All physicians are leaders [PODCAST]

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“In times of uncertainty, human behavior often makes people resort to less-than-stellar behaviors; unhealthy personal environments can become manifest as well. Often, these coincide with health care being used more frequently and the safe haven of health care delivery being sought. With all physicians being leaders, it is incumbent upon us to demonstrate a variety of professional qualities, and we must also draw on our own human qualities to succeed as well.”

Peter Angood is CEO and president, American Association for Physician Leadership, and author of All Physicians are Leaders: Reflections on Inspiring Change Together for Better Healthcare.

He shares his story and discusses his KevinMD article, “Professionalism: We must also draw on our own human qualities to succeed.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Peter Angood. He is CEO and president of the American Association for Physician Leadership, and he is the author of the book All Physicians Are Leaders: Reflections on Inspiring Change Together for Better Healthcare. There’s an excerpt from that book on KevinMD, and it’s titled “Professionalism: We must also draw on our own human qualities to succeed.” Peter, welcome to the show.

Peter Angood: Hey, Kevin, thanks so much for the opportunity. I look forward to it.

Kevin Pho: So we’ll get into your excerpt and book in a little bit, but first off, can you share your story and journey to where you are today?

Peter Angood: I’m a surgeon by background training. I did the trauma surgery, surgical critical care route for 25 years or so, primarily in academics, places like Yale, WashU, et cetera. And then as I got into that further, I found myself thinking more about systems and how to create larger-scale systems change. I was fortunate. I was able to shift out of my academic career, and then I became the first chief patient safety officer at The Joint Commission, which was really eye-opening for me in terms of where some of the levers and pulleys of health care actually occur. I did that job for several years, both nationally and internationally, and got some exposure to the World Health Organization and a number of things like that.

As I moved along, I then realized that the measurement side of life was also critically important in health care, so I was fortunate to shift over to the National Quality Forum. I worked there for a few years. I dabbled very briefly in the for-profit sector: I was a chief patient safety officer for the patient safety organization in GE Healthcare. And those three sequences helped me realize that, for all of the policy development and implementation in the large-scale for-profit sectors, they still didn’t really fully understand health care. So I was looking for an opportunity to really work in that gap zone between the front line and that higher-level stuff.

And so I’ve been the CEO of this organization for about 10 years now. It’s a great organization, because we really do touch both sides of that gap. We’ve got direct contact with the front line and creating change there, but we also stay very in touch with what’s going on at the upper levels, within policy, accreditation, financing, for-profit, etc. So that’s it in a nutshell.

Kevin Pho: So this audience is primarily practicing clinicians, and I’m a practicing clinician myself. What would you say are some of the biggest misconceptions? You mentioned a gap. You mentioned two levels, the policy, the higher-ups, versus the people on the front line. So from the perspective of the front line, what would you say are some of the misconceptions that you want to clear up, having been associated with both sides?

Peter Angood: Yeah, now, a great question, Kevin. You know, we tend to assume when we’re on the front line that there is a good understanding of what the front line is actually going through by those who implement policy, or different types of regulatory influences, accreditation. And yet when you look critically at those types of organizations, oftentimes there are not that many physicians, or even other health care providers, in those organizations. So there are, yes, committed individuals working in those types of organizations, but they don’t necessarily understand health care in the same way that folks like you and I do, and those who are your listeners: what it’s like to really interface with the patients, what it’s like to deal with the bureaucracies of day-to-day life.

And so when you’re on the front line, don’t assume somebody’s really got it figured out for you. But the corollary to that is that those folks all highly respect the physician voice and the physician insight. So don’t be hesitant to provide your opinion in a diplomatic and supportive sort of way. They value the physician perspective, and so let’s not be shy about bringing that physician perspective forward.

Kevin Pho: Now, I’m sure we’re going to talk about this later when we discuss your book, but again from the perspective of the front line, what are some ways that we can make our voices heard to those who make policy, or those who are making decisions for us? Like, how can we broach that gap and make our voice heard, and even ourselves, how can we ourselves transfer into that leadership position?

Peter Angood: Well, as we all know, we get no leadership training or even management training in our medical school or specialty tracks, do we? I mean, there’s nothing. And so we kind of learn this on the fly. If we’re fortunate, we’ve got good mentors who have helped us get there. And so I think there are a few stages here. One is to recognize you’ve got some passion to create some change. Don’t just get frustrated that change needs to happen, and why isn’t it happening? If you tap into that emotion, recognize you can help to create some of that change, but start small. Get involved in your group practice’s committee work, or get involved in a hospital you might be affiliated with. Start trying out the committee work, and listen. Listen to those other voices, try to learn their perspectives, and then gradually bring your own voice into this.

And recognize that in this day and age, just because you’ve got the magical MD behind your name doesn’t mean you have all of the authority, because we don’t anymore. But they do listen to us, because that patient-physician relationship is still the primary driving force in health care, and everybody knows that. Yes, there are all these other disciplines around it. There are all the administrative components and the financial components. But that relationship is sacrosanct in the industry, and so those of us who are closest to it are the ones who can provide the perspective. The others in the room usually listen to that perspective, as long as it’s delivered in an approach that’s encouraging and collaborative in nature.

