Melissa Phillippi, President and Co-Founder of Performance Culture Inc., Dr. Philip Brown, Chief Physician Executive at New Hanover Regional Medical Center (NHRMC) and Dan Goodwin, Vice President of the Physician Group at NHRMC discuss the importance that leadership plays in the culture of their organizations.
Key Discussion Points
- Developing trust with your employees by earning the will of your team
- Overcoming challenges faced with new physician leadership
- Avoiding physician and non-physician burnout
- Understanding your organization’s culture and your team’s various personality profiles and communication styles.
Hello and welcome to the MGMA insider podcast. I’m Daniel Williams. Today we have a special inside or episode, we’re joined by three guests, Melissa Phillippi, who is president and Co-Founder of Performance Culture Inc., Dr. Philip Brown, who’s Chief Physician Executive at New Hanover Regional Medical Center. And Dan Goodwin, Vice President for the physician group at NHRMC. New Hanover, is located in Wilmington, North Carolina. And in fact, all three of our guests are located in the Wilmington, North Carolina area. They have a fascinating story to share with our listeners today about how the leadership in NHRMC was able to build a culture that could grow and thrive in the day to day stresses of a hospital network, but also have a plan in place for a natural disaster such as the one they experienced with Hurricane Florence.
You know, Dr. Brown and Dan are here to join us today because of really their experience and their background. And one of the topics and the goals of the research report is how can medical practices, how can healthcare organizations really reduce employee burnout, position and opposition alike? And how can you do that through the focus of intentionality with your culture and having a healthy culture? That’s our premise of the research report. But is that right? Is that the answer? Is that an answer? And if so, how can you do that? If someone were to ask you that question? How can you really impact burnout, decrease burnout. I think it starts with culture, and taking the time to invest in creating the right culture will set you up when you do have either emergency situations, or just, you know, your typical daily grind to get through. What we found the biggest impact that we’ve had in in creating good sound culture, is making it fun. Again, like too many times, people just get focused on the mundane things and coming in and having to solve problems. And what we’ve done in our practices, in particular, from a cultural perspective, is we’ve given the ability for our employees to have employment engagement councils, we give us a just a side of money, it’s very small amount to create fun events within their practices
that gets them engaged and interested in coming into work. And that’s kind of really the foundation that we work with, is setting the fun up with our employees. And then from there, you can go ahead and you got to meet you have to track at what your engagement looks like, you have to set goals and align the staff to those goals. But if you don’t have the right foundation, and you’re not having fun, and employees aren’t having fun to try to get to part two, and part three, what we found is that you end up with employees that are distrustful of the process. So again, part of the way to get them to trust you and be open with you, in my opinion, is to have fun at work again,
and Dr. Brown you had earlier talked about your past career, maybe it was a as a basketball coach is something about that kind of coaching and teamwork is that integrated into the leadership models that you’ve developed?
It’s huge, actually, the two real real tightly parallel if you will, and I want to start with kind of a story of where we are in our culture, just a small example from the hurricane. And then I can say a little bit about how we got there. But one of the things we did after the hurricane was set up a relief center for supplies for our employees, we have about 10% of our workforce whose homes or severely affected by the flood, many of whom had total losses. And my wife actually had a chance to spend a lot of time working into Relief Center and helping these people get supplies. And we had one employee who came in and only wanted a single pack of diapers.
And my wife says, Well, you know, we’ve got all this stuff do you need, you know, can I just get you some more stuff are you need for your children, everything. And she said, No, this is all I can take right now. Because I can only drive to within a half a mile of my house. And then the last half a mile, I have to get in a canoe and paddle to my house. And so it’s really inspiring to have a workforce that is that dedicated to coming in and serving their fellow man basically. But it really starts when people recognize each other’s vulnerability. And the concept around it is no more complicated than any other heroic event that you hear a lot of somebody go to great exchange to help somebody else is because they would do it for them. And they know that. And so we spend a lot of time actually at leadership levels, talking about our own vulnerabilities, and making sure that everybody understands that we’re all subject to the same human condition.
