LEADING CHANGE: A residency curriculum for developing family medicine leaders of the future Colleen T. Fogarty, MD, MSc Steve Schultz, MD James Diekroger, MD Society of Teachers of Family Medicine Seattle, WA

Learning objectives 1.List 3-5 resources from the business literature applicable to FM leadership development. 2.Strategize implementation of leadership curriculum in your program. 3.List elements to include in a coaching program for developing resident leaders.

5 Leadership seminars 1.Seven habits of highly successful MD leaders 2.Leading change 3.Family of origin influence on leadership 4.Difficult Conversations: strategies for leaders 5.Emotional Intelligence in the workplace

Who teaches leadership? Department faculty & leaders  Department Chair—7 Habits  Associate Chair--Family of Origin  Residency Director—Leading Change  Fellowship Director--Difficult Conversations & Emotional Intelligence

1. Seven habits of highly successful physician leaders Habit 1: Be proactive Habit 2: Begin with the end in mind Habit 3: Put first things first Habit 4: Think Win-Win Habit 5: Seek First to Understand, Then to be Understood Habit 6: Synergize Habit 7: Sharpen the Saw

1. Seven habits of highly successful physician leaders Learning objectives: List the 7 habits, and how the first 3 can be used to improve one’s effectiveness Focus on the first 3 habits Be proactive Begin with the end in mind Put first things first Develop a personal mission statement 6

A habit: the intersection of knowledge, skill, and desire KNOWLEDGE (what to, why to) DESIRE (want to) SKILLS (how to) HABITS

2. Leading change Learning objectives: Recognize why a great idea is not enough to bring about change Identify similarities and differences between leaders and managers Learn to identify and leverage allies in the change process

2. Leading change Focus on exercises to build awareness of Building coalitions Getting buy-in Developing a sense of urgency Working within the institutional climate/structures

3. Family of origin influence on leadership Learning objectives: Describe lessons learned from your family about leadership and dealing with conflict Brainstorm strategies to apply this learning to current & future roles Topics covered: Gender dynamics and decision-making Strengths – recognizing their own and others’ Conflict – what you learned from your family Vulnerabilities – important for facilitator to frame these to allow residents to address safely over time Teams – personal experience and roles in teams

3. Family of origin influence on leadership Learning activity: Present genogram to small group of peers Examine relationships and family structure vis a vis leadership

4. Difficult conversations Learning objectives: 1.Recognize the role of emotions, identity, and different versions of what happened when engaging in a difficult conversation 2.Develop skills in persistent listening mutual problem-solving reframing Difficult Conversations: How to Discuss What Matters Most Douglas Stone, Bruce Patton, and Sheila Heen; Penguin Books 2000

The Goal Going from…. to… A Battle of A Learning MessagesConversation

The “What Happened” Conversation A Battle of Messages A Learning Conversation “My side of the story” vs “the truth” Assumption: I know all I need to know to understand what happened. Assumption: Each of us is bringing different information and perceptions to the table; there are likely important things that each of us doesn’t know. Intent vs Impact Assumption: I know what they intended. I know what I intended and the impact their actions had on me. I don’t and can’t know what is in their head. Blame vs Contribution Assumption: It’s all their fault. (Or it’s all my fault.) We have probably both contributed to this mess.

The Feelings Conversation A Battle of Messages A Learning Conversation The importance of feelings Assumption: Feelings are irrelevant and wouldn’t be helpful to share. Assumptions: Feelings are the heart of the situation. Feelings are usually complex. I may have to dig a bit to understand my feelings.

The Identity Conversation A Battle of Messages A Learning Conversation “All or Nothing” vs “Somewhere along the Continuum” I’m competent or incompetent, good or bad, lovable or unlovable. There is no in-between. There may be a lot at stake psychologically for both of us. Each of us is complex, neither of us is perfect.

5. How’s my EI: how to develop and use emotional intelligence as a physician leader Learning objectives: List dimensions of emotional intelligence Provide examples of interpersonal situations in which enlisting EI may have improved interaction Self-Awareness Self-Regulation Motivation Empathy Social Skill

Dimensions of Emotional Intelligence SELF Awareness OTHER Awareness ManagementRelationship management

Coaching program for Chief Residents Brief history of our system: - Chief coaching from AAFP Chief leadership conference -Chiefs chose own coach Our “new” system: -Paired up with “coach” for the chief year -Different from prior residency advisor Associate Program Director or Assistant Program Director 19

20

What is coaching? One-to-one relationship, confidential, regular meeting time Coach provides support for the person to identify, focus on, and achieve what is important to them ( guide-what-is-coaching.php) guide-what-is-coaching.php “Provides the outside eyes and ears” (Gawande) Speaks with credibility, make a personal connection, focuses little on themselves (Jim Knight, quoted in Gawande article) 21

What isn’t coaching? Mentoring (mentor usually sets agenda) Advising (no evaluative role) Therapy Counseling (Coaching is proactive, counseling reactive—Whitmore) 22

Our focus for Chief Coaching Goal setting and clarification Realization of goals Career planning Balancing Chief role w/ clinical role and career planning 23

Exercise Emotional Intelligence Pair up with another participant. Think of a recent interaction that you observed or were a participant. Discuss with your partner how applying the principles of emotional intelligence may have improved that encounter.

Exercise Difficult Conversations Pair up with another participant. Discuss concepts about Difficult Conversations and how these apply to your work as an educator. Review the “three conversations” and discuss a recent or future conversation where these will be important. How might you implement this model in your program?

Exercise Implementation Planning What are the leadership experiences of your residents? What formal training do they have in leadership skills? What training gaps have you identified for your residents’ leadership development? Who in your program/institution can teach leadership skills? What time is available in your curriculum? Who can provide on-site coaching? 26

Learning objectives 1.List 3-5 resources from the business literature applicable to FM leadership development. 2.Strategize implementation of leadership curriculum in your program. 3.List elements to include in a coaching program for developing resident leaders.

Bibliography The Seven Habits of Highly Successful People (with workbook). By Stephen Covey, What Leaders Really Do. By John Kotter. Harvard Business Review. December 2001 Leading Change: Why Transformation Efforts Fail. John Kotter. Harvard Business Review. March/April 1995 Difficult Conversations: How to Discuss What Matters Most. Douglas Stone, Bruce Patton, & Sheila Heen. Penguin Books, What Makes a Leader? By Daniel Goleman. Harvard Business Review, 1998.

29