Posts Tagged ‘psychiatrist administrator’

Psychiatrist Administrator VI: A Few Concluding Thoughts

December 6th, 2010

Being an administrator or manager usually implies that people report to you. There are physicians, other professionals, or administrative staff whom you hire, supervise, promote, and can discharge. What motivates them?

Most of us need to work, to earn “a living.” We need to put bread on the table and a roof over our heads. But beyond attaining the basics of survival, people work to give their lives structure and meaning. For many of us, work defines who we are. It provides a social network, a sense of goodness and efficacy.

Most people want to believe in what they are doing, to share in a good mission. The effective leader communicates mission, vision, and values—and ensures that every decision the organization makes is consistent with them. A good leader solicits input from all staff in regular meetings, which achieves “buy-in” and gives the leader multiple sources of information and advice. Being a good listener and communicator doesn’t slow a leader down or weaken the leader. Quite the contrary. People want to feel as if they are making a difference. And the staff in a vibrant, functional organization feels needed, valued, respected, and motivated. These are people more likely to “go the extra mile.” They will appreciate a bonus or pay raise, but they will understand clearly and frankly communicated budget constraints that keep salaries flat and be less likely to leave. They are more likely to go home each day feeling good and return to work with enthusiasm and optimism.

In the army I learned that a good leader doesn’t think about himself or impressing the boss. A good leader keeps the focus on mission and people.

- Alan J. Gelenberg, M.D.
Biological Therapies in Psychiatry
Professor and Chair, Psychiatry, Penn State University
Journal of Clinical Psychiatry

Psychiatrist Administrator V: thoughts on effective leadership

November 29th, 2010

A good leader is always respectful. Some people we really like and admire—others less so. Regardless, all merit respect from a leader—at all times. Some comments may be thoughtless or uninformed. Still, the leader must respond with tact and diplomacy. You may hold and share strong opinions, but do so in a manner that is respectful: in word, tone, and body language.

Respond to communications in a timely manner. Create a system (paper, electronic, assistants) that ensures timely follow-through on all promises.

Integrity is essential.

Leaders are expected to make more money, have bigger offices, and enjoy other perquisites. But the leader must be altruistic, putting the interests and needs of the people he or she is responsible for ahead of his/her own. The host serves him/herself last at dinner, so to speak. If you must lay people off, it’s not a good time to give yourself a raise or buy something expensive for yourself.

Be thoughtful in important personal matters. For example, acknowledge personal losses and celebrations.

Be a good role model. Personally illustrate your values by your own behavior.

Leaders are expected to make more money, have bigger offices, and enjoy other perquisites.  But the leader must be altruistic, putting the interests and needs of the people he or she is responsible for ahead of his/her own. The host serves him/herself last at dinner so to speak. If you must lay people off, it’s not a good time to give yourself a raise or buy something expensive for yourself.

Be thoughtful in important personal matters. For example, acknowledge personal losses and celebrations.

Be a good role model. Personally illustrate your values by your own behavior.

Psychiatrist Administrator IV: Email etiquette

November 22nd, 2010

We all communicate. Even if you are not thinking about going into administration, you probably use email.

With apologies to Ecclesiastes, there is a time for all things—and vehicles of communication. Email is wonderful. It’s easy and instant. Email is ideal for brief communications of facts (there’s a meeting at noon in the multi-purpose room) or congratulations.

Brevity is essential for email. Long wordy emails turn readers off and are frequently ignored. I wonder if people who write them aren’t wasting valuable time, energy, and talent that could be put to more productive use. If you find yourself getting beyond a couple of hundred words, consider another vehicle for communicating.

And the affect in an email should be positive (e.g., congratulations) or neutral (e.g., a meeting change). Email is really bad for complaints or criticisms. Writers tend to hit “send” when they’re upset, without sufficient time to reflect on impact and possible consequences. And emails can reverberate—being forwarded to people far and wide. Unlike paper, which can be destroyed, most documents on computers can be recovered from your hard drive long after you think you have deleted them. They are anything but confidential or private.

Words and subjects likely to stir up negative feelings are best delivered (at least initially) in person—where there is opportunity to read facial and body language, choose nuanced tones, and modify ideas and words in process. If an agreement is achieved, written communication can memorialize details—between the parties. Such a process is much less likely to become inflamed and to spread far beyond the originally intended participants. No one needs to make enemies, and toxic emails are deadly weapons.

Psychiatrist Administrator III: Delivering bad news

November 15th, 2010

My last two blogs have been an ultra-brief “crash course” on what to do if one day you awaken to find yourself in the role of an administrator. Today’s continues that course.

