Lessons in health care leadership_ joseph pina – nejm catalyst
How should a young Army colonel deal with a physician colleague who pulls rank with juniors and creates an environment hostile to speaking up? Colonel Joseph Pina of the U.S. New innovations in science Army Medical Corps reflects on leveling the status differences that both military rank and professional hierarchy confer and the lessons in this challenge that are relevant for all physician leaders.
Mary Jane Kornacki: I’m here at the IHI Forum in Orlando, Florida, the 28 th annual forum, and I’m speaking with Joseph Pina, a colonel in the Medical Corps of the U.S. New innovations in technology Army.
Pina: Sure. New and innovative business ideas in india So, maybe about 10 years ago or so, I was a brand new Chief of Medicine at Tripler Army Medical Center, which is one of the Army’s larger facilities out in the Pacific, and I was in charge of physicians and nurses and allied health professionals within the department to provide care. New innovations suny downstate It was an early leadership position for me, and I do recall working on honing my skills interpersonally and working with my staff so that we could provide the best care possible. New innovations in technology computers And we were just getting to thinking about things such as psychological safety on teams.
TeamSTEPPS is a program that we promoted. New innovations in construction technology I was an instructor in TeamSTEPPS, so I really embraced the idea, and that program allows us to flatten the organization as far as the authority gradient was, the rank structure was. New innovation technologies dubai My being a colonel was a very senior rank, and most of the people in my department were majors and captains, which were relatively junior rank. New innovations partners I had a provider who was a civilian for most of his career but came into the Army for patriotic reasons, but he was actually a pretty skilled internist, and because of his experience and background, he was given the rank of a lieutenant colonel, which is one grade lower than my rank, but it was certainly a superior rank to most of the people in the department.
We’ve got our rank structure, which creates this power gradient, which is a barrier, really, to learning and psychological safety, and then we are also health care providers, which in and of itself has its own culture that we have to get around to get to that psychological safety and team-based play.”
And he was a very fine internist. New innovations for 2014 However, he had difficulty working as a team player. New innovations in electrical technology Tripler being a training organization, we have a GME program there. New innovations sign in He was the attending physician for many of our residents who were junior in rank to him, and those residents really were intimidated by him. Partners new innovations He was a lieutenant colonel, and he let you know that he was a lieutenant colonel. Vanderbilt new innovations He was very much focused on his rank, and so there were episodes where he was reported to. New innovations in computer technology 2013 If a resident said the wrong thing to him, he would have them do push-ups in public, on the ward, with patients around, and nurses around, and other staff around to see that, and he would not have a problem with berating the residents in public.
I heard similar stories about that with some of the other team members, the nurses, et cetera, if things didn’t go his way. Www new innovations So, a very difficult personality, challenging personality. New technological innovations I had gotten enough of these reports that I would bring him in, and I would counsel him, and we would have a discussion as to what’s going on. New innovations in technology in 2015 Essentially, I was telling him, “You can’t behave like this. New technology innovations in business It’s disruptive to our culture, and we’re trying to have a culture where we’re non-punitive, and then people can report and people can feel that they can speak up when they need to for the sake of patient safety, and also for staff well-being, and for morale purposes.” And it was very challenging for him to accept that.
So, I had these conversations with him — actually it was several conversations with him — and I don’t think I really got through to him, because the episodes still continued, and eventually he had to be let go or essentially was reassigned. New innovations log in I thought that that was a very introspective moment for me in my career, because I’m an introvert by nature, and it takes a lot for me to basically say no to people or confront them. New technologies trends innovations and research But if you do it in the name of patient safety, it helps to justify that behavior. New innovations ttuhsc Looking back on that, knowing what I know now, I think I would’ve acted sooner to nip it in the bud.
They need to be competent and stay competent, and those who are not competent, we have to hold them accountable, and then those who are disruptive and who are not team players have to be held equally accountable.”
