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If you look at a fundamental definition of leadership, which is influencing behavior to achieve a desired result, then every doctor is doing that every day,

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you Happy Memorial Day, and welcome to Off the Chart, a business of medicine podcast, featuring lively and informative conversations with healthcare experts, opinion leaders, and practicing physicians about the challenges facing doctors and medical practices. My name is Austin Luttrell. I'm the Associate Editor of Medical Economics, and I'd like to thank you for joining us today. In today's episode, I sat down with Dr. Leon Morris, a pediatric neurosurgeon with nearly 37 years in practice, an experienced leader of large healthcare organizations, and the author of All Physicians Lead: Redefining Physician Leadership for Better Patient Outcomes. We're talking about what physician leaders actually need to do when their teams are under stress, and why being honest about what you don't know is more important than projecting false confidence. Dr. Morris explains why every physician is already a leader, whether they think of themselves that way or not. How to deliver difficult news without losing trust, and why the single most important thing that a leader can do this week is simply listen better. Dr. Morris, thank you for joining us. Now let's get into the episode. Dr. Leon Morris, thank you so much for joining me today.

1:42
Austin, thanks for having me. I really appreciate the time.

1:44
So, before we get started, do you mind just taking a second to briefly introduce yourself to the audience?

1:50
Sure, thanks. I'm Leon Morris. I'm a pediatric neurosurgeon by training, and I've had the opportunity to take care of kids and by indirect their families for almost 37 years now. During that time frame, I've also had the opportunity to run some medium and large healthcare organizations, and have studied leadership. I'm an aficionado of learning how to lead better and help others lead better, and appreciate the time to talk about some of that today.

2:26
Great, and to kind of just jump into that. I mean, physician leaders are being asked to guide their teams through a period of real uncertainty, whether that be economic, political, operational. Before we get into the how they should do that, could you kind of talk about like what you're seeing on the ground in terms of how uncertainty affects medical teams.

2:45
Sure, no great question. And you know the group that I'm working with, and that many of us have worked with, when we talk about uncertainty, none of us can hesitate but think back to Covid, and to a degree, when I think about uncertainty today, when you compare it to with what we were dealing with then, life and death of patients, life and death of providers, maybe even taking a deadly disease home to your family, and yet still coming to work in very, very, very uncertain times. Many times, when we talk to folks nowadays, after having lived through that in hospitals and big healthcare systems, there's almost a man, you know, it's not as bad as it was during Covid. I mean, come on, Leon, what are you worried about? That said, everybody processes this current time, past times, and future times differently, and different things become important in their daily lives. For many now, costs fuel prices sitting in beltway traffic for long, long periods of time watching your gas gage drip down. Where I live and work, there are many, many, many military personnel, both active and a lot of retirees that work with me. I'm of that age, retired from the military, and the military is often a very generational sort of family business, and so many of my colleagues have children who are in the military, as my wife and I do, and so thinking about that and the impacts of what's going on in the Middle East introduces some uncertainty, and I'm a big fan of knowing that you don't leave your personal self at the door, you put on a professional face when you come in, but those things that are in your life are still back there, and if we're paying attention and listening and showing empathy toward our colleagues, if they're having a particularly tough day, we should be able to pick up on that and try to help them through

4:59
it, definitely, and I think that's. A great point about the pandemic, I mean, that really is, you know, to go back to the military example, there, I mean, it's kind of like the uncertainty boot camp, I feel like, or, you know, it kind of compared to that, I feel like that probably did shape a lot of teams and a lot of leaders in a lot of ways,

5:15
for sure, yeah, and you know, and it wasn't something that, you know, in the abstract, when you go through any type of medical training, nursing technicians, our administrators, you read about the history of medicine and plagues in the past, but and there are certainly communicable diseases that we've always been dealing with, and the possibility of getting stuck with a needle and getting hepatitis and tuberculosis is here and there, but the just overwhelming everybody involved effect that COVID had was like nothing anybody could ever have prepared for mentally, physically, otherwise.

