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Leading Today's Physicians

Leading Today's Physicians

The Truth - The Whole Truth

INTRODUCTION:

You’re listening to Tiller-Hewitt’s Leadership Lens Podcast. If you’re a leader - or an aspiring leader - who wants to stay relevant and impactful… YOU’RE IN THE RIGHT PLACE.

At Tiller-Hewitt we believe it’s faster, smarter -- and less painful -- to learn from leaders who have walked before us. That’s why we invite top leaders to be our guests on the Leadership Lens.

Your host is Tammy Tiller-Hewitt – Founder of Tiller-Hewitt HealthCare Strategies. Let’s jump into the podcast.

TAMMY:

It’s always a treat to hear from a physician executive with years of experience. First as an independent practicing physician. Then, moving into leadership and becoming nationally recognized as a champion of innovation. This is a guy who sits at the top but hangs out in the trenches every single day.

Our guest today is Dr. Mike Finley System Medical Director and Designated Institutional Official for the CHRISTUS health system. Prior to this leadership role, Dr. Finley served as Chief Medical Officer for 20 years. If you’re a physician leader or a leader with responsibilities for engaging your physicians, you don’t want to miss this interview.

Dr. Finley has a wonderful perspective on today’s challenges and expectations of both our patients and physicians. And while not always congruent, he explains the leaders’ role in helping physicians through very specific paradigm shifts. If you want to hear a successful physician executive share what healthcare leaders of today need to understand, take a listen to this.

TAMMY:

Dr. Mike Finley, welcome to the Leadership Lens Podcast.

DR. FINLEY:

Thank you, Tammy. It's good to be here.

TAMMY:

Awesome. Hey, listen, if you all are out there listening to this podcast years down the road, or if it goes viral in a good way, know that Dr. Finley was our very first podcast guest. And as you will all hear quickly, he set the leadership bar high. So, Dr. Finley, I love your newest title, or should I say titles? I'll never understand why we can't just have one job in healthcare. So first we have System Medical Director and then wait for it, wait for it, Designated Institutional Officer, or DIO. What on earth does that mean?

DR. FINLEY:

Well, Tammy, DIO means that I am the contact between the CHRISTUS residency programs and the accrediting body, the ACGME. The ACGME requires that any entity that is the sponsor for residency program, have one designated official that is responsible and accountable to ACGME that these programs are following all the criteria.

TAMMY:

Okay. Well, let's back up before your DIO days and tell our listeners a little bit about your professional career journey. First, a private practice physician, then to an executive role, and then talk about - did your journey to the executive level and your physician skills intersect.

DR. FINLEY:

I'm a family doctor by training. I practiced in a place called Hope Arkansas famous for producing a president. I stayed in that practice full-time for seven years and then part-time for ten years. During that latter part of that time, we started a family medicine residency program at Texarkana, which was down the road, a bigger city. I transitioned from those things, including working in ER for a lot of years part-time, I transitioned to my executive role as a VPMA at a CHRISTUS hospital in Louisiana. And then had the opportunity to transfer back to a CHRISTUS hospital at St. Michael in Texarkana.

I started my first role as the medical director, which it was now called at Saint Michael. It was a new hospital, and we grew up a lot of service lines and I became Chief Medical Officer for the region which had a couple of other small entities and went on to develop cardiovascular service lines. The residency program was still in Texarkana, and I was peripherally involved in it but had left it in good hands of my associate who was the program director at that time. And then 2018 I had the opportunity to become the DIO for the CHRISTUS System and the System Medical Director. So, I have transitioned out of my CMO roles in the last year and I moved on to more system entities and projects.

TAMMY:

Wow, that's quite a journey. Hey, when you transition from practicing, or from a practicing physician to an executive, were you ever accused by any of your physician colleagues as switching teams, or going to the dark side as you moved in the hospital Administration?

DR. FINLEY:

Well, I went from that practice and that environment to Louisiana. So, they only knew me as their Medical Director. I had immediate recognition as the Medical Director, and I was placed on a lofty position. I really enjoyed it. So, I had no background with them. But when I came back to Saint Michael, I did go through a period of a couple of years where physicians I had work side-by-side with question why are you now telling us what to do? Tell us why you're my Medical Directo, when we all work together as practicing physicians, and now you're in Administration… which they would always highlight that word as some sort of negative implication.

