Rural Physician Leadership Curriculum

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Rural Physician Leadership Curriculum

• West Virginia University
• Rural Family Medicine Residency Program

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Rural Physician Leadership Curriculum

• Module 3
• Servant Leadership in a Rural Clinic

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Description
Rural Physician Leadership Curriculum

• Funded by HRSA Grant D22HP00306
• Objective 1
• Develop a competency based longitudinal
  curriculum in Rural Physician Leadership

Konrad C. Nau, MD
Principle Investigator Chair, Dept of Family
Medicine-Eastern Division WVU Rural Family
Medicine Residency Program
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Learning Objectives Module 3
Rural Physician Leadership Curriculum

• Understand the characteristics of the Leader as
  Servant
• Identify the steps in creating a meaningful
  clinic vision statement
• Understand the six most powerful employee opinion
  questions that will determine your clinics
  success
• Know how to give negative appraisals and fire
  employees as a Servant Leader

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Servant Leadership

• spirit of work
• Deeper connection with our work
• Connection that transcends power/money
• Attitude
• Behavior
• Relationships

SERVICE
James A. Autry
The Servant Leader , 2001, Prima Publishing.
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Servant Leadership

• The servant leader is a servant first, it begins
  with a natural feeling that one wants to serve,
  to serve first. Then conscious choice brings one
  to aspire to lead.

Robert K. Greenleaf
Servant Leadership Paulist Press, NY 2002.
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Five Ways of Being/Servant Leader

• Be Authentic
• Be Vulnerable
• Be Accepting
• Be Present
• Be Useful

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Be Authentic Servant Leader

• Be who you are
• Be the same person in every circumstance
• Hold to the same values in your various roles

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Be Vulnerable Servant Leader

• Be honest with your feelings in the context of
  your work
• Openly admit mistakes in your own performance
• Realize that you cant be in total control /
  depend on others
• Note you can express anger but you cant act
  in anger

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Be Accepting Servant Leader

• Accept ideas as valid for discussion and review
• Focus on the ideas themselves not the person
• Embrace disagreement as a human part of the
  process of work
• Avoid making everything Win/Lose

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Be Present Servant Leader

• Having your whole self available at all times
• Available to yourself
• Available to others as you respond to problems
• Remain centered and grounded in the midst of
  perceived crisis

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Be Useful Servant Leader

• Care about people and be a useful resource for
  them
• Be present for people and building a community at
  work
• Let go of your ego, and bring your best self to
  work
• Create a place where people can find meaning in
  work, and bring their spirit to work

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For Discussion

• Business is about people. Business is of, by,
  about, and for people.
• Being vs Doing What you do at work is a direct
  reflection of you are.
• Efficiency is not the same as effectiveness
  and history has shown many examples of efficiency
  becoming the enemy of effectiveness.

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The Vision Thing

• The confluence of three aspects of an
  organization
• Purpose
• Mission
• Values
• Can inspire people about the clinic
• Defines what your clinic does
• Defines your workplace culture

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Purpose

• Why are we here ?
• Use language that helps everyone involved with
  the organization understand and focus on why they
  themselves are here

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Mission

• What do we do ?
• What do we do to fulfill our purpose

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Values

• How are we together as we go about performing
  our mission in order to fulfill our purpose ?
• Fundamentally about how we will behave toward one
  another
• Framework for creating your community of work.

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Bring it Home

• Meet with the employees of your clinic and as a
  group create your vision
• Consider using an outside facilitator
• Consider the several hours used in this process
  as an investment in the most challenging part of
  your job the people.

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Building your Clinic Vision

• Purpose Why are we here ?
• Mission What do we do to fulfill our purpose ?
• Values How do we behave at work ?
• We want to work with people who value.?
• Record on a 1 2 page document that all
  employees sign in orientation.