5:54
When things are uncertain, what kind of things that people look for and actually need from their leader?

6:02
I think that one of the biggest things we need to do to be successful is very similar to what we need to do to be successful as clinicians, and that's being honest and being upright, forthright about what we don't know, and the interesting thing is, we're very used to that in clinical medicine. If a patient comes in and they're sick, we don't have all the data yet. We have to make some decisions right up front, but then as we get more information, those decisions that treatment plan may change, and often does one of the things that you know we may have hurt ourselves a little bit in the healthcare profession and science in general. I feel during the pandemic is an inappropriate level of certainty in what we were putting out to the country and the world, and rather than saying, hey, we're scientists, we know this isn't going to be the final answer. This is what we know right now, and really being honest about that, and I think in any environment that is key to be able to say this is the best information we have right now. This is why I made that decision. You're very honest and open about that, getting people's input to help you with the best decisions, but then saying, as we learn more, things may change. I think the other thing, too, it can flip that around. What do leaders need sometimes? When folks get into a position where they're in charge of a team, you forget that you're affected as well, and that self-awareness is a requirement before you can self manage, and so if there's a lot going on in your head, if there's a lot of anxiety or uncertainty flipping around, it's going to impact your performance, and you should know that and plan for that. Maybe that means extra sleep, maybe that means talking to someone about what you're going through to help you through it, maybe it means staying home for a shift in order to bring your best game in when your patients and teammates need it. So that's an important thing for leaders to take care of themselves and to recognize when they might be off a step.

8:19
While you were talking there, kind of brought up another question for me. You kind of talked about the parallels there between, you know, just being a clinician in general and leadership. I guess could you kind of talk more about that parallel, and maybe say to maybe younger clinicians who don't see themselves as leaders yet, but I mean could be or will one day be.

8:40
Well, that's a great question, and I, one that I love to talk about quite frequently, and have been for a number of years. I, one of the things that I've written about is, if you ask 100 doctors to name a physician leader, they will almost inevitably name a medical director, a chief of service, a chairman, a dean, a chief medical officer, those are what we refer to in our vernacular as leaders, physician leaders. When in reality, if you look at a fundamental definition of leadership, which is influencing behavior to achieve a desired result, then every doctor is doing that every day. You do it with patients, you're trying to get patients to stop smoking, lose weight, take their medicine. You're leading teams in the ICU, in the ER, in the OR, so you're constantly having this influence, this impact as a doctor. Therefore, you are leading other people, and the fact that we are not explicit about that with our doctors in training, medical students, residents, and young faculty means that we're missing opportunities to teach and coach that skill, and folks aren't necessarily reflecting upon their ability to use their leadership. To accomplish the goal of better patient outcomes. When you look at what we do in medicine, it's very, very effective, and if we take the framework of how we gather information, analyze data, formulate a plan, evaluate how that plan is working as we implement it, gather more data. That loop is very similar to what leaders in all businesses do, so it's not like we have to get three more advanced degrees to learn how to lead better. I think it's a lot of it is just recognizing that we're doing it all the time as doctors, and therefore whenever we put that hat on and say, oh, I need to lead my team through this event, fall back on what you're already good at as a template.

10:59
I think there's an instinct for a lot of leaders, to when you're in uncertain times, to you know, kind of try to project calmness and say that everything is fine, even when it isn't. I guess, what's your take on that? And is it good to protect the peace, or is it better to be honest with your team?