And we’re all in there to help each other get by, we’ve made no, no secret all the way from the CEO level, my level, Dan’s level, all the way through that family is most important and that we consider each other extended family, and that does miracles for your culture. Just as a starting point, it gets you to a fundamentally different place and gives you something to really build on. And that’s the same way that you would then construct your team because you got everybody now you’re you’re all at least in a place of some level of trust. And in the case of Hurricane Florence, huge, common experience, nothing brings people together like a crisis. But of course, we had this before. And what it becomes at that point is, instead of having to work so hard on building that basic level of trust, you begin to set up things like standards that you would expect to treat each other by. And then everybody sort of learns that set of rules that, you know, this is how we intend to treat each other, because we have respect for each other. And we have a really important common mission that we’re trying to achieve in the community. And it just works. It just builds on itself from there.
Yeah, you You said something very insightful, that a crisis really brings out the best and the worst of people in many ways. But it really does it, it challenges people and it’s some of the, the ideas that you put in place the philosophies so that people can react and respond to those crises. What did you do prior to that,
sure, so is not our first hurricane. And it’s not our first we’ll call it a shelter experience, we call it shelter in place, we’ve had to do it for several ice storms as well, because based on our region, any little bit of ice actually paralyzes us, in many cases, worse than the Hurricanes do. But we have a command center structure that we go into
at based on a preset time frame from onset of disaster, if you will, and it has enough people to run the entire hospital part of the enterprise 24 seven for the duration, we’ve bring an extra food, we bring an extra fuel for generators, we have all kinds of things set up, we have, you know, utility companies on standby we have our is a huge operation to do that we actually practice and plan ahead for. And then we have basically a couple of commands structures you may have for during a storm, you probably have a duplicate command structure. So you can do day and night. And you also have day and night shifts. So we had a small city during a storm of about 2500 employees and patients together in our facility. And then we have another team that is basically at home during the time. And as soon as that shelter is broken, based on the safe travel conditions, then that team comes in and replaces everybody that was there. That actually provides one of our greatest challenges in a long story like Florence. Because what you see is when you have this culture of highly motivated people, and there are two fundamentally different tasks, the while you’re there during the storm is very, you know, everybody together, you know, you got physical plant challenges that have to be dealt with. And then it just brings everybody into, you know, a close proximity. And then when that breaks, and you have to stand everything back up, I mean, we’ve got 40 facilities, there is a whole different challenge. And so that our, our biggest
sort of diplomatic hurdle was how do you disengage those people who have been so highly engaged so that the next team can come on where people have been there for five days this time, tired as they can be, you know, and they just need a break, and I need to go and check their homes and things like that. And, but they also just need to disengage from the process. And so the intentionality behind setting up the system like that is really important. Because, you know, it’s not something that we stumbled on we know, it’s like that, it’s like that every time that you just have to shift gears and take on a fundamentally different task. And it’s easiest to do that, if you make a clean break of the leadership, it also sends a tremendous message to the entire organization. So for instance, in the case of Florence, Our CEO
was incident commander during the storm. And our COO was the flip side of that coin during the storm. And then after the storm, I was incident commander, both of those people left completely went home took care of their stuff, that was a message to the whole organization that, you know, it was okay to make sure that you’re taking care of yourself, your family, and we have this taken care of here. And when you come back with be ready for it, I think
a lot of what he’s saying what you asked earlier, I think there was some allusion to behaviors and core values, and, you know, all of everything that he said, comes with, of course, careful operation, operational excellence, operational planning, but you have to have teammates and employees that are willing to do this kind of stuff, they’re not going to be willing to do to respond that way, if they don’t see leaders responding this way, and modeling that behavior. So that’s kind of where they’re, I think the research report really kind of speaks to is that behavior modeling that we were talking about, from a performance culture standpoint, from our experience with working with healthcare organizations, and really all organizations that an organization is only as healthy as its top leader. So we talk about performance culture, having a defined set of core values that everybody is in alignment with, that they all know that that you can lean on and from those core values, what are those workplace behaviors that demonstrates those core values? And we then say, okay how can we translate that into coaching. So we’ve got alignment on that, and we need to coach our employees. And that’s what we use that performance values matrix that I think you’ve seen with performance culture, where we’re going to really lean heavily on not only being a great company and winning, winning with our high performance a high patient standards and also want our revenues got to have that, but also, how do we do it in a way that has those behaviors that are displaying the core values, you know, that we have a healthy, get it get it done culture.
