Understanding emotional intelligence can help alter problem behavior.

We know from numerous studies that physician behavior has broad ramifications in the health care system. It impacts employee satisfaction, employee turnover, the cost of conflict and malpractice liability, all of which are significant sources of potential lost revenue.

Characteristic behaviors of physicians that are noted in medical literature and can impact these areas include:

* Lack of flexibility

* Under-appreciation and/or devaluing of multiple perspectives

* Failure to consistently demonstrate respect for individuals

* Failure to seek win-win solutions (the need to know and be right)

* Valuing professional autonomy rather than other professional cultural attributes like trusting others

* Being the solo player vs. being a team player

* Under-developed interpersonal & communication skills

* Insularity and lack of openness

There is a growing understanding in neuroscience that cognition and emotions are interwoven in mental life, especially in the areas of complex decision making, self-awareness, emotional self-control, motivation, empathy and interpersonal functioning.

The body of skills that derive from this interweaving of cognition and emotion comprise emotional intelligence--a set of abilities that differentiate between outstanding performers and average performers.

In fact, several decades of research in emotional intelligence (EI) demonstrated that 80-90 percent of the difference between outstanding and average performers is linked to EI.

While there are a number of emotional competence models, each with their own lexicon of emotional intelligence abilities that offer a valuable perspective, the work of Drs. Daniel Goleman and Richard Boyatzis in collaboration with the Hay Group illuminated the relationship between emotional competence and performance. (1)

In their model, there are four clusters of emotional intelligence with 18 competencies identified as differentiating outstanding performance. There are many paths to success within this framework, for one size doesn't fit all, one competency may substitute for another, certain combinations may contribute to outstanding performance and some competencies are more critical than others. There are six critical core abilities, however, for which no others compensate. They are:

1. Emotional self-awareness

2. Accurate self-assessment

3. Self-confidence

4. Emotional self-control

5. Empathy

6. Influence

Self-awareness is the linchpin 

The essence of self-awareness is seeing yourself as others see you. Research supports that self-awareness is a necessary underpinning of both self-management and social awareness.

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To increase self-awareness, 360-degree feedback from managers, peers and even patient customers is essential for obtaining objective insights.

Disruptive behavior is a non-specific marker for concerns that can range from a lack of intra- and interpersonal effectiveness skills to deeper problems such as chronic stress, burnout, depression or other mood disorders and substance abuse.

In evaluating the non-pathological end of the spectrum of concerns, it's critical that physician executives understand that there are various drivers of behavior and they must take an integral approach to addressing issues related to physician behavior.

The drivers immediately behind behavior and actions are the mental frameworks, thoughts, attitudes and feelings that cause us to act in certain ways. We tend to be largely unconscious or only partially conscious at best of those drivers.

What predisposes us toward particular thoughts, attitudes and feelings? One major factor is our conditioning--from family, school, the various communities to which we've belonged and certainly our medical training.

The traditional values of medical training honored autonomy and independence, being the solo player vs. being the team player and the model of heroism/protection. It is not uncommon for those who hold these values to convey a certain invulnerability that often translates behaviorally as lack of respect, under-appreciating multiple perspectives, objectivity polarized against emotion and intuition, failure to seek win-win solutions, or as insularity and lack of openness.

Another important factor influencing behavior is the organizational culture and system within which individuals must operate. Edward Deming, the father of modern quality management, defined five factors of performance:

1. Individual innate ability

2. Individual effort

3. Selection, training and development

4. Variation in the system

5. Variation in the judgment of performance

In supporting optimal behavior, we must recognize that only one factor is within an individual's control--individual effort.

Emotional intelligence fuels high-performing teams

While we recognize how critical teamwork is in creating quality patient care and in addressing the myriad systemic challenges facing health care, it is imperative to understand that high-performing teams also demonstrate emotional intelligence.

Research shows the superiority of group decision making over that of even the brightest individual in the group, except when the group lacks harmony or the ability to cooperate. Then decision-making quality and speed suffer. When people feel good, they work more effectively and are more creative.