11:16
Yeah, I think there's a balance there as well. I love the movie Apollo 13, and you know, lived through it. Actually, I'm old enough for that, but the in the movie, the ship is starting to fall apart, almost certain death for the crew missions going to fail, and the mission commander, who cares very much about the mission, the crew, and of course his own life, just picks up the microphone and says, "Houston, we have a problem. So that's acknowledging that there's a problem, getting a hold of people who may be able to help you with that problem, and yet not breaking down screaming, yelling, and becoming completely useless, right. So, to a degree, maintaining your professionalism, your calmness, while being able to rationally talk about what's going on, even if it's a crisis, not just uncertainty, is is super important. If you take that too far, and you seem like you're a robot, and you don't have any feelings about it, then that's not necessarily going to engender the type of trust you want to engender as a leader, but you shouldn't come in panicking every time the stocks drop, or there's a healthcare issue in Congress, or you know CMS is going to decrease reimbursement, then the hospital is going to have a challenge meeting those things. Those happen all the time, so it's not cheerleading. You don't want to just be completely Pollyannish and tell everybody it's fine, it's fine, it's fine, but rather acting as a stabilizing force, a credible stabilizing force to allow people to optimize their performance and remain calm, and as we'll talk about later, say, hey, we can get through this. We've done tougher things.

13:33
Hey there, Keith Reynolds here. And welcome to the p2 Management Minute. In just 60 seconds, we deliver proven real-world tactics you can plug into your practice today, whether that means speeding up check-in, lifting staff morale, or nudging patient satisfaction north. No theory, no fluff, just the kind of guidance that fits between appointments and moves the needle before lunch. But the best ideas don't all come from our newsroom, they come from you. Got a clever workflow hack, an employee engagement win, or a lesson learned the hard way. I want to be true. Shoot me an email at K Reynolds at mj life sciences.com with your topic, a quick outline, or even a smartphone clip. We'll handle the rest and get your insights in front of your peers nationwide. Let's make every minute count together. Thanks for watching, and I'll see you in the next p2 management minute.

14:22
Bye. What advice do you have for delivering difficult or uncertain news to a team in a way that still preserves trust in you as a leader?

14:32
Yeah, touching on what we just talked about, the idea that yes, I'm affected by this without breaking down and becoming useless is a really good start. If it's something that is super challenging to your team, they probably want to know that. You're trying to deal with this issue as well, and then being honest with what we know and what we don't know, super important. Talked about that before as well. The type of leader that comes in and says, hey, you know, everything's fine, people know everything isn't fine. A good example from my past is we were in a big organization, we started rolling out an electronic healthcare system, health medical records system, and the biggest of the big bosses would just talk about how great it was well, that person wasn't using the medical record, had no idea what it was like, or the challenges that the people who were using it were facing, and yet was trying to tell everybody it's all fine, that's the, you know, the Wizard of Oz leadership mentality, right? Just there's a man behind the curtain, just, you know, don't worry about it, it's all gonna be fine. Pay no attention, that that's not going to help. Being honest, being upfront, showing a little humanity yourself, I think builds that trust, and, and I think the humanity part also makes it easier for people to approach you if they have a difficult question, or if they're questioning your point of view. Your decision as a leader, I think you really want people to be convinced that they can raise their hand and say, you know, I don't, I don't think that's right, Dr. Moore's. I, I've got information here that I think we need to make a better decision,

16:43
so now going into kind of individual team members that you're leading, right? People process stress in very different ways, and as a leader, it might not always be clear when someone is really stressed, you know? Maybe they hide it well, whereas other people might tell you, how do you make sure you're actually seeing that and not just assuming that your team is fine, because no one's saying otherwise.

17:04
There's a, there's a great scene in a movie where this man and woman were, you know, sort of getting into a relationship, and he makes a comment and says, you know, you just, I just never can figure out what women want, and she looks at him, and she says, Do you ask them? Then he kind of hesitates, and goes, Well, no, and I think that's such a great commentary on humanity and leadership that if you want to know what people are thinking and feeling, ask them, and there are environments in which to do that, and there are ways to do that effectively that aren't offensive or intrusive. Some folks don't want to share their feelings with their boss, that's perfectly appropriate, but through repeated actions, letting people know that it's okay to do so, asking, How are you today? What do you need? Is there anything that you know I can get to make your day better? All of those things give people the idea that you know, maybe, maybe the boss really does want to help out, want to know what I'm thinking, feeling, and you know, I'm having a tough day, and maybe we can work this out together is a much better position to be in than having all the folks around you feel like they're just a cog in a wheel that has no feelings and nobody has any feelings for you. Definitely don't fall into that trap.

18:51
Absolutely. How do you maintain team trust when a situation is still unfolding and you don't have all the answers?

18:58
Yeah, I think when people come into a healthcare organization, whether you're a physician, nurse, tech administrator, you, you probably have a certain basket or bucket of trust that you bring just because you got hired into the organization. We're, we're going to trust you somewhat, and you can add to that trust through actions, and you can decrease the coinage in that trust bank, if you will, by actions as well. You don't want to be in a situation where there's a true crisis and things that are falling apart or you're in the operating room in the middle of the night with a trauma, and you just have to get people to move and have them not trust you, so if you've built that trusting relationship over time, and one of the ways to do that in my business, if you're in the. Or is just to be constantly asking questions, and when people ask questions or make suggestions, you celebrate that, you applaud that. You know, thanks, Susan, that's great. You know, thanks for bringing that up. Everybody hears that, especially if it's something that's challenging, you know, something you're about to do as a doctor, you really want to say, "Oh, wait, that's great. No, let's all pause, let's look at this X-ray again, right? Or whatever the person who raised their hand was talking about those are the things that you just do routinely to build that trust with folks on your team, then if there is a crisis, if there is a stat true emergency, people are going to respond, they know they can trust you, people are going to raise their hand in a, you know, in a high stakes environment like that, people are even less likely to say, oh, wait, let's pause. I don't understand why we're doing this. Is this okay? That takes a lot of courage, and it takes a lot of feeling safe in that very, very high-stress environment. You want to build teams, you want to build the trust level in you as a leader, that they know that they may be just not seeing why we're doing it, and as soon as you say this is why we're doing it, they're like, "Oh, okay, that's fine, but you want them to throw the flag, the challenge flag, if you will, freely without losing a timeout if they're wrong, right? To a football analogy, that okay, yep, no, that's right. You're absolutely right. This is why the films are like that. That makes sense. Okay, thanks for pointing that out. Next, move on. Unfortunately, we have a tendency in all environments to kind of get flustered, and if you're challenged, you might snap, or even less, just kind of be indifferent, ignore, go, nah, don't forget about it, stay in your lane. Comments like that are not useful, and in fact are going to do exactly the opposite. I was in the OR not too long ago, and just there were two nurses, a scrub tech, a tech in training, me, a resident, an anesthesiologist, and a nurse anesthetist, and we just very quickly added it up that there were 123 years of operative experience on that team, that's a lot of knowledge, a lot of experience, and if every one of those folks doesn't feel comfortable saying, "Hey, I have a question, then you're missing out on something that could probably help your patients.

22:59
As simple as it sounds, I mean, I think everyone's has that experience with whether it be a boss or someone with authority who you brought something up and they've kind of dismissed it because they know better, they've been doing it longer, kind of, I mean, you don't want to speak up after that. So that's that's a good point.

23:16
That's right. Yeah, it persists, right, to me a while before, if ever, you'll take that risk again,

23:23
definitely. What mistakes do you see physician leaders making most often when their teams are under stress?

23:32
You know, docs are under a lot of pressure quite frequently. Most people in healthcare are, we've got health consequences, if not life and death consequences, with what we do, whether we're nurses, techs, administrators, docs, so stress level a often under a time crunch, we try to see more patients, there's more stuff rolling in, you got to get these cases done, and then move on to a medical economics interview and stuff like that, right. There's there's you're always trying to move, move, move, move, move, and quite frequently what I'll see folks doing is because you're just trying to move on to the next thing. If somebody says, "Hey, can I ask you a quick question? or "I've got a suggestion, or I'm wondering why we're doing this this way. There's a tendency to stay sort of blinded, moving in that direction, and maybe just sort of brush it off and say, about, you know, talk to me later, or no, don't worry about it, and if that isn't as bad as, you know, shut up and stay in your lane, but it's not great, and that dismissiveness is not building that trust. Like, I know I really want to hear what you have to say. You are a valued member of the team. I value your experience. Just stopping for a very. Very short period of time, if necessary, turn face, make eye contact, listen intently, and then respond appropriately. And the response might be, you know, that's a great point. And yes, I do really want to follow up on that. I've got to get down to the, or they're positioning my patient right now, but can you, can we touch base at like five this afternoon? That's much, much better than just going, yeah, catch me later, and you keep moving down the hallway, so I think it's done not out of any serious ego problems or sociopathic tendencies or anything else. It's just that there's that pressure all the time to be moving on to the next thing, and we don't just take a fraction of a minute or two minutes to say yes. What are you thinking? I value you. I value your experience, and I want to hear

26:06
it. If you have to give advice here, what's the single most important change that physician leaders could make as soon as this week to keep their team steady?

26:16
Honestly, I think none of us really listen enough or as intently as we could, and that's a switch that you can flip pretty quickly just by thinking about it. Anytime anybody says anything to you, look up from the computer, make eye contact, put your phone in your pocket, turn your body to face them, sit down. There's good studies that show that if you just sit, people think you've spent a lot more time if you time it than if you stand, particularly if they're sitting. That does wonders for communication, and what you're ultimately trying to do is improve that psychological safety and allow people to get people to know that you want to hear them, that you want to get their point of view to take advantage of their experience and their lens. Physicians have, and this is not saying that we're all that or we're special, or anything else. I really don't want to imply that, but there is a psychological size mismatch between most of the time with doctors in a healthcare system and our other colleagues, and the reason you should recognize that as a doctor is that means that you have to make extra effort to get people to feel comfortable challenging you, and you want them to feel comfortable challenging you. You absolutely want that. You need that. Your patients need that, and it's not going to happen passively. You have to actively do it, and the one thing you could do this week is just listen more or listen better, ask questions, and then listen. Don't flip your brain onto the next thing while they're answering, and you're not even paying attention. That'll go a long way in getting people to say, "Wow, you know, Moore's really actually listened to me, and do it over and over and over and over again in, in front of everybody when it happens, because then everybody on the team says no, you know, he really cares, she really cares. What I think,

28:32
excellent. Is there anything that we haven't talked about today that that you want to share?

28:37
I think we've heard a ton of good stuff, certainly emphasizing listening, you'll hear me say that all the time. You already have knowing in a crisis that everybody's going to respond to it differently, and paying attention, looking at people's body language, they might not always speak up, but there are going to be stuff. Oftentimes, there are going to be signs if you've created that psychological safety where people feel comfortable talking to you, they might just step into your office and say, 'Hey, doc, I'm having a tough day, can we talk about it? That is so fulfilling when people are willing to do that, acknowledging the reality. Don't dismiss, be dismissive of it. And, importantly, very, very importantly, because we, it's going to take us years and years and years to gain back societal trust. I think is acknowledging the gaps where we don't know things, and that our recommendations, our diagnoses may change as we get more data, more information. Be clear about that from the start, and people will trust you more than you want to be trusted as a doctor, as a leader, as a human.

29:46
Dr. Leon Morris. Thank you again for joining me today.

29:48
Well, really appreciate the time, and thanks for what you're doing to educate everybody.

29:56
Once again, that was Dr. Leon Morris, a pediatric neurosurgeon, physician leadership. Expert and author of All Physicians Lead: Redefining Physician Leadership for Better Patient Outcomes. On behalf of the whole medical economics and physicians' practice teams, I'd like to thank you for listening to the show, and Estee, please subscribe, so you don't miss the next episode. As always, be sure to check back on Monday and Thursday mornings for the latest conversations with experts sharing strategies, stories, and solutions for your practice. You can find us by searching off the chart wherever you get your podcasts, and if you'd like the best stories that Medical Economics and Physicians Practice publish, delivered straight to your email six days of the week, subscribe to our newsletters@medicaleconomics.com and Physicians practice.com Off the Chart, a Business and Medicine podcast is executive produced by Chris Mazzolini and Keith Reynolds, and produced by Austin Luttrell. Medical Economics and physicians' practice are both members of the MJH Life Sciences family. Thank you.