Dr. Ilan Alhadeff, MD, SFHM
The Value of Communication
In his two years as Program Medical Director, Dr. Ilan Alhadeff of Cogent HMG has transformed a mix of eight house doctors and hospitalists into a thriving hospital medicine group of 14 full time physicians and 10 part time physicians. The revitalized group at Hackensack University Medical Center has grown its average daily census during that period from 40 to 120. While juggling a percentage of clinical work, he has also in that time built a teaching program, which has now expanded into two teaching teams. Without a doubt, these accomplishments speak to Dr. Alhadeff's strength as a leader. Yet he was eager to join the first class of SHM Leadership Certification candidates and build on his skills through the program's individualized, project-based learning. "I'm always looking to expand my horizons, grow as an individual, grow within my field, and see what we are capable of doing." With those goals in mind, Dr. Alhadeff is looking toward his next initiative.
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For Dr. Alhadeff, the role of communication was one of the biggest takeaways from Foundations for Effective Leadership. There he says he gained a better understanding of an administrator's thought process and how to adjust communication appropriately. While upward communication has been important in his career, Alhadeff explains that there is also a need for better communication with patients from physicians and non-physicians, and this is where his Leadership Certification project is focused. What may seem like a simple matter of patient satisfaction is a lynchpin for a variety of better outcomes including physician satisfaction. Dr. Alhadeff sees the impact of improved patient satisfaction as multifold: economic, logistic, and, potentially, clinical. Alhadeff explains, “I always tell my docs, ‘Put yourself in their shoes and think about how you would feel.’” The goal of the new initiative is to educate physicians that good communication is not just a nice concept; it’s crucial to success. Alhadeff estimates the potential for $50,000 in savings from improved communication alone, and this is just for his program's patients, who account for about 25% of the Medicare population in his hospital.
Since his first Leadership Academy in 2007, Alhadeff has subsequently attended both Advanced level courses and says they have contributed to his repertoire of skills, particularly the financial aspects of leadership, understanding how to strengthen a team, and thinking globally. Of course there will always be complex challenges, and Alhadeff has taken lessons from these as well. “One of the biggest has been culture,” he says, going on to explain that it takes consistency and patience to let culture emerge naturally. Culture, like communication, can be elusive. Like communication, it is as much about listening for it as actively creating it, and this is often not a one-to-one transaction. “You have to get that emotional and political bank account built up. Sacrifice for others is an important part of building toward return on investment,” says Alhadeff, clarifying that he is not advocating being a pushover. While communication strategies and other contributions to cultural capital can seem nebulous at times, the measurable outcomes, as Dr. Alhadeff’s projected ROI suggests, can be extremely tangible.
Voice of Experience
Kay Cannon, MBA, MCC
SHM: Why was it important to you to bring a focus on Women in Leadership to the most recent Leadership Academy in New Orleans?
Ms. Cannon: It would be tempting and true to say that it's because women have different leadership needs than men. But while that may be true, there's a more important reason. Women in leadership is a hardcore business performance issue. The number of female physicians continues to increase dramatically. Currently, almost 50% of medical degrees are awarded to women. There's no doubt that women are playing and will continue to play a critical role in hospital medicine. Yet women remain underrepresented in physician leadership roles and earn about 20% less than their male counterparts. If healthcare systems, academic medical centers and for-profit healthcare companies want to perform at their best, they must find ways to attract, retain, and develop women hospitalists. A critical component of that process is making sure women hospitalists are represented at the highest leadership levels. To fail to do so will put the organization at a severe competitive disadvantage in a rapidly changing and chaotic marketplace.
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SHM: What is the best piece of leadership advice you have ever received? If you are able, please provide an anecdote or elaborate briefly on how it has impacted your leadership style or career.
