“Each of you is here because of your role as a leader,” said Patricia L. Turner, MD, FACS, Director, American College of Surgeons (ACS) Division of Member Services, in her opening comments at the fourth annual Leadership & Advocacy Summit, April 18−21, at the JW Marriott, Washington, DC. “This year’s program features actionable topics that each of you may employ at your home institution,” she added, referring to presentations covering an array of leadership issues, including the following: overcoming resistance to change, moving from a transactional to a transformational leadership style, managing physician burnout, and negotiating employment contracts.
Part of a dual meeting held in conjunction with the Advocacy program, the 2015 Leadership sessions also featured success stories from ACS chapters in Tennessee, Louisiana, and Pennsylvania. Attendees met in breakout groups organized by state and region after these presentations to identify opportunities for chapter development and enhanced member engagement. (Member Services staff are compiling the information presented in the breakout session reports and will provide a summary of these presentations later this year.)
The 2015 Leadership & Advocacy Summit drew 417 attendees representing all levels of ACS leadership, including Regents, Governors, Advisory Council Members, Chapter Officers, Resident Member leaders, and others.
“Broker and build relationships with surgeons in your own communities,” suggested Dr. Turner, who noted the steadily increasing number of summit participants each year as an example of how surgeons are continuing to seek innovative ways to connect with each other and learn how their peers are leading with influence while overcoming resistance to change.
Leading with influence
“People don’t follow you because of what you do, they follow you because of who you are,” according to Doug McKinley, PsyD, MCC, managing partner of Xcellero Group, Naperville, IL. Dr. McKinley, an expert in the leadership development of medical professionals and hospital and health care administrators, said leading with influence is more effective than leading from a position of authority in fostering long-term change. “Leading with influence means changing minds, hearts, and actions,” Dr. McKinley said, while leading with persuasion simply “involves getting someone to say yes or no, without getting to underlying behaviors.”
Leading with influence, according to Dr. McKinley, starts with an understanding of what he calls the three elements of credible communication: tone (38 percent), nonverbal communication (55 percent), and words (7 percent). Each percentage describes the relative effect of tone, nonverbal communication, and body language when speaking with others. He emphasized the importance of recognizing communication cues that an individual may not realize he or she is exhibiting, especially nonverbal cues (for example, posture or eye contact) that might diminish a person’s ability to lead by influence.
“Assuming that others do contrary things because it’s in their makeup or they actually enjoy doing them—and ignoring any other potential motivational forces—is a mistake,” Dr. McKinley said.
Additionally, he encouraged summit participants to “make sure your story aligns with your values and beliefs” to amplify an individual’s ability to lead by influence. “What are your beliefs? How do you see yourself?” he asked, adding, “If I am in a conversation with you and you don’t believe me, the conversation is not productive. If you don’t believe who I am, you won’t believe me as leader.”
Chapter success stories
The achievements of the Tennessee, Louisiana, and the four Pennsylvania Chapters were shared by ACS chapter officers with the aim of inspiring other chapters to boost member engagement and satisfaction and to improve chapter effectiveness.
Daniel Beauchamp, MD, FACS, deputy director, Vanderbilt-Ingram Cancer Center, Nashville, TN, and President, ACS Tennessee Chapter, noted several accomplishments over the last year, particularly an increase in dues-paying members. He also highlighted improved patient outcomes as a result of the Tennessee Surgery Quality Collaborative (TSQC).
“We traditionally have a low rate of members paying dues, and we have made a concerted effort to engage regional leadership to make personal calls and send e-mails to those individuals who are on the member roster but are not paying dues,” Dr. Beauchamp said. In 2014, dues-paying members were up nearly 11 percent from 2013 and 18 percent from 2012.
The TSQC is a unique partnership between the Tennessee Chapter of the ACS, the Tennessee Hospital Association, and the BlueCross BlueShield (BCBS) of Tennessee Health Foundation. The program began with 10 hospitals in 2008 and grew to 22 hospitals by the first quarter of 2012, and, according to Dr. Beauchamp, these hospitals perform more than half of the general and vascular surgeries in the state. TSQC cumulative improvements from 2009 through the third quarter of 2014 include the following:
- 42.9 percent decline in mortality
- 2,332 fewer cases with surgical site infections
- 3,602 fewer patients with a postoperative occurrence
- $56.3 million savings in complications-related costs
According to Dr. Beauchamp, for 2015 and 2016, the BCBS of Tennessee Health Foundation has offered funding for half of the total cost of participation, including program fees and the required clinical abstractor. The six current rural TSQC hospitals will also receive a small grant to cover 25 percent of their costs.
Members of the ACS Louisiana Chapter accomplished two primary goals over the past year, according to William S. Richardson, MD, FACS, a bariatric surgeon at the Ochsner Medical Center, New Orleans, LA, and ACS Governor. The chapter hosted mock oral examinations, administered by Fellows, for postgraduate year-4 residents, and expanded its social media presence.
