090825 How to lead when you are not the boss academic medicine edition
[00:00:00] Hello and welcome back to the Medical Mentor Coaching Podcast. I'm Stacey Ishman, and today we're gonna be talking about leading when you Are Not the Boss: Academic Medicine Edition. Now if you think about all of the things you're doing, and if you're the chair of a department, great, you are leading as the boss, but you're not the boss in every room, and especially at the beginning of your career when you don't feel like you're the boss in any room, this can be really useful.
Some of the most influential people I have ever worked with are not the people who are running the department on paper, but oftentimes they're the people who help the residents learn or change the national conversation or were great mentors or sponsors. And so too many early career people think that leadership only starts once you get a title.
But real influence often starts well before this, and you have an opportunity at any point in your career to start. Now, part of the reason this me matters, [00:01:00] excuse me, is because one, you wanna enjoy your job and almost everybody who's gone into medicine came there because they had to lead their life.
They had to lead their study group, they had to lead something. In fact, every single one of us is leading a clinical encount. Whether we're leading a clinic, we are helping a patient. And there was somebody I, I do coaching obviously. And so as I started looking at it, I realized like every surgeon is a salesperson.
I have to tell you, this is the disease I think that's going on. Here's the solution. I think you should follow. If you are a physician and you haven't had to sell somebody on the treatment, you think is the right treatment, then you haven't been doing this very long. 'cause I'm gonna tell you every medical student's how to do this.
Think about how long it takes you just to convince somebody to let you do the physical exam. I watch medical students negotiate trying to get kids to let 'em look in their ears all the time, and that is a sales job. So there is leadership in every single part of being in medicine, whether you are sitting in a pathology lab and trying to get [00:02:00] things negotiated to get the specimen to get there on time, or whether you are a medical student who's trying to look in somebody's ears for the first time in a pediatric clinic.
And there is a lot that's going on in that messy middle as we talk with trainees and front desk staff and colleagues. And so, influencing for the middle allows you to shape the culture and show people how you handle stress, help them learn how to handle stress. It helps you improve systems, change processes , improve patient care protocols, and it helps build your reputation early.
So I wanna give you 10 ways that you can lead without a title. The first is to model the behavior you wanna see. So if you're a senior resident and you consistently prep your cases early and share key thoughts and key anatomy with the team, it gradually shifts or maybe quickly shifts how everybody on your team thinks the expectation is and how they prepare for the or.
And if you are someone who's sitting around and you notice the patients are waiting too long for follow-up imaging, [00:03:00] you have the opportunity to fill some of those gaps.
Now the second one is filling gaps. So one example is if you're in your clinic and you notice that the process flow doesn't work very well, it takes too long, the patient has to go to station A and station B and get weighed and talk to somebody else and fill out paperwork they could have done before.
And so you have an opportunity to say, Hey, let's set up something that's streamlined that the patient will like more, that will like more, that'll get us all to lunch. Now the second piece, a third piece I wanna talk about is leading through teaching. And even micro teaching moments can shift culture.
So this may be mini debriefs you do after a particularly stressful situation. And not just. In your mind, but with the medical student, with the ma, with the nurse, with your colleagues who are there in real time, maybe cross specialties but it be created even by one faculty, it can become the norm.
And I've absolutely seen things that other faculty do, or honestly things that the residents or fellows ask me about that I was like, that's a great idea. I should take that on now. [00:04:00] The fourth one is to mentor even informally. Share your stories about adopting the medical student who came for the month but didn't have a home program or.
Those kinds of things. I can tell you for me, there was a class of residents that I just decided I was going to adopt a few years back at the University of Cincinnati, and I don't really know what my motivation was. It just seemed like a good idea. I think I had actually quite honestly heard that they were out and about before residency started, and they were at a restaurant not far from where I was, and so I went over there, said hello, bought everybody a drink and just met them as people with beer.
At a bar. And so it quickly just became a group that I wanted to be able to connect with. Many of them were from out of town, didn't necessarily know any of the faculty when they walked in the door. There was one of the four who was local, and so they really, I wanted to be their family, and it started as just a connection between people who enjoyed each other.
But continued even now, 10 years later, to be people that call me when they have a question or a [00:05:00] concern. I see them at meetings. I'm excited to hear the triumphs and the tribulations. And so, mentoring can be really, really valuable. I was not officially assigned to that group. I think over time I got officially sent to one of the residents 'cause I asked for it.
But those are things that you can really do to change their trajectory for somebody else. Even just reviewing an abstract for somebody or connecting them with a collaborator can be those kinds of pieces where mentoring, sponsoring can be critically important and also helped really lead from the middle.
