Harnessing Exam Room Experience for Leadership Excellence

Host Mike Sacopulos interviews Hanah Polotsky, MD, MBOE, and Lisa Williams on the intersection of healthcare, leadership, and innovation explored in their book Physician Leader: How Exam Room Experience Drives Leadership Excellence.

This transcript of their discussion has been edited for clarity and length.

Mike Sacopulos: My guests today are Hanah Polotsky and Lisa Williams. Hanah Polotsky is a physician executive with 20 years of progressive leadership experience in value-based healthcare operations and medical group management. Dr. Polotsky is a practicing physician specializing in internal medicine and endocrinology. Lisa Williams has led healthcare organizations across the United States for nearly 30 years. Lisa has delivered professional training programs in leadership development, organizational strategy development, team facilitation, and process improvement. Ms. Williams enjoys a national reputation. Dr. Polotsky and Ms. Williams are more than just distinguished healthcare leaders, they are co-authors of Physician Leader: How Exam Room Experience Drives Leadership Excellence. Hanah Polotsky and Lisa Williams, welcome to SoundPractice.

Lisa Williams: Thank you for having us.

Mike Sacopulos: Oh, it is my absolute pleasure. Lisa let's start with you. Before discussing the book, could you please tell me about yourself and your background?

Williams: I have always been in healthcare. I started right out of college and have done everything from being a nursing home administrator to working in the mental health arena, hospitals, clinics, and really found a passion in teaching and coaching and leading teams. So that is what really led me to Dr. Polotsky. We met while she was working on her master's degree at the Ohio State University, and I was her coach.

Sacopulos: Dr. Polotsky, same question. Could you tell me more about yourself and your path as a physician leader?

Hanah Polotsky, MD: I trained in New York at Albert Einstein College of Medicine, and my initial journey was more of a clinician educator, but I was always fascinated by business aspects of healthcare management. And when I moved to Colorado 14 years ago and joined, at that time, Kaiser Permanente, I ended up in a leadership role, which sometimes you end up in a leadership role when you do not know how to lead. And I have discovered Lean leadership, and it took me on this amazing journey of learning, and this is how I ended up in Ohio State. And through the years, I went through various roles, and I got to appreciate how much, as physicians, we need to learn or unlearn how to lead, and I am probably a great example of that. And I wanted to make sure that me and Lisa can share that experience of helping others to grow in leadership.

Sacopulos: Well, you certainly have through the book. Lisa, the book is Physician Leader: How the Exam Room Experience Drives Leadership Excellence. Why did you write the book and for whom is it intended?

Williams: Through my years being a leader in healthcare organizations and then partnering with physicians in those, like Dr. Polotsky just said, usually the physician leader that gets promoted into leadership positions are good clinicians, and that doesn't necessarily teach you how to be a good leader, and we really started the book thinking about that. And Dr. Polotsky would do a great job explaining how our leadership model and coaching model applies to clinical care. And when she and I made that connection together, it was a big aha moment for us. And so, the book is originally designed for administrative leaders in healthcare, physician leaders, those wanting to be there, but I also must say there've been several people who've come to us since reading the book and just said, "Gosh, this applies to me, and I work in the airline industry, and this applies." And so, the principles can be applied across a much broader audience.

Sacopulos: Dr. Polotsky, in the preface of the book, you focus, at least in part, on physician burnout. You cite a statistic from the Annals of Internal Medicine that between $2.8 billion and $9.6 billion annually is attributed to turnover and decreased productivity costs, and it is a conservative estimate of the direct costs of burnout, you write. Why are you and your colleagues so burnt out?

Polotsky: I think what happened over the years, as technology and regulations creeped in, the amount of time you spend actually taking care of patients versus typing notes and engaging in coding and other processes almost reversed itself. So I think that a lot of burnout comes from inefficient processes and systems that need to be improved, which is why physician leadership is so essential, because you are there, you are working with all of this health information systems, you know all the inefficiencies, and who is better than you to lead and help your colleagues to drive the change, to basically improve their practice, to decrease the waste and unnecessary stuff? Maybe use AI to dictate notes. There are so many possibilities, but we need to get physicians and ABPS and other clinicians to do clinical work and not spend time on bureaucratic tasks.

