Dear Director, I want all of my docs to sit on some hospital committees, but I hesitate with some, not knowing if I can trust them. What makes a physician good at representing the department? Is it a quality that I can teach?
Successfully climbing the administrative ladder has as much to do with empathy and communication as it does with clinical know-how.
Appointing someone to rep- resent the ED on a commit- tee can free up your time and make the department look great. Or it can backfire, increase your workload, and give a poor view of emergency physicians to colleagues through- out the hospital. These responsibilities require a special skill set – particularly a need for emotional intelligence – which your average emergency physician may or may not have when they enter practice. The good news is that these are skills that can be learned and improved upon.
Dr. T. Rex
Although every hospital and committee has their own culture, the déjà vu feeling I get when I switch facilities and join new committees always amazes me. Regardless of the facility, chairmen meetings are typically friendly affairs, punctuated by intense yet collegial discussion. Which is why I was so surprised when I met Dr. T. Rex at an MEC. He was recruited from an outside facility to be our new surgical chairman. He came from the old school where the ABC’s stood for “Accuse, Blame, and Criticize,” and he verbally attacked those around him as though he was going in for a kill. Although he had tremendous confidence in his ability, and perhaps knowledge as well, he lacked the understanding of how his approach affected those around him. He killed debate by making otherwise confident and competent physicians afraid to be attacked. He lacked the ability to in- corporate behavioral change recommendations based on the feedback that was given to him so no one was surprised when he left after two years. His skill as a successful surgeon with a big practice got him the job as chairman, but his lack of EQ ultimately cost him his administrative position.
Traits to consider
There are a variety of traits that make a physician more successful when they serve on hospital committees. First I look for someone with motivation to do a good job. This not only means reliably attending meetings, which may require adjusting vacations or clinical shifts, but also doing the homework and preparation necessary to fully participate in the meeting. I next look for someone with confidence in their knowledge base and skill set so they will speak up at meetings and defend the actions that are being discussed. But as Dr. T. Rex so aptly demonstrated, confidence alone isn’t effective if the physician doesn’t have the communication skills to make a cogent argument and the negotiation skills needed to work with other departments. Finally, I look for someone who is a team player, since many discussions, case reviews, and projects rely on many people working towards a common goal.
Emotional intelligence: what it is and why it’s important
When I consider who will do a good job of representing me or the ED on a hospital committee, what I’m really doing is gauging the doc’s emotional or social intelligence. The concept of emotional intelligence is a relatively recent one, penetrating the public consciousness in the 1990s with the publication of Daniel Goleman’s book Emotional Intelligence: Why It Can Matter More Than IQ. Since then nearly 3,000 scientific articles have been published on the topic. As the name of Goleman’s book implies, your emotional quotient (EQ) may in fact be more important than your IQ – particularly in medicine. Most physicians are smart enough to do the job, but at some point in leadership and teamwork, ‘what you know’ becomes a level playing field, and how you communicate and work with others grows in importance. Studies indicate that IQ accounts for at most 25% of your career success. In fact, in a cognitively demanding field such as medicine, IQ has the least power in predicting career success. Goleman’s research shows that among “star performers in all jobs, in every field, emotional competence is twice as important as purely cognitive abilities. And leadership success at the highest levels, emotional competence accounts for virtually the en- tire advantage.”
eQ: personal competencies
Goleman breaks emotional intelligence into two main categories of “emotional competencies”: personal (how we manage ourselves) and social (how we handle relationships). Personal competencies are further broken down into self-awareness, self-regulation, and motivation. Self awareness is “knowing your emotions and their affects, knowing your strengths and limits, and having a strong sense of your self worth and capabilities.” This not only means knowing your limits but also seeking out feedback to get an honest assessment of yourself and then having the emotional maturity to change. Dr. T. Rex lacked this de- spite many feedback sessions with the hospital CMO. It hasn’t always been easy or pleasant, but I’ve learned an awful lot about my weaknesses through the years by receiving critical feedback, and I’ve tried my best to respond positively and proactively in my work.
Next up is self regulation, which is keeping disruptive emotions and impulses in check (not screaming profanities at the guys across the table), “maintaining standards of honesty and integrity,” as well as being adaptable and comfortable with in- novation (reigning in your own biases to try new things). Personally, I’m not a yeller but I do need to work on being open to new ideas that other people suggest. I used to work with Dr. D, a truly amazing physician, who was on our MEC. As a physician, he was highly skilled and always available and helpful. In one-on-one situations, I really liked him. However, he was extremely arrogant and highly opinionated. Even when his opinion was likely right, he usually delivered it in a very loud diatribe and in such a black and white manner that you left speechless. However, because he lacked self awareness and self control his message would get lost in his delivery and all anyone remembered afterwards was his outsized behavior.