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Building your Clinic Vision

• Record on a 1 2 page document that all
  employees sign in orientation.
• Consider review and revision as a group every
  several years or in times of great change

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Building your Clinic Vision

• Record on a 1 2 page document that all
  employees sign in orientation.
• Consider review and revision as a group every
  several years or in times of great change

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Leadership Comparison
McGee-Cooper, G. Looper.
The Essentials of Servant Leadership , 2001,
Pegasus Communications Inc. p 3.
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Leadership Comparison
McGee-Cooper, G. Looper.
The Essentials of Servant Leadership , 2001,
Pegasus Communications Inc. p 3.
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Leadership Comparison
McGee-Cooper, G. Looper.
The Essentials of Servant Leadership , 2001,
Pegasus Communications Inc. p 3.
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Leadership Comparison
McGee-Cooper, G. Looper.
The Essentials of Servant Leadership , 2001,
Pegasus Communications Inc. p 3.
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Leadership Comparison
McGee-Cooper, G. Looper.
The Essentials of Servant Leadership , 2001,
Pegasus Communications Inc. p 3.
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Leadership Comparison
McGee-Cooper, G. Looper.
The Essentials of Servant Leadership , 2001,
Pegasus Communications Inc. p 3.
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Leadership Comparison
McGee-Cooper, G. Looper.
The Essentials of Servant Leadership , 2001,
Pegasus Communications Inc. p 3.
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Servant Leadership in your Clinical Workplace

• 1999 Gallup Organization study of a wide variety
  of business work environments
• Over 2,500 businesses
• 21 were health care
• Over 100,000 employees surveyed
• Meta-analysis of 13 employee questions

M Buckingham , C Coffman
First Break All the Rules The Gallup Org, Simon
Shuster 1999.
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Servant Leadership in your Clinical Workplace

• Correlated 13 core item measures of a strong
  workplace to
• Customer satisfaction/loyalty
• Profitability
• Productivity
• Employee Turnover

M Buckingham , C Coffman
First Break All the Rules The Gallup Org, Simon
Shuster 1999.
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Servant Leadership in your Clinical Workplace

• Six most powerful employee questions
• Do I know what is expected of me at work?
• Do I have the materials and equipment I need to
  do my work right ?
• Do I have the opportunity to do what I do best
  every day ?

M Buckingham , C Coffman
First Break All the Rules The Gallup Org, Simon
Shuster 1999.
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Servant Leadership in your Clinical Workplace

• Six most powerful employee questions
• In the last seven days, have I received
  recognition or praise for good work ?
• Does my supervisor, or someone at work, seem to
  care about me as a person ?
• Is there someone at work who encourages my
  development ?

M Buckingham , C Coffman
First Break All the Rules The Gallup Org, Simon
Shuster 1999.
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Landmark Gallop Findings

• Definite link between employee opinion and
  business unit performance
• The employees manager was the critical player in
  building a strong workplace

M Buckingham , C Coffman
First Break All the Rules The Gallup Org, Simon
Shuster 1999.
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Landmark Gallop Findings

• The managers role is to reach inside each
  employee and release their unique talents into
  performance.
• The manager role is best played one employee at a
  time
• Multiplied company power supply

M Buckingham , C Coffman
First Break All the Rules The Gallup Org, Simon
Shuster 1999.
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Core Activities of Catalyst Manager

• Select a person
• Select for talent not simply experience
• Set expectations
• Define the right outcomesnot steps
• Motivate the person
• Focus on strengthsnot weaknesses
• Develop the person
• Find the right fitnot just the next rung

M Buckingham , C Coffman
First Break All the Rules, The Gallup Org, Simon
Shuster 1999.
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I. Select a person for talent

• Talents are recurring patterns of thought,
  feeling, or behavior that can be productively
  applied.
• 3 types of Talent
• Striving talent why you get out of bed
• Thinking talent how you think decide
• Relating talent- whom do you trust, confront,
  build relations

M Buckingham , C Coffman
First Break All the Rules, The Gallup Org, Simon
Shuster 1999.
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II. Set Expectations Outcomes

• People need to know how to do a core set of
  things for accurate, safe work
• Defining the work OUTCOMES relieves you from
  having to micromanage every step of every process
• Have employee sign off on expectations

M Buckingham , C Coffman
First Break All the Rules, The Gallup Org, Simon
Shuster 1999.
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II. Set Expectations Outcomes

• Customer Dissatisfaction can be prevented by
  following standard processes.
• True Customer Satisfaction/Loyalty requires 4
  expectations be met
• Accuracy - Partnership
• Availability - Advice

