Healer, Leader, Partner with former Kaiser Federation CEO Jack Cochran, MD

As the former National Executive Director (CEO) of the Permanente Federation of Kaiser Permanente, Dr. Jack Cochran is the penultimate physician leader.  He shares his advice on why physicians need to become leaders of change in healthcare (in short, because if we won’t, who will).  He uses his experience mixed with evidence to teach us how in his new book, Healer, Leader, Partner: Optimizing Physician Leadership to Transform Healthcare, and in this podcast episode.

He began as a pediatric plastic surgeon at St. Joseph Hospital in Denver for over 20 years where he also served as President of the Medical Staff and a member of the hospital’s Board of Directors. He then became the President of the Colorado Permanente Medical Group, leading until 2007 when he assumed the role at the Federation. The Federation’s focus on clinical improvement and innovation achieved national recognition and led to extensive collaboration with the White House and the U.S. Senate on national health policy development. Modern Healthcare named him one of The 50 Most Influential Physicians for three years. Today he works as a professional speaker, corporate consultant, and author. He speaks on Transformation of Healthcare in the Digital Age and The Power and Synergy of Strong Physician Leadership in Transformation.

 

EPISODE TRANSCRIPT

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Unknown Speaker  0:03
Welcome to the physicians guide to doctor, a practical guide for practicing physicians. Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have been learning while we were memorizing the Krebs cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of our respective employers. And now, here’s Dr. Bradley Block.
Unknown Speaker  0:27
On today’s episode, we interviewed Dr. JACK Cochrane, the former CEO of the permanent a federation who recently published the book healer, leader partner, optimizing physician leadership to transform healthcare is a bit of a cold number some minor issues with connectivity so please bear with us. It makes an argument for why physicians after all of our sacrifices need to work to write the ship that is the healthcare system. And it gives us some strategies for finding ways to take those leadership positions and how to be effective entrepreneur.
Unknown Speaker  0:57
He talks about finding motivation to lead by reading our med school applications. But after the interview, I brought something up to him. And this is my show, so I’m going to mention it now. One of my favorite books is Victor Frankel’s Man’s Search for Meaning. And the theme is to help cope with your grief, stagnation, depression. You find purpose, purpose in that suffering. So I would argue for those suffering from burnout, rather than turning to idealism. Use that to find the cause. This is where you make your stand. This is where you make your fight. And this is where you direct your leadership. He also gives us some recommendations for to small but powerful habits that we can use to help cultivate leadership traits within ourselves. One that fits neatly on a two by two and the other that fits neatly into three by five. And at the end, we discuss his views on mentorship and it reminded me of a Calvin and Hobbes cartoon where Calvin says there’s treasure everywhere.
Unknown Speaker  1:53
You’ll see what I mean.
Unknown Speaker  1:56
Welcome back to the physicians guide to doctoring On today’s episode, we have Dr. JACK Cochrane, he started out like me as an otolaryngologist, and then went on to become a pediatric plastic surgeon. And eventually his career led him to become the executive director of the permanent a federation. Now, Dr. Cochran wrote a book called The doctor crisis how physicians can and must lead the way to better healthcare, and recently published his second book, healer, leader partner, optimizing physician leadership to transform healthcare. So, Dr. Cochran, thank you so much for being on the podcast today.
Unknown Speaker  2:33
Thank you, Brad. It’s great to be here.
Unknown Speaker  2:35
So first, can you tell us how you went from a plastic surgeon, pediatric plastic surgeon to the executive director of the permanent a federation?
