Medical Staff

Stress? Who, Me?

Medical Staff Affairs Monthly, April 15, 2009

Even in the best of times, healthcare delivery is high-stress work. After all, it is often literally about life and death. Well-trained and strong clinicians are rewarded time and again for reacting to urgent and emergent medical conditions. When coupled with collapsing revenues; increasing expenses; a never-ending upward spiral of accreditation standards and regulatory requirements; and a seemingly insatiable hunger for public accountability, you have a potential recipe for disaster. Yet every day across the country, a myriad of high-functioning and healthy organizations are meeting these challenges and moving forward.

A common thread is leadership rich in what Daniel Goleman calls emotional and social intelligence. In his book, Social Intelligence: The New Science of Human Relationships, Goleman describes "the best bosses are people who are trustworthy, empathic, and connected, who make us feel calm, appreciated, and inspired." On the other hand, he describes the worst bosses as "distant, difficult, and arrogant" and "make us feel uneasy at best and resentful at worst." The highest-functioning organizations try to get the right people on the plane by spending a great deal of thought and attention to having the best possible candidates enter leadership positions on the medical staff, the hospital executive team, and the board. Just as importantly, they try to ensure that they are sitting in the correct seats on the plane to get maximum lift and flight.

Socially intelligent organizations recognize that leaders, as with all human beings, possess a combination of good and bad characteristics. The successful leaders understand and recognize their emotional makeup and compensate as circumstances require. However, under stress, people tend to revert to their innate tendencies and emotional comfort zone—their psychological home.

As the stress and strains on the healthcare economy and delivery systems continue in an unabated fashion, there is a great potential for leaders—medical staff, hospital and board—to decompensate and fall back into old ways. Many successful organizations anticipate this and establish clear expectations of performance but, more importantly, follow through with measurement of the expectations and feedback to the leader.

The 360 evaluation tool is just such a tool in which a leader is evaluated by his or her superiors, peers, and direct reports to see whether any of those undesirable traits are leaking through. Leaders can undertake course corrections as needed and help keep their organizations on track through these tumultuous times. Socially intelligent leaders recognize that emotions, like viruses, are contagious and that every leader can make things better or worse. Go into a thriving and successful organization and signs of this intelligence will be seen.

In addition to providing appropriate feedback, leaders must also understand that dealing with their own stress becomes a critical leadership competency if they are to remain effective leaders. The solutions will vary from one leader to the next and may involve a cornucopia of solutions, including hobbies, meditation, physical exercise, nonwork-related reading, travel, journal writing and so forth. The Benson-Henry Institute for Mind Body Medicine ( at the Massachusetts General Hospital in Boston lists several "stress busters." One of the more poignant asks whether the source of your stress is something of such importance that it would matter a year from now (or even a week or day from now).

The astute reader will have noted the use of adjectives to describe organizations as successful, high functioning, thriving, and so forth. The corollary is that organizations exist on a continuum. At the opposite end of this spectrum are the organizations that might fit the bill for toxic nuclear waste dump sites. They may be held hostage by a CEO who has given definition to a command-and-control style that is the stuff of dreams. Or maybe a medical staff member has held the organization hostage with his or her behavior and negativism. Or perhaps a board chair's political dealings and corruption have occurred at the expense of the organization. At best, they may be bullies; at worst, sociopaths. Experience would indicate that changing such organizations involves external assessment and facilitation of change.

Unfortunately, many of these organizations are circling the drain before the call for help goes out. The bad news is that their crisis is a true danger to continued survival. The good news is the crisis offers an opportunity for everyone to pack their baggage into the closet, lay down their arms, and come together to promote the common good, such as patient-centered care of high quality and safety. It is best to remember that organization existence does not guarantee organization success or for that matter even organization survival. Look at the ruins of once great institutions lest any reminder be needed. But that's another story.

Until next time, be the best that you can be.

William K. Cors, MD, MMM, FACPE, CMSL
Vice President, The Greeley Company

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