questions. Thank others for bringing rumors to your attention. Invite clarifying questions after every attempted communication.

5. Accept the blame for every communication failure. If you do not accept responsibility for a problem, you cannot fix it. You forgot to include a key stakeholder. Your message might have been clearer. You might have found a more effective way or chosen a better context. You might have worked harder to prevent misunderstandings. You might have dampened your emotional arousal more and thereby confused the message less. Apologize and mean it. It was your fault.

What effective communication strategies have you observed and used? What communication challenges have given you opportunities to learn and improve?