Dying with Dignity

The last week has been incredibly difficult as I had to say goodbye to my beloved friend and companion, my German Shepard, Lola. Like for many of us dog owners, Lola was more than a pet, she was a faithful companion and loyal friend. She could be found by my side every waking minute I was at home. 

Lola’s illness came on fairly suddenly.  I immediately sought the care and advice of one of the best vets in the region. I wanted to explore all possible treatment options for her. I was prepared to embrace any recommended treatment, no matter the cost. At the same time, I knew I wanted to the right thing by her. I wanted to make sure she was free of pain. I did not want to keep her alive just to make it easier on me. She deserved to die just as she had lived—with dignity and on her own terms.  And so, after long and thoughtful conversation with the vet, and considering all options, I knew the best thing for Lola was to let her go. It was difficult and sad, but peaceful. She did not suffer. 

Lola’s death fell near the anniversary of the passing of my “other” best friend, my father. A vibrant and healthy man, my father died in 2015 after battling cancer. At the end of his life, my family and I were fortunate enough to help make important end of life decisions for him. We were able to move him to a wonderful hospice facility, where he peacefully spent his last few days free of machines, comfortable and surrounded by family in a beautiful and calm setting. While it was an incredibly difficult time, I was comforted in the choice we were able to make regarding my father’s end-of-life care.

Lola’s death as well as my father’s, once again reminds me of the importance of being able to make the appropriate end of life decisions for our loved ones. Often, as health care professionals, we are focused on patient outcomes and restoring their health. As an industry, what we sometimes fail to realize is that the best outcome can sometimes be letting a person go. Each year, it is estimated that 30% of Medicare expenditures (over 50 billion dollars) are attributed to the 5% of patients that will die that year with one-third of those costs occurring in the last month of life.  Furthermore, most studies show that if the person is sick enough, this type of medical intervention does not have a positive impact. In fact, it can make those last few days and months of life worse.

So whether you are a health care professional or a family member, the reality is that we need to openly discuss end of life options before it is too late. And as health care professionals, we also need to devote resources to offering patients and their families the kind of services and space they need in those final difficult days. It was what I was able to provide my father and what I think all families deserve. 

The house is a lot quieter now without Lola. It will take me a while to get used to her not being right there next to me. But, I remain grateful of the time we had together, and I was honored that I was able to make the choice I did at the end of her life.

Walking in their Shoes

As I noted in a recent post, I spent several hours each month working on the front lines with team members across the hospital. Over the course of the last year, I have helped transport patients, worked with surgeons, residents and fellows, logged in 20,000 steps in one night delivering meals, accompanied nurses in the Cardio Thoracic ICU and Neuro ICUs on rounds and vitals, changed beds sheets with patient care techs, drawn blood with phlebotomists, and worked on medical surgical floors with nurses and therapists. In many ways, this is one of my favorite parts of the job—so much so, that I have been doing it for years. 

My intention in shadowing team members is not to spy on them, micromanage operations or garner unnecessary attention. I do this to be a more effective leader and team captain. Through this direct experience with my team members, I am able to understand my team better, grasp the challenges they face and see first-hand the amazing work they do. Additionally, it provides me the opportunity to garner vital feedback and gain invaluable insight into our operations.  

Working side by side my team members, I’m able to build a stronger connection with them. I gain an insight into who they are as people which improves communication. Witnessing their work up close, I can provide better feedback as I have a greater understanding for the complexities of their work, the challenges they face, and the sheer amount they have to accomplish. 

This time I spend with my team members also strengthens our ability to collaborate. Working together in this capacity, we develop a deeper understanding that we’re all in this together and have a greater appreciation for the unique talents we all bring to the table. 

While we might not all have the opportunity to work on the front lines with team members each month, they’re ways in which we as managers can gain a deeper insight into who our team members are as people and glean their perspectives on their work and the organization:

• Ask questions! Ask questions that enable you to understand their process-why they work the way they do. Spend time talking with them to learn what they value most about their work and what they would change if they could.
• Get to know them as people. Always spend the first five minutes talking with them on a subject outside of work. Relay a personal anecdote of your own to encourage them to share something about themselves. This will allow you to build a connection and a sense of trust.

The most effective leaders are ones that listen, act on what they learn and teach along the way. They are also ones who have empathy and an understanding of who their team members are outside of work. Spending time walking in your team members’ shoes will help you develop these skills.

