Medical Director Not Managing The Naughty Doctor

One experienced doctor's toxic behavior is jeopardizing team morale and driving away staff and new graduate veterinarians. In this episode of the Uncharted podcast, practice management expert Stephanie Goss and Dr. Erica Pounds from Banfield Pet Hospital dive into a critical issue faced by many practice leaders: dealing with toxic behavior from a team member. The episode begins with a heartfelt email from a frustrated practice leader detailing the challenges their practice has faced since losing several doctors after a corporate buyout. Stephanie and Dr. Pounds explore actionable strategies to address this issue effectively. Let's get into this episode…

ABOUT OUR GUEST

Dr. Erica Pounds is the enthusiastic Program Manager for Team-based Care with the Veterinary Affairs Team at Banfield Pet Hospital. Since graduating from the University of Tennessee College of Veterinary Medicine in 2011, she has climbed the ranks at Banfield, taking on pivotal roles such as Chief of Staff, Area Chief of Staff, and Interim Director of Veterinary Quality. Erica has a fervent passion for learning and particularly cherishes opportunities for leadership development.

Outside the office, Erica's life is full of adventure and creativity. She's not only the supermom to four amazing boys and a partner in crime to her husband in the bustling world of superheroes and soccer, but she also finds joy and tranquility in quilting. Her sewing room is her sanctuary, a place where colorful fabrics and intricate designs come to life, providing a perfect balance to her dynamic professional life.

You can also listen to the episode on Apple Podcasts, Spotify, Google Podcasts, Amazon Music or wherever you get your podcasts.

Do you have something that you would love Andy and Stephanie to roleplay on the podcast – a situation where you would love some examples of what someone else would say and how they would say it? If so, send us a message through the mailbag! We want to hear your challenges and would love to feature your scenario on the podcast.

Submit your questions here: unchartedvet.com/mailbag

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Episode Transcript

Stephanie Goss: Hey, everybody, I am Stephanie Goss, and this is another episode of the Uncharted Podcast. This week on the podcast, I am joined by my friend, Dr. Erica Pounds. Erica is a experienced multi-site medical director and she is currently working to address the concept of team based care, the idea of fully leveraging the paraprofessional staff so that they can practice at the top of their licensure and the veterinarians can do all the veterinarian only kind of things and we can see more patients and provide access to care for more pets.

So, I think that today's topic is a perfect one for Erica to weigh in on. She has done some speaking for us at Uncharted and through her role with Banfield Pet Hospital. And Erica is going to be at our upcoming Medical Director Summit and doing a workshop for us. So when I got this topic in the mailbag, I thought Erica was the perfect person to come and join me on today's episode and try and get into it. So shall we?

And we are back. It is me, Stephanie Goss, and today I am not joined by Dr. Andy Roark, my partner in crime, but in fact, I am joined by my dear friend, Dr. Erica Pounds. Erica is well, Erica, you have been a multi site medical director with Banfield Pet Hospital for years, and you are now in a new role.

And I actually don't even know your official title of your new role. So tell us– Welcome to the podcast and also help me out here cause I was completely unprepared for your new bio and your new role.

Erica Pounds: No worries. Well, first of all, thanks so much for having me back. I'm super excited to record with you on this super exciting episode today. So new role. Yes. Last year at the end of last year, I joined our veterinary affairs team for Banfield. And I am the program manager for team based care.

So really helping to support that focus within our practice. So it's a very exciting role and great and just being able to provide support and impact to all of our hospitals across Banfield is a really exciting opportunity and I'm loving it.

Stephanie Goss: I love it. I love it. I love the idea that so much of what you all are doing and looking at and supporting from the veterinary affairs team to the hospitals in your new role is really, when you say team based care, I know enough about what you all are doing to know that it's really just the focus on, it takes the whole team and the better that, and the more efficient, the better we work together.

The better we all get along, the better we work together, the more efficient and effective we can be and therefore the more pets we can provide care to and provide access to care for and allow the veterinarians to be leveraged. When you leverage the team, you leverage the veterinarians better too to do the veterinary things.

