Well, the fact is…that is most of what they do. And we need them to keep right on doing it.

While we can roll our eyes or scoff, the reality is it’s those meetings that keep our practices going and our hospital making money which keeps us in business and allows us to take good care of patients without worrying so much about all the other stuff.

We can avoid meetings like the plague and survive. But, like it or not, there will be times where we need to attend meetings in order to thrive in a healthcare system.

Here are 4 mistakes that doctors make in regards to meeting…and what you can do about them.

1. We don’t realize their value.

If you talk about your administrators spending all their day in meetings and roll your eyes, you probably won’t be ready to engage in one when you need to. But, the problem is, if you want to affect change anywhere beyond interactions with individual patients, you will have to participate in meetings. Now, don’t get me wrong, it will inevitably take twice as many meetings as it probably should and it’s possible that you won’t have to be present for all of them but it’s important to listen to those times when your presence is necessary. Are you hearing chatter that suggests the initiative might be facing opposition or losing traction? That’s when you have to be there. An advocate can cover the rest.

2. We don’t appreciate the importance of an agenda or preparation.

If you are running a meeting, one of the most important things you can do is to prepare and have an agenda. Meetings with agendas get more accomplished in a shorter amount of time and will lead to a lot less frustration. If you send the agenda out ahead of time, it’s much more likely that the people you need to attend will come. Sometimes the calendar invite doesn’t quite sum up what is going to happen in a way that lets everyone know whose attendance is optional and whose is mandatory. During the meeting, it keeps everyone on track and minimizes fruitless chatter.

3. We don’t understand or aren’t used to conflict.

Most doctors are used to working in environments where their word is the final say. Meetings with admins don’t always work that way…and it’s a good thing. Conflict in a meeting helps us challenge our thoughts and beliefs in a way that could lead to bigger and better ideas. If you attend a meeting where everyone pats you on the back or simply agrees, you didn’t have a meeting, you gave a presentation and it probably should have been done through email.

4. We don’t perceive how our presence affects the meeting.

When you go to a meeting you change the dynamics. It’s often difficult for members of other departments to speak up to or share idea with doctors. They may be used to speaking freely and sharing opinions but they may be more cautious around you because they don’t know you as well or are afraid how your will take their thoughts (maybe even criticisms). It’s important to set the ground rules early, let everyone know that you want to hear their thoughts and then respond well when they give them. Make sure everyone has a chance to speak up. If someone isn’t contributing, seek their opinion directly.

So, go ahead, roll your eyes but roll into your meeting with energy and preparation and they will feel a lot more productive.

Sometimes you have to lay out the risks of not innovating to affect change. What are they?

1. Becoming obsolete. Someone will pass you up. It could be a digital health company, another health system or a small mom-and-pop clinic. If it’s a small, irrelevant business line it may not matter but what if you miss out on the next big thing.

2. Accepting status quo. A health system that isn’t looking to innovate or improve will miss out on delivering the best care possible. A culture of innovation and improvement helps to protect you from providing average or below average care.

3. Losing great personnel. Innovative and creative people need freedom to innovate. They need a structure to help them execute. If you don’t have freedom or structure, frustration sets in. When frustration sets in, those personnel with great ideas will get picked off.

Health care systems can innovate and they must in order to maintain relevancy in a rapidly changing and challenging landscape

Electronic medical records, retail medicine, urgent care and freestanding ERs are just a few examples of recent topics that have divided the medical community. The current debate that I find myself in the middle of: telemedicine.

And it’s not that physicians are all Luddites who wish for the days of paper charts. Many of the concerned doctors are tech-savvy, customer friendly and progressive. Their concerns are very valid and come from a position of care. However, I do believe that some of the concerns reflect an incomplete understanding of what telemedicine is and what it could do for their patients.

Here are 5 half-truths about telemedicine

1. It’s not a good as an in-person visit.

This is true. Period. If we all had the choice to have 100 percent of the information possible before making decision we would like to have it but, even in medicine, we make decisions based on the best available evidence all the time. We even make choices to forgo gathering more information in certain cases. Not every patient with abdominal pain gets labs and an abdominal CT. Is it possible that, with certain complaints, we could gather enough information with a virtual consultation to diagnose and treat without an in-person physical exam?