So then, after you’ve gained a little bit of local experience, our various medical societies offer opportunities to get engaged. The state and federal agencies, whether it’s within the governments or within the payer groups, are often looking for physician input, so look for where those opportunities are and apply for them. And then as well, at some point, depending on what your thirst for all this is, you’re probably going to need some more education and some more exposure to formalize what we just didn’t get in medical school. Groups like ours and others out there can offer some of that.

But it’s that combination: recognizing your passion, getting some trial runs, gaining a little bit more education, and then gaining more of a broader reach with your expanding influence. There are very few of us who just get to punt into one arena and take advantage of it. So it’s a gradual process, and it can be really rewarding, I’ll tell you.

Kevin Pho: All right, let’s transition now into your book and the KevinMD excerpt. That excerpt is titled “Professionalism: We must also draw on our own human qualities to succeed,” and it’s an excerpt from your book All Physicians Are Leaders: Reflections on Inspiring Change Together for Better Healthcare. Now, Peter, for those who didn’t get a chance to read that excerpt, can you just walk my audience through it and share the story of why you decided to share that particular one?

Peter Angood: So the title of the book kind of implies one of my strong beliefs, and that is that at some level, all physicians are leaders. Just reflect on your own interactions, professionally, personally, and socially. As soon as folks find out you’re a physician, the flavor of the conversation subtly changes, doesn’t it? Always. And so at some level, all physicians are leaders, and you don’t have to be in formal title roles at all. So it’s up to us to embrace that responsibility, if you will, because the general public views physicians and the medical profession as a lead profession.

So it’s a privilege that we have. We’ve got this wonderful platform that we just naturally have on. And so as we do that, we have to reflect on how we behave professionally, and how we leverage that professionalism so that we’re able to create that positive influence in our industry. How do we leverage that patient-physician relationship? But how do we do it as kind, caring human beings who really do care about other folks? And that’s what brought us to health care in the first place, right? We care about other people, and we really do want to create some change in other people’s lives. And ultimately, for many of us, we do then want to try and create some change in our industry, because it needs a lot of change.

So draw on the innate human characteristics that we have, and leverage those so that we can move them into our professional arenas. And then, as I’ve said, utilize the skills that we can and the influence to create that professional influence. And that’s professionalism. It’s being ethically driven, morally driven, and really taking a focus on what’s best for others, by just recognizing how strong we are innately as human beings while we are physicians.

Kevin Pho: A lot of physicians today, especially in primary care, are dealing with a monolith of bureaucratic commitments. We’re pressured to see more patients in less time. We have to fill in more check boxes in EMRs and fill out more forms. And sometimes it’s hard to maintain that professionalism, or express some of the ideas that you had mentioned, in today’s environment, where physicians are just time-pressured. So how do you reconcile that tension, and how can physicians express some of your ideas in the current medical practice setting?

Peter Angood: We all know the numbers at some level, right? This is a three-and-a-half, now approaching four, trillion-dollar industry. It’s got 30 percent waste and inefficiencies. It’s got a huge overhead burden in terms of just processing the financial paperwork, and it’s still got a 10 percent major error rate. Now we’ve got huge rates of stress, anxiety, burnout, and suicidality, all those numbers. And so yeah, it’s an industry under duress for a lot of reasons.

But again, it comes back to, it’s not enough, in my opinion, for us to just complain about the bureaucracy. It’s looking for ways to create and help influence the changes that are needed in this industry. Complaining about it doesn’t get you anywhere. Actually, it just gets you a bad reputation as an individual. We have to recognize that in the broader context, it’s an industry under terrific duress, and yes, each of us feels it as well on our own personal and professional levels. But if you put that broader context into place, then that can allow you to hopefully maintain a little bit of a balance, and then to look for ways to become involved with your organizations and help to become a part of creating that change.

We all recognize creating change is a slow process, and this industry is going to take more time to get through change. You know, we’re 20 years into the current era of safety and quality, and arguably we haven’t made significant change yet. But there are many example institutions and practices out there that are doing good work, and it’s because committed individuals are engaging. And it’s like in our regular lives: The more we engage with others, the more we can feel like we’re contributing. And so it’s that engagement piece, Kevin, rather than the complaining piece, that helps to maintain some of that balance and that perspective. And keep in mind that broader context, because it’s a tricky industry. It’s just inherently complex.

Kevin Pho: Your book is titled All Physicians Are Leaders. Now, what are some other ways that physicians can lead? You did mention that they should become more engaged in their organization, participate in more committees, and try to inspire that change from within. What are some other ideas from your book on how physicians can be better leaders?

Peter Angood: Yeah, you know, I mean, again, at our core, let’s again recognize that intuitively we are leaders. We are idealists, we are ambitious, we like to create change, and we like to help others. So keep tapping into those core values that we all carry. And then, in addition to engaging like I was describing earlier, just continue to emulate those core values, those core characteristics.