And so I love what you guys are doing. I'm excited. You are actually going to be doing a workshop at our medical director summit and talking about the idea of how do we get to that place of efficiency and effectiveness? Because I think that's everyone' dream. Especially when we're bogged down and overwhelmed in practice.It's like we, we imagine ourselves– it's kind of weird how most veterinarians uh, and veterinary people think. I think instead of on our bad, really bad days, we probably wish we're sitting on a beach with a drink in our hands. But for most of us, it's like, what would it be like if we were fully staffed and we had no challenges and everyone was fully leveraged and we could just sit there see all the pets.

Erica Pounds: Yes, that is our ideal state. You're 100 percent correct. I think that probably is the thing that like runs through our brains the most, especially, you know, when you're on the floor and you're seeing the pets, you're just like, man, what would this look like? And how many pets could I see? And like, how many families could I positively impact?

And, you know, and I think that really just speaks to the heart of, All of us in veterinary medicine, right? So we joined this profession. We're helpers, and we want to be able to see that. So you're exactly right. I think that ideal state is probably something that runs through our heads more times than not. 

Stephanie Goss: So you're going to be doing a workshop at Medical Director Summit. And this is our second medical director summit. We did one last year and it was so great. It was so fun to bring together. You know, the idea of a medical director role, I think really kind of was born in the corporate side of veterinary medicine and over the last five years, especially as more and more practices.

Corporate and private have grown in size from that one and two doctor practice to that middle level, three to five to six doctors. You know, certainly the bigger hospitals that are six, seven doctors plus for years have been having someone at the top who is looking at the, you know, medicine side of things and kind of directing traffic, not dissimilar to the way the practice manager has always kind of directed the traffic on the people side.

Now you have someone looking at the medicine side. And so, you know, last year when we said, what would it look like if our team did some hallucinating and said, what would it look like if we pulled together people who Private practice, corporate practice, it doesn't matter, but this role is unique, and it's growing, and so can we pull medical directors together to have a day just dedicated to the the ups and the downs, the joys and the challenges of this unique role, and talk about how do we really solve some of those challenges.

So we're going to be doing it again. And so we said we have to have you back because we had so much fun last year. And so you're going to be talking about leveraging the team and creating that culture and setting the framework and the foundation for being able to get to that place where you're efficient and effective. So I'm super excited for that. 

And it's in part why I said, Hey, Erica, come back on the podcast with me because we got a mailbag episode. And I'm super excited to get into this one with you. So, there was lots of meat on the bones here. And as a veterinary person, I kind of feel weird saying that.

But there's lots of meats on this bone. So we got a mailbag. We're making the assumption that it's either from a practice manager or a team lead because they are in charge of making the staff schedule for the practice. So that's pretty much all we know about their position. But they are– they are in a bigger practice.

They have transitions. They are a corporately owned practice, but I really honestly don't think that has much relevance here. And we'll talk to that because I've experienced a similar situation like this in private practice multiple times. So I don't think it's unique to the corporate environment, but when they transitioned, they had a transition in staff and doctors.

And so they had some experienced doctors and some new grads. come on board to fill some of the gaps in their doctor team. And they have an experienced doctor who this team leader/manager for we'll just call them a manager for, ease feels like they're ruining the hard work that they have done to get everybody working together, working smoothly, working efficiently and effectively from a culture perspective.

So this manager is really frustrated because there are some behaviors that they are seeing that they are labeling as a really bad attitude and negative. And, in fact, I think it is strong enough that they said point blank, this doctor is a bully. So there is bad mouthing of the team, bad mouthing of the doctors to other team members, clients they are making comments under their breath, side comments in front of people.

And this leader in the practice is really struggling because they have a medical director counterpart and their perception is that the medical director is not acknowledging that these are issues, real issues that are impacting the team. And when they have tried, or someone on the team has tried, the per to bring it up, the perception is that the medical director glosses over things or makes excuses because this doctor, as many have experienced, is a super producer.