To be most effective, the team needs to create emotionally intelligent norms that support behaviors for building trust, group identity and group efficacy--three conditions essential to a team's effectiveness.

Norms that foster group EI involve

* Courageously bringing feelings out in the open and dialoguing about how they affect the team's work

* Using humor to diffuse tense situations

* The willingness to explore and expose unhealthy work habits in order to build more effective group norms and performance

* Behaving in ways that build relationships both inside and outside the team

In self-aware, self-managing teams, members hold each other accountable for sticking to norms.

However, it is the leader's job to instill a sense of responsibility in each person for the well-being of the team. It takes a strong emotionally intelligent leader to hold the team to such standards. An emotionally competent leader who is skilled in creating good feelings can keep cooperation high. Good team leaders know how to balance the focus on productivity with attention to members' relationships and their ability to connect.

One of the leadership styles that has the most positive impact on organizational climate is the coaching style, in which the primary motivator is to develop others. When physicians and physician managers adopt more of a coaching style in working with others--rather than the traditional heroic, pacesetting and commanding styles--they support increased emotional intelligence in the organization. In this way, they become potent influencers and catalysts for change and transformation in the health care system.

Helping physicians change

Where interpersonal effectiveness and working relationships (vs. technical competence) are the concern, it's extremely effective and efficient to bring in a developmental coach to work with the physician in creating and implementing a developmental plan.

In developmental coaching, the focus is on using conscious intention to develop awareness and change behavior through a strategy-focused approach.

A powerful diagnostic tool that can guide the focus for developmental work and increased behavioral effectiveness is the Emotional Competence Inventory (ECI). Developed by Goleman, Boyatzis, and the Hay Group, this is a 360-degree multi-rater assessment tool that measures observed behaviors and impact on others. (2)

As a theory of performance, the theoretical underpinnings of the Emotional Competence Inventory are that it is a competency-based methodology with behavioral differentiators based in research that looked at what the outstanding performers did, thought, said and felt that contributed to their success.

In looking at behavioral change, the research also demonstrates that competencies can be developed. Not recommended for therapy or clinical work, the ideal applications are in executive developmental coaching and to develop organizational bench strength in emotional competence.

The data provided by the assessment give a person their baseline of competence on 18 EI abilities. Beyond that, because the competencies are broken down into behaviors, the assessment not only helps people understand what emotional competence looks like behaviorally but it heightens awareness of areas that may be true blind spots.

While behavioral codes are essential tools to enforce compliance, how do you change people to get the desired behavior?

On the front end, training combined with developmental coaching offers the greatest leverage for change both preventively and remedially. Through increased awareness, people are able to take more purposeful action leading to greater competence and enhanced well-being for the individual and the systems to which they belong.

Understanding that emotional competence is a set of learnable abilities provides a context and a framework for helping physicians expand and refine the competencies that provide the edge in effective self-management and relationship management, both of which are essential to quality patient care and collegial working relationships.

References:

1. Boyatzis R and Burckle M. Psychometric Properties of the ECI. Boston: Hay/McBer Group, 1999.

2. Hay Group, ECI Accreditation Training Manual, November 2002.

RELATED ARTICLE

The relationship between Self-Awareness and Self-Management:

* With self-awareness, a person has a 50-50 chance of demonstrating self-management.

* Without self-awareness, a person has virtually no chance of demonstrating self-management.

The relationship between Self-Awareness and Social Awareness:

* With self-awareness, a person has a 38% chance of having social awareness.

* Without self-awareness, a person has an 83% chance of lacking social awareness. (1)

By Manya Arond-Thomas, MD

Manya Arond-Thomas, MD, is co-founder of Encompass Health, LLC, an executive coaching, training and consulting firm that supports health care leaders and organizations through facilitating executive development, high-performance teams, and organizational effectiveness. She is also a co-coordinator of the ACPE Detroit Regional Network. She can be reached at 734-480-1932 or [e-mail]

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