Communication tips for the job search and on the job

Listening, speaking, and nonverbal skills are the most important success factors in getting a job or being effective in your current position. If you don't communicate well, your technical knowledge won't ever be put to good use. Recruiters, hiring organizations, and bosses are looking for people who can play well with others and can sell. Playing well with others involves listening and having self-control about what you say. To sell yourself and your ideas or products, you must speak well. You also must be well-groomed, look energetic, and sound reasonably happy to be at work. Good listeners: Stop talking; ask open-ended questions; para-phrase, restate, or summarize some of what the person had said; and talk about feelings. Effective speakers: Have voice mail etiquette; are courteous and tactful; don't react to a verbal attack; don't engage in verbal attacks; use the right amount of words; don't say too much; prepare ahead of time; and decide whether they should speak or write their message. And remember the power of body language or non-verbal skills--how you look and sound. Experts estimate that 65 to 90 percent of what you communicate is nonverbal.     

The application of future technologies to medical informatics

Physician: "Condyloma, Toxoplasmosis, Blepharoplasty, and Fibroadenoma." Technoguru: "Pardon?" Physician (referring to "PCDR, Physician's Computer Desk Reference): "Carrier Sense Multiple Access, Spread Spectrum, Application Programming Interface, and Clustered Indexes." Technoguru: "Oh, now you're talking! How many do you want?" Until such time as computer scientists holding degrees in medicine become de rigueur, there will inevitably be conversations such as these. A pediatrician friend once told me that he could teach me in 30 days what I would need to know to handle 95 percent of the cases he sees. To handle the other 5 percent would still require 8 years of postgraduate medical education. The corollary for the application of technology is that I can teach you how to use a personal computer, and even to do a little programming, but to build a robust, mission-critical system for a production health care environment, well, back to school you go.     

Elected medical staff leaders: who needs 'em?

Authority, influence, and power are not synonyms. In working with elected medical staff leaders, a physician executive who chooses to exert authority may soon find him- or herself relatively powerless. But one who chooses to downplay authority, to influence through persuasion, and to coach leaders to lead effectively soon generates support for his or her ideas. The need to coax, cajole, explain, persuade, and "seek input" frustrates many leaders in all kinds of organizations. It would be much easier just to order people about. It's so tempting to think: "Who needs 'em? I'm the 'chief physician.' I know what needs to be done. Let's weigh anchor, take her out, and do what it takes to sail those rough, uncharted seas." If you really enjoy sailing a large ship in rough seas without a crew, go right ahead. Or if you think it makes sense to run an organization with only an executive staff and no knowledgeable middle managers, by all means let clinician leaders know that, now that you're aboard, they're just window-dressing. If you can make this approach work, well and good. Your life will be much less complicated, each day will have far fewer frustrations, and progress toward established goals will be much faster. However, given the reality of traditionally thinking physicians, it would be best to keep an up-dated resume in the locked lower left-hand drawer of your desk.     

Becoming who you are.

It's difficult to predict success based only on educational background and career experience, important as they are. More is needed. And one of the aspects that needs to be evaluated is the degree of self-actualization. Self-actualized individuals have worked out their personal issues well enough that their personal life no longer has to intrude into their professional lives and actions. In a word, they are free people. In career terms, self-actualized people are "company people," but not "yes-people." They are executives who have freed themselves to be able to internalize the growth, development, and strategic planning of their organization--because they are able to rise above personal considerations, to shed emotionalism, and see more clearly. Some methods you can use to figure out where you stack up are: Conduct a self-evaluation; identify role models; do what is called "a 360 evaluation."     

The purpose of a job interview is a job offer

Perhaps empathy has been overdone in recent years. Most of us would admit to some cynicism or disbelief when we hear the words, "I know how you feel." Having said that, however, I actually do know how you feel. If I can't identify exactly where you are coming from, I do know where you are likely to be going and how bumpy the ride is likely to be. I'm a physician and a physician executive. I am also an executive search consultant who is daily in the field interviewing physicians who may or may not be the right individuals for a client's situation. If I don't exactly feel your pain, at least I know its sources. I know how difficult it is to make the move from challenging clinical work to an administrative role in health care. While, as a group, physicians are multiskilled and multitalented, it's an unfortunate fact that some of the skills and talents that made you an excellent physician may be blocking you from succeeding in an executive capacity. My hope is that, through an occasional entry in this column, I can share my experiences and relate the remarkable wisdom of the impressive physician executives whom I meet every day. The first issue I'm opening up for discussion is employment interviewing: Why the interview is so important, what the interviewing process is, and how you can become more adept in this critical skill area.     

Networking--getting to know more people

One of the first and often the most difficult tasks for job seekers is increasing their networks--the number of people they know. A large percentage of people get jobs because people knew them and thought they would be good at it. People must know who you are and what you do in order to recommend you for a job. Networking should be an ongoing process, so that when you need a new position, you have people you already know that you can contact.     

Physician anger--Part 1. Changing perception: an interview with Charles E. Dwyer, PhD. Interview by Richard L. Reece.