And so they are a revenue generator. They are capable of seeing a lot of patients. And this leader acknowledged that's not without a downside, because this doctor is very effective as a producer because they are highly leveraging their team. And so they are taking technicians' assistance, any free hands from other doctors to see all of those patients and therefore generate all of that revenue and the perception is that which it usually is when you have somebody who is exhibiting some, you know, toxic behavior, they're on their best behavior.

When the boss is around, but you know, it's like my toddlers. When my kids were toddlers, they were always great for other people. And then you get them back in at home where they feel safe and boy, is it another story. And so it sounds like that's kind of what's going on here.

And so the bottom line is this leader is really struggling because they're like, look, I have team members who have already told me they refuse to work with this doctor. And if they're scheduled with this doctor, they will call out and just not show up to work. And they have already lost team members who have privately told the manager, I'm leaving because of this doctor.

Like, I don't need to put up with this. And so, this manager, from their seat, feels like this is a toxic person with toxic behaviors. And they're looking at their medical director partner going, can you please do your job and deal with this person? So, we're gonna, we're gonna make, probably make some leaps and some assumptions and we'll kind of talk through some of those as we get there, but the bottom line question that they asked us was, how do we get them to realize that there is an issue and how do we do it fast, because I'm worried that we're going to lose half the team over it.

We're already shorthanded para professionally and I can't handle this. So help was the ask. So, I'm super excited. So let's get into this one. And as we, do we are going to start with headspace. So, when you think about getting into a good headspace for this leader or manager where do you start?

Erica Pounds: Yeah, I, because there's a lot. Right? In this there's so many different angles to, to look at and things. And so I think that the first thing is taking a moment to really take a step back and start to get into a very curious head space. This is where we are going to embody our inner three year old and we are going to ask why and why. You know and so it is definitely one of those things that we run the risk if we don't take a moment and check in our with ourselves as leaders before, you know, really facing this head on, we run the risk of the fact that we are going to fill in the blanks and we are going to make a lot of assumptions on everybody's behavior and on everybody's responses and interactions.

So I think that the first step is really taking a moment, checking in with yourself and go, I've got to sit and ask why, and resist the urge to fix the problem yet. We've got to make sure that we get all of our information so that we know that the problem that we're solving for is actually the problem and not on the surface level.

Stephanie Goss: Yeah. I love that. And I think I think, you know, your idea of getting curious and asking why is a great one. And, so I think the thing you know, Andy and I always talk about getting are, you know, are you safe to have this conversation? And I think we'll talk about that towards the end of headspace, but I think from the leader's perspective, in order to ask yourself why, in order to get curious, in order to do any of the other steps. I think the piece that I would pull out of the idea of SAFE is, are you in a place where you can get zen and just breathe about this, or are you in a place where you're triggered?

So if you are angry, if you've had to deal with this that day, if that doctor has been you know, acting naughty or acting up in front of you, like, take a walk, take a breath, take a, you know, get to a, place where you can sit and look at them in the face. And on that kind of day, on a good day with that doctor, really challenge yourself to ask the questions because I think you're spot on, we have to ask ourselves some, why questions a lot and you know, you talked about getting to the bottom of it, really being able to do some root cause analysis and figure out are we looking at the symptoms because a lot of what is just discussed in this email is, symptoms, right?

It's the, you know, the behavior, the acting out, but why is that happening? And to be able to ask yourself those questions, I think you have to be in that clear headspace to be able to ask yourself why. And then the other piece that I would add to that is I think that it's very clear that this leader is frustrated and I understand that and I can empathize with them and sympathize with them because I've been in their shoes and it's really hard to ask yourself why when you want to just wring someone's neck. And you're just like, why are you acting like this? And I think that there's, that is, coming through loud and clear. And so I think just taking a minute to acknowledge, like, we see you, we hear you. This is a really tough space to be in because as a leader, there's a lot of work here for you to do.

And if you can't get into that headspace where you're asking good questions. You're setting yourself up to fail from the start. So I think being in that clear headspace and then what I would layer on to your asking yourself why and doing it a lot to kind of get to the heart of the matter would be the ability to ask myself and question my own assumptions.