2. I want to protect my patients from bad medicine.

First off, it’s not all bad. Just like any innovation, there will be many providers more concerned about profit than providing quality care. Perhaps they are more liberal with antibiotics or giving in to patient demands despite it not being the best medicine. The reason this is a half-truth is because you can’t protect your patients from participating. If a patient wants access to telemedicine, they will be able to find it and this will only become increasingly more the case as restrictions continue to fall in state after state. Physicians will not be able to keep you patients from using it, forever.

3. Telemedicine is only for “telemedicine companies.”

No, in fact there are many vendors out there that will allow you (for a pretty nominal price) to start to provide telemedicine for patients. Taking care of your own patients in a new and different way can be a great driver for patient satisfaction and practice engagement. Yes, there are vendors out there that all they do is telemedicine but why let them take care of your patients when you could do it as well.

4. My schedule is already full. Why would I do this?

Surveys increasingly show that patients are using telemedicine, are interested in using telemedicine or would consider the option of telemedicine an important part of their decision to select a practice. All that to say, if your schedule is full now, it’s probably because you were doing things that patients like. If what patients want change, will you?

5. I’ll wait until I can get paid.

With higher deductibles, patients are looking for more cost effective ways to receive care. Many are more than willing to pay cash for a visit. I’ve seen costs anywhere from $30-60. Overhead for providing the service is so low that you can sustain and even be profitable at this price point. Secondarily, if there is any increased draw to your practice, the benefit will certainly outweigh the cost.

Telemedicine is evolving quickly and will likely become a greater part of our days in the coming years. How will you respond? I encourage you to ask questions and learn from those who are providing care in this way to see what might work for you.

Cheryl Petersen has had an amazing career in the nursing field. She came to Cook Children’s with the plan to help start the Pediatric Intensive Care service. She has held many nursing leadership positions at Cook Children’s and currently serves as the Chief Nursing Officer.

Ways to listen:

• Listen on Soundcloud
• Subscribe for series on iTunes
• Download/Listen to MP3
• Google Play

Maria Perez, M.D., is a pediatric rheumatologist with Cook Children’s in Fort Worth, Texas. She has practiced pediatric rheumatology for 23 years and continues to find joy in her career despite the unique challenges of caring for children with chronic illness. Her clinic has been a winner of the Practicing the Promise award eight of the last nine quarters. The award is based on elements of patient satisfaction and depends upon a the impression that the staff has made upon patients and families.

Ways to listen:

• Listen on Soundcloud
• Subscribe for series on iTunes
• Download/Listen to MP3

Today’s guest is Dr. Artee Gandhi. She is a pediatric anesthesiologist and pain management specialist. She has trained across the country including residency at the University of Missouri and fellowship at Stanford Univeristy.

Ways to listen:

• Listen on Soundcloud
• Subscribe for series on iTunes
• Download/Listen to MP3

Today we are going to talk again with Mary Uhl Bien. If you didn’t catch our last conversation, go to checkupnewsroom.com/pediatricleadership and find Episode nine where we talked about leading through complexity. Mary is the BNSF Endowed Professor of Leadership at the Texas Christian University Neeley School or Business. She teaches in the Advancing Healthcare Leadership class which is a combined initiative between Cook Children’s and TCU.

Ways to listen:

Ways to listen:

• Listen on Soundcloud
• Subscribe for series on iTunes
• Download/Listen to MP3

We talked last week about complexity and how it is changing the way that business and particularly health care organizations must operate if they want to be successful. To position ourselves for success, we must have leaders that not only accept complexity but that are agile and ready to change in complex environments.

Today, we are going to talk again with Mary Uhl Bien. If you didn’t catch our last conversation, go to checkupnewsroom.com/pediatricleadership and listen to "What is complexity?" Understanding the answer to this question will be important to discussing how you can learn to lead through complexity. Mary is the BNSF Endowed Professor of Leadership at the Texas Christian University Neeley School or Business. She teaches in the Advancing Healthcare Leadership class which is a combined initiative between Cook Children’s and TCU.