But then as well, seek out other ways in which to demonstrate your professionalism and demonstrate your leadership. Now, that can be through being an entrepreneur, such as yourself, or it can be involved in some other sectors of the industry. It could be looking, just simply in your practice environment, at new and innovative or creative ways to solve some of the day-to-day problems that are always there. If you’re in a multispecialty group of 25, and you’ve been doing the intake the same way for five years, and you’re not unhappy with it, well, approach the rest of the group, approach the practice administrator, and say, “Hey, look, I’ve got a few ideas here. Can we talk about it? Let’s see what I can innovate on with you guys.” And then look for ways to create that change.

So it’s that combination of emulating these core human characteristics, engaging with trying to create the change process, and then looking out on the horizon at all of the different ways that we can be innovative and creative, and really following where the trends can occur and where you can leverage those trends.

Another example these days, obviously, is telemedicine. Telemedicine really came to the forefront through the pandemic. It’s been in the background for decades, but it really came through. It’s starting to ease off now. It’s going to resurface with the Delta variant going on. But as an example, you could look and say, “OK, now how can we better incorporate telemedicine in our practice environment, and how do I take a leadership role to work with the others in my group, to work with the administrators, or even to take it into the hospital that I’m affiliated with?” That’s leadership. And always do it while you’re looking at how to help others do better in their own environments, because ultimately, Kevin, it’s about other people, not yourself.

Kevin Pho: We’re talking to Peter Angood. He is the CEO and president of the American Association for Physician Leadership, and he’s the author of the book All Physicians Are Leaders: Reflections on Inspiring Change Together for Better Healthcare. Peter, you have a pretty good perspective in terms of the macro view of the health care system. So in your opinion, what are some of the trends that are coming up that are going to impact practicing clinicians going forward?

Peter Angood: Yeah, well, I think we’ve heard a lot about them in different ways. Clearly, the value-based care proposition is not going away. That is here to stay, whether it comes through the federal agencies or it comes through the for-profit payers. We’re all trying to figure out what value-based care really means. And if you think about it, the value equation is very simple: It’s quality over cost. But depending on who the audience is and how they look at that equation, quality means different things to a whole variety of different types of people, and so does the cost. So your value is going to be variable, but it’s not just a financial equation. So I think we need to better define value and recognize there are different perspectives on it, but at its core, it’s quality and cost. So that’s one thing that’s just not going to go away. You can start to implement those sorts of changes in your own practice environments, and look for ways to recognize it and kind of get ahead of the curve on it.

The other one, which primary care folks have been beating this drum on for a long time, but I actually claim it’s somewhat of a disruptive force, is true patient-centered care, or person-centered care. We all walk around saying that’s what it’s all about, but the systems and processes and our attitudes and our cultures tend to get in the way of that. So let’s look more closely at what true person- or patient-centered care is really all about. Break it down in the context of value, and then in your own environments, figure out ways: So how can we make this occur? Those are the two main influences that are out there. Telemedicine, it’s going to be transient, I think. It’ll always become a part of our practices.

And then the final comment would be, excuse me, I mean, this pandemic is sort of a once-in-a-lifetime, once-in-a-generation sort of thing, a once-a-century sort of thing. But what it’s really taught everybody is how, in our own environments, work and personal and family, we make sure that we’re prepared for whatever the next crisis or disaster is. That doesn’t mean you have to have more money in the bank and your exit strategy. It’s all about how we make sure we can weather those storms, because we’ve got this dichotomy going on in health care. We’ve got a whole bunch of folks who are overworked, and we’ve had, as you know, for many months, several folks who have been underworked, because folks just aren’t in their practice environments. So how do you be prepared for those kinds of eventualities over time? So those would be the main ones, I would say. But it takes leadership through all those things, and physicians are those natural leaders.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Peter Angood: You know, it’s hard to not get worn out and feel like you’ve got to hit the eject button and go somewhere else. But you’ve invested so much time, energy, and effort in developing yourself to where you are now. Draw on your human quality components that are already there, your core values. Draw on your altruism, and just redirect, because you, a physician, are a leader in our society, and you can create so much more change. And if you start to redirect to the positive side, as opposed to staying focused on the negative, you’ll feel a lot more satisfied in your career. And all physicians are indeed leaders.

Kevin Pho: And Peter, how can people find your book?

Peter Angood: Well, you can catch us at physicianleaders.org, and look us up at the American Association for Physician Leadership, but you can also find us on Amazon. The book’s out there, and in a number of other channels where you can get the digital copies. I encourage you to have a look at it. I’m not saying just because I wrote the darn thing. It’s just a nice, healthy little perspective on what it’s like to be a physician, both on the front line and on the upper tiers, and know how to build the context for yourself. Thank you, Kevin.

Kevin Pho: Peter, thank you so much for sharing your time and insight, and thanks again for being on the show.

Peter Angood: All the best. Take care.

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