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What Causes A Toxic Hospital Culture?

Hospital culture is largely influenced by the relationship between administrative and clinical staff leaders. In the “old days” the clinical staff (and physicians in particular) held most of the sway over patient care. Nowadays, the approach to patient care is significantly constricted by administrative rules, largely created by non-clinicians. An excellent description of what can result (i.e. disenfranchisement of medical staff, burn out, and joyless medical care) is presented by Dr. Robert Khoo at KevinMD.

Interestingly, a few hospitals still maintain a power shift in the other direction – where physicians have a strangle hold on operations, and determine the facility’s ability to make changes. This can lead to its own problems, including  unchecked verbal abuse of staff, inability to terminate bad actors, and diverting patients to certain facilities where they receive volume incentive remuneration. Physician greed, as Michael Millenson points out, was a common feature of medical practice pre-1965. And so, when physicians are empowered, they can be as corrupt as the administrations they so commonly despise.

As I travel from hospital to hospital across the United States (see more about my “living la vida locum” here), I often wonder what makes the pleasant places great. I have found that prestige, location, and generous endowments do not correlate with excellent work culture. It is critically important, it seems, to titrate the balance of power between administration and clinical staff carefully – this is a necessary part of hospital excellence, but still not sufficient to insure optimal contentment.

In addition to the right power balance, it has been my experience that hospital culture flows from the personalities of its leaders. Leaders must be carefully curated and maintain their own balance of business savvy and emotional I.Q.  Too often I find that leaders lack the finesse required for a caring profession, which then inspires others to follow suit with bad behavior. Unfortunately, the tender hearts required to lead with grace are often put off by the harsh realities of business, and so those who rise to lead may be the ones least capable of creating the kind of work environment that fosters collaboration and kindness. I concur with the recent article in Forbes magazine that argues that poor leaders are often selected based on confidence, not competence.

The very best healthcare facilities have somehow managed to seek out, support and respect leaders with virtuous characters. These people go on to attract others like them. And so a ripple effect begins, eventually culminating in a culture of carefulness and compassion. When you find one of these gems, devote yourself to its success because it may soon be lost in the churn of modern work schedules.

Perhaps your hospital work environment is toxic because people like you are not taking on management responsibilities that can change the culture. Do not shrink from leadership because you’re a kind-hearted individual. You are desperately needed. We require emotionally competent leaders to balance out the financially driven ones. It’s easy to feel helpless in the face of a money-driven, heavily regulated system, but now is not the time to shrink from responsibility.

Be the change you want to see in healthcare.

Family Medicine Residents And Students Discuss Leadership And Advocacy

Just wanted to get some initial thoughts down following the Family Medicine Summit organized by the California Academy of Family Physicians. I’ll have some more developed thoughts in a later post. These initial thoughts were from the plane going from that meeting to the Mayo Clinic Social Media Summit – the meeting I’m at right now.

First of all, thanks again to the California Academy of Family Physicians for the invitation to speak. The audience was mainly Family Medicine Residents and medical students. From my understanding, the registration numbers exceeded expectations (I take full credit for that – Hehe). It’s always energizing to me to present to residents & students.

The opening keynote was from CAFP President Dr. Carol Havens. She asked the audience for words that they think of when you hear “Family Physician.” And, as you can see from this twitpic, the audience came up with a huge list of Family Physician qualities. My favorites are “comprehensive care,” “revolution,” and, of course, “Love.”

My leadership & advocacy sessions Read more »

*This blog post was originally published at Family Medicine Rocks Blog*

Why Aren’t There More Women CEOs In Health IT?

The Health Tech 2011 Conference, held earlier this month in Boston, featured presentations from startup CEOs in the health and wellness space. The conference had nothing to do with gender issues or leadership per se. Yet the Twitter feed from the conference (#ciht11) contained this:

@ml_barnett By my count, only 3 of 27 speakers are women. RT @taracousphd: where are the female entrepreneurs? It’s healthcare!!!

taracousphd and @ml_barnett reminded us of a painful fact. There aren’t many female CEOs in Health IT. Why is this?

wecandoit 115x150 Where are the Women CEOs in Health IT?Women certainly aren’t short on content knowledge in health care. In fact, they dominate men in this area. More than 40% of all practicing physicians and 50% of all medical school graduates are women. Women earn nearly 3 times more PhDs in psychology (useful content knowledge for startups in the space covered by Health Tech 2011). Nearly 94% of nurses and 74% of physical therapists are women, and they rule the workforce in public health, social services and pharmacy  as well.

The problem–and it’s a big one–has to do with the ‘IT’ part of ‘Health IT.’ In 2008, only 6% of Fortune 500 technology companies had female CEOs and 13% had women corporate officers of any kind, according to the National Center for Women and Information Technology. Among tech startups that raised venture capital in 2009, only 4.3% were led by female chief executives. A recent Business Week list of the ‘best young entrepreneurs in tech’ included 45 people, only 3 of which were women.

Among the many explanations for the gender disparity among chief executives in IT, the 4 that make the most sense to me are these: Read more »

*This blog post was originally published at Pizaazz*

Depression: Is It A “Character Issue” And A Disqualifier For Leadership?

When the Republicans took back the House of Representatives [recently], John Boehner, the presumptive new Speaker and current Senator from Ohio, unleashed a “sob heard round the world.” As The New York Times quotes:

“I’ve spent my whole life chasing the American dream,” (Boehner) said, beginning to cry. He swallowed and tried again. But describing all the bad jobs he had once led to near sobbing when he got to the line, “I poured my heart and soul into running a small business.”

Boehner has cried in public many other times, the recent election night being only the largest stage to date. The tears also flow at his annual golf tournament, or while watching a child pledge allegiance to the flag, listening to a Republican colleague speak about his Vietnam War experiences, the unveiling of a statue of Ronald Reagan, while accepting various awards, during a rendition of “America the Beautiful,” etc. Could these tears be signs of major depression? Should melancholy be a disqualification for leadership? Were Clinton’s tears any better? Read more »

*This blog post was originally published at The Examining Room of Dr. Charles*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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