On January 21, Richard Reece, MD, interviewed Charles E. Dwyer, PhD, to talk about solutions for changing the perceptions of today's beleaguered physicians. He discusses the state of affairs of physician executives in this turbulent industry and how they need to move beyond their thinking about organizations and their current responses to change. The key, Dwyer emphasizes, is influencing people to do what you want them to do. "If you want somebody to do something other than what they are doing now, then you must bring them to perceive that what you want them to do is better than what they are doing now in terms of what is important to them." He also explores how physicians can change their responses to the health care environment: "You can actually decide how you are going to respond conceptually, emotionally, and behaviorally to anything that happens in your life." Part 2 of this interview will appear in the upcoming May/June issue and will provide hands-on strategies for dealing with physician anger, fear, and resentment.     

Can the patient be the focus of managed care?

If the question were simply put: "What is it that succeeds or fails to meet patients' needs in managed care?" Dr. John M Ludden would have a short answer. "It depends. Success depends on whether you are talking about individuals or about populations of patients. And it depends on whether you are talking about meeting patients' needs or their desires. It depends on whether you're talking about well patients or sick patients, young patients or older patients, new patients or established patients, rich patients or poor patients. And it depends on your ability to balance each of these qualities." This article explores how to translate high-quality care for a population to high-quality care for individuals.     

Health care is sales

Health care is all about sales--everyone today in the competitive arena of health care is a salesperson. Your selling days began when you applied to medical school. Your product was yourself, and you worked hard to sell it. That was only the beginning. In your daily work as physician executives, you are selling yourself and your ideas-your ideas about relationships, management structures, partnership issues, merger questions, etc. It's a complicated world, and the concepts are often abstract and difficult. But it is your job to communicate with others to get things done. It is the most important part of your job. It is selling, in fact, at a sophisticated level. How do you communicate and sell yourself and your ideas effectively? Here, some ideas on how to listen and communicate.     

The successful physician negotiator

Whether you realize it or not, you are in the middle of a negotiation every time you are asked to do something. Negotiation skills are important for physician executives, both in their professional and personal lives. The Successful Physician Negotiator: How to Get What You Deserve provides useful examples of how to negotiate and helps you get in the proper mindset to get it done effectively. While the book explores the concept of cooperative negotiation, which is important if you want to have a long-term relationship with a person, it's also important to have other tactics. You need to understand your opponent by gathering information about his or her values and work situation. You can gather information when talking to your opponent, but you also need to do some "behind the scenes" preparation before the encounter begins. Other recommendations include: don't negotiate in your office, use time to your advantage, be able to keep silent when necessary, have options, be able to say no and walk away, keep your cool, and take notes.     

Thriving in change

The turbulent state of health care and the rapid changes that show no sign of abating point to many career-related challenges for physician executives. How can you predict the impact of these changes on your career? What measures can be taken to prevent any negative impact of change? And how can you prevail when dealt a negative blow like job loss? The signs that foreshadow the unraveling of a physician executive's career are described. The warning signs are: Not keeping up with change, losing your influence; getting negative feedback; turning your "concerns" into complaints; the economy working against you; and being blindsided because we think leaders operate logically. Being proactive puts more control in your hands and leaves less to chance. You can prevent being blindsided if you: develop your people skills; get comfortable and involved with e-business; stay abreast of health care trends; pick up the pace; and develop "You, Inc." There is a final component to prevailing over adverse circumstances--find your work-related passion and apply it to your career.     

Can you take your soul to work?

David White in The Heart Aroused: Poetry and the Preservation of Soul in Corporate America explores ways for professionals to take their souls to work, instead of checking them at the door. "We simply spend too much time and have too much psychic and emotional energy invested in the workplace for us to declare it a spiritual desert bereft of life-giving water." Several ideas are presented to help physician executives preserve their souls in an increasingly corporatized U.S. health care system: (1) Figure out what you are meant to do as your life's calling; (2) know what you think and want; (3) share some of what you think at work, while being careful to not lose your job unless you choose to; (4) be a trustworthy listener and find one; (5) get yourself outside; (6) pay attention to your physical space; and (7) develop some new hobbies or refresh old ones. "One of the disciplines of building a rich soul life seems to be the simple act, on a daily basis, of remembering what is most important to us."     

Medicine, management, and me.

What is medical management? How do you learn about it? How do you get into it? Is there a future in it? Is medical management for you? Can you do it? What will it mean to your original plans for your life in medicine? Is it worth the sacrifice? Get comfortable. I have a story to tell you. It may help if you hear about medical management from a medical director who has preceded you. I doubt I can answer all your questions. I can, however, tell you about one physician's visions, expectations, decisions, experiences, and rewards from what can be loosely called "medical management." If you find something of help in your decision making in this account, my telling it is worthwhile.     

Changing what goes on in your head: how to stop "ain't it awful?"