M Buckingham , C Coffman
First Break All the Rules, The Gallup Org, Simon
Shuster 1999.
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II. Set Expectations Outcomes

• Insurance company Gallop investigation of core
  emotional outcomes that patients truly value
• I feel my doctor is competent (accuracy)
• Kept waiting not more than 20 minutes
  (availability)
• Doctor explains my condition in words I
  understand (partnership)

M Buckingham , C Coffman
First Break All the Rules, The Gallup Org, Simon
Shuster 1999.
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II. Set Expectations Outcomes

• Insurance company Gallop investigation of core
  emotional outcomes that patients truly value
• Someone in the office cares about me, doesnt
  always have to be the doctor (partnership)
• Doctor gives me something I can do for myself at
  home to help my condition (advice)

M Buckingham , C Coffman
First Break All the Rules, The Gallup Org, Simon
Shuster 1999.
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III. Motivate Focus on Strengths

• Spend the most time with your best people
• Paint a picture with your most talented as to
  what excellence looks like.
• If you spend most of your time with your worst
  performers you send a message
• Better performance means less time and attention
  from my manager

M Buckingham , C Coffman
First Break All the Rules, The Gallup Org, Simon
Shuster 1999.
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III. Motivate Focus on Strengths

• Poor Performance
• Is the poor performance trainable ?
• Is this caused by me tripping the wrong trigger
  as to what motivates them ?
• Is this a nontalent/weakness issue ?
• Is it mechanical (inadequate tools) ?
• Is it personal (emotional/health) ?

M Buckingham , C Coffman
First Break All the Rules, The Gallup Org, Simon
Shuster 1999.
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III. Motivate Focus on Strengths

• Nontalent
• Behavior that always seems to be a struggle
• A thrill that is never felt
• An insight recurrently missed
• Weakness
• A role where success depends on excelling in your
  nontalent

M Buckingham , C Coffman
First Break All the Rules, The Gallup Org, Simon
Shuster 1999.
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III. Motivate Focus on Strengths

• Ways to quickly turn weakness into success
• Devise a support system
• Find a complementary partner
• Find another role/job
• Correct your casting error
• Stop trying to fix the person

M Buckingham , C Coffman
First Break All the Rules, The Gallup Org, Simon
Shuster 1999.
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IV. Develop the Person The right fit

• Dont always promote people out of excellence to
  the next rung
• Promote people to where they can succeed
• Use creative trials to develop hidden talents
• Mentor
• Special projects

M Buckingham , C Coffman
First Break All the Rules, The Gallup Org, Simon
Shuster 1999.
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IV. Develop the Person The right fit

• One rung on the ladder does not necessarily lead
  to the next
• Each rung is not a slightly more complex version
  of the last one.
• Different talents are often needed not just
  more training.

M Buckingham , C Coffman
First Break All the Rules, The Gallup Org, Simon
Shuster 1999.
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IV. Develop the Person The right fit

• Create heroes at every rung
• Make every role performed with excellence a
  respected profession
• Reward value/excellence
• Money
• Titles
• Meetings
• Do not simply reward years of service

M Buckingham , C Coffman
First Break All the Rules, The Gallup Org, Simon
Shuster 1999.
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Servant Leadership Negative Appraisals

• If you see one coming set up a meeting asap
• Goal give person a chance to improve and avoid
  probation/firing
• This is the caring confrontation
• Do not show anger or agitation
• This is a do not disturb event

James A. Autry
The Servant Leader , 2001, Prima Publishing.
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Servant Leadership Negative Appraisals

• _____ you are not accomplishing what we agreed
  upon, and the quality of your work is not up to
  our standards.
• Why ? (Then be quiet !)

