Working In Jeans: Life Replaces Career

It’s been more than three months since stepping down from ACPE.  Like many of the readers of this site, I’m in a transitional period.  After nearly four years of big responsibility - 24/7, 365 - the change to part-time work in health care has been wonderful!  Our lives, careers, events, and people are interconnected, but sometimes we have to make an effort to see those connections in hindsight.

I’m taking an Improv class now that I have more time.  After hearing that two of my role models for presentation skills attributed their success to Improv classes, I decided to try it.  Just as my friends told me the secret of Improv, I’ll share it with you.  Two or three words: “Yes.....And”, or “Always say Yes”.  

The point of Improv is to always keep the conversation going, and to link improbable thoughts.  All too often in business and health care, that doesn’t happen.  People frequently try to stop conversations and ideas from moving forward.  “That won’t work”.  “We tried that before.”  “There’s no money in the budget for that.”  Or my favorite: dead silence.  If we can laugh as hard in business as we do in our novice attempts at Improv when an idea moves through its zig zag path from the absurd to the sublime, we will be better off.  We’ll also provoke new ways of thinking or seeing something differently.

Like most of you, my life since finishing medical school has been pretty much pedal to the metal in private practice, management roles, and family responsibilities.  Mix in regular periodic sleep deprivation to the physician’s life of self and family sacrifice for patients and the expectations of our profession, and it becomes very difficult to step back and assess who we are, and how we want to live our lives.  It seemed like I always knew what my life was about, but seldom had the proper time and circumstances to reflect on the more existential questions.

I decided to continue doing health care related work no more than half-time after leaving  ACPE.  One part practical, another part passion for improving health care, the experiences from working at the bedside to the boardroom provide insight that I like to share with health system leaders - both clinical and non-clinical.  Now, as a free agent, I can be more provocative and take more risks in advocating for better leadership for health care.  For example, at the American College of Cardiology’s January leadership meeting in Las Vegas, the title of my topic was, “Venus and Mars: Why Can’t Hospital Administrators and Physicians Get Along?”  They chose the title, but I was excited about laying out the multiple reasons for conflict - and providing some ways to move beyond conflict to cooperation.  Judging by audience feedback, and the feeling of “flow” as I spoke, I hope to have more opportunities like that. 

Just before arriving in Las Vegas for the ACC meeting, I returned from my second visit to Saudi Arabia as an ACPE faculty member for a physician leadership development program at a major health system there.  The system’s determination to learn “American” principles of leadership, teamwork, and management was absolutely refreshing and motivating for me, and for Marty Martin, my fellow faculty member, and now frequent travel companion to the Middle East. 

In addition to being a witness to the profound changes happening in the world through international programs like this, I found myself enjoying even the unanticipated events associated with travel abroad: Missing a connecting flight in Amsterdam, and spending a night in that city; meeting Marty the next morning in the airline lounge for one of our usual discussions about insights into American health 

care (it feels like there’s ample time to listen when we’re far from home); and tagging along with Harry, the Dutch engineer with the gigantic handle bar mustache who was the only person in the Saudi customs lines that got smiles from the Saudi officials.  He sat next to Marty on the flight, and I’m sure our experience in customs would have been less cheery had Harry not given the impression that we were friends of his.

My attraction to international work continues.  I’ve also gotten involved in an interesting project based in China, with an American political connection.  Too early to tell if it will come to completion, I know it might never have come my way if I hadn’t traveled to China and Tibet in 2005.  On that trip I remember being drawn to the Tibetan symbol for interconnectedness, which was in all of the monasteries, including the Potala Palace, built in the 7th century, and home to several Dalai Lamas.  That symbol is prominently in my thoughts as I contemplate spending more time in the Himalaya doing something useful. 

Now the morning chill is gone, the snow is melting, and it’s time to resume my stonemasonry project that’s been on hold for too long.  Though my thoughts and activities are on a zig zag pattern, the stones are coming together in a beautiful, interconnected pattern that pleases my eye.

Movin' On: The Path Not Taken

Last week I got an email from a former physician colleague. He still works at a health care organization that I left years ago. The re-connection got me thinking about what I would have missed in my life and career had I remained at that organization. Now that I'm about three months away from leaving ACPE after three and half years as CEO, I've been in a reflective mood.  

First, leaving the traditional health care organization, with its typical hospital-physician-insurer tugs of war over reimbursement, culture, and authority dynamics, was a breath of fresh air for me. Never comfortable with the status quo, I wanted to get out and find new approaches to improving health care. 

Freed from the constraints of orthodoxy, I signed on to join a small start up company focused on changing consumer behavior in the workplace to reduce health care costs, and create a healthier workforce. I learned how to find investors. I learned how to assemble office furniture from IKEA because frugality, functionality, and teamwork was required of everyone on the senior team. I liked the idea that our work and execution of strategy would determine whether the business concept would succeed. When a couple of senior professionals left, I understood that I would have to take over some of their responsibilities of consumer research. I enjoyed doing that. Even though the company eventually closed its doors (like most start ups), the experience was a good one.  

Next, I joined a couple of system safety engineers in their growing consulting group to learn about how aviation, nuclear power, manufacturing, and other industries had become highly reliable. It required learning new concepts and language, then translating that to health care. It was exciting to work with health systems, physicians, and nurses who were committed to being pioneers in adapting the safety science of engineering to health care. I soon discovered that several other physicians were intrigued by the same concepts. We could talk the same language, and see a path to improving performance and patient safety. The consulting work was part-time, which allowed me to travel, and get a major stonemasonry project moving along. Could life be any more interesting or satisfying?