When you hear of bad behavior, particularly with physicians, who are held in high regard in the hierarchy of medical, you really need to be on top of that. New innovations in technology 2016 And I would also have tried to understand why he behaved the way he did, and what was his perspective on things, more so. New innovations in computer technology 2014 It was frustrating for me, especially my being a physician and he being a physician. New innovations in software technology I said, “You really should be behaving better. List of new innovations You are a role model, and you’re messing up.” And I think I could’ve been a little bit more sympathetic to his position and his side of it.
It also reinforced some concepts that in the military, we have a double-whammy. New innovations login We’ve got our rank structure, which creates this power gradient, which is a barrier, really, to learning and psychological safety, and then we are also health care providers, which in and of itself has its own culture that we have to get around to get to that psychological safety and team-based play. New and innovative ideas for business So, in the military, we have that double-whammy effect with our rank as a power gradient, and then also our disciplines, the physicians versus non-physicians, is a typical thing you see in health care. New inventions and innovations And so, we’re doing a lot. New innovations in computer technology 2015 We’ve recognized that that is a hindrance to patient safety, and we know that our outcomes could be better.
We’ve got great outcomes in different areas, but we know it could be better, and for that reason, we have to focus on the culture piece. New innovations in educational technology I mentioned TeamSTEPPS is one tool that we use to try to flatten the organization, or flatten the team so then we can get around that power gradient and have better learning. New innovations in healthcare technology We also have leader development courses that we have that focus in on, getting a mentor, having a role model who doesn’t display toxic leadership, but actually promotes those positive things that we want to see with leadership. New innovations residency Deferring to expertise rather than deferring to rank in situations as they are appropriate is a key part of that.
As a leader, if I’m not changing, I’m not recognizing where the tension points are or the vulnerabilities are in my team, then I’m failing, and I need to recognize that.”
I’ve had mentors who’ve taught me some great, great things about how we need to revere all of our team members for the knowledge that they know, and go to them. New innovations in mobile technology And as a critical care physician myself, I know that patients die very quickly if I don’t defer to the person on my team who has the knowledge, for example, the respiratory therapist or the nurse, with that.
The other thing is that, to talk about accountability, in the military we’re trying to foster this just culture. New innovations in banking technology We know that systems problems can be the crux of many errors that occur, but we do have to realize that people have to be accountable for their actions and for their own training. New innovations residency login They need to be competent and stay competent, and those who are not competent, we have to hold them accountable, and then those who are disruptive and who are not team players have to be held equally accountable. New innovations 2014 For physicians, if you look at the ACGME, we have six levels of competency that we have to meet. New innovations resident login And basically, to be a complete physician, you have to meet all of those, and any one of those levels, those elements that you don’t meet, you need to work on. What is new innovations That’s where the accountability comes in, and if you have somebody on your team who just is not going to work on [that], is not going to be able to make it and puts your mission at risk, then you may have to let that person go, which is a challenge in the federal system as it is, but that’s all the more reason why we need to identify these folks early on.
And I have to be held accountable as well. New innovations and inventions As a leader, if I’m not changing, I’m not recognizing where the tension points are or the vulnerabilities are in my team, then I’m failing, and I need to recognize that. Best new innovations We do a lot of introspection now, as leaders, and use that, as long as we’re focused on patient safety as that primary mission.
This story was recorded at the Institute for Healthcare Improvement’s 28th Annual National Forum in Orlando, Florida, on December 4–7, 2016 by Mary Jane Kornacki on behalf of NEJM Catalyst. New innovations in packaging technology We wish to thank IHI for support of this project, especially Madge Kaplan for her technical advice and guidance. New innovations in medical technology Click here for more Lessons in Leadership stories .
Very good interview, it points out a problem that COL Pina failed to address. New innovations of 2014 That is the inability or unwillingness to discipline or replace active duty physicians and surgeons who refuse to be team players.
Any civilian facility faced with this physician that was truly worried about their organizational culture would have pulled his privileges until he managed to conduct himself appropriately. New innovations vcu Instead he was “reassigned,” which basically means he became someone else’s problem. Rms new innovations This happens all to often.
COL Pina implied this problem was ingrained in federal healthcare but it is almost exclusive to active duty providers in the DOD, or at least that has been my experience in the 28 years I have been around military healthcare.