This year’s mock oral exams included 20 examiners and 14 resident participants, with 10 chapter members donating the use of their hotel rooms at the chapter’s annual meeting for the exams.
To expand its social media capabilities over the last year the leaders of the Louisiana Chapter redesigned its website to create a more responsive design that is more user-friendly on smartphones and tablet devices. The chapter continues to be active on Facebook and Twitter to promote announcements, annual meeting information, and chapter dues-related postings.
Following up on the chapter success story he presented at the 2014 Leadership & Advocacy Summit, Francis D. Ferdinand, MD, FACS, FRCS, FACC, a thoracic and cardiac surgeon at Lankenau Medical Center, Wynnewood, PA, and ACS Governor for Pennsylvania, emphasized the importance of leaders in states with multiple chapters working together to find areas of synergy. “We were like silos in the farms in Lancaster County,” said Dr. Ferdinand, referring to the state’s four chapters—Metropolitan Philadelphia, Keystone, Northwestern, and Southwestern. He credited previous Leadership Summit meetings for revitalizing inter-chapter communication in Pennsylvania, which he said is particularly key when it comes to advocacy-related issues.
Dr. Ferdinand encouraged chapter leaders to leverage the ACS Communities to foster communication, particularly in states with multiple chapters. The ACS Communities, which can be accessed through the ACS home page, is the College’s members-only communications tool, where members may share information and experiences and build professional relationships. “It’s important to have strong relationships with the College because it makes our job easier and [allows us to] achieve great things,” Dr. Ferdinand said, referring to the opportunities provided by ACS Communities to connect with both colleagues and College leaders.
Moving from transactional leadership—a managerial mind-set that focuses primarily on getting the job done—to a transformational leadership style that inspires team members to develop creative and enduring solutions was the focus of What Got You Here Won’t Get You There, presented by Ron Campbell, PhD, director, Leadership Research Institute, San Diego, CA. Developing a transformational leadership approach, according to Mr. Campbell, involves redefining what it means to be successful versus effective. A successful leader prompts team members to complete a task by virtue of his or her title or position of authority, whereas an effective leader is someone who fosters productivity by being a mentor and developing team members’ skill sets.
“What got you here is being a successful leader,” said Mr. Campbell, “but what gets you to the next level is recognizing the bad habits that prevent you from being an effective leader.” Mr. Campbell outlined examples of negative leadership habits, including the following:
- Winning too much (overly competitive behavior)
- Adding too much value (the urge to add one’s “two cents” to every conversation)
- Starting statements with “no,” “but,” or “however” (overuse of negative qualifiers)
- Punishing the messenger (misdirected and nonproductive criticism)
- Withholding information (refusing to share information to leverage an advantage over others)
Surgical leadership of the future
Surgeons who want to effectively lead hospital and academic systems in the future must identify the differences between leaders and managers, according to Vincente Gracias, MD, FACS, interim dean, professor of surgery, and chief of acute care surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ. “Managers deal with the status quo, while leaders deal with change. Managers work in the system, enforce the rules, and coordinate effort and alignment, while leaders work on the system, change organizational rules, and coach and empower self-leaders,” Dr. Gracias noted in his presentation, Cultivating Surgical Leadership: The Next 100 Years. Dr. Gracias was introduced to session attendees by Joseph V. Sakran, MD, MPH, FACS, Chair, ACS Resident and Associate Society.
In an Ohio State University leadership study conducted in the 1940s—one that is still widely cited today, according to Dr. Gracias—survey respondents listed two essential components of leadership: “initiating structure” (task-oriented leaders) and “consideration” (people-oriented approach.) “We love working around the operating room table, but we have to also enjoy working around the conference room table,” said Dr. Gracias, emphasizing the importance of both leadership styles.
The future of successful surgical leadership will require physicians to learn to motivate without fear, which is especially important in reaching quality metrics. Dr. Gracias suggested motivating staff with additional training, appropriate recognition, and shared goals.
“Surgeons are leaders—born or forged,” Dr. Gracias said in closing. “If we can learn to manage, we are the perfect storm to help design the future of health care.”
Resiliency: Overcoming burnout
In Resiliency: Overcoming Physician Burnout, Andy Kindler, PsyD, MCC, managing partner, Xcellero Group, emphasized the importance of identifying the symptoms of burnout and providing strategies for developing a more buoyant career and home life. “The problem with burnout is that it’s invisible…and we don’t want to admit we are experiencing it,” said Mr. Kindler. “It’s a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals who do people-oriented work of some kind. It’s an unwelcome outcome for those who care too much as part of their job.”
Citing research published in the October 2012 issue of the Archives of Internal Medicine, Mr. Kindler noted that of 7,288 physicians, 45 percent reported at least one symptom of burnout. About half of the session participants raised their hands when he asked if they or someone they know has suffered from burnout.