So yes it was, but that transition, maybe over two to three years, I began to do things to help the practicing physician deal with very difficult family issues or patient issues, things that doctors tend not to, they don't ever want to deal with it. They don't want to be the ones on the point for that, but I was able to do that and it was part of my role.

TAMMY:

So, you were able to deliver value in a way to, or prove your value by doing things that they just really hadn't thought that they needed maybe?

DR. FINLEY:

Difficult situations. Physicians tend not to do well when patients or families complain about them, because we spend our whole career trying to please or satisfy or get good results or have high quality, and sometimes that's just not possible all the time. And sometimes we could create our own problems. We don't communicate. In fact, most of the things I handle even now are communication issues. Either no communication or bad communication, or confusing communication. So, doctors bring a lot of things onto ourselves. And our patient public is getting a much more savvy about what service is, because we are a service industry, and you know when patients have to wait hours and hours for a doctor or a test or in the ER or for a bed in the hospital, that is not a crowd-pleaser, and it makes our patient satisfaction go down.

TAMMY:

Right. And you hit on it, and I think so many leaders forget about the basics. The basic being communication. That people just want to know what's going on. They want to know the why it's happening, what’s going on, and oftentimes, we just forget about that piece because we're busy saving lives and you know, stamping out disease and suffering and think that they'll just know intuitively what's going on. So, I love that, that you are a champion of communication.

For our listeners, here’s part of why Dr. Finley is our first guest. You’re a powerhouse leader. And I know that on your watch as VPMA and Regional Chief Medical Officer, you led countless quality and growth initiatives at Christus St. Michael and I just want others to hear so that they can even maybe understand where you're coming from. You implemented the hospitalist program, the development of the simulation center, the laborious in the intensivist programs. And you are integral and establishing Christus St. Michaels, as an affiliate center of excellence, and the partnership with Cleveland Clinic Heart Institute, which began years of growth and development and advances in your heart program. So it's not surprising that during your tenure as VPMA at Christus St. Michael, the Health System, on the top 100 hospital award, not once, not twice, but three times. And the top 50 Cardiovascular Hospital in the past two years. So, what did your medical school training prepare you, or how did it for your leadership roles?

DR. FINLEY:

So, Tammy, I've seen a lot of things. I've seen a lot of things in healthcare go really well. Unfortunately, in my role, I see a lot of things that don't go well, because we get the complaints and we look at the problems, and we look at the bad outcomes or the unexpected outcomes I should say. And I would have to say that from my background, nothing in medical school or really even residency, fully prepared me or even began to prepare me to think about us as a service industry.

My parents taught us to do the right thing. Be good. Tell the truth. And I, I guess it comes from inside. You have to want to be a compassionate person. You have to want to follow the guidelines so that you can have the good outcomes. You cannot take someone and make them or force them or coerce them into being a careful, kind compassionate physician or in anything they do. We had a lot of seminars. We had a lot of courses. I handled a lot of physicians to try to get them to see where it went wrong. And when I talk about things, such as simple as communication. When a physician walks into a room, eyes are on that physician. I mean on. And they process everything, our patients and their families. They process body Language. They process eye contact. They process how close that we stand to our patients. Do we touch the patient? I can't tell you how many times my complaint that I've gotten is the doctor never even listened to my chest, never touched me, never looked up from the computer. So, I think it's a long journey of experiences of common sense, of not feeling that the physician is that better than anyone. We have a lot of knowledge but so do our patients and families now. You know, we used to own the knowledge. Back in the eighties we were the ones that they got knowledge from. Now we managed the knowledge.

TAMMY:

Oh, that's good.

DR. FINLEY:

It's a whole process. I can't take a person, physician or not, I can't take a person and make them be a role model physician that has the compassion. As I said before, you can't do it.

TAMMY:

I think a lot of leaders and especially young leaders may not realize that this is an area that someone needs to manage. So, what advice would you give, especially to a young leader or someone who hasn't really had a strong VPMA or CMO…How would you guide them through this with all the knowledge that you have?