Because I think that there was a lot of really strong language used in this email, and I completely understand because when I have been frustrated, when I have had, I actually called them my naughty doctor for, I dealt with a naughty doctor for years and it is very hard to not get irritated and triggered when it has like repeated behavior, and as a leader, your job is to try and figure out how to be the example for your team and how to really ask yourself the hard questions and wrestle with the hard questions.

And so if you can't look at the behavior objectively, if you can't look at the information that is being gathered either by your own observations, by your team sharing feedback and information with you, if you can't look at it objectively and ask yourself, okay. When I hear this, I immediately assume that this doctor is doing this because X, Y, and Z. And there's a whole lot of ways you could fill in those blanks, because they are, you know, money hungry, because they are just a jerk, because they are, you know, they just think that everybody on the team is idiots. Whatever, fill in the blanks you're doing when you're angry, if you can't sit there and ask yourself, okay, what else could be?

What else could this mean? What other story could I tell myself about this doctor and their behavior? If you can't ask that question and really look at both sides of it, that's the ultimate leadership challenge in this scenario. And so the, challenge for everyone, wherever you are on your leadership journey is if you want to try and get to that place where you can ask yourself those questions, you can ask why you can, you know, do the engaging with that. And ultimately for me, I asked myself, what else could this mean? Like what other stories, what stories am I telling myself and what stories could I make up that are on the opposite end of that spectrum? So if I'm looking at this doctor and I'm like, they're just an a hole and that's like what immediately comes to mind. If I can't force myself to sit there and think, what if they're a really nice person and they're, you know, favorite aunt just died and they're sad about that. If I can't do that and put myself into a place of empathy, then I'm not ready to deal with it. And so that's the headspace challenge that I would give our writers.

Like, how are you going to get yourself to a place where you can assume good intent? And here, what I mean by good intent is asking yourself the question, what else could be happening here? What else could be going on? What, and own your own, own your own bias and ask yourself, what else could, what, am I telling myself?

What's the story that I'm telling myself about why this behavior is occurring? And if you can't, if you can't do that, you're probably not ready to have that conversation or start to deal with it and start to unpack it. And so I love your why, like channel your inner two year old.

And why is the sky blue? I don't know, mom. Why?

Erica Pounds: Yes. And you know, and I mean, thankfully for me being the mom of four boys, like I, I'm very well versed in the why-nesss, but I love your call out around being able to check in with like, again, with your own emotions even before you get to the Y state because you're exactly right.

If something happens and I'm upset or I'm frustrated, I'm angry, whatever, those really big emotions. And I try to go have this conversation with any of the people involved. Right? I could bet that it's not going to go well. I'm not going to get the response that is ultimately needed. Right. And so It doesn't do anybody good for us to do that without taking that moment to really get clear.

The other thing that I love, and, I mean, and sometimes, like, for me, I'm a super literal person and so to avoid continuing to fill in the blanks with my own assumptions, sometimes there have been situations where I've actually had to, like, write the situation down on paper. Like just everything just write it down like this is how I felt this is what was said. This is what I heard writing all of it down and then Looking at it and literally crossing out everything off that paper that I don't know to be 100 percent true and 100 percent fact.

And oftentimes, then what you're left with, again, is just very much the objective facts of the situation. And then you can kind of take a look for it and start to peel it back. And the other thing that I will say, You know, geez Louise, like it's been about three years now since we started you know, the Uncharted program with the area chiefs and Banfield.

And so, you know, we've been on this journey for a while now. And one of the things that I will say that I was most thankful for and continue to be most thankful for because even as my role has shifted, these people are still my people. And it is, you know, the, relationships formed within our leadership group.

And so sometimes too, if you're struggling to get through, and did I clear all of my stories? Have I removed all my biases? Have I taken out all the assumptions? It is great if you have someone that in a safe space, you can say, Hey y'all, this is my situation. These are my feelings. Here's what I've worked through.