Sacopulos: Very well said. I can see the pitchforks and torches queuing up behind you to lead the change on this one. Lisa, as someone who has been involved in healthcare delivery across the country, is burnout worse in certain demographic areas? For example, are rural providers more or less burnt out than their urban colleagues?

Williams: I can't really quantify it in terms of more or less, but maybe different. And the way I think about it and the way I see it is, in some organizations where you have a lot of support and a lot of administrative support, and I'm not referring to assistant level, I'm really referring to the board of directors and the executive team really supporting the physician work, there's less burnout I see. But then at a rural clinic, you may see it because there are more demands, because you have fewer staff and you have to cover more responsibilities. And so, it is just different, I see it. But there's one thing I do see that's common across every organization I've worked in, and I've worked in a lot of organizations, there's some commonalities in the physician feeling like they need to be right, their patients expect them to be right, and so there's that need. Having that kind of pressure can cause someone to get burned out over time.

The second thing is being afraid of being perceived as weak. And so, if you are asked to be in a leadership position and you don't know exactly how to go about doing it, you could be perceived as weak, and that can cause burnout. It's like you're turning at every turn with your patients and your documentation and now your leadership responsibilities. And then I think the other thing for a physician leader in burnout that is common is not taking the time to really understand their strengths and weaknesses as a leader, and so we see not only practicing physicians burning out, but also leader physicians burning out.

Sacopulos: This may be an odd question, but Dr. Polotsky, do physicians face unrealistic expectations from patients in the exam room, and do you think that patient attitudes towards healthcare providers have changed over the course of your career?

Polotsky: I think it depends where you are practicing. I think that in a lot of communities where people are underprivileged, I think they have less demands on physicians from that standpoint. I think I got to practice in a lot of different places from the east side of Manhattan to different parts of Denver. So, I think when a physician is not burned out, when the physician is in a good state of mind, I think they can handle all those different demands, because at the end of the day, I think it's a good thing that we want to have a mutual decision making. I think we went from being sort of very hierarchical, like you, the doctor, having all the answers, to shared decision making. I actually think it is better in healthcare. So again, as a physician leader, you need to support your physicians through some of the changes that happen with patients and the systems as well.

And I do think one of the reasons why we wrote the book, if your physician leader, obviously supported by your business partners, they give autonomy to your physicians and ABPS, and they design systems and processes with them and their colleagues in the clinic, I actually think they will be less burned out. I think a lot of this burnout is lack of autonomy and somebody else telling you what to do, because physicians are scientists at heart. They are extremely brilliant. And if you get them in the room together and give them some boundaries to say, "Hey, listen. We don't have an indefinite amount of money, but use your brain. How can we design the process to make it better for patients?" Most people are so driven to help their patients that if you get them to design things together, not only does it help them to improve the flow in the clinic, but it actually helps them with camaraderie, and the camaraderie decreases burnout.

And again, leadership is local. I've been in companies where you have the same systems and processes, but in one clinic, physicians are completely engaged, and others, engagement scores are very low. So, you need to teach those local physician leaders how to lead and how to design and change things together. Don't do it to people, do it with people, and it makes a tremendous difference.

Sacopulos: Great answer. You make me feel hopeful. Lisa, over your career and mine, we have seen physicians move from business owners to employees. Has this shift impacted leadership skills in physicians?