Unknown Speaker  2:45
Right. I can only tell you that because I experienced it, but it was not a thoughtful, proactive, intentional life plan. It was more a series of learning reaction acknowledgement. What I was seeing and then changing. So I started off because somewhere in medical school, I did not come from a family of doctors. I’m not a physician family. And so I didn’t know what I wanted to do. So probably general family practice or something. But I really realized I had a great interest in surgery. And I really love doing the reconstructive plastic surgery that I saw in med school, because it seemed to make such a difference to kids with facial deformities in bars, etc. So it seemed very, very impactful. So I did that practice. It went into private practice in Denver, Colorado. And while I was there was sort of encouraged you’re tapped by some of the hospital leadership along the way to, oh, why don’t you become chairman of the surgery department. I did that for a few years and then President, the medical staff so I was sort of being encouraged by my colleagues to do some leadership. I then switch my practice base from a private practice to Kaiser Permanente because another acknowledgement of the changes in healthcare, I thought, I think the future is going to belong to systems of care, and not just isolated practices. And so it might be useful to be part of a system of care. And I practice alongside Kaiser in Denver, and it was a high quality group and I thought, well, this, this could be a good match for me. And I practice there for several years, again, just a full time surgeon and change happen. The managed care era came in and lit up the skyline with all kinds of concern and a son became involved in the medical group for Kaiser as a board member. And shortly thereafter, was recruited and selected to be the president of the Regional Medical Group. So a series of things that were not not well necessarily planned but happened and I realized, I had some sense that leadership was at least a capability of mine, although I had to spend an awful lot of time developing it. And then the Colorado region, which I read for seven years, or for nine years, from nine to 99 to seven was did very well. And I was recruited to be the national leader for the permanent Federation, which is the national organization, providing support for all eight permanente Medical Group. So that was the journey, it was a bit of a take advantage of situations learn, do what, what I could try to make improvements and then, you know, getting some recognition that maybe what I was doing was, was working and helping and so I got asked to do some, some more things. And, frankly, I learned on the job as, as I’ve often said, The reason I think physician leadership is so important is that it’s just not a part of any of our intrinsic training. And so, to be a plastic surgeon, I had four years of medical school, six years of residency. Extensive certification and examination and monitoring and proctoring to ensure that I was competent. On the other hand, when I went into the leadership of the business of medicine, as the President of a regional group, my training was just in time on the job, trial and error. And that is to not be a more stark contrast between the two career paths. So lots of self learning, lots of learning on the job, and I thought, maybe what I learned should be distilled down into something that can be useful for aspiring and established doctors to make them more competent, and more confident because we don’t get trained in the skills of the human condition of leadership in our basic training.
Unknown Speaker  6:54
And in your book, it’s not just it’s not a how I did it, right. It’s a compilation I have evidence based information that can help us to become better leaders. And that’s that’s one aspect of it that I really appreciate it not just, I was a leader, this is how I did it. And this is why I was successful. But rather, these are the lessons that I learned. And these are the studies and psychologists and other leaders that I’m referencing, to show you that it wasn’t just how I did it, but how others are doing it as well.
Unknown Speaker  7:28
Right? Well, you’re very discerning the, the that book prototype that you mentioned, which is, look at me, this is what I’ve done, and this is how I did it. There’s no shortage of those. And I have read a number of them, but not finished all of them. And I think it’s because you realize after you’re into it a while it’s like, you know, it’s my own personal saga, and while it doesn’t have to be bragging and all that it really is more about a Biography and I think that this this world of leadership is a very personal journey. And I was I really thought it was fun what I learned because the the the model for for medical education and for most frankly most professions, engineering nurses is high levels of academic achievement and academic