When ACPE's founder and CEO announced his retirement in 2008, the opportunity came to build on everything in my background. I found the new challenge that made my life more interesting and satisfying. I'm convinced that having worked in the insurance, hospital, medical practice, consulting, and entrepreneurial sectors of health care was attractive to the ACPE Board. I viewed the College more as a nimble, creative start-up opportunity than a thirty-five year old professional association. The strategic thinking and business plan execution required of start-ups was far more important than having a background in association management.  

Learning how to listen to the staff, which includes journalists, artists, educators, and professionals in marketing, IT, and finance, was key to surviving the recession, and rebounding from it. I asked our creative artists and journalists how they would redesign our journal - pej - to give it a more contemporary look and feel.  Who would have thought that changing to small case, big blocky letters would have such an impact?  The quality of writing - both from physicians and free lance journalists - increased.  

From my private equity market experience, I paraphrased a quote from Malcomb Forbes with my Board about their role and my role:

"There are but two questions a board should ask at each meeting.  The first question is always the same: 'Should we fire the CEO today?'. If the answer to the first question is "yes", then the second question is, "Then who among us shall serve on the search committee?". If the answer to the first question is "No", then the second question is, 'Then how can we support the CEO and the staff to be successful?'

Some said that was "too harsh" a way to look at the governance-management issue. Not for me, nor for the great board chairs I had the privilege to work with. All are great friends - but we all understood the harsh reality and consequences of running a business.  

I was left thinking that if I'd stayed with my previous organization, I would have had a nice salary, important title, pension plan, and nice people as colleagues. But I most certainly would not have found my way to ACPE, learned how to lead and manage through the recession, or have the opportunity to work with talented people outside of health care, who have a lot to offer to those of us working in the health care industry. I'm looking at my next transition at the end of the year as adventursome, exciting, and fulfilling. One way or another, I'm "leaving the tribe" again - a topic I'll be speaking on in Las Vegas at the Medical Fusion Conference in November.

Trust Your Inner Voice

You'll Know Why Eventually!

We just finished our ACPE Annual Meeting last week.  As I watched some of our best physician faculty members teach what they're passionate about, I thought about how they got to this point of their career.  At one point, they were at the same intersection that many readers of this website can understand.  Here are some people and their journeys that might convince you that your inner voice deserves your attention.

John Kenagy is a surgeon who fell out of a tree years ago, fracturing some cervical vertebrae.  During his convalescence, he thought about the inefficiencies and frustration in his daily routine as a surgeon, and as a patient.  It led him to a decision to get a Masters at Harvard.  Once that decision was made, he found himself intrigued by Toyota's manufacturing process, which is legendary for producing a product with few defects compared to their competitors.  I met John a decade ago, when I was also fascinated by Toyota.  At the time, we had to contend with our physician colleagues who thought our intellectual diversions from medicine were useless.  Wrong!  Though we might wonder ourselves why something fascinates us, it is always worthwhile to pursue that fascination.  It led John to work with Clay Christensen, the business thinker who's written books on the concept of disruptive innovation.  John has also made a major contribution to health care leadership with his new book Designed to Adapt, which summarizes his experiences and thinking about transforming health care.  He's taken Toyota's Lean concepts and applied them to health care.

Alan Kaplan, the CMO of the Iowa Health System, and Immediate Past President of ACPE, is a very dynamic and engaging speaker.  I asked him how he got so good at extemporaneous remarks and connecting with his audience.  Improv.  When he worked in the Chicago area, he joined an Improv group to learn how to connect with an audience.  Was that just another restless doc daring to have fun?  No relationship to health care?  That would be the conventional "wisdom".  Maybe that's an oxymoron.  The secret to Improv, Alan (and another faculty member who's really good) says, is to think "Yes.....and?.....".  That keeps a conversation going.  That little tip has been really helpful to me when I'm in the inevitable trap of having at least one physician in a group who wants to shut down a conversation with the entire audience by making comments that will stop the conversation.  One of my goals this year is to find someone in my hometown of Albuquerque who can teach me more about Improv.

Grace Terrell, CEO of a large physician group in North Carolina, is an insightful thinker, speaker, and powerful writer.  She's combined her passion for writing, strategic thinking, and compassion for people in her role as CEO.  She just finished her three year tenure on our board.  She made a connection with a first time attendee, a young physician grappling with her career interests.  The connection that provided the bond: English literature.  That's something both had in common, in addition to being physicians.

Barbara Linney, our career counselor, leader of our CPE program at ACPE, and wife of a physician, typically  counsels physicians individually.  She says that a common issue is boredom.  Most physicians are high achievers, have perfectionistic tendencies, and work really, really hard.  At some point, doing excellent work becomes well......boring!  These physicians tell her, "Everyone tells me I should just shut up about it.  You're a physician, you're supposed to be happy."  Some find that new challenge they seek in leadership and management.  Others want to explore concepts of engineering applied to health care.  Sometimes you must indulge your passion for music, the arts, stonemasonry, or quilting as you wrestle with your career boredom, until you figure out where you're heading.  It's all OK, whether it takes a month, or a decade to figure it out.   

Finally, take a tip from my oldest son, a commercial pilot.  He came home from a fourteen and a half hour day working at our shop (old truck restoration), and said, "I am really tired - but NOT fatigued."  A big difference, and a good difference.  Fatigue is what pilots, physicians, air traffic controllers, and others with stressful jobs experience when the brain and body are overloaded from stress.  His comment resonated with comments I heard at the Annual Meeting: we often don't realize how little time we have to think, because we are often fatigued.  Take time - non-fatigue time - to talk with your family and friends about what you're mulling over.  Don't allow the "shut up, be happy" dialogue to enter the conversation.  Just ask for support or indulgence in what may be a whim.  But it just might be really important!