Friday, November 14, 2003

Developing Your Doctors: Management Complimenting Your Leadership

A decade ago, firmly ensconced in an academic health sciences center and as a relatively recently tenured full-professor I became a participant in an exercise intended to assure the medical school that tenured faculty remained productive. A worthy idea, but various events conspired to leave me with little more to show for it than a loose leaf binder full of barely intelligible notes, some beautifully printed but poorly documented forms and a floppy disk full of WordPerfect™ templates.

Over the years I’ve been at Maimonides, I’ve reworked those forms and the ideas embedded in them for our employed, but non-tenured physician practice. In harkening back to the idea in my column of July 2000 of the “Pyramid of Medical Staff Development” it seemed to me that I needed a management tool that would implement my leadership idea. Then too, as our department focused on developing a residency faculty from out of a clinically focused physician staff, the ambitions of individual physicians manifested—supporting the individual physicians’ professional development and security seemed appropriate to the process.

As shown in Figure 1, medical_staff_pyramid

the “pyramid” develops from recruitment through the phases of managing a medical staff. Like you, I have a fine staff; but do they understand not only the mission of the department but also the strategic objectives the hospital and department have in mind for accomplishing this year, and next? Only if I tell them. Yet at the same time these physicians have ambitions for their own career, and I’m responsible to help them attain those.

So I’ve worked and reworked the decade old forms and instructions and developed a package that we distributed last year; but which I really didn’t fully follow through on implementing all of the steps. This year with the help of my office assistant, I hope to do a better of job of staying on schedule and take this professional development tool from an idea to an accomplishment to a routine component of my work. The essence of the tool is shown in Figure 2.

A cover sheet with a preamble and signature/date blocks for you and the staff member covers how many ever sheets needed for your staff member to describe their ambitions for the forthcoming contract year. The broad areas of accomplishment should fit with your environment. In a small community hospital practice you may include nothing more than “clinical service;” “service to department, institution and community” and “other activities.” At an academic health sciences center, which doesn’t impose its own approach, you may find a single category for “scholarship” overly restrictive. Including an additional sheet allows for the staff member’s personal goal statement for the next 2-5 years (A junior person probably won’t want to look further ahead; a mid-career physician may enjoy the opportunity for expressing a desire for stability or change over the period.). It also provides room for a time breakdown—in percentages—among the categories included.

Mail or email the forms to your staff members and ask them to complete the forms prior to meeting with you at contract renewal time, perhaps in the quarter prior to the new contract year. Regardless of the number of categories selected, the form is a tool that precipitates one-on-one discussion and deliberation with you. It provides you an opportunity for understanding your staff member’s horizon while allowing you chance to share your specific objectives for your department and while coming to a “fit.” Don’t merely accept the input, discuss and “test” it by asking yourself and your staff member how you will both know that the objective has been met.

By encouraging at least two regular meetings annually at which clinical productivity and clinical performance can also be reviewed you provide the feedback necessary for your physician staffs’ growth in performance and confidence in your leadership through conveying your continuing interest and support of your staff member’s overall professional growth and development.

At the beginning of each subsequent year, your staff member returns with both a new set of forms for the forthcoming year and the previous year’s forms completed with their self-assessment of their level of accomplishment. This meeting becomes both a review and a look forward with the forms providing a chronological record of objectives and expectations asserted and a measure of their accomplishment—together a fine management accomplishment in support of your leadership.

Figure 2

[Area of accomplishment & evaluation (see list below)]

(make all boxes auto-resizable in word processor)

Physician Annual Objectives:

List specific, measurable accomplishments; ask staff member to complete this section prior to meeting with you at contract renewal time.  Don’t hesitate to edit and enhance with your staff member during your meeting.

Chair’s Response:

Describe exactly what support will be provided; complete in longhand at time of meeting with staff member for contract renewal.

Level of Accomplishment:

Entries made by staff member continuously as objectives accomplished;  reviewed with chair at ~5-6 months into contract year and again at contract renewal time.

Chair’s Response:

Interim evaluation entered related just to these objectives at mid-year meeting; overall evaluation on these objectives entered at contract renewal time.

Areas of accomplishment & evaluation:
1. Clinical Service
2. Teaching of Residents, Interns and Medical Students
3. Teaching of other than above (might include EMS personnel, nurses, PAs, etc.)
4. Scholarship (including publication in peer-reviewed journals, books and other critically; reviewed forums; invited presentations outside of your institution)
5. Professional Service to department, institution and community (departmental administrative work, speaking to medical staff or other departments, representing the department or institution to community or governmental groups, health fairs, becoming a “nighthawk”, etc.)
6. Other activities (self improvement, including adding ultrasound credentialing, pursuing an advanced degree

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