So, I will turn this over to Dan. And just a second, but I want to put a little background spin on what you see, particularly in the physician leadership component that you’re talking about. And then I’m going to get Dan asked Dan, if he will sort of go over how we have recently really, he has done it more than anybody else revamped our physician leadership culture. But in general, what happens in in medical training is that
a lot of your leadership tendencies get beaten out of you as a part of that process. So you got four years of medical school and three to eight, nine, ten years of residency training. During that time, many of the leadership qualities you may or may not have had get extinct, and they’re certainly not specifically addressed, which is a real gap for us. And we’re actually starting to do some things in some of our residency programs to to remedy that. But that’s a whole different story. But what happens is that with the exception of physicians who take a special interest in in leadership and begin to pursue it on a parallel track, there’s no experience that really occurs to any meaningful level in training, and then all of a sudden, they come out of the chute as someone who’s supposed to be in charge and be able to lead a team,
the stress is associated with that, whether it’s the stresses of just being ineffective and leading that team or the behaviors that you really don’t have the the techniques to deal with in a productive way, those things are big drivers of burnout. So what we did as a part of our strategic plan was to make provider engagement, a major component as one of our major strategic initiatives and physician leadership and governance is one of the three key headings under that. And provider burnout is another one. And so by having that, again, systematic emphasis on something that we know is a problem, it gives us a great focus to be able to address it. And as a result, we’ve gotten a number of physicians engage in those initiatives, specifically, and then Dan has done some great things in terms of our medical group. So our facility, we have about 300 providers that are our medical group, but that’s slightly less than half the total medical staff. So I’m gonna let Dan talk a little bit about how he really got the physician leadership group reconnected and purpose driven again, yeah, I think
of the, one of the interesting things too and healthcare, what we’ve done is we’ve determined that we need more physician leadership. So we’ve come to that conclusion. It’s the right conclusion. But I bet if you asked the individuals that are hirer, Dr. Brown and his position, give me an idea of what you see me doing on a day to day basis, I’m not sure that they could have answered that question adequately, that we’ve come to the decision that it’s important, but we haven’t created much structure behind any of it. And I think one of the things that these platforms do is they provide that type of structure, they determine the types of traits that you’re looking for in those individuals, they help you determine maybe where you have strengths and weaknesses, so that you can create a plan in order to improve yourself to help get there. But I think one of the things that we’ve done in healthcare we often do is we rush into something, because it’s a great idea, but we really haven’t flushed it out like
I think would have been beneficial. Some of the things that we have specifically done on developing our physician leaders, we had a chronic issue, I think, our physician leadership groups where we didn’t really know what to talk about. So by default, what we were doing is bringing up operational lower level issues that were just around the saddle, which were often incredibly difficult to solve. And we felt like, consistently, we’re just spinning our wheels and getting nothing done, that led to physicians feeling higher burnout rates, because they’re spending their time doing this stuff, and we’re not accomplishing anything. And also, you know, physicians are very results oriented. So if there’s no results at the end of it as well. Again, that’s another thing that helps from a burnout that helps lead to burnout. Same thing with the administrator, I’m the one leading these things, and for us to spend two hours with our physicians and really not have concrete things that didn’t make me feel so good on the administrative side. So we did is we actually stopped, took a pause took the opportunity to come up with a charter for our, our network level physician group. Now, this is not something you can do at a network level at a smaller practice level. And we created a charter start off with the vision statement. And then we went down into these are the four or five key focal points that we’re that we’re going to take a look at. And then we started crafting our agenda is around that one of the mistakes that I personally made as an administrator is I always felt like I needed to have a populated agenda. For some reason, I was so fearful of an empty agenda, because I was afraid there was going to be much dialogue, or I wouldn’t be able to control where the dialogue went, I eventually got more comfortable with that. And what I found is the meetings that we now have, we, we have a charter that helps us keep on track. And then with the open ended discussion, it gives us a lot of opportunity to think about strategic level items, and we’re not floating down to, hey, send me your agenda items, and they get populated with Geez, I don’t like this benefit, or I don’t know, this person is not keeping up with my charge entry, I need to talk about that. And that’s the type of stuff we were talking about in the 300 provider network, which just wasn’t getting us any anywhere. But we found that having structure in place and open dialogue with our doctors has really helped us brainstorm and improve our results.
