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.     

When it's time to say goodbye

You've landed the perfect job, but now you must face your current employer and deliver the news that you're leaving the organization. While an exciting time, this can also certainly be a stressful one. Here are some strategies and ideas for saying goodbye to an employer that may be useful in guiding your actions. From being ready for counter-offers to downright hostility, you need to be prepared to deal with various scenarios. No matter how you have steeled yourself to go into the boss's office to share your news, you cannot predict with total accuracy just what his or her response will be. There will always be surprises, although usually things are never as bad as your imagined worst-case scenario. However, when you are ready to make your plans known, one simple rule is always required: You must have total commitment to your new position.     

Just row.

To learn anything outside of our usual experience is to try on a new way of being. Doing something new--dealing with change--calls for a commitment to be where you are, to be present in the experiment, even while you are uncertain about the outcome. Being present and committed to the moment is as essential in management or self-management as it is in rowing a boat. How, for instance, can you tell the difference between intuition and fear? In the midst of a crisis, a change, a white water passage, a "learning opportunity," what if you get this gut feeling that something is wrong? If the feeling goes away when you drop into the present, into your body, and "just row," it's not an intuition, it's fear. The opportunity is to know the difference between opinion and intuition, between judgments and experience. Because judgments and opinions carry extraordinarily high price tags.     

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."     

Don't fix it

Next to doing nothing, fixing a problem is often the worst thing you could do with it. Fix a problem but miss the context, and you still have the problem--only it's bigger, it's weirder, it costs more, and everybody's grumpy. When something comes at you with a "problem" label, use it as an opportunity to connect things up, to explore, to ask the bigger questions, to find the new possibilities. When we react to a problem, we put ourselves into a dilemma. To find fruitful and creative solutions, we need to be in a place of choice, with many possibilities. Real participation--giving people real choice--is the only way you can bring people's intelligence and life experiences to bear on the situation at hand.     

Bouncing back

If you have taken a career sidetrack, realize that you are still marketable. You have skills, traits, and knowledge that are transferable to many new opportunities. Fortunately, many leaders today in health care and executive search are familiar with your plight, given that they all have their own version of initiatives that did not fly. They will not judge you unfairly because they understand all too well the complex pressures of today's health care environment, filled with risk, cost constraints, and unrealistic profit targets. If you're bouncing back from an unfortunate career move, these steps may keep you focused on your search for new opportunities: (1) recognize that you are not alone, (2) realize that the entity failed, not you, (3) discuss the former position in a positive light, (4) don't give in to cynicism or self-pity, (5) don't let it happen to you again, and (6) play an active role in structuring your next position.     

Touching what is, touching what might be

How do you master change? You have to master the paradox of changing while staying grounded. To make use of the power living inside any new thing that comes your way, you first have to touch it--not tentatively but profoundly--at the same time that you maintain a firm connection with that which is deepest and most fundamental within you. Here, some ideas on how to create "touch points," the ability to look at a problem or impending change from many different angles, thus broadening your understanding and possible response. A key tactic in creating a variety of touch points is quite simple: Ask a lot of questions. Ask especially the questions that have difficult answers, or for which you suspect there is no answer.     

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.     

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.     

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.     

Professionalism is judged by appearances ... like it or not

Exploring the larger subject of executive professionalism should include the whole range of behavior issues that affect others' perceptions of you. In this competitive environment, with limited time to manage relationships, physician executives must take control of all aspects affecting their credibility and communications. This is not to suggest that you become the stereotyped, air-brushed news anchor, all style and little substance, but that you create a total package, one in which the "inside" and the "outside" of your presentation are complementary. Focus your attention on how well you have developed these factors as a physician executive: Appearance; demeanor; professionalism; and integrity. To create a "total package," it is helpful to consider the following recommendations: Write "commercials" for yourself and your organization; use every interaction as a selling opportunity; make every context a platform; don't hide from criticism--seek it out; and use every opportunity that comes your way to listen.     