Now the next one is to bring data to the table. So documenting, how many cults and accounts were seen last night may lead to changes in evening coverage, or, looking at your own data, looking at the department's data. Those are things you can do to actually help affect change. , The next is to use service roles strategically.
So it may be when you talk about how committees often set an agenda and there's great data showing that agendas actually increase efficiency and productivity and reduce burnout. But you might wanna talk about how to [00:06:00] add things to the agenda. I can tell you in my own. Day job, I work in a insurance company.
I have somebody on my team who's fantastic and making sure she sets her own agenda and or will set up the agenda for the team. And it really helps so that I can understand what she thinks is important. I understand her visibility. People go to her and give her other items to put on the agenda she is leading without having to be the person that's, the named sponsor for that meeting.
And then the next is to speak up at the right moments. This is really important for junior faculty members. You may think, I don't have anything to contribute. I haven't been here long enough. But oftentimes you have fresh eyes to look at something that may or may not be working. You may be coming from another institution where you've seen some other things.
, And so if you're not sure exactly how to do things, you might suggest a new way to do it. Maybe the clinic template's aren't working for you and you can use your own clinic as the example. It's the end of one approach. But speak up in the meeting. This isn't working. I'm thinking about trying this. Has anybody else tried it or is [00:07:00] anybody else interested?
It allows you to be a leader without feeling like you're stepping out of place. Now, the last three are be a connector, and this gets a little bit easier as you move further along. But you know people, even if it's just the faculty at your last institution or somebody in another department, or the guy you go running with who happens to have something that would be useful for you to have a conversation about.
Introducing a resident who's passionate about AI to a pathology faculty member who's already running a project can fundamentally change, the trajectory for both of them and in a joint publication or even just a great conversation. The ninth one is to champion collaborations across departments.
So one example might be that you work with pulmonary faculty all the time. Well, this is clearly about me, and you create a joint sleep disorder breathing clinic, or. You come up with a mechanism for you to take care of, inspire patients in your clinic, or you work with all the folks who are interested in looking at dysphasia and you come up with a feast and a dysphasia clinic, like maybe these are all personal examples and they [00:08:00] are, um, but it's not hard for you to think about how to do that.
And then as a new person coming in, there are opportunities to say, Hey, I saw this work somewhere else, or I read about this, or, I'm just excited at this idea that I'd love to see how we can try it. And then the 10th one is to volunteer for visible wins. So maybe suggest small wins leading a QI project on handoff safety or creating a template for your m and m discussion that might make things more efficient.
Or running a wellness check-in initiative. I was just at the University of Utah I'm doing departmental coaching there, and they are doing an initiative where all of, well, not all of them, five faculty there are working with five faculty at the University of Colorado and they are doing. Training and coaching to coach the residents, but in order to give them some psychological safety, they actually are exchanging.
So the people at Utah are actually coaching the residents at Colorado and the people at Colorado are actually coaching the residents at Utah, and I think it's a phenomenal example of where you can create some very visible wins [00:09:00] and cross collaboration between institutions. The person who came up with that isn't the chair.
Isn't the division chief, but is the person who was excited about this exchange. And so, things like that can be huge and visible wins and show your leadership without having to have a title. So I want you to think about what's one thing that you can do to create some of these sort of leadership from the middle?
Is there a behavior that you want to copy from others? Is there a gap in your department that you could quietly or visibly fix? What's a project that you could solve and raise your own visibility? And so I just want you to remember that leadership is not about the title, it's about the habits that build trust and influence.
Influence often comes before the title, not after. We've all been in a place where it seems super obvious to all of us that the person who deserved whatever that title might be, was right in front of us. We'd seen them leading. If you can, I want you to pick one of these 10 items and try it this month.
Influence builds from those small, consistent [00:10:00] actions. So take a swing and give it a try. I'll also tell you that if you're not sure what to do, this is where coaching can come in really, really valuable. And maybe you're feeling a little uncomfortable that this is, a little out of your wheelhouse.
But you will find if you speak, spend a little bit of time, there's lots of ways in which you have the opportunity to lead from behind. Now if this episode was useful for you, please pass it along to somebody else who might benefit and please rate review and follow the Medical Mentor Coaching Podcast either.
On Apple or Spotify or your favorite app or on YouTube. And if you wanna get in touch with me, please reach out to me. Send me a DM
@sishmancoach
on Instagram. Or I'm on LinkedIn or on Facebook. Or contact me at my website at medicalmentorcoaching.com. If these are interesting ideas or you wanna talk more about this as a department, think about departmental coaching and give me a call or talk to your chair.
I look forward to talking to you next week. Thanks for joining me.