Present and Accounted For

Over the last couple of months, I have met with nearly all of 8,200+ team members in groups of 200 to 300 to present, review and discuss our new organizational strategic plan. Over the course of these two hours sessions, my goal is to communicate to them the direction for the organization, explain their critical role in our evolution and engage with them—answering questions and gaining feedback and insight.

For me, this experience has been beneficial on many levels. It’s been so productive, in fact, that I will be holding one-hour sessions twice a year with my team moving forward. While the topics will vary, I will use this time to engage and connect with team members across the organization. 

One of the biggest takeaways from these sessions for me is the reminder to be present—to entirely focus on my team members when I am with them, to listen and be in the moment. Being present and engaging with others in a focused way allows me to not only create meaningful connections with my teammates and colleagues but helps me and my organization perform at a higher level. I genuinely believe that to lead successfully you must be present.

There are tremendous benefits to being present. Being focused and thus being present, demonstrates to team members that you are engaged, empathize and understand them. You show them that you are actively listening and hearing them. You build camaraderie and connection. Conversely, when you are not focused or present, team members get discouraged and lose motivation. They think if he does not care, why should I.

Being present improves your skills as a leader and manager as it enhances one’s ability to cope with stress, to stay level-headed and allows you to operate from a proactive position as opposed to a reactive one. Often, problems don’t need a definitive solution, they merely need clarity of thought and attention.

Practicing being present can take just that, practice. Here are a few tips to help you focus and thoughtfully engage with colleagues and team members:

• Take a moment to clear your head before each interaction. This will allow you to focus on the person in front of you and the issue at hand.
• Don’t multi-task and give your team member or colleague your full, undivided attention. If this is not possible, reschedule your conversation.
• Don’t interrupt or prematurely form opinions. You want to listen actively. 
• Recap or summarize what your colleague or team member is sharing. This forces you to listen for comprehension and allow you to ask probing questions to understand more thoroughly. 

At the end of the day, what drives us all to do and be our best is the connections we create with others. Being present, listening and focusing on others makes that possible.

From the Bottom Up

Over the course of my career, I’ve had the opportunity to work with some amazing folks, and I’m not just talking about my direct reports or folks on my immediate team. Every day I work with compassionate and dedicated professionals from hospital dieticians, to transport staff, to operating room nurses to occupational therapists to world-renowned oncologists. They all give 110 percent to the patients in their care and the organizations in which they work. 

In my current role at Tampa General, as was the case in previous positions, I spend several hours a month shadowing team members throughout the hospital. I get to witness their hard work and dedication first hand. I get to “live” the work of the hospital in a profound and very specific way. I am able to talk in-depth with team members, hear their ideas for improving efficiency, see their problem solving skills in action and witness the challenges they face up close.  

These hours each month are some of the most productive - and certainly the most meaningful - I have had the chance to experience. They also directly inform the work that we are trying to accomplish, particularly in the area of innovation. 

Regardless of the industry in which you work, when you are trying to on-board a new initiative or program, you must harness the experience and knowledge of those who are in the trenches every day. You must ensure that your approach supports and enhances the work that is already being done as you work towards achieving buy-in across the organization. If you take the opposite approach and issue a directive to implement a plan or program that was developed by only a small isolated team, you are sure to experience failure. 

For example, at Tampa General we are currently working with GE Healthcare to implement a command center that will serve as mission control for the hospital. The center will use artificial intelligence and predictive analytics to help improve efficiency and shorten the time patients are in the hospital by better managing their care. However, the center will not achieve success on technology alone. It will rely on the expertise and knowledge of team members who are on the ground doing the work. In order to make this center as effective as possible, we must involve team members from across the hospital in the process as we get the center off the ground. 

By involving folks at all levels of your organization as you build a new program, you will not only gain their knowledge and experience, you will empower them to give everything they have to achieve success. They will be able to spot potential problems and work through them as well as see areas for improvement and make recommendations. They will take pride of ownership, feeling heard and engaged.  

The bottom line is that if you’re going to make real change and do it successfully, it has to be built from the bottom up. 

To the Point

No matter what position we hold within an organization, or what place we are in our career, we all need mentors. At the very least, we need colleagues with whom we can seek professional advice in order to get open and honest feedback as well as spitball ideas.

I am often asked what traits I look for in a mentor or colleague. I find myself drawn to folks that are open, honest and direct. Over the course of my career, I have learned the most from people that practice the art of being direct. I say “practice,” because I think there is a skill to being thoughtfully direct without intentionally hurting a team member’s feelings or belittling them. 

I realize that being completely open and direct can cause a bit of anxiety. You don’t want to make a colleague feel bad and or engage in conflict. There are also times when one’s instinct is to believe that telling folks what they want to hear is more comfortable than being honest and upfront.