Head for open space

Is it possible that the herd mentality, the "Follow The Other Guy" idea is not the golden road to transformation? In fact, the three questions that are most helpful in deciding your path, as a person or an organization, lie almost completely in the other direction: (1) "What am I really good at?" (2) "What am I afraid of?" and (3) "What is no one else doing?" Heading for the open space means looking for the hole in the market, searching for what no one else is doing. Only by going toward open space can you or your organization stay ahead of the pack in a turbulent health care environment. Get out in front of the pack, either as a leader or quarry, and you have a measure of control. How does the quarry control the pack that is hunting it? By choosing the terrain, choosing the ground on which the chase will take place.     

High expectations mirror high stakes for physician executives

Because the stakes in health care are high, physician executives are challenged to meet high expectations set by their CEOs and boards. These may be unrealistic--for example, demanding that physician executives possess expertise in finance or strategic planning. Job stresses for physician executives are specific to the role, but are not unlike those faced by other senior executives. It's a fact that professionals leave jobs for any number of reasons; sometimes, not through their own choice or fault. Thus, every time a physician executive leaves a job, it should not be characterized as "being fired," and not every job-leaving should be taken as a failure. Accept that you may make mistakes while doing the best job you can. Rely on your own value system and integrity to see you through.     

中国管理环境:暧昧文化因子、管理真实形态与情境嵌入机理

基于中国文化复杂含义的"关系"本位伦理的"意言行"错位结构,所形成的思维模式和行为方式具有典型的"暧昧"特征,暧昧文化与暧昧法则控制了组织所谓"知行一致"和"表里如一"的表达方式,支配了非正式组织的利益取向和私下行为。基于中国管理情境的实践所提炼的暧昧管理理论十分有价值和必要。这种理论基于跨文化、跨情境"关系"的差别与联系,建立信任关系与暧昧关系交叉相容的均衡结构;在主体集聚因素和环境集聚因素的耦合过程中,实现普适性管理理论架构的优先嵌入和差同性知识系统的能动根植。     

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.     

What to do next

Why do we work? While there may be some obvious, practical answers to this question, like needing to make money to survive, there are other reasons that people work. These include working: to have stimulation and excitement--to meet new challenges and have variety in your life; for love and affection--to be with colleagues, clients, customers and to provide security and protection for family and friends; and to leave a thumbprint on the world and change individuals, systems, and institutions. For quality life, it is necessary not only to work but to enjoy your work. For physicians considering careers in medical management, the key to success is being truly excited about management activities. If you are heading towards management, you need to view some of the tasks as fun or you probably won't stay with it very long.     

Mentoring: women learning from others

Informal mentoring allows a relationship to evolve naturally over time much like a friendship, without an official obligation or commitment to coach someone. However, some women prefer a more formal, organizationally driven approach to mentoring. In either case, both represent an opportunity to learn and grow. In Learning from Other Women, Carolyn Duff interviewed many women to understand their expectations, preferences, and experiences. Mentoring, Duff says, "begins with affinity between two people, but the focus remains around work. It's a magical thing that happens when one person sees something in another person and wants to help that person grow." This column explores some of the barriers, as well as how to ask for help and benefit from a mentor. Whether you like the word "mentoring" or not, whether your organization has a formal program or not, always be thinking about how you can learn from others. Keep your eyes and mind open, look around to see who is doing what you want to do.     

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.     

Negotiate the salary you want

How can physician executives negotiate the salary and terms that they want for a new position? The idea of negotiation raises the anxiety level of all but a few people, those who thrive on the thrill of competitive bargaining. Most physicians do not relish the process and view it as a type of conflict. But without knowing what you want to accomplish and preparing to ask for it, you may well leave the meeting frustrated and unhappy with the offer. Determine what you want before you get into an important negotiation. You will get clear on what you want much quicker and you will remember the points better when you talk to the other person.     

Habits of mind for turbulent times

How do you deal with change--in either personal circumstances or in the turbulent health care environment? Do you rail against the variables that seem to put you in the uncomfortable situation, blame yourself, take it personally? Are there ways to start looking at change differently and more effectively? Here's the key: It's all weather. Whatever you can't control, no matter who does it or why, is just part of the weather--where you are right now. How do we treat weather? We try to find out as much as we can about what's coming, but we keep its unpredictability in mind. We prepare for its extremes as wisely as possible. We grieve any losses it causes us, and celebrate the lovely spring days and quiet summer evenings it gives us. And never once do we take it personally, think that the weather is out to get us, or that lousy weather means that somehow we have failed. We just know that its not personal.