Ways to listen:

• Listen on Soundcloud
• Subscribe for series on iTunes
• Download/Listen to MP3

I’d be hard pressed to compare waiting for a doctor’s appointment including an appointment with me to the anticipation of waiting in line for any Disney ride or show.

It happens that the question about Disney and healthcare actually crossed my mind in March. While checking in on Twitter, I came across an intriguing book mentioned by one of the folks whom I follow: @JohnNosta.

The skeptic in me wondered how the entertainment industry could have any relevance to health care. Fortunately, the curious skeptic in me decided to buy the book and learn more.

The author approaches healthcare from a business, non-physician perspective focused on serving patients and those who care for patients. I found some fresh perspectives that I think will help me going forward.

Here are three pearls that I got out of the book.

Pearl 1: A focus on loyalty and not satisfaction

Loyalty and trust are different from satisfaction. Loyalty is built on a consistent caring and engaged compassion. Loyalty is built in large part by creating a memorable event in a patient care experience.

Pearl 2: Courtesy is more important than efficiency

A commitment to courtesy both improves experience and can lead to opportunities for efficiency improvement.

A focus on the satisfaction and service for others in your institutional may improve responsiveness and lead to better sharing of resources.

Pearl 3: Create a climate of dissatisfaction

Dissatisfaction with the status quo combined with the dream for what can be are key ingredients in growth and improvement. Even when all measures are near the top, there will always be room for improvement.Final Thoughts

I don’t believe it’s completely valid to compare the work done by me and others at Cook Children’s to work done in other service fields. Stakes and expectations are much higher - solving a problem, managing chronic illness, fixing a hurt - than getting a Starbucks order right or the thrill of a roller coaster ride.

Still we are all compared to real life experiences. Waiting in line is seldom fun. And the ride is sometimes not a ride the child or family would choose. We can still strive to make the experience as pleasant as possible.

About the author

Joel Steelman, M.D., is an endocrinologist at the Cook Children's Endocrine and Diabetes program, which treats infants, children and teens with conditions that are caused by or affect the hormonal balance of the body. We understand the importance of working together and that's how we approach the care of our children.

The world is changing quickly. The world of medicine is no different. Understanding how these changes affect you, your practice and your organization is critical to your success as a leader. At times, the amount of change can seem overwhelming. It feels at times that there is no order, only chaos.

• How do we survive in this environment?
• What is complexity?
• How do we see it in today’s world, both inside and outside of healthcare?
• How do we navigate the world of consumerism and value based health care?
• How do we as leaders prepare to work in this environment?

Listen to this episode of the Pediatric Leadership Podcast with our guest Mary Uhl-Bien is the BNSF Endowed Professor of Leadership at the Texas Christian University Neeley School of Business:

Ways to listen:

• Listen on Soundcloud
• Subscribe for series on iTunes
• Download/Listen to MP3

There is no single criteria that makes a person eligible to lead. Education, job title and seniority can all be a start to establishing a role as a leader. But sometimes, the best leaders aren’t the highest ranking of any of the three. Today we are going to talk about leading when you are starting your career and how an early-career physician can develop leadership skills when they are not the most senior physician on their team.

Today’s guest is Matthew Carroll, M.D. He is a pediatric hospitalist at Cook Children’s and serves on Quality Improvement/Practice Management. Prior to coming to Cook Children’s, he served as the chief resident at Cincinnati Children’s Medical Center.

Questions to work through on the topic:

• What do you think are some personality characteristics that allow you and other young physicians to find roles within leadership?
• How big of a factor is the institutional culture toward the ability to develop young leaders?
• How do you see medicine changing now and as we go into the future?

Ways to listen:

• Listen on Soundcloud
• Subscribe for series on iTunes
• Download/Listen to MP3

With the rates of burnout and suicide in physicians at shocking levels, it’s important that we continue to talk about the satisfaction and mental health of physicians. There are systemic issues at hand that lead to the situation that we are in. In her article “Physician burnout is physician abuse” for kevinmd.com, Dr. Pamela Wible has said that, “Burnout is physical and mental collapse caused by overwork. So why are we blaming the victims? The fact is medical students and physicians are collapsing because they are suffering from acute on chronic abuse.”