James A. Autry
The Servant Leader , 2001, Prima Publishing.
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Servant Leadership Negative Appraisals

• I didnt know that I was supposed to do/say
  that !
• RESPONSE
• Review the values/performance/outcome
  expectations

James A. Autry
The Servant Leader , 2001, Prima Publishing.
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Servant Leadership Negative Appraisals

• Im doing just as good as _____ and _______
• RESPONSE
• I cant comment on other peoples performance
  with you. You have to trust me to evaluate
  everyone fairly. Right now we need to focus on
  your lack of performance. Why are you not _____

James A. Autry
The Servant Leader , 2001, Prima Publishing.
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Servant Leadership Negative Appraisals

• Be sensitive to the fact that in criticizing the
  persons work,
• you are often criticizing part of the definition
  of that persons self perception.
• Demonstrate you are doing this because you care
  that they can succeed

James A. Autry
The Servant Leader , 2001, Prima Publishing.
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Servant Leadership Negative Appraisals

• Document all meetings in writing
• Signatures to indicate meeting occurred (not
  necessarily that they agree with you)
• Invitation to add any written response
• Document the consequences
• Required Follow-up meetings
• Probation / Termination

James A. Autry
The Servant Leader , 2001, Prima Publishing.
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Servant Leadership Negative Appraisals

• Beyond the first offense Counsel in a concerned
  way
• Im concerned this job may not be a good fit
  for your talents.
• Lets talk about why.
• You may need to find a role that plays more to
  your natural strengths.
• What do you think that role might be ?

M Buckingham , C Coffman
First Break All the Rules, The Gallup Org, Simon
Shuster 1999.
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Servant Leadership Negative Appraisals

• Follow-up Meetings
• Weekly at first
• Then monthly
• Document, Document, Document
• Then the performance improves or.

James A. Autry
The Servant Leader , 2001, Prima Publishing.
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Servant Leadership in Firing

• Dont fool yourself into thinking that enough
  willpower virtually all behaviors can be changed
• This makes every case of poor performance the
  employees fault
• The poor performer knows they are struggling
  before you do
• It is not a matter of stupidity or disrespect

M Buckingham , C Coffman
First Break All the Rules, The Gallup Org, Simon
Shuster 1999.
57
Servant Leadership in Firing

• Understand that a persons talent and nontalent
  are an enduring pattern
• If you have truly tried to manage around their
  nontalents and they still underperform
• Their talent does not match this role
• It is a matter of miscasting

M Buckingham , C Coffman
First Break All the Rules, The Gallup Org, Simon
Shuster 1999.
58
Servant Leadership in Firing

• Non-caring
• Being too weak to act quickly and honestly
• Allowing a person to struggle in a role that does
  not fit their talents
• Shirking your moral obligation to the rest of the
  group

M Buckingham , C Coffman
First Break All the Rules, The Gallup Org, Simon
Shuster 1999.
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Servant Leadership in Firing

• Caring
• Setting people up for success
• Find roles that play to their talent
• Firing the miscast person

M Buckingham , C Coffman
First Break All the Rules, The Gallup Org, Simon
Shuster 1999.
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Servant Leadership in Firing

• Document in writing the repeated
• Outcome that is not achieved
• Value that is not practiced
• Violation of standards with regard to accuracy
  and availability

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Servant Leadership in Firing

• Come right to the point
• ________ I think we both recognize that you
  continue to struggle in this position.
• You have some good personal qualities and talents
• But, they are just not right for this job.
• I have to tell you that you are fired.

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Servant Leadership in Firing

• End on a supportive note
• Allow the employee to participate in the wording
  of the announcement
• resignation
• leaving to pursue other opportunities
• When in doubt, err on the side of generosity and
  dignity

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Servant Leadership in Firing

• Procedure
• Have paycheck with unpaid vacation time in hand
  if possible
• Give employee contact name/number for benefits
  (ie. arranging COBRA etc)
• Pro/Con empty desk/security/locks
• Pro/Con allow time to say goodbye
• Timing
• End of the day the last day.

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Servant Leadership in Firing

• I have often said that if you cant say I love
  you, youre fired, then you shouldnt be in
  management.
• James A. Autry
• You must be able to feel and exhibit affection
  and goodwill and, yes, loyalty toward the people
  you have to appraise positively, negatively, or
  even fire.

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Servant Leadership Conclusions

• You now KNOW
• What it means to be a Servant Leader
• How to create a mission.vision, performance
  expectations for your clinic
• The six most powerful employee satisfaction
  questions that will directly effect your clinic
  productivity, profitability, employee turnover,
  and patient satisfaction/loyalty
• How to give the most difficult appraisals in a
  caring way.