How can you change your negative thinking? This column describes a process that, on the surface, seems too simplistic to be beneficial, but that works: choose a few good words to repeat to yourself constantly, progress to better thoughts, and then improve what you say to others. If you want to be more satisfied with your work life and your personal life, you must change the internal dialogue in your head. If you have some version of negative internal chatter, you need to substitute positive statements. You need to say something different from what you have been saying every spare minute of the day. You must say it even if it is the biggest lie you have ever heard yourself think. You must say it for days or weeks before you notice a difference in your attitude, relationships, and health. Eventually, you will notice you feel better and people are behaving better.     

A personal formula for motivation.

Have you ever wondered why some colleagues or subordinates are outstanding in their work while others are less so? Training and experience are extremely important factors but, by themselves, they will not ensure outstanding performance. The pivotal factor that activates all others is motivation. And underlying motivation is the fact that we all have needs that we desire to have fulfilled and that we make choices regarding the course of action or strategy to fulfill these needs. As managers, we do not typically create the "products" of the organization but rather must rely on subordinates. It is incumbent upon us to obtain from our employees desired behavior that will fulfill organizational goals. Indeed, it has been asserted that "one of the most basic responsibilities of the health service organization manager [is] motivating constructive participation of other organization members."     

Health care organizational uses of information technology

Let's say that, by having read the many inspiring articles on medical informatics in this issue of Physician Executive, you are now ready to move ahead with some serious applications of information systems in your organization. Or, you were already a believer in the usefulness of information technology (IT), and are wondering how to proceed. What types of systems should your organization be looking at to acquire or build? How should you get to there from here? Perhaps you'll find what you're looking for in what follows--an initial roadmap through organizational "IT Land."     

Dealing with a shifting paradigm.

In 1970, T. S. Kuhn, in The Structure of Scientific Revolutions argued that scientists work by creating a comprehensive model--a model he called "a paradigm." A paradigm, Kuhn said, is an encompassing world view that tells us what facts to pay attention to and what to ignore. He contended that, although we may think that we consider all the facts and ask all the questions, there is always some ordering and selection going on, and we must first be prepared by our paradigm to make sense of what we see. He stated that one of the first signs that a paradigm is shifting is the discovery of facts that seem significant and indisputably true but cannot be explained by the current model. The essential elements, according to Kuhn, that are required for a paradigm to shift are a strong stimulus, a rapidly changing environment, and the realization that whether the change is good or bad is essentially of no significance. The parties most closely involved are frequently the last to appreciate that the shift has occurred.     

Was that really funny? The politics of humor

Everybody loves a comic--or do they? A Human Resources Department picked up a pattern when several departing employees, all excellent performers, said they liked their jobs but felt "excluded" from the camaraderie. One said he'd found the humor "barbed." Another said she's never seen anything funny in jokes that seemed to convulse everyone else. The past five years have been so gloomy, economically speaking, that, in many hospitals and health care organizations, laughter is a mega-event. But lately I've been listening to what employees joke about and watching how their humor affects others. Physician executives need to be alert to some kinds of humor that are weapons used by employees against other employees, their managers, and the company generally.     

Uncertainty about Probability: A Decision Analysis Perspective

The issue of how to think about "uncertainty about probability" is framed and analyzed from the viewpoint of a decision analyst. The failure of nuclear power plants is used as an example. The key idea is to think of probability as describing a state of information on an uncertain event, and to pose the issue of uncertainty in this quantity as uncertainty about a number that would be definitive: it has the property that you would assign it as the probability if you knew it. Logical consistency requires that the probability to assign to a single occurrence in the absence of further information be the mean of the distribution of this definitive number, not the median as is sometimes suggested. Any decision that must be made without the benefit of further information must also be made using the mean of the definitive number's distribution. With this formulation, we find further that the probability of r occurrences in n exchangeable trials will depend on the first n moments of the definitive number's distribution. In making decisions, the expected value of clairvoyance on the occurrence of the event must be at least as great as that on the definitive number. If one of the events in question occurs, then the increase in probability of another such event is readily computed. This means, in terms of coin tossing, that unless one is absolutely sure of the fairness of a coin, seeing a head must increase the probability of heads, in distinction to usual thought. A numerical example for nuclear power shows that the failure of one plant of a group with a low probability of failure can significantly increase the probability that must be assigned to failure of a second plant in the group.     

Doing or being?

The founder of Aikido, Morihei Ueshiba, would occasionally distill the essence of the art into three simple shapes--a circle, a square, and a triangle. These are three basic ways of dealing with what's coming at you. The square is the simplest. It is about, essentially, doing nothing. The saying here is from the old spiritual: "I shall not be moved." You meet the challenge head on. The triangle is about forward motion--attack, cutting right to the heart of what is coming at you, or cutting right past it to the space beyond. The circle is often the most interesting space. The circle is not about standing ground or cutting through. The circle is about dancing with whatever is headed your way. The real danger lies in being stuck in any one mode--perpetually intransigent, always flailing away in attack mode, or forever slip-sliding through one dance step after another. It is only when our response is embodied in who we are that we will have the power truly to lead other people.