However, the reality is that beating around the bush doesn’t ultimately work and it takes away from what is important—getting the job done. Being direct, straightforward and honest with colleagues is the only way to go in my experience. 

Direct communication has a lot of benefits, and there are ways to speak openly and honestly without being punitive or demeaning. By being direct you:

• Build trust with your team. 

• Demonstrate that you are honest and authentic.

• Show that you respect colleagues by telling them the truth.

Being direct is also much more efficient than avoiding the problem. Direct communication cuts through the drama, saving energy, time and money.

They are ways to be direct while being mindful of others and their feelings. Here are a few tips:

• Provide feedback that is about the quality of the work and not the person doing it. 

• Be clear and concise.

• Be constructive rather than aggressive.

• Don’t put others in the middle. Speak directly to the source and focus on their work and not that of others.

• Ask follow-up questions to make sure you are being heard and that you are both on the same page. 

• Work to come to an understanding and get “buy-in” from the team member before ending the discussion.

The reality is that there are times when discussions with team members are not going to be fun, and you have to give feedback that is hard to hear. But if you approach the conversation with honesty and thoughtfulness, the news is much more likely to be received in the spirit in which it was intended, and you and your team can move forward with the great work you are looking to accomplish.

True Colors

I have spent the last several blog posts focusing on the lessons I learned from past mistakes. For me, taking on this exercise was not only about the lessons learned and the chance to be self-reflective, but also the opportunity to practice vulnerability.

When everyone spends so much time curating the perfect highlight reel for their Instagram story or Facebook feed, it’s now harder than ever to be open about what is really going on in our lives. While nothing is perfect, it seems that these days we feel the need to paint that picture. And so, I think, it’s important now more than ever to show vulnerability and be willing to admit to one’s flaws and foibles.

Traditionally and especially in business, I believe vulnerability has been viewed as weakness. This negative connotation has often prevented folks in leadership roles from revealing their true selves. And so, when I talk to other leaders and members of my team about this trait, I position it as “practicing vulnerability,” as I think we have to make a conscious effort to show others who we really are.

And while practicing vulnerability can be a scary proposition to some, I would argue that when it comes to leading a team, it has tremendous payoffs. By practicing vulnerability, you:

• Demonstrate that you need others and signal a willingness to collaborate.
• Create a sense of relatability and accessibility among your team and colleagues.
• Inspire others to be vulnerable and follow your lead.
• Build bonds of trust and loyalty.

At the end of the day, being perfect does not equate to being successful. Leaders who admit mistakes, are open and honest about the missteps and flaws garner much more than those who don’t. 

Meeting in the Middle

I’m often asked by colleagues and those I mentor to define my management style. I’ve found, what they’re really asking is for my advice on how I manage a team. A friend recently posed this question to me, and as I had been thinking about the lessons I’ve learned through the mistakes I made, I realized that the way I approach the management of my direct reports today has been significantly informed by my learnings from the past.

Micromanaging is not my style. It never has been, and I can’t imagine it ever will be. I want my team members to feel empowered and accountable. I want them to trust me and know that I trust them. I want morale to be high and team members to feel like they are valued and have significant input in decision making. I feel like none of this is possible when folks are being micromanaged and the team leader is holding the reigns too tight.

Earlier in my career, my mistakes in managing were rooted in the opposite approach—giving my direct reports too much autonomy and freedom. As a result, I experienced moments where team members felt lost or unsure of their direction and tasks failed to get completed or projects remained stuck in place. I encountered a few situations where team members took their new-found level of authority too far and decisions were made that were not in line with our overall objects. Their struggles were a direct result of my choices as a manager and I own that.

Creating a management balance has its challenges but it’s totally achievable. I think over the years I have met my team members in the middle and found a way to create a healthy work environment that is rooted in a mutual trust and respect. I strive to delegate, manage from a safe distance, hold team members accountable and empower them to make decisions and take risks. For me, this is possible by practicing the following:

• Providing clarity around a shared goal of purpose—clearly communicating the how and why so my team has the knowledge to move forward.
• Operating from a place of transparency—letting everyone know what I expect from the start.
• Developing a series of benchmarks and checkpoints for my team so they feel secure and we are all kept up to speed.
• Building an environment where autonomy and accountability make the others possible.

At the end of the day, I want my team members to view me as standing with them as opposed to on top of them or completely out of the frame. My role as a leader is one of the things I cherish most about my work and is the aspect of my job in which I take the most pride.