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Are You an Intentional or Unintentional Leader?

Does Your Team Always Bring Their ‘A’ Game?

How many times have you heard ‘Are great leaders born or created?’ And of course we can and have debated that question over and over for years. But for those of us dermatologists working in our practices, caring for our patients, it’s the wrong question – the real question is ‘Am I an intentional or unintentional leader?’

No matter what we do or say, no matter how effective our practice manager or administrator, our staff look to us as leaders. Clinical and administration staff will always take their lead from the physicians on staff. It is, therefore, down to each of us to decide – am I an intentional or unintentional leader? And to those of us who don’t want to be seen as a leader, who answered ‘I’m am unintentional leader’ the message is clear – your staff see you as a leader anyway!

What this means in reality is that your staff look to you as their leader by example even if you don’t think you outwardly exhibit the traits and behaviors of a leader. Your behavior and attitude set the example for your practice, and in doing so establish the culture for your practice. The culture in the practice is exhibited by the behaviors and attitudes of the staff and is keenly felt and experienced by your patients – without us realizing or noticing that it is happening.

We read constantly about the ‘patient experience’ and, as clinicians, we have strong focus on the patient’s diagnosis, treatment plan and outcome. We often overlook the proven connection between the patient’s experience and the quality of the patient’s outcome - patients who have a great experience are always more engaged in their treatment, leading to better outcomes. The patient experience starts with a referral from primary care or family medicine, or a phone call for an elective procedure. Maybe a friend has recently had a cosmetic procedure and your patient is curious to learn more. The way the initial telephone call is handled is the beginning of the patient experience and sets the tone for any subsequent interaction between the patient and your practice. The challenge we face is simple – every patient EXPECTS to have a great experience through-out their course of treatment, at every touchpoint with any of your staff. It only takes one miss-step by one person in the chain to ruin the good work by everyone else who touches that patient, resulting in an overall poor experience for the patient.

In the Dermatology Business Accelerator business community, we have a series of business rules, one of which is particularly relevant to this issue, and that is ‘Face reality as it is, not as you wish it were’. As clinicians we have a tremendous empathy for our patients and that empathetic demeanor often times results in us avoiding confrontation. We would prefer that our staff work together and we hope that difficult issues simply go away. However, difficult issues don’t go away, they fester and ferment until they are addressed. One reality that we have to face is the absolute requirement for our staff to have a professional relationship with everyone in the practice, contributing to the culture of the practice and resulting in your team bringing their ‘A’ game to the office every day.

You surely have a number of standard operating procedures in your practice, covering everything from recording information into the electronic health record to preparation for surgical interventions. You expect your staff to follow these SOPs because the efficiency that is gained by eliminating variances, and thus eliminating wasted time and re-work, is simply good clinical and business practice. Do you also have SOPs that cover behavior? When you set goals and objectives for your staff it is essential to set clear and firm expectations for behavior and demeanor for your staff. Team members with a bad attitude simply cannot be accepted in the team, not even the high-performers, and it is a core responsibility for us as leaders, intentional or not, to address and resolve these issues.

The starting place for behavioral goals is to set a framework for everyone to abide by, that gets circulated to everyone and posted in the staff lounge. A great idea is to have everyone, including the physicians, sign the poster on the wall as a commitment to the behavioral expectations and as a commitment to each other. Those goals might include:

  • We commit to respect each other and to support each other

  • We will always greet our patients with a smile and positive eye contact

  • We will always introduce ourselves to our patients and give our name

  • We will always explain to the patient our role and set clear expectations

  • We will answer questions and ensure that our patients understand

  • We will have patience and tolerance with each other

  • We will not engage in gossip or sharing rumors about each other

  • We will bring concerns and problems to the weekly staff meeting to discuss and resolve

A great way to establish these behavior standards is to debate and agree them at a staff meeting. In this way everyone has the opportunity to contribute suggestions, debate suggestions and to ‘buy-in’ to these expectations. This is a key step to expecting the staff to make the personal commitment to respect and adopt the behaviors required.

Probably someone will raise a question during the staff meeting as you discuss behaviors. The question is invariably along the lines of ‘Why do we need to do this when we’ve been working just fine for the last number of years?’ A strong recommendation is that your requirement for introducing behavior standards is just one piece of a bigger project, and that project is all about the Patient Experience. With reimbursement now reflecting patient satisfaction scores, not to mention the critical importance of positive social media posts by our patients, we should be focusing our staff on the patient experience and shame on us if we are not.

There are three more strong recommendations for physician leaders as the new behavior standards are introduced and implemented:

  1. Employ the power of enthusiasm. Enthusiasm is infectious and when your staff see you enthusiastically embrace the behaviors standards they will follow your lead

  2. Engage with your staff every day. Take an interest in the work they are doing; ‘round’ the office once or twice each week to recognize something that has been done well and simply to thank your staff for their work

  3. Employ emotional intelligence – treat each person as an individual and interact with each member of your team in the way that the employee is most comfortable. For example there are the confident and positive staff who relish being recognized in your weekly staff meeting, and then there is the more reserved, understated employee who appreciates a quiet word of privately. Knowing the employees who need an ‘arm around their shoulders’ and those who relish a challenging conversation is the key.