Most of us enjoy making others happy. We became doctors to alleviate illness and pain. We chose psychiatry to diminish psychic suffering and anxiety. How unpleasant it is when we become instruments to cause pain or negative affects—anxiety, sadness, anger. And as managers sometimes we must do just that.

On the milder end of the bad-news spectrum comes the raise or promotion you won’t give. More severe, of course, is letting someone go. Even worse is if you have to dismiss someone and report the person to other authorities—like criminal investigators or a medical board.

Human resource specialists and attorneys can help you with specifics—like the nature of a severance arrangement, the presence of another person in the meeting, taking notes, the timeline, and written communication.  At a personal level, I have found it helpful to back my own ego out of the equation (as far as possible) and to attempt a measure of calm detachment. I remind myself that whatever the employee did—even a legal, ethical, or moral infraction—was not directed at me, even though it puts me in a painful position. I may need to rehearse for a few days to get myself in the Buddha-like frame of mind. And sometimes I’ve taken a sleeping pill the night before. And I’ve made sure my schedule wasn’t frenetic right before or after the tense meeting. If I succeed in keeping my own perspective, I can be calm, respectful, and even compassionate at the unpleasant event. I can truly feel sorry for the individual and for the act I must complete. By my voice, words, and body language, I can communicate empathy and respect. It has made me feel better, and I like to think the likelihood of unpleasant outcomes has been lowered.

Psychiatrist Administrator II

November 8th, 2010

In a previous blog, I mentioned the challenges involved when a clinician is transformed overnight into an administrator—and how to begin facing them by admitting , “I don’t know.” In this blog and a few to follow, I will share some of the key lessons I’ve learned in the “School of Hard Knocks.”

Be organized and efficient. In fact, if orderliness and organization aren’t your strong suit, say “no” when asked to take on a management role—even if the increment in pay is tempting. You will have to be able to sort “wheat from chaff” swiftly and effectively, to respond in a timely manner (not precipitously, but not delaying too long), to give prompt feedback, and to reach good decisions without much delay. Most of us get better over time—if we start with basic executive skills. Be judicious about the use of electronic and other means of communication. Don’t get caught in long emails, but always respond to constituents promptly and with courtesy. And always be respectful.

More to come….

Psychiatrist Administrator

November 1st, 2010

I’ve been a physician for over 40 years. I’ve held administrative posts for more than half of that time. I’ve been a Psychiatrist-in-Chief at a private hospital, an academic department chair, etc. I am well trained as a doctor and psychiatrist. I learned how to do assessments, differential diagnosis, and treatment plans. But administration? I have had next to no formal training.

Typically, medical administrators are chosen for intelligence, some measure of social skills, and (one hopes) being a good doctor. In academia, teaching, science, and scholarship also are prized. But these have little to do with predicting aptitude at management and leadership. And even if someone has the raw talent and instincts, there are vast areas to be comprehended: finance, accounting, human resources, strategic planning, and much, much more.

In blogs to come, I will share a few tips I’ve learned in the “school of hard knocks.” First and foremost, as a new administrator (whether in a clinic, private practice, mental-health center, public or private hospital, or university) you need to know what you don’t know. The best clinicians know their limits. The same holds true for administrators. On that first day, you’ll likely be hit with a knotty issue about hiring, firing, promotion, resources, or budget. Knowing that you don’t have a clue is the first step toward wisdom and knowledge. Find out whom to turn to: a colleague, peer, predecessor, consultant, superior. Talk to an old friend who has preceded you in the world of management. And resolve to get some formal training—just as soon as the shell shock wears off.

Strong Medicine

October 25th, 2010

From time to time, a patient or family member asks about a treatment I have recommended and am about to prescribe, “Doctor, is this a strong medicine?” Sometimes the person talks about a previous doctor who just prescribed something “mild” for perhaps minor symptoms.

I’ve been a doctor for so long that such questions often take me aback. They are phrased in a foreign tongue. I think in terms of potency, efficacy, and safety. I weigh numbers needed to treat and harm, risks versus benefits. Scientific stuff.

Naïve questions prompt me to re-engage my empathy, to metaphorically put myself in the consumer’s seat. Occasionally I recommend something mild: mint tea for a little nausea, or walking for tension or easy exercise. They are pretty safe and unlikely to cause discomfort. But most of our treatments are in fact powerful. They can cause harm. It’s important to ask what a patient or family member means when a phrase is ambiguous. (“What do you mean by ‘strong?’”) But often the meaning is simply, “Will it hurt or harm?” And that’s a good place to start the process of building a partnership for treatment.