Goleman’s third personal competency is motivation, being engaged in work and trying to perform your best while overcoming obstacles. According to Goleman, there is exponential benefit when leaders are strong in all of these competencies, and lacking significantly in one area can have significant consequences.
eQ: social competencies
Goleman’s first “social competancy” is empathy – a skill that most emergency physicians probably think they’ve honed to an art after so many thousands of patient en- counters. At its core, empathy is being aware of others’ feelings, needs and concerns, and it goes way beyond bedside manner. From an administrative perspective this might mean seeking out mentors for ourselves or providing mentoring to younger physicians. Empathy also plays strongly into your political awareness, which requires the ability to sense others feelings and concerns. I continue to work with good docs who forget that there are political ramifications to their actions. Take for instance Dr. E who was having a hard time getting a PT consult on a patient. In his view of putting the patient first (get the PT consult and the patient could probably go home and avoid an undesirable admission), he jumped the chain of command and pulled the chief nursing officer out of a meeting to complain about the delay in PT consult. All this did was make him that much more memorable as a loose cannon so anytime his name came across the CNO’s desk, she remembered that bad interaction.
Goleman’s other competencies are made up of classic social skills. These include the ability to influence, negotiate and collaborate. There is a reason why when a politician speaks, even if you don’t necessarily agree with them in the beginning, there’s a fairly good chance you will start to agree with some of their platform by the end of the speech. They have studiously honed their ability to influence. Some physicians I’ve sat with at committee meetings have the same ability to pull you in, get you to buy into their ideas, and agree with them. Of course, there are others that you tune out after 10 seconds because they don’t speak well enough to convince you of anything and their argumentative style is anything but collaborative. Dr. S. is a master of social competence. As a successful doc moving his way up the ladder to a supervisory position, Dr. S remained easy going, had a natural way with people and made everyone feel comfort- able. He was an extremely competent and successful physician, like Dr. T. Rex, but he was nice and wasn’t afraid of confrontation at meetings. He communicated clearly and gave an inspirational talk to the C-Suite that convinced them to build a new ED. As a new leader, he recognized that he didn’t know everything so he talked to everyone to increase his own knowledge base. Ultimately, he made himself indispensable to the organization and got promoted out of the ED. You see examples like Dr. S in many former department chairmen who become chief medical officers at their hospitals or deans within their medical schools. In the end, committee and leadership success involve high levels of social competence such as being able to tell your story, get your message across, and moving people to an intended goal.
Can eQ be Taught
While the best leaders may be those who top the charts in every area of EQ, most people represent complex combinations of strengths and weaknesses. Thankfully, how- ever, these skills can be learned. Unlike IQ, which is generally stable from an early age, people can continue to develop the EQ throughout their lifetime. Which is fortunate given that this the trait that will make a physician stand out, IQs being generally equal in medicine. Over the years, I’ve made so many mistakes in hospital interactions, sometimes I feel like my foot has been glued to my mouth. But where I’ve been extraordinarily fortunate is to have mentors with high EQs who allowed me onto committees so I could see the interactions and the types of behaviors that occurred. Frequently, I would dissect and discuss the meeting afterwards with these mentors. These experiences have certainly increased my EQ over the last 15 years (which is fortunate since I didn’t start with a particular high EQ or an IQ higher than any other physician). Other ways to improve EQ are simply by reading about it (and making an effort to improve) and by the use of 360-degree evaluation tools.
There are numerous benefits to getting the right physician on a committee. There are also negative consequences if the ED is not well represented. Consider the physician’s emotional intelligence before assigning them to a committee. People who are confident, motivated, communicate well and work well in teams will likely be successful contributors to hospital committees. People who are too arrogant, skip meetings, bring an approach of “my way or the highway,” will likely create more work for their department chair. Ultimately, emotional intelligence can be learned and improved upon, so if a doc is motivated to get involved they may simply need a little coaching from their favorite chairman.
Michael Silverman, MD, is a partner at Emergency Medicine Associates and is chairman of emergency medicine at the Virginia Hospital Center.