Volume 6 Number 3 In This Issue

EDITORIAL:  Engagement in the health system

Johny Van Aerde, MD, PhD

This issue of our Canadian Journal of Physician Leadership is about engagement. Physician engagement takes place at two levels: the independent, individual level and the interdependent, systemic level. At the independent level, physicians act as disease experts and as advocates for each patient, all on a one-to-one basis. In contrast, the interdependent level of engagement consists of two-way interactions, relationships if you will, with all the elements in the health care system: patients, physicians, health care workers, and all other stakeholders, each with their own needs and contributions. read article

PERSPECTIVE: Mastery of time: a challenge for physician leaders

Malcolm Ogborn, MBBS

Dealing with time demands is an ongoing challenge for physician leaders and a significant reason for the reluctance of physicians to accept leadership roles. Mastering time involves more than just maintaining a structured calendar; it requires understanding the bias our own perception places on time choices, understanding how we assign priority, and developing and maintaining good, consistent habits of time allocation. Time perception falls into five main frames: Past-Negative, Past-Positive, Present-Fatalistic, Present-Hedonistic, and Future.

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ADVICE: Coaching competencies for physicians: the artful question

Nancy M. Merrow, MD

In this series of articles on coaching competencies, we have been exploring how the coach approach fits into medical practice and leadership. Whenever you are faced with a person or group of people who want things to change, there is an opportunity for coaching. In coaching, artful questions and deep listening skills are used to identify the person’s goals, intentions, and inner resources that will be drawn upon to move forward. We propose that the coaching style of conversation is one tool that can be very useful once the physician has explored the utility and circumstances that make it powerful.  read article

PERSPECTIVE: “Us” and “them” in medical culture

Brian Goldman, MD

Empathy is the capacity to see things from another person’s point of view. In some health care settings, empathy and kindness are lacking. One factor in the lack of empathy toward both patients and colleagues is the tendency to see others as the enemy. Although humans are hard wired to be kind and empathic to one another, under conditions of stress, they are also hard wired to decide whether another individual is friend or foe. Some medical cultures are defined by conflicts between in-groups and out-groups and a resultant lack of empathy. One way to restore friendliness and empathy is to address the underlying sources of stress. read article

How a throughline focused on virtue may be a key strategy for physician leaders to stay in the infinite game

Duncan Rozario, MD

We are at a tipping point in society, where income inequality, employment instability, and a fundamental lack of societal virtue are poisoning the well of happiness. In his seminal 1776 work, An Inquiry into the Nature and Causes of the Wealth of Nations, Adam Smith1 said, “Consumption is the sole end and purpose of all production; and the interest of the producer ought to be attended to only so far as it may be necessary for promoting that of the consumer.”  read article

The LEADS framework as a roadmap for implementing quality management

Dawn S. Hartfield, MPH, MD

Large-scale implementation is a significant leadership challenge. The task can seem overwhelming, but a structured approach can transform what seems to be an impossible problem into a solvable one. When implementing our quality management framework, our team used the LEADS framework as a roadmap. As a physician new to a senior leadership role, using LEADS, along with other tools, bolstered my skills, ability, and confidence and those of the team to carry out a significant, large systems change. This journey demonstrates a unique use of LEADS and other tools that medical leaders may find of value in their daily practice.  read article

Measuring physician engagement in quality improvement: a pilot study

Tyrone Perreira, PhD, MEd, Melissa Prokopy, LLB, Adalsteinn Brown, DPhil, Anna Greenberg, MPP, James Wright, MD, MPH, Christine Shea, PhD, MEd, and Julie Simard, PhD

The term “physician engagement” is overused and often misunderstood. It is believed that system transformation requires physician engagement in quality improvement (QI); however, no tool exists to accurately measure this. The purpose of this study was to develop an instrument that could be used to evaluate physician engagement in QI and then pilot it with a small sample of physicians and physician leaders. read article

PERSPECTIVE: The journey to retirement for physician leaders

David Mador, MD

You have risen to a senior medical leadership role — the culmination of your administrative career. You have decided that the time is right for full retirement in the next one to three years and that this “retirement” will not entail continued medical roles or activities. Your family is strongly supportive. You have an adequate financial plan and have developed or considered other interests to keep you occupied and stimulated in retirement. read article

BOOK REVIEW: Humanity and relationships in health care

Reviewed by J. Van Aerde, MD, PhD

These three books deal with relationships, perceptions, and suffering as perceived by people who have experienced the health care system from different angles. One author was a student nurse, an administrator, the mother of a child who needed help, an advocate for children and families in a children’s hospital, and finally a patient.

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