Can you help me make sure that I don't have any other blind spots? So that I can really go in and show up as the leader that I need to be for my team right now. And time and time again, right? We've been able to show up for each other in those spaces and help provide that very third party, very objective lens.

And that has been something that's been so helpful. And again, those strong friendships and strong partnerships was something that came out of, you know, the Uncharted community you know, within our area chief group within Banfield.

Stephanie Goss: I love it. I feel like we could do a whole whole episode on finding your people. And I, love that you said that because I think and I love that you, know, I love that you brought up the idea of writing things out because I think that's the, you know, when Andy and I first started talking about this on the podcast Andy used to tease me and, we used to laugh because I do quite literally have like a, sheet, a worksheet that I put myself through, like when it's really tough and I'm really struggling, I don't do it, you know, every, time I have a frustration or an upset, like then you'd spend your whole life writing things out because something is always on fire as the leader in a practice.

Right? And when things are really hard, when there's emotions involved, either my emotions or potentially in this scenario, the team's emotions, I might be unemotional about the situation. I might get along with this doctor just fine. Right? I don't think that's the case of our writer here, but you know, Play Devil's Advocate, as the manager, there have absolutely been times when I get along with the person in question just fine.

The rest of the team, it can't, is losing their minds. And then my job is to figure out how to unpack their emotions? And I think being able to work through the steps. And like you said, write it out for yourself. And that part is particularly helpful for me asking myself, what else could be happening here?

And writing all of the things out and getting to that place of Zen. And then I think the other thing that you and I talked about from a headspace perspective, that is a really important to bring up here before we kind of jump into action action steps, then we'll take a quick break before we do that.

But I think it's the idea of once you ask yourself why, the last piece of that why, I think you you framed it really well because you said like, what have we done in the hospital, like, we as the leader, what have I done to actually figure out why the behavior or behaviors are changing? are happening.

And so I think that is going to speak directly to when you deal with this, when you start to action step this, you have to be able to be clear and objective. And the only way that you can do that is taking the information that other people are giving you and being able to figure out how do you frame that in your own experience and your own observations so that you can have the concrete and objective conversation with your medical director and potentially with beyond with this doctor directly with you know, help above you. If you, it gets to the point where you have to manage up and ask for help from your boss's boss or your field leaders, or however it's structured in your hospital.

But, you know, we talked about figuring out that why, and you had some really good, you know, kind of examples of things that we should look at here to try and figure out the why.

Erica Pounds: Yeah, you know, I think that it's really important because the fact of the matter is like, we're dealing very much with those interpersonal dynamics here, right? And so we want to try to be as objective as we can be. We want people to understand that as a leader, I am here to listen and to hear you and to be supportive. But also understand that I'm here to help too. So I think that you know When these situations are happening the things that were going through my head is I wonder what the conversations have looked like So far.

So in, in, all regards, right? So with the team members that are coming with those concerns, you know, what does that look like? Is it just very much a hear me moment where we're just listening and we're just taking it in or how we started to translate that to some action steps that again, we'll talk about in just a little bit, but very much into that help me moment, because I do wonder, you know, Was there a point in time for these team members where maybe they, yes, they had a concern, but they were in a space where they wanted to make that relationship better, but they didn't know how and was there an opportunity perhaps where we could have maybe helped with that situation?

Same with the doctor, right? Hearing but then helping with the solution because the biggest thing is that sometimes I think when we go into fix it mode as leaders. We have a plan, and we're moving forward with the plan. Well, if the other individuals don't see themselves as part of the plan, or if they didn't want us to solve it for them in the first place, they just wanted to vent about it, now we have some missed expectations, and could we be potentially making the problem worse?

And so, you know, I think that there's definitely that moment, you know, where I would use this a lot, And this is not something that I came up with. This is something that a dear mentor of mine told me years and years ago. And as very much of helping to set the expectations when people are coming to you with questions or concerns or a problem, right?

And that is really setting the clear understanding of what is being asked of you and what they're looking for in that. Is this a hear me moment where I really just need five minutes to vent and get these feelings off of my chest and then I'm going to be able to move on. Is this a help me? Would you please help me figure out how I could better improve this situation?

