Speaker 1:                                             You're listening to Your Practice Made Perfect, support, protection, and advice for practicing medical professionals. Brought to you by SVMIC.

J:                                                     Welcome back to Your Practice Made Perfect podcast. Today, SVMIC's Meghan Clark will be diving into previous episodes, focusing on the different relationships at a medical practice, relationships between providers and each other, providers and staff, relationships between all those that work together to keep a practice running smoothly. We've spoken to a variety of guests throughout the years who have given us personal antidotes, tips and information on the topic, and we feel like this particular subject remains relevant through the times. Relationships between coworkers is a topic we can all learn from. But I will note that the importance of open communication and a positive working relationship between physicians and fellow providers or staff within their practice cannot be understated. Patient care can often depend heavily on the communication and relationships within the practice. So let's hand it over to Meghan, who will take us through some helpful tips and lessons learned.

Meghan:                                                Well, thank you, J. I'm excited to be here with you and our listeners today. As we all know, the physician-patient relationship is the foundation of clinical care, but what about the relationship between a physician and their practice manager or the relationship of a nurse and a physician? These relationships are a critical determinant of the success of healthcare organizations. Lifelong medical practice executive Tom Stearns spoke about the wisdom he's learned over the years through both managing practices and working with practices on our podcast in August of 2018. Let's revisit his idea that no one person in a medical practice should be held above the others.

Tom:                                                   What we're going to talk on the first subject everyone is good and no one is too good. And I used to say that to all of my supervisors when I was managing a practice. It was one of the first conversations we would always have is about the understanding that everyone is good. And it just seems like, "Well, yeah." But if you think about how most people, particularly new young managers manage, they think they're the boss. And as a boss, their role is to be a task master and to therefore stand behind people with the whip. They just sort of have that image in their mind to drive people to do what they're supposed to do and to catch them doing things wrong, because we know everybody's stealing those paper clips and those sticky notes. And so it's just that kind of mentality.
                                                       Even though people don't really think about it much, most new managers and some old managers manage from that perspective. And it just then creates a competitiveness between the manager and the employee where the employee then is playing the game of "What can I get away with so I won't get caught?" So it's just not productive at all. And so why not assume that they are good and work with people with the idea that people are good. And I think are. I think people wake up in the morning and say to theirselves, "I want to go to work and feel good today. And when I go home at the end of the day, enjoy what I have done and felt like it was productive." And so if you think about that's what's going through the employee's mind, then it really changes the role that we have as the leader or the manager. And so if we lead from that perspective, then our role is not to stand behind the person and catch them doing something wrong, but to stand behind them and help them do things right.
                                                       The whole nature of our work is that there's just this constant flow of paper and people and it just never stops. And if an employee gets stuck trying to deal with something they don't know how to deal with, then all of that just backs up. And pretty soon they're going to get swept away in the flood or drowned. And so if you think about what our role as the manager is to stand behind them, and when that occurs, they simply turn around and give it to us and we step forward and help them solve that problem, we solve that problem. And then later we can talk about, "Well, let's talk about what happened today and how if that were to occur again, how you should handle it or we should handle it." So I think just looking at your role as a manager that way is that we're all on the same team and we're all trying to get to the same place, and how can we help each other to do that? It makes the end of the day enjoyable for everybody.

Speaker 5:                                             Now, the second part of this phrase here, you said, "Everyone is good, but no one is too good." Talk about that a little more. That's interesting to me.

Tom:                                                   Well, sure. And that's exactly the way it has to be, because as a manager, you can't be too good to do anything, particularly if you're expecting your employees to do something, they need to understand that they can do it the same way you can. I'll often go into a practice and you'll see the manager walking around back there and the phone's ringing or people are backed up at the front desk and they're just doing their thing. And instead, the customer, in our case, the patient should come first. And even if we don't have the ability or the knowledge to necessarily do the task of the person there at the front desk, we could certainly reach out to the patient and just greet them and say, "Somebody will be with you in just a moment." And that satisfies most people. Or answer the phone and just say, "Just a moment. Let me take a message." Or "What can we do to help you?"
                                                       And so as you begin to do those things, showing that you are willing to do whatever you can in their role or walking down the hall and picking up a piece of paper or, sure, helping patients get in and out. And if you see that things are backed up and you can help in some way and you're willing to do that, the employees will emulate the way you're willing to act. That even works for physicians. One of the physicians that I saw that was bested that was a neurosurgeon, and he would come to the office every day and the first thing he did was go to the front desk and greet the ladies on the front desk and say, "Good morning. Let's have a great day today." And when he would leave in the afternoon, go back and say, "We had a great day. And thanks, except for that one lady in the yellow sweater. It was a great day."
                                                       And thank them for the day. He didn't feel like he was too important to do that. Or if he was really backed up, he, personally, would walk out to the waiting room and say to the patients out there, "I'm sorry, we're backed up today. We had an emergency. But we will get to all of you just as quick as we can, or would be happy to reschedule you." Took that burden away from the employees and let them know that he was willing to do it as well and take that responsibility. So the more you can demonstrate that no one's too good to do anything, the more your employees will step up and follow you anywhere.

