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Physician leadership development hinges on communication

July 16th, 2014

by Kenneth H. Cohn

I quip that I have amphibian DNA because despite having worked in 43 states, I learned the hard way that each hospital has different people, culture and expectations.

I was told that physicians clammed up when in a room with administrators.

Yet, when I taught leadership development to physicians at a hospital in the South, discussing the role of relationships, communication and team-building, a COO attended and participated in my sessions. We had a session on ways to avoid amygdala hijack, having the mid-brain take over at a time of stress, leading to deteriorating relationships. I mentioned that sometimes 20 to 30 seconds is all that we need to give the frontal cortex the opportunity to overcome the stress response and promote communication and team-building to improve patient care outcomes. For example, we can pause--take a breath, sip water, ask a question, and/or leave the room for a moment.


To my surprise and enlightenment, the COO confessed a time that amygdala hijack led to a deterioration in his relationship with a physician that caused him to have a sleepless night and apologize the next morning. He and the physician, who was in the room, now get along well. His confession led other physicians to comment on times when they could have performed better and what they learned. One physician confessed that as a result of our leadership development sessions, she and her teenage son now get along much better because she asks him to do tasks rather than ordering him to do them. Another physician said that as a result of the leadership development sessions, he implemented some of the practices and was proud that when a mentally ill patient disrupted the clinic, the nurses wrote in their evaluation that he was part of the solution rather than part of the problem.

I wrote in Building Trust that we earn our patients' and colleagues' trust by being transparent, keeping our promises and admitting when we fall short of expectations. When I complimented the COO to his boss, the CEO, she wrote back to me:

I am so pleased to hear your feedback and look forward to also speaking with our team about their experience. I also appreciate your recap of the content and the observations you had about the level of participation and engagement among team members. As you probably discovered, [we are] a culture- and relationship-oriented organization--frankly I believe this is one of our core strengths. Culture however, must constantly be tended to and reinforced and leadership skills, particularly among our physicians, have an enormous impact on the tone and tenor of the organization. I have seen this play out in both amazing ways and in terrible ways in the past 30 years of my career as a nurse and an administrator.

The impact of culture on quality, safety, innovation and our ability to navigate a healthcare organization through turbulent times cannot be understated. In the future I see even greater need for this kind of work, and I consider you a pioneer. I am happy that our paths crossed and hope that they do again.

When a physician CEO dismissed one of my case presentations as soft skills, another physician CEO said, "Communication, negotiation and conflict management should be called the hard skills because they are so hard to do well and so hard to make part of our daily practice."

What's your experience? Have you ever confessed your experience to members who sit on the opposite side? What was the effect that it had on trust-building, quality, safety and innovation? What did you learn?

Kenneth H. Cohn is a general surgeon and CEO of, who works with organizations to engage doctors to improve clinical and financial performance.


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