Williams: That is a great question, and it comes up more and more as smaller clinics are becoming part of the bigger conglomerate, an organization. I think that the leadership skills that one needs when one is a business owner is very much like Dr. Polotsky was saying, you have a lot of autonomy, you are able to make decisions. And then one of the things that Dr. Polotsky mentioned is wanting to be able to just focus on your clinical work. So as business owners, I think they have a lot more flexibility to do that. As I have seen organizations get bought and move into larger companies, that leadership role looks very different. I would even use the word diminished in some cases, and a little less intentional, but now having said that, on the plus side, oftentimes the larger organizations have more formalized physician leadership programs, and so that can be an advantage. So, I see pros and cons both ways. And so, does that answer your question?

Sacopulos: I think so. I think it answers it very well. Thank you. Dr. Polotsky, your book, Physician Leader, lists seven leadership attributes for successful physician leaders. Could you please pick one or two and describe them, maybe give us an example or two?

Polotsky: I would focus probably on effective communicator. And I think a lot of things in this book are actually our own stories, because it is making fun of yourself that helps people to learn, but I think it is essential to focus on listening. And I think a lot of times when we come out of residency, and it's kind of a command and control environment and everybody's listening to you, and everyone deferring to you just because you've got an MD or DO after your name, suddenly somehow people are afraid to speak up to you. So, it is quite a transition to learn how to listen without thinking how to jump to answer. And this is why I think I had to learn how to listen in the exam room. And for my patient satisfaction scores to go up, I have to step back and stop focusing on myself.

And I give examples of that in the book, how you need to start focusing on the patient. And at the end of the day, it is them connecting with you because you are listening to them and empathizing is what is going to get the outcomes. And that is when we realized, oh, that applies to leadership. If you are not listening, and it is about you, even if you are trying to help, it is about you, right, versus you encouraging people by listening and asking the right questions. It is about them and helping them find solutions and grow. They as leaders, just like patients, they are going to get into that space where we want them to be so they can make change, they can problem solve, they can achieve goals. I hope I have answered your question.

Sacopulos: Yes, yes. Is there maybe one patient encounter from the exam room that comes to mind that helped you develop your communication or earlier skills?

Polotsky: Yeah, I think, I don't know if I put it in the book, but I think I did. I think early on, I am an endocrinologist, and I deal with patients who struggle with weight. And I am from New York, and I have some Russian background, so I am quite direct. And my first two complaints were about me telling the patient that they're obese and they need to work on their diet and exercise and it was very offensive. I told people what to do before they got the chance to get to know me and my style, and I also could have found different ways to say that, to achieve the same results. So those two patient complaints, they changed me, because I was like, it doesn't matter what the reality is, it is what is the perception of, it is how do they see it, not how you see it. And that is what helped me to readjust and step back and be a little more perceptive of are they ready for me to actually discuss things that are more challenging, or do I just spend time getting to know them? Completely translates to leadership.

When I got into my last job, I took a completely different approach. It was more about letting me meet people, let me get to know them as their personal stories. Do they have a dog, do they have kids, what do they enjoy, and then in as little as have few one-on-ones, just to get to know and establish the relationship before I even bother engaging on any business aspect.

Sacopulos: Great example. That really brings it home to me. Lisa, I thought the section in your book on the mindset of the strategic thinker was particularly interesting and useful. Could you please talk about the mindset of a strategic thinker and tell me why you believe it's important?

Williams: There are so many components to this. It is easy for me to speak about this for hours, so you may have to cut me off.

Sacopulos: The floor is yours.

Williams: Okay, thank you. So the mindset of a strategic thinker is so important in leadership, and oftentimes, I've seen that the physician leaders think that's the job of the administrator partner, the CEO, the chief strategy officer or whatnot, but it is equally as important, if not more so, for the physician leaders to be able to think in that aspect so that they can partner with their administrative leader. And sometimes I've seen the dynamic be like the administrative leader is more predominant in strategic conversations versus the physician, but in reality, it's the physician and providing good clinical care and having satisfied physicians and satisfied patients that really needs to drive the strategy, and we often don't think about it from that vantage point.