prowess, you know, the A’s in chemistry will inherit the earth. Excuse me, and while that’s not an important, it does not necessarily make it thank you capable or make it easy to relate to and deal with vulnerable, independent, seriously capable human beings. And, and because leadership is not about leading the status quo for the next several decades. Leadership is all about leading change. You will You better have some understanding of what makes your fellow man tick, and how we can either be engaged and enthused and committed or not. And I was sitting there saying commitment and compliance. And both can make people change but commitment is you actually share enough context and capability with people that they that they see a future that works for them, ideally, is the same one or similar to what you see. And therefore they will take their focus their discretionary energy, and their enthusiasm and work toward that. And that’s commitment. Compliance says, If we don’t do this, by the end of this year, we’re all screwed. That also works. But it is not the same as creating a long term culture of creativity and innovation and an enthusiastic career satisfaction. So I just learned an awful lot. I probably Lovely read 60 or 70 books and thousands of articles, listen to everybody’s lecture I could. And I found that there were themes, and that there were things that I agreed with things I didn’t agree with. I mean, people who believed in highly forceful, dogmatic leadership would sign my my book, not something that’s so I could relate to. But on the other hand, it works and it works for a variety of people. And I can only tell you the some of my greatest joys are people who originally heard me talk about one of the most important initial steps in leadership is listening. And you know, and I’m a surgeon, remember, and they would roll their eyes and go, Oh, my God, what’s this going to be about? The most important starting point is listening. And they have learned with me and from me and watch me and watch the results and they’ve come back to me. months, two years later and go, jack I got a Dahlia. My eyes were rolling. out of my head. I used to hear what you took some of the things you said and wrote about leadership. I thought, this guy’s got his head in the clouds. This is this is about getting the right decisions, giving them to people and and making them do it. So well, there is a place to that. But I said long term, you end up with somebody who’s 80% committed, and you get a pretty good result versus versus a group of people that go, this is exactly what I care about. This is exactly what I do want to do. And thank you for asking my opinion. And for listening to me. I have this little thing and I’m sorry, I’m going to record so I’m a very noxious but I’m sorry, drinking lots of water and doing all the good doctor things. But as a my book that said something to the effect of
Unknown Speaker  11:49
leadership is a continuous iterative process of sharing context, with trusted friends and individuals. hearing their response, listening do what they say acknowledging it challenging in another way. So you continue to co create solutions, co create ideas, and co create methodologies for going forward. And as you do that, you develop, talking about the whole is greater than the sum of its parts. You actually now are building context that you both agree on. Because you come to sing, you come to ideas with one point of view versus another point of view, that if you spend all your time trying to argue your point of view, you really miss the opportunity to listen. And one of the things I tell people about credibility, which, again, some of my more dogmatic leaders don’t like his credibility is based on two things. One is your ability to influence. Can you convince me Can you teach me Can you show me a way that I believe it or care about the ability to influence Ah, but that’s not full credibility, full credibility, also requires that you demonstrate a willingness to be influenced. And the nuance there is, if all you have is your ability to influence, then then your your whole guard or your ace in the hole is omniscient, right? because nobody’s ever given you feedback, and course corrections, and nuanced corrections of what you’re saying. And so that’s why I think it’s very important that people understand the power of listening, and it never goes out of my teaching never goes out of my writing. And after people have experienced it and learned that they say, Boy, that was so powerful, and I just when I first started, I thought, come on, let’s get to the meat of this jack. Let’s get to the really hard stuff. I said the hard stuff is building a coalition of people who want to go the same direction. That’s the hard stuff. You do not do that by coercion. You can now March alone ways to never build a culture. That’s going Continue to turn out great innovation and high discretionary effort people.
Unknown Speaker  14:05
Let’s take a step back. Because a lot of the discussion among physicians now is about burnout. Right? That’s a big concern among physicians. And what you’re proposing is, is a pretty big ask, right? And I’m going to take a quote directly from your book, it says, I’m a good doctor, I send up to work hard and pre med, get into a good medical school, make good grades and get into a residency. So I could work 100 hours a week, then pass my boards, go into a practice where I take calls often in the middle of the night, and deliver great care to my patients. That’s what I signed up for. So please don’t talk to me about leadership. And so what we’re, from my perspective, I’ve devoted my life to my training, and I still work really hard to take good care of my patients, to keep up with my education, and to try and better myself. But I’d also like to Spend time with my family. So, what I need you to do is tell me what I why I should take time either away from my family, or my practice or my own self care to devote myself to leadership.
Unknown Speaker  15:15
Outstanding, outstanding question. This is where the two books link. The doctor crisis was an attempt to assemble a clear view of reality and clarify and personalized patients and caregivers, the real realities of certain contracts and the contracts that are alone that career you just described. Healthcare got a lot better. We had great advances, miracles, cures, all of which were good for patients, all of which were good for doctors. But unfortunately, some other things happen. The care was also uneven. We found out the medical error was an issue we found that the patients families are Having bankruptcies from medical bills, and we found out the doctors were burning out and all around us. And what happened was, there was nothing wrong with the covenant that we believed in and that we believed was guaranteed. The flaw was it wasn’t guaranteed forever based on, you know, us just doing our work and letting the whole other ship go its own way. Dr. burnout, it was something I brought up in 1998. When I became president, the group, my number one constant focus for a turnaround was preservation enhancement of career. I would say that the enthusiasm for that was very, very limited. Most people related to it. A lot of people said, tomorrow, they’re a bunch of well paid spoiled guys. Come on, get them, get them working, or the other extreme, which was equally worthless. Oh, the poor things is just awful being a doctor. And so the reason I bring that up is I started talking about this one years ago, and nobody was was talking about today, thank goodness, it’s very pervasive and, and what we have to do is to own it like we own any other scientific challenge. What is the problem define the problem, but the computer world is yours, as well as the employer as well. It’s okay. It’s okay. Let’s define the problem. Let’s then take our best thinkers and say, how do we parse this out to grade some, some potential solutions that we can test? We can measure and then we can improve? This is not physician burnout is not more complex than cancer. We just haven’t focused our science, our energy and our intellect to it. So we were we were little. We were a little focused on our careers, which was good, but things happened around us. Things happen to us, and many of us were to Pepsi then we were victims. Was that wrong? No, it was You’re right. The rules change. And some of us on zones did now. It’s not 100% burnout. Interestingly, it’s somewhere in the 5060 70%. What are the happy ones thinking? Well, many of them have gotten into organized systems of care or other careers. They’ve done a lot of things. But But basically, the the issues that we’re talking about is when we were young, and we had the dream of being doctors, we knew we had to work our butts off. So we took hard classes and we make good grades. And then when we came to the medical school application process, we had to fill out an application, including write a couple of paragraphs about why did we want to be doctors? Well, guess what? Find that application and read those two paragraphs. They are bringing tears to your eyes. They are teeming with idealism. They’re full of hope. They are over written with humanity and compassion, and that’s exactly where it should be today. So let’s not give up and, and so, so doctors are retiring early and quitting and all that. I can’t I can’t go into full retirement salmon to work on my fly fishing. There is a covenant that I have with patients even though I’m not operating. And there is a covenant I have with my profession, which I cannot just turn my back on and say it’s that that kind of victimization, says patients, you’re on your own. You are on your own. And so things got more complex, knowledge exploded, technology exploded, everything got more complex and the old model of the doctor patient visits as the location, paper chart as the record and the physician brain as the source
Unknown Speaker  20:02
Simply inadequate in the complexity of the world of exploding knowledge and technology. And so we can’t just sit in our small practices and ponder that and make a change. We have to get into some organizational changes and some changes that I talked about in great detail in the book. But where we are doing that, we’re starting to see some very encouraging things happen. And that’s the notion of disproportionate impact positions still have, that we are the most highly respected profession for medical information. We are not the most highly respected medical profession that is nursing. We are the most highly respected for clinical information. And so that’s that’s an honorable place. And by the way, as I said before, we may have a hard day we may be having hard time but the role of patient no matter how big Our day is the role of patient is involuntary and instantaneous. And they need us to retain our evidence to the issues that are facing them in health care, because they don’t want Watson or some AI system to scare. The other hand, let me give you a real example. This seminar been in two years on two continents. And it was like, jack, I think he’s been slapped. I was at an app development conference in about 2012. At Stanford Business School, not Stanford Medical School, Stanford Business School, about two medical app developers. I was probably the only guy in the room with a tie. And I was I gave a talk about business and leadership. And then I was on a panel. And the panel was to medical app developers in their 20s and 30s. And the guy who ran the panel, he said, okay, the three of you guys developing apps, trying to get health care of six from a different place. interview them doctors. Turn to Dr. Cochran and tell him how you view doctors in your business development. And what a setup. So the first one says, we’re still trying to figure out, we can’t get doctors interested in what we’re doing. You know, every once in a while someone say, that’s interesting that I’m busy. I get to see 40 people a day. Sorry. So we can’t even get an extra cycling says, We gave up. We tried, they wouldn’t listen, they were only gonna do things their own way. They weren’t going to try anything new. So we gave up. So you can tell it the temperature the rooms growing right? The third one said screw them. They had their chance that he said not to embrace the modern world of information and technology. We completely ignore them. All we care about as patients and insurance companies. And you talk about a nice to the heart of a doctor, a person who’s trying to develop cures for problems to the test. worlds day, we cared about the next year I was in Brussels. And I was on a panel with a guy who was the president of the European medical. And I said to this medical student, I said, How do you deal with the complexity we security, the Washington manual or the airplane handbook or something with us all this time in our little white pocket pocket, as well. We still have some of those. But our professors suggested we use Wikipedia and Google and I thought I was gonna fall off my chairs. I thought, what is what is going on right this minute in the ice covered brick, endured walls of organized medical schools. Do they know this is just said this, that they talk about Wikipedia. And I was shot. But what he was saying was, he was He wants to carry around two, three journals and four books and all that. And just spraying for me that all of my assumptions were just that they were my assumptions. And these guys were dealing with a new world trying to adapt to it, try to create different solutions. And so now instead of the doctor brain and the one on one visit, very much like the old, go to the bank to cash, the checks, and then there was ATM machines. And now there’s cash in your in your cell phone. Now, we have got to do the same thing with medicine, which is to move and much more electronic and impersonally to the patient. So I think I think
Unknown Speaker  24:39
what you’re saying that the argument to put forth to the reluctant physician who’s saying, I barely have time for myself, how how am I going to have time to devote to to leadership? The answer is, well, you have to because if you don’t, someone else will and if if you’re not the one steering the ship And someone else without your best interest in mind will be doing it. So you have to find the time somewhere. Let me tell you what it’s not.
Unknown Speaker  25:08
Because I think you have probably experienced that. And this is very common in community hospitals. I’ll tell you what it’s not. It’s not a bad day a good guy, volunteer, be Chief of Surgery, you’re going to have to go to a dinner to Thursday nights a month. One is the Quality Committee. And after you’ve operated all day and made rounds, and you know, barely gotten through the day, we’re going to sit down and give you a chicken dinner and go through quality reports. And then the other Thursday night a month, we’re gonna have the executive committee, another chicken dinner, and another evening out of your life. And by the way, I hope you’re good at it. Because we’re going to give you some people who understand quality are going to help you. That is the model that created no traction around physician leadership because we weren’t prepared. We were weren’t trained, we were supported. And we were not given time. And so what what we have to do, and that’s why in my, in the final chapter when I talked about becoming, you know, or practicing either leader partner, talk about you have to first of all start in an organizational construct where there is a sense of where you’re going, what is the direction or the mission that sounds like old school thinking but you better know what you’re signing up for. And they better know what you’re signing up for. So that’s important. And then the second one I call it structure for efficacy and efficiency that’s been in place Kaiser Permanente, the CEO similan. By structuring you start to say, I’m going to have business structure, systematic approach to care that’s going to include actually spending money for doctors to not deliver care to be on finance committees to be on it. And not to do it at 10 o’clock at night after the end of the day, we’re going to invest time, money and training to give physicians the opportunity as part of their lives. Most physicians actually don’t mind a little break from semicolons times. But not if it’s on the backs of their life, their budgets, their family, etc. so organized for efficacy and efficiency, and then create a system that says, Yeah, we’re not going to just say all the doctors are volunteers and all the finance people are well paid. We’re going to have a system that says and the physician should not be positioned as victim which I talked about, they should also not be position is tiring, which says, okay, you you business people, I’m done. That that is also a it’s really a slap in the face to the profession. So yes, the place where you can become part of the solution. Sometimes it means moving or changing or changing bosses. Those things are all possible. But if you say right now I’m not happy, and I’ve got another 15 years, and I’m going to spend those 15 years treading water, I’m going to have a miserable life, a miserable life and my family deserves better, and I deserve better. So the systems that tend to have less unhappy doctors tend to be systems, group practices, organized systems, sometimes faculties. But then they have to have leadership that has, you know, the compassion, of understanding the profession. But this is where the book is so good. Is it just, it is so approachable and so easy. I say that the subtitle of the book how to be simple, not easy. I don’t I don’t throw anything in there that’s so esoteric that it’s possible, but you got to have the capability and the competence. And what I love is when bag goes a resident at Duke, who read it and he said he says, I have a Call every other 96. I read this book twice in one week. He said it’s just perfectly timed for me. He said we all of our residents need to read this business had to just say this is not some esoteric problem and give up and turn all the finances over to the CFOs. And all the it over the CIOs know, we need to be on those teams. We don’t we do not need to be domineering, and rude and all that. But we need to be on those teams. So
Unknown Speaker  29:29
in the book, you talk about traits. So let’s say we find yourself in that position, right? The the board or the executive committee of the hospital, ask you to serve in a leadership position. You accept it with the caveat that it is, instead of summing up your clinical hours, not in addition to them. You have you outlined in the book a couple of traits for leaders and how to cultivate them. So one thing that I like for this podcast to be Is instructional what’s a simple high return on investment habit that you can have to help cultivate your leadership traits? So first, what are the you know, you outline those traits in the book. So what are they in what what’s a simple thing that we can do? The first one you mentioned is respect and clinician. So I don’t think there’s really anything that you can do other than, you know, work hard and know your stuff and and treat your patients well to become a respected clinician, but but maybe with the others Unless Unless you do have something specific for that some some specific high return on investment happen we can do.
Unknown Speaker  30:38
I do have something specific. And the reason I put it in there is, is exactly this. You will find a physician who’s burned out being a doctor doesn’t like it, and by the way, isn’t all that committed or all that good at and so they decide They’re going to become an administrator. And it’s not impossible it’s happened before. That’s why that’s they give us a bad name because now they’re going to be administrators. And they’re going to turn over their shoulders where we used to be their friends and go Okay guys, you can do this this this and this so respected to your clinical craft is more than your skill as a surgeon, it’s where is the three in the morning when I need them and call them are how is the tour the nurses are dignified. So it’s really important respected for your craft. And it’s number one a or something with integrity, and integrity. It’s just that I’m a little romantic, but I’m a pretty, pretty convinced that this profession is a real high calling. And I think it’s an honorable thing for us to take really good care of. And so integrity is that unassailable trust. You know, the person is you know where they’re going to be. That’s number one respected clinician is number two things like EQ, humility, more enterprise like us, those are also important. But those first two are just the most important before I’d like to, and we can stay there. But there’s something else that I have put in the book and it’s not quite as clear. It’s sort of called the essentials of leadership. So it’s neither traits, nor is it expectations, which are the behaviors of the of the corporation. They all turned out to be seized. So I just want to mention them because the first one nobody talks about. It’s one that I said, I learned this for some reason so early, and it was it confirmed about every year in my career. So the five C’s are clarity, consistency, collaboration, compassion, and courage. And why is clarity number one, and again, Consistency is wanting clarity is number one, because we have to make hard decisions. And we have to make complex solutions out of really very complex data and information. And so when we do that, these are the situations and always real clear. But your team, your group, your organization, deserves to know how you think and how you feel. And why is this because for example, you say, I think we should stop doing robotic surgery for trusting are they which is pretty bold statement, but it’s clear. And the beauty of the clarity is that then your colleagues say, Okay, I didn’t have to guess. Here’s why you are exactly wrong. I’m going to give you data, preaching you’re wrong. Or glad you said that because the literature has Suggest You’re right. So clarity is so hard, because it’s sort of brands you will see opinion and people go well, I think we should build a hospital in the south part of the city. But on the other hand, you know, the other guys are building down there. Maybe we should look at the west side and pretty senior teams though. Okay. me to call the question. So clarity you watch it, watch it when you go to meetings, brands business, see people waffle. It was separate. And, and it’s not about being more bold, more self assured. For more, right? It’s about being clear, because clarity gives people the gift of saying I disagree and this is why I agree fully and this is what clarity is one of the things that I see people really bundle when they get stressed. They just don’t want to take in and that’s Because taking a stand implies that you’re going to be wrong. And that’s why the number to see is consistency. They wonder who’s going to show up? Oh, my God, what’s Cochran tonight, Lizzie, what’s going on? Does that make sense? I see, I’ve seen leaders who couldn’t articulate a clear point of view make people crazy. And you know, all they were trying to do was avoid a really tough dilemma because they just didn’t have the solution. And by the way, wasn’t one solution as I thought about I have no bias, you guys are going to help. And that’s why I go back to start listening. Listening is
Unknown Speaker  35:40
it’s more important than people ever understand. Because Don’t forget, you are a gifted or learn voluntas you are trained deeply in a field with multiple years of residency and training, and research and all kinds of things. You’re not deeply trained in leadership. And so listening says Going to be a leader. I’m not omniscient, I’ve done have to take the time to understand what my my friends and colleagues points to you.
Unknown Speaker  36:08
Well, I think that gets also back to, right. Because if you’re if you’re clear about what you want, but in the setting of humility, if it turns out that you’re very clear and very wrong, you still have to have the humility be able to be able to accept that.
Unknown Speaker  36:27
And I’ll just give you a lesson I provided for a guy one day and he said, he thought I was kind of full of it. And they said, he said, within three months, it was so valuable to him. And that is, the consequences of clarity. Are it’s your decision, your names on it, you made it. And so there’s no question when the outcome occurs that you had your fingerprints all over it. But I said, Here’s what’s important is it When you are wrong, and if you are not wrong enough, you are not making very large decisions. You’re making 60% decisions. Sometimes you got to make hundred percent decisions. And if you’re not wrong with the law, you’re not taking enough stretch and not staying at risk. But here’s the situation if you go through a process, you come up with a solution, and you declare it and it gets next year and it’s wrong. It is a pivotal point for you, in your personal development and your personal well being. And it’s this, if you’re wrong, how you go from there is one of the most telling realities of yourself and of your leadership. If you say, if you deflect blame, if you externalize blame, if you minimize results, if you deny the results. If you do all those things, then you really create lose out of a potential neutral win. Because now you’re spending all your time backtracking. And there is nothing no learning going. On the other hand, if you say, Well, this was my hypothesis, this was our idea. It did not work. Starting point is it did not work. Where do we go from here? Well, we better examine our assumptions. We better examine our data, we better examine our thought process around the strategy. We better examine our structure around execution, and we better examine the execution. Now, if you commit to do that, and you’re dead wrong, then you deserve the final. The final piece of the learning curve, which is personal forgiveness, personal forgiveness is what you deserve. Me make bold decisions when you’re clear about it. When you talk to people and you say, we’re going to have to do this. I’m not 1,000% Sure. But this is where we’re gone. And then you’re wrong. In order for you to ever do that again, and not next time, take a 50% less risk. You got to learn to forgive yourself. And it’s this is not the grovelling fall down. I’m not worthy forgiveness. This is, well, I really I really learned from that I was wrong kind of forgiveness.
Unknown Speaker  39:23
And I think I’ve heard that referred to is talking to yourself, as if you were one of your friends, right? If your friend was in that situation where they made a mistake on the outcome wasn’t, wasn’t what they wanted. Right? What would you tell your friend? Well, what we tell ourselves is only not the same voice that we would use to tell our friends and we’re much harsher. And if I think I’ve heard, if you split if we speak to ourselves, we speak to our friends, the way we speak to ourselves, we wouldn’t have any friends. So I think that is that is that correct?
Unknown Speaker  39:54
Yeah, that’s good.
Unknown Speaker  39:57
That’s great.
Unknown Speaker  40:00
just you know, the concept of personal forgiveness is not weaknesses, it’s a matter of recharging yourself from a position of great vulnerability. And we need to make our decisions. So
Unknown Speaker  40:14
what about habits, so I’m also a big fan of small habits, small effective habits win the day. So, if if our listeners were to put a sticky note on the bathroom mirror, and one on the fridge and one on their computer at work, to just remind them of something simple that they should be doing each day to cultivate either a leadership mindset, or one of you are one of the leadership traits integrity, humility, EQ, passion, what’s a small thing that we should be doing each day in order to cultivate that
Unknown Speaker  40:51
leadership? That is, I love it.
Unknown Speaker  40:56
I don’t think I’ve been asked exactly like that. Some of the battle here for a second while I take a minute. First of all, let me just do a tiny, tiny digression, I think we have time to take about a minute. I have a chapter of the book called The crux. And the crux is basically understanding yourself. Because if you don’t understand yourself, then you are you’re very vulnerable to living a very mythological existence of how things happen. And by that, I mean this. Do you fundamentally believe that your fellow man, your fellow colleagues, your doctors, your nurses, whatever, given the options, the information cetera, are most likely to try to do the right thing want to do the right thing and care and carry good values? But for? Do you fundamentally believe that your fellow man are out to themselves, they’re gonna do what they need to do to get their things done and get them done. And They’re very self centered. Now, as you know, from the dichotomous nature that question, there are people on both sides, we have both types of people. But the issue about the crux is, understand your own by your own eyes because it’s going to color how you respond to people. And you’re going to be fooled sometimes if you’re the trusting one, and that’s okay as long as you learn from it, but so the trusting one says, I believe in you, I’m going to share information, I’m going to, you know, carry along with this conversation, etc, etc. And I’m going to believe in you Sarah. It starts with listening. And then acknowledging their points of view, and then challenging the greater context as you build it. And it’s a it’s a slower iterative process. Then also a lot of listening very slow at the beginning, but it builds tremendous momentum between you and your colleagues, whomever they are in this process. The other side of that, which is that if you don’t believe in people that money you do it fool them, you incent them, you coerce them, you you try to either force them or fool them. And less leaders do that. That’s that’s their day. They try to coerce or force or cool people. By the way, both techniques can get you a result. But again, one creates a culture of, you know, compliance. Okay, I’ll do it. So I’ll go on, and the other creates a culture of possibility. So I say that because one, three by one sticky I might put would say manage yourself. But it could also be part of a instead of a two by two sticky a three by fives to eat, which is my leadership on a three by five cards, and that is, manage yourself. Develop great leaders in teams and learn continuously. And that’s to me the daily mantra leadership, manage yourself, develop great leaders and teams and learn continuously and manage yourself is number one because he wants people to voltage drops because they get, they get hooked, and they get angry, or they get rude or they get something because they’re not managing themselves. That’s, that’s the EQ. But then the one other one the other sticky and this is a two by two, I would put, listen, listen, because you’ve already heard what you have to say. You don’t need to hear yourself more. You’ve heard you know what you think. Listen, it’s so powerful. I said the one of the great, great opportunities for me wonderings I was by some standards successful early was I was so inexperienced, you know, on the job just in time travel there was so many expressed that I had to go out and sit down with primary care Doc’s and just listen to them. I go. Really? Yeah, that’s What that computer does to our daily practice, I said was it’s not that hard. And so, listening is is so important.
Unknown Speaker  45:10
And I would add as a caveat to listen, that when you’re listening, you really need to be fully present because we always have that running monologue in our own heads that frequently responds to people as they’re speaking, and you need to find a way to shut that off. And when you’re really present, you’re you’re shutting that off so that you really are listening, because it’s, I think it’s the kind of nod and, and, and kind of acknowledge what they’re saying. But you also have to find a way to shut off your own inner monologue while you’re doing that so you can truly be present and really, that’s, that’s an effective tool for listening.
Unknown Speaker  45:53
And that’s, that’s the listening that says, I’m just going to listen long enough to you Give me an opening to make my point. Right? That’s, that’s the listening, you’re talking about which which
Unknown Speaker  46:05
it sounds like what I just did to you. So I guess I apologize for that.
Unknown Speaker  46:11
No, not at all. Not at all. You get a very good example. Very good example. But that’s the true listening is. It’s, it’s a practice craft and you know, it’s, it’s because we’re all in a hurry. We’ve all got to get things done. But the act of listening creates a little space in the room where people who are because otherwise, you know, you go in there and you blow people away with your, your rank, your serial number, your title, and your charisma and all that and pretty soon, they just said, Okay, forget it. It just doesn’t happen. And this is just going to go on. But I think but that’s that’s the listening for. And you see that it’s just that it’s almost stunning disrupts the meeting with somebody just sitting there listening As soon as somebody says something where they get their two cents and they have it in there, and as opposed to sometimes the best example of good listening is when somebody who I never thought I, I gotta tell you that never crossed my mind. When we spend a minute on air. I think
Unknown Speaker  47:26
we have plenty of opportunities to practice it. Because we see patients every day where we listen and need to be present and need to shut off that inner monologue and actually hear, hear their story and they’re saying, so that that’s the two by two right there. Listen. Yeah, there’s one more thing that you you spoke about in the book that if you have time, I’d like to go into a little more detail before we wrap this up and that’s mentorship. So how do we find mentors, how do we keep them? How do we effectively learn from them?
Unknown Speaker  48:04
I wrote a whole chapter on it. And it is it is not a static discipline or field in my view. And that’s why I wrote the one piece called mentors everywhere.
Unknown Speaker  48:19
My daughter My grandson is you know,
Unknown Speaker  48:23
sometimes you learn from people just by being present, watching them. And then in your in your private mind saying, Oh my gosh, I never want to act like that. Oh my gosh, I don’t like what that’s
Unknown Speaker  48:39
so
Unknown Speaker  48:41
there’s mentors everywhere. And one of my favorite stories was a we had this I was doing searches except in the Philippines and we have this young Filipino general surgeon, one of three plastic surgeons in the US. Were working in Manila and this kid was So gifted he was he was just shocking us second year surgery resident, and we were doing cleft lips. And usually those guys, you know, they cut not they got the not so nice. And so one day we were having dinner this one guy that I worked with the same with you today. And he he’s amazing. He said, You know, you think he was third year plastic surgery so good. And then somebody else worked with them. And then I worked in Sector three nights were involved with us good. So the next day we go and you say, okay, Victor, we’re not gonna let you do the surgery. But how would you design and draw this is well, I’m stronger. As I recall Dr. heggs as we saw this angle and this and also is pointing to things and showing me things and I’m going this is just me. He, he has such a hand I get but we finally sat down and we said we gotta we have to learn more from this get some than we could ever teach him and what it was was He had a serenity and a reverence about him. That term is the opera. Arguably the most junior and operator. This is sort of reverence. And his mind was, it was just amazing. We were just shaking my head. And he would laugh cuz he didn’t see it. And we said, Victor, you know, just never, ever stop being Victor and Susan was teaching as you can, and as much mentoring as you can. So that’s what I mean by mentors everywhere. I go in there for teaching relationship is not mentor mentors everywhere, say, mindfulness, who can I learn from today, and sometimes it’s really positive. And sometimes it’s really not, you know, the classic mentoring this sort of structured, you have two people or that sort of thing and you get a topic and you create a paradigm from expectations in some ways. You’re going to measure it I would say this Don’t let it go forever. And don’t continue to say the gradient goes one way, especially today, those of us older physicians really need to learn a lot more from the millennials, and many to learn from us at times. So I think that this should be pretty fluid. And then we have another model called soul mentoring. And the total mentoring model was, we would take to senior leaders of eBay or to VCs, and we would match them with a couple of junior leaders. And we would pick a topic and we would meet and it was good because it one senior leader could be leaving and talking to the other could be watching and learning. And it just sort of mix things up. And then after six months, we would change groups, and then we would just then we would get together and have dinner talk about so I think keeping it fresh, keeping a dynamic in that sort of these important but the standard mentoring is no Some of the higher gradient of knowledge or information of the lower gradient and how do you transmit that and learn that? That’s important, no question, but I think that the whole learning philosophy is a lot deeper than that.
Unknown Speaker  52:12
So, where where can people find you online?
Unknown Speaker  52:17
www jack Cochrane, MD. com. Fantastic. And then the books, the first book Dr. Crisis, how physicians can and must lead the way to better health care. And the one that just came out healer, leader partner, optimizing physician leadership to transform healthcare, to fantastic books, and, you know, if we don’t, if we don’t take the reins and lead, then someone else will. So it’s, you make some excellent points, have some excellent instruction for for us physicians, on how to do it. And I really appreciate your time to talk taking the time to talk to me and the listeners on the podcast about it.
Unknown Speaker  52:54
But you my friend, who I don’t know well but hope to know better are already charting Your own pathway. And you’re finding a new and different way to deliver on the healthcare equation besides just clinical and we must all do that, be creative, be committed, and continuously learn and and run this network, you know, the coalition of courageous colleagues. We have a lot going for us we have the high ground of the morality of the profession. We have the needs of society. We have the the American dream. You know, I say one of the problems we have today is that because of the cost issues in healthcare, the average family is rationing health care at the kitchen table. They’re taking the side is activities and they’re sitting down at the kitchen table and saying, I got to get into the truck, we’re not going to be able to do the tonsillectomy this month, or I’ve got to get a new refrigerator. We’re not gonna do the MRI this month. And that is just rationing healthcare to get some tables. It’s it’s a tragedy and
Unknown Speaker  53:54
and we have the, the lead in our profession, we have the leverage and the ability to do something about it and we need to.
Unknown Speaker  54:02
And by the way, we have the credibility. Deeply people still love them believe in us. And people who say I’m going to quit, I say, don’t find another way, because the profession needs honoring Not, not abandoning.
Unknown Speaker  54:19
Thank you very much for your time and for your leadership.
Unknown Speaker  54:24
So great to talk to you.
Unknown Speaker  54:27
That was Dr. Bradley Block at the physicians guide to doctoring. We can be found at physicians guide to doctor and calm or wherever you get your podcasts. If you have a question for a previous guest or have an idea for a future episode, send a comment on the web page. Also, be sure to leave a five star review on your preferred podcast platform. Our show is produced by guilt free Studios in New York City. You can find them at guilt free studios calm our theme music was written by our show’s producer, voice actor carnivale free
Transcribed by https://otter.ai