How To Engage Intensively

A practical guide for physician leaders when things go wrong.

There are two types of physician leaders: those that have dealt with a potentially catastrophic issue—and those that haven’t yet.  I’m referring to those incidents that tend to excite the media or bring regulators to your doorstep.  It could be a failure of your quality system or a product recall.  Even worse, it could result in a serious injury or death of one or more of your patients or staff. 

You may be a practicing physician in a clinical role—or a physician seeking a non-clinical role in industry.  Whether you are managing a clinical practice or a commercial enterprise, chances are you will face such a serious challenge sometime in your leadership experience.  The question is how to engage intensively—and lead others through the investigation and problem solving. 

Here is a multi-step process developed for the military that has been adapted for use in industry.  This process can also be modified to fit the needs of a clinical practice.    

Gathering Information

• Use multiple communication channels and early warning systems, such as dashboards, operating reviews, and skip-level meetings to monitor important performance dimensions of your business or practice.
• Take initial reports for what they are…initial.  Acting prematurely before having reliable facts may force you to “put toothpaste back in the tube.”
• Beware the vividness of the moment.  Time settles your emotions.
• Don’t shoot the messenger

 When Deviations from Plan Occur

• Expect bad news to travel to you slowly
• Expect and get over denial ASAP
• Expect the reality to become distorted as it traverses layers of management (not necessarily a result of devious acts).
• Anticipate a “victim” mentality (i.e., it wasn’t my fault) and counter-productive finger-pointing (i.e., it was someone’s fault), which further distort the true underlying causes.

 Getting to the Root Causes

• Collectively, the people closest to the problem (e.g., nurses, technicians, clerical staff, and clinical monitors) know the problem.
• Establish a direct line to these people—and preferably, see them on their turf and in the process.  Do not alienate their management chain—they need to support you and learn the lessons with you.
• A “root cause” is not a restatement of the problem or one of its symptoms—but rather a critical assessment of the underlying cause.
• Strenuously separate fact from opinion.  Keep asking “Why?” until you are satisfied that you have gone deep enough.
• Once you have broken the situation into its component root causes, you need to assemble a “shared reality” before moving forward to “solve the problem.” 
• Problems often stem from a series of causes; avoid focusing only on the last event.

 Problem Solving

• Tie the thread together that links root causes (facts) to corrective actions, which lead to potential solutions (opinions and recommendations).
• Vigorous debate of potential solutions leads to the highest quality decisions—but maintain an appropriate sense of urgency.  Encourage and reward dissenting opinions.
• Develop a detailed plan of action with a clear timeline and accountability.  A good leader shares accountability for the situation, but gives all the credit to the team once success is achieved.
• Be mindful to separate short-term fixes from longer-term systematic solutions—which may require different people, processes and/or a full-scale change management program).

 Lessons Learned

• After the dust has settled, assign a smart non-participant in the situation to do an objective “Lessons Learned” report.
• Teach the relevant colleagues the “Lessons Learned” to avoid repeating the mistakes.
• Remember that anybody can lead in good times.  The best leaders are those who rise up and inspire in times of adversity and uncertainty.