Meghan:                                                What a great reminder from Tom. Every person on the team plays a significant role. To hear more about Tom Stearns' experience as a practice manager and his experience working alongside practice managers, check out Your Practice Made Perfect's episode 27, No One is Too Good. One challenge many practice managers are facing today is how to deal with staffing shortages. Gretchen Napier spoke on ways practice managers can create a more positive and inclusive culture for their employees in our November, 2021 podcast episode. Let's revisit her strategies and recommendations for creating a more engaging and positive work environment.

Gretchen:                                              Practice leaders have always had to be creative in staffing their offices, because hospitals paid more. So now more than ever, employees are choosing to work at a place that enhances their quality of life. Believe it or not, people are willing to forgo a dollar or more per hour in pay to work at a place that values them as human beings, that allows for some flexibility with their family and their personal life, and that adds joy to the many hours that they spend at work. So creating a more positive and inclusive practice culture often centers around the right kind of communication.

Meghan:                                                Creating a positive culture, such a simple theory that can yield great results. Gretchen talks a bit more here about the positive implications that can result from simply giving feedback. Let's listen on.

Gretchen:                                              One of the primary barriers to a positive culture is the lack of effective feedback to staff. And the main reason most leaders don't provide helpful feedback is because it feels uncomfortable. Giving feedback, especially criticism, is painfully difficult, but it is still the duty of a leader to give it. On the other hand, some leaders deliver the feedback in a harsh or overbearing way that really ends up doing more damage than it helps. Leaders owe it to people to help them improve and to help them improve at the earliest possible moment. Some practices have routinely hired people that all look the same and think or believe many of the same things that can make people who look differently or believe differently feel excluded. In a tough labor market, practices need to be welcoming all the most qualified staff, expanding the kind of people that want to work there, not limiting it.
                                                       And we all have biases. As a result, so do the organizations that we build and lead, but talking about these biases and feeling confident addressing them remain difficult for most of us. The truth is that everyone has bias. Bias is a natural, normal human tendency. Most bias is harmless, but stereotypes can lead to bias if you believe them. Being aware of them allows us to control, conquer and prevail over our biases. So one thing that's a fun thing to do is to take Harvard's Implicit Association Tests. You can just Google Harvard IAT. They have tests that rate your biases on everything from race, weight and skin tone to weapons presidents and sexuality. It's a great way to begin to just think about your own biases. Another communication thing that I'm really passionate about is clarifying expectations. Only about half of employees would strongly agree that they know what's expected of them at work. The employees who agree that they have clear expectations at work are two and a half times more engaged. And we know that more engaged employees have reduced turnover, fewer safety incidents, and increase productivity.

Meghan:                                                Great tips from Gretchen. To hear more about how to create a positive and inclusive practice culture for your employees, listen to episode one 19, Staffing Challenges. Now, setting expectations and establishing good communication is vital when forming new physician staff relationships. But what about improving existing relationships with coworkers who are not new to your practice? In July of 2020, we spoke with Dr. Nicole Shields and practiced executive Jill Park on the benefits of getting to know each other's strengths and weaknesses. Let's take a look back at this conversation.

J:                                                     Today, we're going to be talking about the successful physician-practice executive relationship. Why don't we start by having each of you give just a short introduction of who you are and what your role is with the group that you currently are with?

Nicole:                                                Well, sure. My name is Nicole Shields. I'm a family medicine physician practicing at what is a multi-specialty clinic with Lincoln Memorial University. I've been with LMU for about six years and have been a medical director for five.

J:                                                     Okay. And Jill, what is your role with LMU?

Jill:                                                  I am the practice manager of LMU's outpatient medical clinic, working alongside with Dr. Shields for the past five years. I joined Lincoln Memorial University in January of 2007 with the opening of the DeBusk College of Osteopathic Medicine.

J:                                                     First of all, let me ask you this. How long have you two work together in your current roles at LMU?

Nicole:                                                Five years.

J:                                                     Now, that you've been working together for about five years, how would you describe your communication style? How often do you connect with each other?

Nicole:                                                We do a little bit of everything, informal, kind of like, "Hey, Jill, I need this..." or vice versa. But also we have planned time on a weekly basis and a monthly basis to go over strategic planning, budget, finances, that sort of thing. I think that most of our urgent communication is easily done face to face, and we put it in writing just so sometimes we can remind each other, "Oh, this is what happened with that." And so we have a paper trail. But it comes pretty naturally, I think, for the both of us.