things that I’d say is, from a cultural perspective, to drive culture, you need to first understand where your culture is, and what personalities are within your culture.
One of the stories I have that I took one of the personality tests, and I used to have this employee that would work with me, and we didn’t really know until we started talking about our personality types, we would drive each other nuts,
I’m more on the red side of things, and I want to get in and, and take care of business. And then after that, I can take a deep breath. And we can sit there and and have fun and joke around. The other individual was much more social oriented, and wanted to have this, those social discussions up front, and then get down to business. So she’s coming in trying to talk about social things, and how things are going with the family. And like, we got these five things to get to come on, we need to move then she would basically took that from me as being disinterested in her on a personal basis. But it’s because I wanted to get it out of the way and relax, and then be social, and she wanted to be social, and then get down to business. But until we took these tests, we didn’t really understand how we interacted from a cultural perspective, once we did that, what we determined is, we could talk for about five, you know, five to 10 minutes socially, and then we get down to business. And then we would go ahead and finish on a social note as well. But unless you take the time to understand this stuff, you won’t know. And if I jumped to conclusions, that person had a lot of good traits, but we weren’t interacting really well. And was that really that person’s fault? Was that my fault? Or is that just because we didn’t sit there and take the time to understand one another? And how we need to interact with each other
people listening? What can they do then when they do see there are those different types of personalities, talented people, but that maybe don’t immediately mesh and then how do they recognize those differences, and then how can they bring those together and be complimentary of one another.
So I would say, you know, we did spend a tremendous amount of time going through that learning process of what the personality types meant, and how to how to interpret what you actually were seeing on a day to day basis, but not just recognizing it,
as valuable I’ve been through a bunch of different ones over the last dozen years. And you can in fact, I’ve got it on my to do list for this weekend, quiet time is to go back through, I’ve got a whole notebook of the different ones I’ve taken, which are strikingly similar, as you might imagine, but you know, to go back and look back at it just for that self awareness piece. But the one thing that I would say that if there is a way to simplify how you get out of the gate, there’s one thing I think simplifies everything. And that is you have to create a culture of most respectful interpretation. If that’s your starting point, then you’re in a good place, then you can do more sophisticated things that allow you to really refine it, but you have to, you have to start with that expectation. It says, you know, we’re all here part of this organization, because we haven’t, we’re bound to have at least some common values, we believe in what we’re trying to accomplish. And so I’m gonna give my teammates the benefit of the doubt right out of the gate and make sure I really clarify what I’m hearing and what I’m feeling then when you do those assessments and learn then you can have incredibly more powerful one on one conversations or even group conversations to really get yourself to a much higher functioning place but but it really takes work.
Thank you all so much. I know we’re up against time but I really appreciate y’all coming together and sharing this with the audience.
Thank you Daniel. We really appreciate the time to we’re very grateful for this opportunity.
Thanks again to Melissa Phillippi, Dan, Goodwin and Dr. Philip brown for joining the insider podcast today. To access the entire catalog of episodes or to offer us suggestions or feedback, please go to MGMA.com slash podcast.