DR. FINLEY:

I think we need to pick the right people, and we need to remove the wrong people.

TAMMY:

The people being the doctors or the providers?

DR. FINLEY:

Yeah.

TAMMY:

Okay.

DR. FINLEY:

The providers, whether they be nurse practitioners or physicians even nurses. Anyone that interacts with patients. I'm sitting in my office in a large medical center and every patient that's being seen up there - I won't see them but someone is seeing them representing this area here where Administration is. We depend on them to represent us. We have a mission. We promise people that we will be compassionate. We promise them that we will treat the patients with dignity. I cannot make people do that. I've got a to get the right people. And I've got to remove the people that aren't the right people for what we are, who we are, and what we're doing.

TAMMY:

So, let me stop you for a second. So, you've got two groups. You have the group that is already there right - They’re already part of your organization that has it or doesn't. And then you have the new cohorts that are coming in. So, new recruits. What do you do about the people inside that are already there, to help them get up to the standard that you want? And then how do you recruit for that?

DR. FINLEY:

You model who you are and what you are. You meet with people and sincerely tell them you know, these are the things that we are. And what I'm reading about you or whatever complaints I'm getting whatever, this is not who we are. Do you really want people to think this of you? I want physicians to be in a place of respect. And I tell them - I’ve told many physicians - you don't want people to think this of you. This is not who you are, is it? Look inside of yourself. Is this really how you want to be thought of? I try to reach people and give them their chance.

TAMMY:

So, do you think they would take this feedback as well from a non-physician?

DR. FINLEY:

I don't know that you have to be a physician. I don't think so. I think you can, you're a human being, you’re a compassionate human being. I have a professional acquaintance that wrote a book one time about physician behavior. And he talked about in the book, how he structured a recovery-type program for physicians that were sent to him from medical boards because they couldn't practice because of the way they acted. So I called him and I talked to him. I told him - it was the time in my career - I said, you know, I don't believe adults can change. I really don't. And he said well, I'll tell you and he said I had about a 30% success rate and I said, well, that's phenomenal. He said it took the correct behavioral medicine person because he felt like people at our level that couldn’t act right ought to have professional help.

Many of the people that we see are acting out are no different than anyone else, or not acting the right way. They have dual problems. They're depressed or they have a mental illness. Providers are not immune to that. So, addressing that can be helping someone remain in their career. Now, I'm talking both sides here. I'm talking yeah there's a chance, but you cannot do it with any threats. You do this again; you're going to be suspended. We all have those bylaws and rules regulations.

TAMMY:

Aren't there real consequences to not stopping bad behavior?

DR. FINLEY:

There are. Suspension or medical board action, or restrictions. Those usually are very difficult things to get through a medical staff. And medical staffs tend to be in a position of governing themselves. Sometimes you run into a situation where other physicians are looking around saying, you know, this is kind of hospital going after this doctor... What if I'm next? And so they tend to kind of band and protect behaviors and say don't do this again.

I do believe that physicians try very hard to give good care and to get the best quality for their patients. I really do. I think that physicians get burned out, stressed out like anyone else and they have those reactions. It's just that we are always on stage.

TAMMY:

So that's the way you deal with the ones who are there. Then what's the conversation that you should have with candidates who are thinking about joining your organization? How do you set expectations long before they come?

DR. FINLEY:

You can tell a lot during your interview. You can tell some on recommendations, although they tend to be artificially elevated but. You know, anytime you have questions that little voice in you that says hmm this just doesn't look right. Why am I getting averages on these instead of best, or excellent? The interview process or is this someone I really enjoy talking to? Is this someone who's engaging with me? Am I the 8th 2-yr job stop for this person? There are a lot of red flags that if we really said, gosh, there's red flags here, but I have got to have this certain specialty here. I got to have it. So, we'll probably be okay. That almost never works.

