Month: April 2020

In coaching physician leaders over the past week, I heard about a variety of challenges on the front lines. A New York CMO deciding which department would get limited PPE supplies. A cardiac surgery director’s staff angry about being deployed to the ED. A palliative care department chief home sick with COVID herself. Difficult decisions, lack of resources, and the need to maintain already depleted morale.

And whether you’re the physician leader of a healthcare organization, your team, or your family, there are things you need to know. Prior to the pandemic, you may have been overwhelmed by your responsibilities and the challenges of your role. Now, with this crisis, your leadership is being tested daily. So many difficulties and so much uncertainty, with fires of every sort to be put out on a daily basis. But this is also a time where you can shine, and truly flourish in your role.

From Warren Bemis to Atul Gawande to the Harvard Business Review, all expert sources understand that the key to strong and effective leadership is self-management. After all, you can’t effectively manage others if you don’t manage yourself. But did your training provide the guideposts that are required in this difficult time? Most physicians would answer “no.” Unfortunately, there is little in medical or surgical training that does.

At the heart of self-management is self-awareness, another aspect of mindfulness. We first have to build awareness of ourselves and our patterns, before we can intervene with effectiveness. This is how new habits are not only formed but also how they are sustained. Here’s an article from the American Association for Physician Leadership that featured my work in this area. Here are three strategies you can utilize this week to build your confidence, steadiness, and calm.

The Neuroscience Of Stress

When our sensory organs bring information about danger to the CNS, the fight/flight/freeze pathway is activated via the amygdala, that part of the brain that is busy scanning the environment for threat and danger. Within seconds, our sympathetic system is in gear, pumping adrenaline into the bloodstream, shunting blood away from our digestive tract and off to our muscles. We’re primed to fight or take flight, or to roll over dead—the lesser known freeze element.

Where effective leadership comes in, though, is in the next phase, where executive function comes into action. Our prefrontal cortex (PFC) activates, helping us make decisions based on more than alarm and fright, and making sure that our actions are in the interest of long- and not just short-term goals. When the PFC engages, we can take a step back, see that we’re safe from harm, and move into resourceful action.

Infrequent activation of the sympathetic system doesn’t negatively impact us—adrenaline leaves the body 20-60 minutes after the reaction, and cortisol flows out of the blood stream in the following 4-6 hours. But being in a constant state of stress wreaks havoc with our mental and physical well-being. We’re all familiar with the symptoms of stress—from anxiety, depression, insomnia, lack of energy, to difficulty concentrating, to name just a few.

Over-activation of the sympathetic response is dangerous for a variety of reasons. First, it can prevent us from acting rationally in the face of stress. Second, as non-essential body systems are shut down, we lose the systems that regulate our mood and, especially in a crisis, our mood needs to be regulated! Third, chronic sympathetic activation weakens immune function, and we need our immune system to be as strong as possible during this time.

What’s key for effective leadership is engaging the PFC as early as possible to mitigate the stress response. There are two important strategies to do so:

1. Get to know your early warning signs of stress (EWS.) Just as we tell at-risk patients to pay attention to early warning signs of stroke, we need to get to know our EWS for amygdala activation. Racing heart, shallow respiration, clenched jaw, tightness in the body. And just like with stroke prevention, the more we can get to know our EWS, the more we can intervene before things escalate.

2. Allow these physical sensations to cue you to take the second step: taking a purposeful pause.

Especially in times of crisis, it’s all too easy to put ourselves on the back burner. We can be so busy with all the additional tasks and responsibilities that we get home and collapse into bed, only to get up 4-5 hours later and do it all over again. If we do this day after day, we run in sympathetic overdrive, our hearts pounding, body tight, ready and in action all our waking hours.

Unfortunately, running on empty only wears us down. All the stress worsens our ability to make good decisions and maintain calm. It erodes our ability to lead effectively. And right now, you simply can’t afford to put yourself at risk. Not for yourself, not for those you lead, and not for your family. The oxygen mask analogy is an apt one: if you don’t invest in your own care, your efforts to support others will fail. It’s that simple.

You’re probably thinking: how can I possibly take time to care for myself with everything going on? With all the demands of this crisis, there isn’t a spare moment in the day. Here are two important strategies:

First, getting enough sleep is critically important. I’ve coached many physician leaders who boastfully talk about catching up on email or doing meeting planning at 4 AM. Unfortunately, though, inadequate sleep has many adverse short-and long-term effects, from lost productivity to poor temper to cognitive impairment. A few things you can do to get the rest you need are putting your devices in another room, setting and sticking to a bedtime, and avoiding late-day caffeine.

Second, think about what typically fills your tank. This could be exercising, listening to your favorite music, reading a book, being outside in nature, working in your garden, watching TV, spending time with friends or family. Even if you can’t spend as much time as you’d like on these, you can still give yourself a small dose of the activities that fill your tank. Doing so will help ensure that you have what you need to meet all the demands.

During a time of crisis, it’s critical to build and maintain morale. Whether it’s at work or at home, people are working hard to manage, and their efforts need to be validated. Pre-COVID-19 we had high levels of physician burnout. And now, things aren’t exactly easier, are they? Building your people ensures that they’re at their best to stay out of burnout and carry out the difficult frontline work.

Be sure to thank others for all they’re doing. Everyone is working hard, so let people know that you see this. Thank them for a job well done, for going the extra mile, for taking such good care of patients.

Celebrate strengths and wins. Go out of your way to recognize every success your team is having.

Encourage your people to pace themselves and take time for self-care.

In difficult times, it’s easy to fall into command and control. But this physician leadership style will leave your people drained and, ultimately, less willing to follow your lead. These simple measures will bring you a lot in team morale and goodwill.

Next Steps

Your role as a leader is powerful. When you manage your stress you role model calm, helping others do the same. When you avoid running on empty, you have what you need to be at your best. When you build the morale of your people, you help them rise to meet the challenges COVID-19 has brought and stay out of physician burnout.

Now, more than ever, you can step into your full leadership potential. Follow these steps and reap the benefits you’ll find in confidence, steadiness, and calm.