For physicians, they are taught to focus on the patient, that one patient in the exam room at that time, and not think more globally. I think healthcare now, especially in the primary care scene, is getting much, much better in being more holistic in how they think about patient care, and I think that translates really well into having a more strategic thinking mindset from a leadership perspective, if that makes sense. And so really, those two worlds, there are some commonalities. And Dr. Polotsky talks about how our iterative leadership model is so similar to the SOAP model that physicians learn to use back in school, and so that mindset is just so critical.

The other thing I would like to point out is when I am working with physician leaders, like the physician leader of surgery, just picking one randomly, they're really focused on their surgical practice and that of their colleagues, their business, the surgery business. It's really important that the physician leaders across organizations can come together and think, yeah, this surgery business is so important and the endocrinology business is so important, so is nephrology, so is this, so is that, and be able to come together and think more globally outside of just what I'm working on every day as a surgeon, but more like how do we come together as an organization for the benefit of our patients?

And sometimes, an example of that that I will give you, I won't name the organization, but they had patients complaining because they couldn't get in to see the rheumatologist, and that is pretty common nationwide. I mean, rheumatologists are hard to get in to see. And so this organization came together, and so some of the referrals that we get to rheumatology, they don't actually need to come to us, they need to go to ortho or they need to go here or they need to go there, and maybe we can think about how to have a musculoskeletal support system, and we can triage and figure out what would be the best first stop for the patient. It may end up being rheumatology, but it may not. And so that's another example of how, not just in being a physician leader, but being able to think more strategically and having the open mindset that, yeah, I may not get that surgery on my books right away, but it's really best for the patient that they go over here first or second.

Sacopulos: Great answer and super example there. Dr. Polotsky, as our time together comes to an end, I'd like for you to discuss the appendices to your book, because I thought they were really smart, super helpful information and templates. Can you tell our audience, potential readers of your book, what they could expect and why you organize such great information in the appendices?

Polotsky: Thank you for asking this. I think that as a first-time author who has also had some experience publishing more scientific papers, I spend so much time doing research, and all those things end up in a first chapter, until I realized that when you write the book, it's not about your research. So, I did so much research on change management that I felt so bad not putting it together as an appendix, but if I put it in a book, it probably would have been over the top for people who are reading it. So, a few other things in the appendix are more problem-solving models, as well as our approach to cross-functional redesigns. And I see that a lot, that companies, they have silos. In healthcare, there are even more silos.

So, when I think of the best things that I have learned from Lisa is how do you get people together from completely unrelated functions, but from the patient perspective, from the flow of information or flow of the process perspective, those people are connected? And what I put in there is our approach to cross-functional redesigns. So, I think that's probably one of the very helpful appendices, and it probably could be its own book, but that's my passion, sort of the problem solving and redesigns and change management. That is why you see so much time and energy spent on the appendix in the book.

I think that as our time goes to the close, I also want to mention that this book is not just for physician leaders or the leader's colleagues, it is actually for physicians as well. I feel that every physician is a leader. So, when they are in that office or OR, take a place where they are, everybody is looking at them and looking for their guidance. And we shouldn't be just speaking about burnout of clinicians, we need to speak of burnout of medical assistants and registered nurses and so many other support people, that physicians are the ones who are kind of responsible for that. If they create an environment that makes their colleagues comfortable in that practice setting, patients are going to benefit tremendously. And all of those, the mindset, the characteristics, they apply equally to physician leaders and physicians as well.

Sacopulos: Excellent. I should say that the audience should purchase the book. I am pushing the appendices just because I was blown away by the high quality and the smart layout of them, but the entire book is worth the read, but the appendices alone are worth your time and the price of admission.

Polotsky: Thank you.

Sacopulos: Very well done by both of you on this book. My guests have been Hanah Polotsky and Lisa Williams. Their book is Physician Leader: How Exam Room Experience Drives Leadership Excellence. The book is a great resource. Hanah Polotsky, Lisa Williams, thank you so much for being on SoundPractice.

Williams: Thank you.

Polotsky: It was our pleasure.

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