So, it's a, it's a focused interview, a proper assessment, and then, unfortunately in this business, we do orientation. We do orientation for a couple of days at the most and then we're good to go. Well, I'm a believer in onboarding and I happen to know that you are a believer in onboarding, Tammy. And so, for a good year, you need to welcome someone into your organization. You need to meet with them. You need to have a mentor for them. Another physician on the medical staff who is somewhat of a contact. Once a month maybe or have a lunch or whatever. You need to give them feedback. You need to tell them. If they don't believe in your mission, they honestly ought not be in your hospital, your organization. So that's a year process.

TAMMY:

So, for our listeners, when Dr. Finley brought us in to do a robust physician & APP onboarding program that is a year in length and has a formal mentorship program. Because research shows that when you have that your retention rates go up. Remember when we were interviewing physicians, before we launched the program, two of the hospitalists rescinded their resignation because they really felt like you were taking the bull by the horn and things were going to change in their favor. So that was awesome.

DR. FINLEY:

Yes, and it was successful.

TAMMY:

Well, and you know, it's because you have to have a senior champion. I want our listeners to know that it doesn’t go on into infinity and beyond without a senior champion. Because as you know that you get pulled for a million other things and unless you continue to make it a priority and it's really a retention strategy, once you have them there, it's all about retaining them and helping them grow and flourish. And I know that that's always been a passion of yours on the educational side. And so, tell us what you're doing right now as it relates to educating and making sure that new residents know the things that you weren’t taught in school.

DR. FINLEY:

We're having webinars and one-on-one meetings with residents across CHRISTUS. We are talking about our discussions about communicating with each other and about the patient. We talk about our mission and who we are. We have a very large project on health equity and inclusion and diversity within CHRISTUS. And so, we have residents in training that are going through that. We give them feedback. We give them feedback on complaints. We handle a lot of residents right now. A lot of our learners have been… In fact, all of them have been under a great deal of stress with the pandemic that we've had. And the two major surges, they've hit our hospitals very hard in the areas we are located, and then low vaccination rate areas. So, our residents have been stepping up. But I'm very concerned about their well-being. I'm concerned about post-traumatic stress disorder because they've been through a lot. So, we're connecting with them and, you know, they're showing some resilience. When you're 26, 27, 28 yrs old and you're taking people off a ventilator who are your age who are dying of respiratory failure from covid – it’s stressful. So, we are trying to help them into the unknown here and get through it. But we give them a lot of feedback. We do a lot of coaching. We do a lot of examples. From my point – I think no one has as many examples as I do and I’ve got the good, bad and ugly, you know, and I share it with them.

TAMMY:

That’s good, that’s how we learn – stories stick.

DR. FINLEY:

Absolutely!

TAMMY:

So, tell me about a pivotal point in your career. It could be anywhere from when you first started to yesterday. One that you would share with your colleagues across the country.

DR. FINLEY:

I always believed that physicians were responsible for taking care of the patient. They had all the knowledge that wrote all the orders. They did all of this. Did all of that. And my goal had been to make sure that physicians were extremely well, competent and educated in certain things. Like the sepsis bundle, for example, or STEMI or stroke, protocols, and things like that. And then finally I had to accept the fact that that we have now created a lot of micro responsibilities in this business. We have a lot of steps that occur that physicians don't direct, but they’re protocol-driven. For example, a patient comes in with chest pain, they get an immediate EKG, they get an immediate triage, they may get an immediate aspirin, they may get a whatever. And these steps are put in without the doctor saying, I need an EKG and that's a small example of it. But I've had to learn that there are multiple responsibilities for multiple people in this business. And then the mid-level providers. My son is a nurse practitioner, and I have learned that they play what role they play.

So, when all of these pieces start fitting together, it's like a beautiful symphony. But to make the processes where these pieces fit, and all of the players respect each other and they know it's going to be done and they back each other up. And on, and on, and on. It's like my band practice when I was in the fifth grade. It's terrible.

So, I've had to learn that we're not a oneness or twoness anymore. We are a multi-task multi-responsible team that has to work all together. Kind of like, when you turn the key, and your car starts. There’s a whole lot of stuff that has to work.

TAMMY:

That's a good analogy, Dr. Finley. That's very interesting, a good analogy.

DR. FINLEY:

Well, thank you.

TAMMY:

What do you think the top leadership challenges are today, both professionally and organizationally?