There are systemic issues that lend itself to the state that we are in. Many physicians are over-worked and over-stressed. And, it’s not just the grisly 30-year career doctor who is tired that feels burnout, medical students report high levels of emotional exhaustion as well.

There are various numbers in studies but the most recent available studies show symptoms of burnout in 40-50 percent of respondents. It’s a shockingly high number, especially those on the outside looking in. Doctors often appear to have it all together and they can make a great living.

So what’s there to be dissatisfied about? It’s not that simple. Demands to see more patients, giving up less control of our lives and other factors can make what should be a rewarding profession very frustrating.

All this is true and we need to continue to talk about it and continue to search for systematic changes that can lessen the burden on physicians

But, I love my job.

I love going to work every day.

I love the deep relationships I have with my patients and their families.

I love the relationships I have with my staff.

I love the other roles I have carved out within my health care system - Cook Children’s in Fort Worth.

Are there difficulties and frustrations?

Sure. Nothing is perfect but currently, for me, the good far outweighs the bad. Because of this, I walk into and out of work feeling energized and excited about the challenges rather than exhausted.

I certainly don’t think it’s because of anything inherent in me that has allowed me to continue to love my job. Is it just the confluence of good circumstances? Good luck? A great system to work for? Yes, but I’ve also fought to change the system in ways that make life better for myself and others. Maybe I’m just too young and burn out is just around the corner? (Although studies show that people with much less experience than me are already burned out.)

Any of those are probably partially true. But, just like the difficulty in pinpointing the reason for burnout is tricky, pinpointing the reasons for physician satisfaction would be difficult as well.

This post floated through my head for months. I hesitated to put it to paper. How would it be received? Is it trite? Would it be slammed for minimizing the problems?

It’s possible it could be all of those things. I hope not. I hope instead that it is seen as encouragement for those out there that love their job and for medical students and trainees who hear the burnout statistics and wonder if they’ve chosen the right field.

Those of us who aren’t burned out need to listen to those who are.

Together we could take their concerns and our energy and make medicine a fulfilling career for compassionate and empathic people again.

I have been having conversations with some very energetic pediatric leaders and recording them for a new podcast. I hope that you’ll find some piece of their story encouraging: https://soundcloud.com/pediatricleadership

About the author

Justin Smith is a pediatrician and the Medical Advisor for Digital Health for Cook Children's in Ft. Worth, TX. He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnesroom.com. His interest in communications started when he realized that his parents were relying more on the internet for medical information. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” is set to open in Trophy Club in the Fall of 2016.

Navigating Transitions in Leadership

Frank McGehee, M.D., is a pediatrician in the Cook Children’s Magnolia clinic. He practices in an office that has roots in an 80-year tradition of providing excellent patient care to the children of Fort Worth. He has seen many changes in medicine, but still believes that the heart of pediatrics lies in his connection with families.

There are probably a bunch but what are a few of the big changes you have seen in pediatrics over your career?

How have you seen your role in leadership change over your career?

What do you see coming for you in leadership in the next few years?

Ways to listen:

Listen on Soundcloud

Subscribe for series on iTunes

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How do we break down silos for innovative design?

Ways to listen:

Listen on Soundcloud

Subscribe for series on iTunes

Download/Listen to MP3

Innovative ideas often require a team approach. It’s difficult to make changes that truly move the needle when you consider a problem from just one perspective. Broadening the team allows physicians to consider other ideas. These new ideas might just open up possibilities that they may have never thought of.

Dr. Marks is a pediatric neurologist with Cook Children’s in Fort Worth, Texas. He has a particular interest in movement disorders and has been involved in Cook Children’s effort to advance the use of deep brain stimulation in the pediatric population. His latest project has been the design and implementation of an innovative pediatric motion lab, which uses a multidisciplinary approach, and advanced technology to assess and develop plans for children, teens and young adults with movement disorders.

