Coaching Physicians Based on Their Performance: Vital Conversations

Determine the achievement level of the physician you are coaching and create the appropriate plan of action. Here are some examples:

High Achievers

The goal in coaching High Achievers with Vital Conversations is “retention and professional growth.” These individuals are highly sought-after and are the most likely to leave your organization. The most common reason High Achievers leave an organization is not being recognized or valued for their unique contributions. Working closely with your High Achievers to ensure they know that you appreciate their contributions and want to support them in their professional growth, as well as provide them the autonomy to grow, is a critical coaching role for physician leaders.

Best practices:

• Recognize individually and offer appreciation for efforts

• Provide opportunities for further growth and development

High Achiever Physician Case Example:

A strong clinical cardiologist spearheaded a project to improve efficiency and cost reduction in the cath lab with substantial results. While this success was well known to the interventional cardiology sub-section, others on the medical staff had little knowledge of it. In order to highlight his accomplishments, this physician was given the financial pillar award at the annual medical staff meeting and featured both in the monthly physician newsletter and on the information video boards in the doctor’s lounge. He was subsequently encouraged to consider larger leadership roles and given ample opportunity to develop his leadership skills. He ultimately became the chairman of the heart and vascular institute.

Solid Achievers

Solid Achievers comprise most of the workforce, typically anywhere from 50-70%, and it is very important for these individuals to be recognized as well. They are doing good work and appreciate ongoing reward and recognition. Whether in a department meeting, or informally during one-on-one meetings, taking the time to acknowledge their skills, accomplishments, or areas of growth is not only valued but important to their continued growth. Solid Achievers appreciate the support of their leaders and peers as they develop their skills to improve outcomes and provide quality patient care. The most common challenge or opportunities for growth with solid achievers is consistency in their practices. Collaborating on opportunities for growth and development is key with these individuals.

Best Practices:

• Recognize strengths

• Identify opportunities for improvement and create a plan

Solid Physician Case Example:

A skilled surgeon recently transitioned from a two-hospital private practice model to an employed model involving one hospital (which was not his primary location). While he clearly had a strong interest in patient care, he was not engaged in the development of the program at the new hospital. Recognizing his passion for patient outcomes and safety, the CMO took time to meet with him learn more about him personally and his professional aspirations. Subsequently he was appointed to lead a clinical group involving the surgeons, nurses, administrators, and ancillary care involved with his service line. He absolutely flourished! He achieved meaningful improvements in outcomes and patient experience measures because he was given the

responsibility and resources to make positive changes. The time invested in meeting with physicians individually and getting to know personal life stories and strengths helped the strong physician but also benefited the organization, and ultimately patient care.

Under Achievers

The goal for coaching Under Achievers with Vital Conversations is two-fold, either “develop or detach.” Under Achievers need to be made aware specifically of how their attitudes, words, and behaviors do not align with the mission, vision, and goals of the organization. One of the more troubling aspects of the underachiever is a negative attitude, which can manifest as disruptive behavior. Often, this behavior has been tolerated for years because the physician’s issues have been camouflaged as “trying to improve the care and safety of the patient.” These behaviors can no longer be tolerated; referencing the organization’s Standards of Behaviors, Values, Code of Conduct, or Policy in Medical Staff By-Laws related to disruptive behaviors should be the primary focus in these conversations. Directly linking actions, language, and behaviors to the risk of compromising safety, patient care, trust in a team, and the need for a collaborative work environment can help these conversations be objective and less personal. Under Achievers that demonstrate consistent negative attitudes and behaviors need to understand the consequences. In these conversations, it is critical to communicate that ownership of the behaviors and willingness to change in the identified areas is a choice— their choice.

Under Achiever Physician Case Example:

An experienced and clinically talented physician had been counseled on several occasions by our chief medical officer with no change in his behavior. A third complaint included an outburst in the middle of the nursing station yelling loudly about an error that occurred and had an impact on his patient. The medical director met with this physician to address the repeated concerns raised by the nursing leader of the unit and by the patient families who overheard and were very upset with the interaction. Since this was a repeated complaint, the matter had been recently brought to a committee of six physicians, the Health Advisory Committee, which served the role of recommending disciplinary action. This group included a psychiatrist who was very helpful in identifying behaviors which would benefit from counseling. A plan for meeting with this physician and reviewing the latest outburst was identified, and the medical director for this physician volunteered to lead the meeting.

The offending physician initiated the meeting with his monologue describing all the errors that were committed by the nursing staff that led to his inappropriate behavior. Using the tactic taught in Vital Conversations, the medical director immediately cut short the tirade and quickly redirected the conversation to address the way in which the physician responded to the errors. This medical director took control of the meeting and simply and clearly referenced policy on disruptive physician behavior and his past advice that “this behavior will not be tolerated in the future.” Since this was not an initial vital conversation the consequence had been pre-determined, and the physician was sent to anger management. He completed the course of treatment and has never again been reported for behavioral issues. He communicated that he not only had changed his hospital behavior, but his personal relationships had improved as well. In this conversation the consequences had been clearly communicated, and a follow up meeting to discuss his progress was scheduled. 

Best Practice:

• Improve with coaching and skill development

In conclusion, Performance Management and Conducting Vital Conversations are both an art and a skill. These methods require the finesse and the desire to build strong trusting relationships and bring out the best in the people you work with. They also require the skill of recognizing the nuances and needs of diverse individuals and learning how to deliver feedback, coaching, and mentoring in the most effective and efficient manners.

This blog post excerpts an article in the Q3 2016 issue of Provider Advisor. Complete the form below to download the issue.

April 1, 2021