Without clear behavior standards and expectations it is impossible to hold your staff accountable for upholding those standards. Once these behavior standards are established, committed and published, physicians – be they intentional or unintentional leaders – must be the first to exhibit these behavior standards, because the staff will be watching and will take their lead from their physicians. They will also be watching to see if you tolerate behaviors that fall below the expected standards.

The way that you address any employee who falls short of the expected behavior standards will define how well these standards will become engrained into the culture of your practice. There are three tips for the best way to address anyone who is falling short:

  1. Confront the issue immediately, don’t wait until tomorrow or next week. When there is a free minute, take the employee aside for a private conversation. Explain the behavior short coming that you have witnessed and give the employee an opportunity to comment and/or explain. A good example is when you hear someone being disrespectful to a co-worker. Take that person aside and say ‘I need to speak with you about the way you spoke with ………. Tell me why you made the comments that you did, why you rolled your eyes and were so dismissive?’ When you have listened to the response, you need to request that this style of communication not be repeated. Comments such as:

  2. How do you think that made ……… feel?

  3. How would you feel if I communicated with you in that way?

  4. If you have a real concern or problem with …………. address it directly with them and work out a solution in a respectful way

  5. I need you to not repeat this style of communication – do I have your agreement that this is inappropriate in our team? (Use the language ‘I need.…’ rather than ‘I would like….’ or ‘Please….’ to add emphasis that you are serious about requiring the change in behavior.

  6. Reinforce with the employee that he/she is a valued member of the team and that you have confidence that the short coming will not be repeated

  7. Conclude your brief conversation with a reinforcement that the behavior standards are expectations, to be followed every time, and are not optional

This style of coaching is the perfect way to raise the behavior of all of your staff to the expected level. It is essential that you hold everyone to the same standards – if you allow leeway to certain employees you will create resentment and the culture of your practice will be damaged, as will your own credibility with your staff. You also cannot have ‘favorites’ in the office staff. For example, there may be a long tenured employee – maybe even your first hire from years ago when you started your practice – who is perceived to receive special favors. It’s not uncommon in medical practices to hear staff say ‘Oh, that’s Susan, she’s been here forever and she’s always been a grump’. Once the new behavior standards are launched, even ‘old Susan’ must adapt and be coached into compliance with behavior expectations.

Another challenge may be a superstar employee whose behaviors have been tolerated because the practice depends upon that person’s performance. These superstars also need to be coached into compliance with the behavior expectations using the three step approach described above. But sometimes these employees will not accept change, will not comply with required behavior modifications and become a major obstacle to building the positive culture that you need in order to enhance the patient experience. Or maybe you have a genuinely toxic employee? A ‘toxic employee’ can sap the energy right out of your practice. This toxic employee - true to the name - can poison the atmosphere in the practice, and can make it difficult, if not impossible, for you to manage effectively. The toxicity is insidious, and can drag you, your staff and co-workers into an abyss of low morale and decreased productivity. This will often also be sensed by your patients and adversely impact the patient experience. The characteristics of these employees typically can include being overly negative, blaming other people, thinking ‘It's not me, it's you’, failing to be held personally accountable, may take the credit for others successes while back stabbing and withholding information and assistance that might help coworkers. Yet will always expect the ‘rights’ and privileges that he feels are his due. If you can coach that employee to change their toxic behavior, you will demonstrate your leadership to all your staff, and will achieve a huge positive impact on the patient experience. There are five steps to working with a toxic employee:

  1. Confront the employee professionally and describe the behaviors that need to change. Provide specific examples of the unacceptable behavior. Don’t delay or put-off meeting with the employee – you need the employee to understand your sense of urgency.

  2. Set clear expectations for behavior modifications that are required and your timetable for those expected changes to be implemented

  3. Document the discussion and expectations to the employee by email. Be straight forward in writing the email to explain succinctly and very directly the behavior(s) that need to change

  4. Have regular weekly coaching meetings with the employee to provide feedback from your observations; give the employee an opportunity to discuss progress from his/her perspective.

  5. Be prepared to terminate the employee if there is no progress and the behavior expectations are not met. A ‘three strikes and you’re out’ is a simple but effective approach. Give the employee after the first strike a written warning about future behavior; give a final written warning after the second strike and termination will follow a third strike.

Remember two things:

  1. Toxic staff fire themselves because of their resistance to changing their unacceptable behavior; they are given every opportunity to change behavior and remain our employee, and

  2. Your staff and patients will always thank you for resolving a toxic employee!

In conclusion, our practice staff are a critical component in delivering the patient experience. We clinicians are leaders – intentionally or otherwise – in our practices, and we should pay close attention to how focused our employees are in their work. Bring enthusiasm and your ‘A’ game to the practice every day and gauge your staff’s excitement with new responsibilities and engagement with their colleagues and patients. Are they taking it upon themselves to be collaborative and using initiative to help move practice objectives forward?

Are their hearts in it? Are they engaged and bringing their ‘A’ game every day?

-- A synopsis of this blog appears in MedEsthetics May publication

#leadership #humanresources

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