DR. FINLEY:

Professionally challenges are – morale, to recognize the important things that are simple, but we don't do. Like walking around. When I really need to be energized, I walk through the hospital and I watch. I watch patients being moved from one place to another. I watch transport. I watch nurses taking triage. I walk through the ER and see all the activity and I see all these thousands and thousands of things going on. And I stand in awe that this is what's happening. And so, it's staying energized. It's staying curious. Why is this not working? Why is my sepsis bundle not being followed? Why am I having an infection rate? Why am I having whatever? It's the why and it's looking at your data because data shows you things. You have to understand your data.

I can't tell you how many times decisions are made on data that's not really the right thing to ask. But you're asking people who are not clinical usually and they're producing what you asked them. You’ve got to be careful. So, I think that the challenge of professionalism is to realize we're all in the state of flux all the time, but never so more than now. Covid has challenged us and told us how inefficient our healthcare system can be. It's also a challenged us that gee, we we've got to get more efficient and do better. I think from the standpoint of where we're going when you know, we don't know where we're going. We're just trying to take the best we can of the patients that come to us. When we say we are the best place for this or that …we better be the best place for this and that.

TAMMY:

I like your analogy about non-clinical people looking at data because I'm a non-clinical person that loves data, but we always talk about let data tell you a story instead of just letting it be a set of numbers. But you're right you have to ask the right questions. So, I love that your data-driven physician leader. That's awesome.

So, is there anything that you if there was one piece of advice that you would give a leader today who is passionate about healthcare leadership, whether a physician or a non-physician leader, or leader want-to-be, what would one piece of advice be?

DR. FINLEY:

Work for a place that has a mission that means something to you internally, that drives you, that is passionate to you. And then preach that mission, expand on that mission. That's who we are. Our mission here at CHRISTUS is to extend The Healing Ministry of Jesus Christ. It is that simple. And we have core values. We have a five core values. So that's who we are. That's why I come to work. Go ahead and pour that mission out to the people that you see. I don't mean tell them oh look here's our mission. I mean when you see this is not who we are - I use that term a lot with physicians. This is not who you are, this is not who we are. What's bothering you today? What can I help you with? And realize there are a lot of frustrations in healthcare. When we frustrate our providers, we don't get the best out of them. Try to reduce the frustrations. Don’t tolerate people that should not be here with you.

TAMMY:

So, let's move into the lightning round or rapid-fire questions, I like to call the final five.

What are you currently reading?

DR. FINLEY:

I'm currently reading a book called The Story Bible, which is one my grandson and I, he's eleven, we read every night. It's a beautifully illustrated book of Bible stories. I’ve got my second round of reading Bonhoeffer, which is by one of my favorite authors, Eric Metaxas. It's about a Jewish Pastor, that is a riveting book.

TAMMY:

So, what do you do to relax?

DR. FINLEY:

I do anything with my family.

TAMMY:

And what are the words or Mantra that you live by?

DR. FINLEY:

Be honest, do the right thing for the right person at the right time, don't pretend anything, and relax.

TAMMY:

And what would you tell your younger self?

DR. FINLEY:

Stay true to yourself. Don't be selfish. Take things as they come. Look at the very long picture, not the short-term.

TAMMY:

Do you have a bucket list of things you want to do before you kick the bucket?

DR. FINLEY:

I want to take my grandchildren fishing. And this year we finally bought the kind of boat that we need. It needs to be a big platform because where I want to go fishing, there are alligators in this river. They come up all around us. And maybe frog gigging with them.

TAMMY:

Oh, that sounds like fun! Alright. Well, Dr. Finley, it has been a pleasure hearing about your career path, your journey, and even more so, just the advice that you're giving, So, thank you so much for being part of Tiller-Hewitt's Leadership Lens Podcast.

DR. FINLEY:

Thank you. Tammy. Always a pleasure.

CLOSING:

Tiller-Hewitt works with leaders who want to consistently deliver strategic growth and measurable results.

The organization is recognized as the leading experts in strategic growth, network integrity, and physician engagement. Thanks for listening to this episode of the Leadership Lens. For more leadership resources and strategic growth solutions, visit tillerhewitt.com.