Jill:                                                  Yes, so when you work alongside somebody and you're in the same building with them and you get to know their work style, you can pick up on their body language as well. So I know when I make eye contact with her, when she gives me the look, there's something that needs my immediate attention.

J:                                                     What is it about your relationship that makes it work as well as it does?

Nicole:                                                Interesting that this question to come up because recently, you have ups and downs in life, right? Both professionally and personally. And I think when either one of us senses that the other one isn't quite 100%, we know what the other one needs most of the time. If it's distance, if it's support. And sometimes we are not sure. Jill came to me other day and she goes, "Hey, are we okay? Are we good?" And I really appreciate her straightforwardness and not everybody has that confidence or courage to say, "Hey, is everything all right? And if it's not, let's deal with it. Let's take this head on." So I think that there's lots of things to go into making a relationship work, but, for us, I think it's communication. I think it's mutual respect and I think that we're both very passionate about our goals here for LMU Medical Clinic and what they are and supporting each other as well as others in the practice getting there. And so I think just that overall almost, I wouldn't say unconditional, but very loyal support no matter where you are personally or professionally.

Jill:                                                  And I agree with that too. And just to add, I think if you can define the mission of what it is you're set out to accomplish, you can't reach your mission unless you know what it is. So we decided early on what the mission was of the clinic and how we were going to get there, and we set our goals and our values. And we may get off track sometime, but we always circle back around and get right back on track and keep going.

J:                                                     How do you resolve differences of opinions that you might have with each other?

Jill:                                                  Well, we have had differences of opinions and we normally just gather the data. Most of the opinions that we have are based on something. So in the business of healthcare, you just collect the data of what it is that you're trying to resolve and you present the data. And if we take care of our patients and we make a little money in the end, then we've resolved our differences.

Nicole:                                                That's funny. Jill and I have been working together for so long, that's pretty much what I would've said. I will add a couple things. I think when you've got a good team, administrative team especially, yes, there's the difference of opinions and you collect data and you come up with a game plan together. But once we have decided on that game plan, we usually have a fallback. "Okay, so if this doesn't work and this doesn't meet our outcome, we don't meet our goals doing it this way, then by X date we'll try," fill in the blank. And so I think it's less of a disagreement necessarily and more of an after action review, looking at everything over and over and over again. "Is this working well? Is it not working well? Do we need to go back to the drawing board? That idea that you had, it probably worked better than what we just tried. That sort of thing.

J:                                                     If you could have been given some type of advice before you took the position that you currently have, what is that piece of advice that you wish you had been given?

Jill:                                                  And I guess the first thing that comes to mind for me is personality types. Because I think once you learn the various personality types that you're going to be spending 50 and 60 hours a week with, you can learn how to be successful. Most of the providers in the clinic and our staff want communication in different ways. They want different data presented to them. They have a different goal in mind. It's just preferences. And I think if I didn't have to spend the time learning those, which can take years, I would've been successful earlier on. Just like Dr. Shields said, you just stay on top of your work and you learn the personality styles, what your goal is, what the mission is of the clinic. Then how to be successful? You just stay focused.

J:                                                     Dr. Shields, how about you? What is the one thing that you wish someone had told you before you took the position that you currently have?

Nicole:                                                Oh, there are so many things. I think the one thing that I wish somebody had just taken me by the shoulders and looked me in the eye and said, "Medicine is really hard." And not because you can't necessarily take care of the patient with the knowledge that you've worked years to obtain, but there's so much more than your stethoscope in your relationship with a patient, that if you allow it, we'll get in between you and the patient and affect our patient care. And this is everything from electronic health records to insurance companies, to staff, to scheduling. There's a thousand things that can come between you and the patient and we work, I work daily to overcome those and to keep my efforts towards good patient care. And if you do the right thing for the patient, everything else will fall into place.

Meghan:                                                It cannot be over-emphasized. Communication and positive relationships are so important in the medical practice. If we combine the perspectives of all four of our speakers, we're truly given a well-rounded approach to establishing and maintaining healthy physician staff or provider-to-provider relationships. Thank you for tuning into my narration of today's show. And with that, I will hand it back to J.

J:                                                     Thank you, Meghan, for narrating this topic of conversation for us. Relationships are so important to cultivate and maintain in all aspects of life really. We hope taking you through the insights of our prior guests has been a benefit to you and your practice, and that there have been some good takeaways for you to implement in your professional lives. Thank you for tuning in and please feel free to visit our show notes to listen to the full episodes mentioned throughout today's show.