Mr. Kindler highlighted his personal struggle with burnout as a business executive. He said the key to overcoming burnout is recognizing the symptoms, which may include the following:
- Emotional exhaustion: Feelings of being emotionally overextended and exhausted by one’s work
- Depersonalization: Unfeeling and impersonal response toward recipients of one’s service, care treatment, or instruction
- Decreased feelings of personal accomplishment: Diminished sense of competence and successful achievement in one’s work
“Denial is not a solution,” Mr. Kindler said. “Rebuild your resilience by raising your positivity ratio—halt the negative self-talk—and by reframing your current reality objectively versus emotionally.”
Michael Burke, JD, Kalogredis, Sansweet, Dearden and Burke, Ltd., Wayne, PA, presented Understanding and Negotiating an Employment Agreement, which included practical information on negotiating compensation; restrictions on practice; and “practice specifics,” such as duties, scheduling, and outside services or “moonlighting.”
“When negotiating an employee contract, remember you will not obtain every change that you desire, so focus on key provisions, especially within a health system environment, and make sure you understand what it is you are agreeing upon,” Mr. Burke advised. He noted that contract practice specifics are typically general in terms of duties, and scheduling provisions are often vague, but he suggested that potential part-time employees push for more specifics, particularly regarding schedule.
Mr. Burke said many employee agreements require “exclusive service” for moonlighting or performing outside services, meaning that it is necessary to obtain employer consent before engaging in outside services. Provisions for nonclinical work, such as speaking, writing, or expert witness work, may be set forth in an agreement.
“One of the first things all physician clients turn to in an agreement is the section on compensation,” Mr. Burke said. “While many agreements still include base salary, incentive compensation may be at the employer’s sole discretion. Look for comparables from friends and colleagues when negotiating compensation,” he advised.
Most employers pay liability insurance, according to Mr. Burke, although physicians negotiating an employment contract need to be cognizant of the type of insurance provided. If the employer is providing “occurrence-based” liability insurance, then no “tail coverage” is required upon termination, and the employee does not need to be concerned about the continuation of coverage after leaving the employer. If the coverage is “claims-made,” then tail coverage may be needed for claims filed after termination for services performed before termination.
There are specific “boilerplate provisions” in every employment agreement that physicians should carefully review, according to Mr. Burke. “The ‘entire agreement’ clause constitutes the entire understanding between employer and employee related to its subject matter. All oral or written correspondence or discussions are superseded by this agreement. I always tell my clients, if it’s not in the agreement—even if it was in the agreement letter— the employer did not specifically agree to it,” Mr. Burke explained. The “notice provision” is another boilerplate provision that physicians should review because it defines how formal written notices are to be given, which is important for employees when receiving a notice of termination without cause, for example, or when the physician is providing notice that they intend to leave the employer.
“Try to be as educated about the process as possible and remember not to take the [negotiation] process personally. If necessary, have a health care attorney review the agreement,” Mr. Burke advised.
“Physicians, I would argue, are natural leaders, and creativity is the most desirable leadership attribute,” said David B. Hoyt, MD, FACS, ACS Executive Director, during his Leadership Summit closing remarks. A key “principle of innovation,” according to Dr. Hoyt, is the ability to make “stone soup,” referring to the business concept of creating something significant by accumulating lots of small contributions. “As we interact with each other, we will be better able to anticipate how we are going to communicate with each other,” he said. Referring to four distinct personality styles—creative, competitive, controlling, and collaborative—Dr. Hoyt noted, “Different people have different talents, and we need all four [types], which are required at different points of growth in a system.”
These communication and leadership skills will continue to be germane as the College works with policymakers to develop policies mandated by the repeal of the sustainable growth rate (SGR). As a result of the SGR repeal, “the [value-based payment modifier program] has been replaced with the Merit-Based Incentive Payment System [MIPS] based on performance in four categories—quality, resource use, clinical practice improvement activities, and meaningful use of an electronic health record system. We should not let anyone else choose what is important—we need to help define that,” said Dr. Hoyt, emphasizing the College’s efforts to advocate for changes that allow surgeons to participate in MIPS in a way that best fits their practice environment.
An emphasis on providing quality care will continue to be a top priority for the ACS, and Dr. Hoyt outlined several ongoing initiatives, such as a surgical quality manual currently in development; ACS support of the American Society of Anesthesiologists perioperative surgical home model of health care delivery; the development of guidelines for the perioperative care of geriatric patients; and ACS collaborative efforts with the Strong for Surgery project, which identifies evidence-based practices to optimize the health of patients before surgery.
Challenges presented by these and other new quality initiatives are best met by surgeons who embody the characteristics of strong leadership, Dr. Hoyt said. It is up to surgeons to take the lead on important issues in order to propel the profession into the future.
The fifth annual Leadership & Advocacy Summit will take place April 9–12, 2016, at the JW Marriott in Washington, DC.