Questions to work through on today's topic:

• How are things going with the new lab?
• Going back to when it started. Walk us through some of the different professionals who had input on the design of the lab. How did each member of the team contribute to the big picture?
• What were some of the challenges associated with having a big/diverse team?
• What’s next on the horizon for the lab?
• What part of your work are you most proud of?
• What is the most important quality for a leader in pediatrics?

Quotes:

In order to develop a lab like this, it takes a lot of people who have a great deal of understanding about all the components.

The most important people are the physical therapists who run the lab every day.

The technology itself is just to tool but it does allow for better procedures and better outcomes.

I enjoy team building. I have done that throughout my career…This team was unique because there are constant moving pieces.

There is a huge need to study how childhood obesity affects movement…it should allow us to intervene and better understand what we are doing.

All the things that I have done have required teams.

Neurologists, orthopedists and neurosurgeons desperately need each other.

At the end of the day, we are all in this to help the patient and to make their life better.

I think it is important to surround yourself with good people…and allow them to be creative.

Re: Good ideas-This is not about ownership, it’s about outcome.

Before we see a kid from far away, we do a lot of pre-screening via video and questionnaires.

Links:

• Cook Children’s Motion Lab
• Cook Children’s Neurosciences
• Dr. Warren Marks
• Referring a patient

Why develop a center for clinical excellence for a rare disease?

Getting help for patients with rare diseases can often be a large struggle for families. Finding someone who understands and has the experience to properly diagnose and treat can lead to frustration for families. Often there is no place to go. For long standing issues, this can lead to bouncing to multiple doctors without resolution of symptoms.

For more acute issues, not having an expert available can cause significant morbidity, even mortality. Today on Pediatric Leadership: The New Medicine, we talk to one of our pediatric endocrinologists who set up a center for treating a rare disease, hyperinsulinism.

Dr. Thornton is a pediatric endocrinologist at Cook Children’s and is the founder of the Cook Children’s Hyperinsulinism Center which is one of only two centers in the country focused on hyperinsulinism. The website for the team lists endocrinologists, pediatric surgeons and many other medical specialities as well as coordination between education, social work and even Ralph Lauren, one of Cook Children’s play therapy dogs.

Questions to work through on the topic:

What is hyperinsulinism and when should a clinician expect it?

What motivated you to begin building a center for treating such a rare condition?

How did you get the institution on board? Who did you have to convince?

What were some of those first steps that got the ball rolling?

What has been the hardest step?

How can someone find out more about the center or refer a patient?

What part of your work are you most proud of?

What is the most important quality for a leader in pediatrics?

To listen:

Download on Soundcloud 

Subscribe for series on iTunes

Download/Listen to MP3

For more information:

• Cook Children’s Hyperinsulinism Center
• Dr. Paul Thornton
• Cook Children's Referral Page

Listen to episode 2 of Cook Children's podcast - Pediatric Leadership: The New Medicine.

Questions addressed:

1. Have you noticed differences in leading in or advancing pediatric issues?
2. What are some particular challenges in pediatric leadership?
3. Moving forward, what are some particular issues in pediatrics where we need strong leaders to step in and lead?

Important links:

Texas Pediatric Society

Texas Medical Association

“Future pediatric leaders are waiting to step forward and it’s a matter of responding to the tap on the shoulder, the encouragement of a colleague to get involved.” – Jason Terk, M.D.

Jason Terk, MD-Cook Children’s Keller

Read Dr. Terk’s article about low HPV vaccination rates-Epic fail

Subscribe for series on iTunes

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Listen to episode 1 here. 

Our guest Mary Uhl-Bien is the BNSF Endowed Professor of Leadership at the Texas Christian University Neeley School of Business. She teaches in the Advancing Healthcare Leadership class which is a combined initiative between Cook Children’s and TCU. Participating in the class are about 30 physicians from throughout the Cook Children’s system including both specialists and primary care physicians. The goal is to establish a culture of strong leaders throughout the system so that we can work together to better serve our patients. Listen to episode 1 of Cook Children's new podcast - Pediatric Leadership:The New Medicine.

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