Ms. Cannon: In my role as Vice President of Payor Operations for a specialty managed healthcare company, I frequently found myself caught in the middle between angry healthcare practitioners and incredibly demanding health insurance companies. Every day when I went to work I knew there was going to be a battle and at the end of the day blood would be all over the place. The only thing I didn't know was if the blood would be mine or someone else's. To say I was stressed out is an understatement. Then one day, during a particularly bloody battle that had been raging for what seemed like an eternity, I asked my boss, CEO John Penrose, for suggestions on how to resolve the crisis that was turning me into Attila the Hen. After patiently listening to all of my ranting, raving, and hand-wringing, John looked up from his paperwork, smiled at me, and said, "Whatever you decide to do, make sure you walk the high road. When you walk the high road, you rise above the battle." It was the best leadership advice I ever received. Later that day I found the high road and put an end to the warfare with a solution that all parties felt was fair and equitable. The funny thing is that the solution had been there all along but had been hidden from my view by the smoke from my own volcanic frustration and anger. Since that day, I've always made a conscious effort to find the high road regardless of how frustrated, disappointed, or angry I may be. It's amazing how your perspective expands and solutions magically appear when you rise above your own viewpoint and walk the high road.
SHM: What is one piece of advice you would give to new leaders?
Ms. Cannon: As a new leader it's natural to focus on everything and everyone around you instead of paying attention to yourself. Sadly, that approach creates dangerous blind spots and hidden performance gaps that are capable of turning a promising career into a train wreck. First and foremost, know who you are as a person. Drill down and take an unvarnished, comprehensive look. Find the diamonds and the warts. Then build upon that knowledge to leverage your strengths, eliminate the blind spots, and shore up the weak spots. And if I could give one more piece of advice it would be to ask for help. Don't be the Lone Ranger. Asking for help shows that you have self-confidence, encourages collaborative problem-solving, and promotes teamwork.
Kay Cannon has been an award-winning executive coach since 1999, and is a former healthcare executive. She is a key faculty member, presenting her session "Investing in Yourself" as part of SHM's Advanced Leadership: Strategies and Tools for Personal Leadership Excellence. Read more about Kay Cannon at full faculty bios.
Leadership Pearl of the Month
Patience Reich, MD, SFHM
Very early in my career as a hospital medicine physician leader, I had to deal with a disruptive physician colleague whom I will call Dr X. In addition to occasional complaints from nurses and patients, there was recurrent conflict between Dr X and several colleagues, and for one colleague whom I will call Dr Y, the conflict became personal, vitriolic, and deteriorated into one of those never, ending blame games. Dr X had been with the group for over a year prior to my arrival, but the problems began about eight months after my arrival. I took all the usual measures to try to solve the problem, but the conflict continued to escalate. To make a long story short, I discovered that the underlying problem wasn't Dr X's "difficult personality and horrible character" but the fact that he had been placed in the wrong job and was struggling to perform his duties in his new role. Upon careful review, it became clear that all of the complaints and conflicts occurred whenever Dr X was functioning in this particular role. Once he was placed in the right role, he did very well and the conflict resolved after a few weeks. To use Jim Collins's analogy from his bestseller "Good to Great," I had placed Dr X in the wrong seat on the bus. Once I changed his seat on the bus, the problem went away.
For me, the lesson here wasn't so much about dealing with a disruptive physician as it was about fundamental attribution error. Fundamental attribution error is the tendency we have to attribute the behaviors we observe in others with whom we disagree or have conflict to their motives or characters while ignoring situational pressures that may be contributing to the observed behaviors. I am not suggesting that most disruptive physicians fall into this category. Sometimes, the problem really is the person. What I am suggesting is that as leaders we are sometimes susceptible to this particular form of cognitive bias when we judge employee performance or deal with recurrent conflict. Poor employee performance may be caused by elements in the work context. We all have a powerful tendency to attribute to internal causes (such as motives, personality) nearly all the behavior we observe in others and a tendency to cast ourselves in the best possible light as we explain our own behavior. The next time you are faced with a difficult and complex social situation, particularly one involving conflict or poor employee performance: