Ask the coach: physician executive experts answer your medical leadership and management questions.

Feedback, schmeedback?

I'm a new department head. I felt like I was doing a pretty good job up to this point but I just had my first annual performance review and now I feel like I should quit. The review consisted of a sit-down interview with our VPMA who briefly listed my "strengths" and then focused on my "areas for improvement" for about an hour.

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The main data he seemed to rely on was a recent 360-degree survey that gathered vague opinions from six physicians in my department, five other department heads, three non-physician managers and the VPMA himself. The survey included six generic categories like "relationship to others," "effectiveness at leading the clinical team," "patient access," "recruiting" and "contribution to our organization's financial success." Each category requested a scale score from 1 to 10 and I was given a rating based on the arithmetic mean of these scores. Most of my category scores were between 7 and 9. My overall rating was 8.2.

To be honest this all feels like a bunch of ____ to me! I can't imagine how anybody can get anything useful out of this kind of feedback but my boss says it's the latest thing in management and of course my annual performance bonus is partially based on it. I'm wondering if my feelings about this type of thing are normal and if just maybe my boss might be wrong. Or do you think maybe I'm just not cut out for management?

Wondering in the West

Dear Westerner,

No, actually you sound like you might be pretty well cut out for management and your feelings are completely normal. But the person I'm wondering about is your boss.

Small cell-size, generic, judgment-based performance surveys like the one you just described, whether of 360 or 360,000 degrees, have been widely discredited by legitimate experts for as long as I can remember. No less an authority than W. Edwards Deming (of TQM fame), writing in the 1950s called such instruments, particularly when linked to compensation, "the deadly disease" of management. Your boss has apparently contracted it.

Put simply, feedback to high-level professionals needs to be relevant, respectful, well-focused, timely, behaviorally specific, statistically valid and easily understandable. Global, judgment-based, statistical noise like the stuff your boss is using has only one certain effect, demotivation of the professional.

Your feelings are absolutely predictable. Don't quit yet. Tell your boss exactly how you feel and suggest that he contact the ACPE or his local business school for some re-education.

Job hunting hurts

I'm a board certified OB-GYN with 15 years of practice experience. In addition to my MD I have an MBA and a masters in biostatistics. I'm also a Certified Physician Executive. I have more than 10 years of experience in medical management highlighted by my recent term as president of the medical staff for our 400-bed flagship hospital. My problem is that I can't seem to get past first base with these executive recruiters in my search for a full-time hospital medical director or VPMA position. What am I doing wrong?

Frustrated and Desperate

Dear F and D,

Well, you've certainly got enough sheepskins, so it must be something else. The first thing is to invite a couple of those recruiters to lunch and listen to their thoughts about why you're having trouble getting any further on these jobs. Watch out for defensiveness ("Well, I'm certainly as qualified as....") or your own creeping paranoia ("You recruiters just don't seem to like me...."). Just listen, take notes and pay for lunch.

There are lots of potential causes for this situation. Is it the supply/demand ratio for these particular jobs? Is it your lack of experience in some specific area? Is it your emphasis on education versus actual accomplishments? Is it your CV? Could it be one or more of your references? Is it the way you come across in a phone interview? There are a number of possibilities to consider.

After you listen carefully to some recruiters do the same thing with a colleague or two, especially the CEO or CMO of your current facility. What do they see as your strengths and weaknesses for the sort of position you seek? If you have the courage to do this with people who don't generally like your style, you'll probably learn a lot more.

George Linney MD, past president of ACPE and a recruiter with Tyler and Company in Charlotte, advises, "You should be sure your resume highlights your actual accomplishments in your various leadership roles. Whenever possible use real numbers (e.g. reduction in LOS, specific dollar savings, outcomes from implementing clinical guidelines, etc.) These always make a much stronger case than words."

Once you've done these things, both George and I think you might want to look more closely at your leadership style and your interpersonal communication patterns. Both of these have a big impact on initial perceptions. Consider hiring a coach or an executive recruiter to work with you as you make future applications. Lots of times these folks can spot the real issues and help you reduce those frustrations. Good luck and better base-running in the future.

Successor search

I've been a physician CEO for 11 years. I'm starting to think about life after CEO-ship (traveling, fly fishing, writing.... like some column writers I know). I'd like to have an excellent successor for the usual reasons, i.e. completing some important initiatives, continuing our success, preserving my "legacy," etc.

I really like our current COO. She's worked for us for six years and shows real promise as a future CEO. I've given her increasing responsibility and visibility this year, even had her chair our annual strategic planning process. She's doing great. The board seems suitably impressed and has started talking about the possibility of an internal search.

That's not the problem. My problem is the "other guy," our CFO, who sees himself as a possible successor too and seems to be taking my COO's increasing recognition and visibility very poorly. What can I do to avoid internal warfare on this topic? I still have a couple of years to go.

A Pre-Retired CEO

Dear fellow AARP member

Sounds like not too bad a problem. You've had a successful run as CEO, have one highly likely successor and are doing exactly the right things to help her grow and get a shot at your job someday.

On the other hand some things are beyond your control. Boards have a way of selecting whomever they think is right at the time, not necessarily the person their CEO thinks is right several years in advance. Who knows what the environment will be in a few years? Who knows what other opportunities your COO herself might have? Who knows even what your own mindset will be once you get closer to the date? Many CEOs continue longer than they once intended. Maybe you won't be fly fishing as soon as you think.

Ease up. You're doing the right things to help your COO develop. Get more even-handed. Do the same thing with other members of your team as well. Give your CFO some visible growth opportunities. How about your CMO? Increasing board access is always a big plum. Representing your organization outside is, too.

You need your whole team to be functional for at least a few more years. Help each one of them to grow and see themselves as having opportunities in the future, especially following your departure. The path to the CEO exit door often has unexpected twists and turns. Keep your options open and keep tying those flies.

By Howard Kirz, MD, MBA, FACPE 

Howard Kirz, MD, MBA, FACPE, is a retired physician executive and past president of ACPE who provides executive coaching to health care boards and to a number of successful senior physician and health care executives. Questions for his future columns are encouraged and should be sent directly to [e-mail]

Ask the Coach offers practical advice to answer your questions about medical leadership issues and physician executive concerns. ACPE faculty member Howard Kirz writes the column with help from experts both inside and outside the College. Questions for future columns are strongly encouraged and should be sent directly to Kirz at [e-mail]. All questions will be considered strictly confidential.