Or is this a handle it? Hey, here are all of the things that I've tried and I've not seen any amount of progress. I am at my wits end. I don't know what to do anymore. I am in a handle it. Um, and I think that just really helps and I, you know, and I do think, you know, as, I'm even saying these words out loud, right?

Is there also this moment for very clear expectation setting between this practice manager and the medical director?

Because if it hasn't been clear, does, you know, could there be a moment where perhaps this medical director thinks that this is just a hear me moment and is just listening and allowing those feelings to come off and does not understand that there's action that is

Stephanie Goss: That the manager, yeah, that the manager can help.

Erica Pounds: Again, it's an assumption, but again, when we were thinking about the spectrum of possibilities and probabilities, could there be a spot where maybe it's also along misalignment on expectations of what needs to be done going forward?

Stephanie Goss: Okay, so, the last thing from a headspace perspective, before we jump into the break here, is I think that for the manager, there's a lot of emotion. This sounds like an emotionally charged situation. The team is frustrated. I read a lot of frustration, and I could be reading into that, but the team is feeling emotions, the manager is feeling emotions, both towards this doctor and towards the medical director, because there is a perception that the medical director is not, and an assumption in that perception, I think, that the medical director is not quote unquote doing their job because the doctor is still acting out and being naughty from the team's perspective.

And so the assumption is being made that the medical director is not doing their job. And so I think the last piece is where SAFE comes in, which is once you've done the work on your own headspace and you've asked yourself why, and you've challenged, I think the team to also do some of that work as well.

You have to be able to get safe. And have the conversation with the medical director, because ultimately, when you are in a team structure, it looks different in every hospital, what the practice manager's role is, and what the medical director's role is, and sometimes there's a lot of crossover, sometimes there's none, sometimes the practice manager is actually in charge of the doctors.

Sometimes they're not. Sometimes neither of the people in the practice are actually in charge of the other doctors. Like there's a whole myriad of structures out there now and so we're not even going to get into what those all could look like. However, the important part is: When you're running the practice in the day to day, the medical director as a manager, the medical director is your partner.

And so if you cannot be safe when you sit down to talk to them about your concerns, whether you're going to them with your, and I love that you said this, the hear me, the help me or the handle it. When you sit down to have that conversation, you have to be able to be safe. So you have to be able to sit next to the medical director.

You cannot have that conversation with your partner in crime in the practice when you're angry or frustrated because you feel like they're not doing their job. Or if you are going to, you need to acknowledge that's the place that you're coming from and be able to say, I'm feeling a lot of really strong feelings and I want to work through this and I know that I could be making some assumptions and I need your help because I need you to understand that I am coming at this from an emotional place. And you need to kind of do that pre-work to, apologize if that's where you're at, because you need to be able to assume good intent on their part and also on the part of the doctor. And we talked a lot about the doctor in this scenario and not as much in the medical director, but you have to be able to look at them and assume good intent.

And that means when you are truly in a partnership and you are supposed to be working together to run the practice, you have to be able to look at that other person and say, I know that they're working hard. I know that they're trying to do their job. And if you can't say that, there's some work to be done.

There might be hard conversations between you. It might be work on your own headspace perspective, but you have to be able to assume good intent. You have to ask yourself the question, how has this person been set up to fail? Both the medical director, if you are feeling like they are not doing their job, what could be missing in this scenario?

Like what could be causing them to potentially be in a place of failure? And on the part of the other doctor, and then ultimately, before you sit down to have this conversation, you need to know what the end result is, you need to know where you want to get to in the end, and so, is this a conversation with your medical director, because you've You need to address the fact that you don't think they're doing their job?

Or is this a conversation with the medical director to say, Hey, I need to understand how you are handling this other doctor? Because those are two radically different conversations. And I don't think we can judge here which direction it is, but I do think we're going to go in the direction of, Hey, how do you, Talk to the medical director about getting this other doctor to do their, job and get along with the staff because ultimately the question that was asked in the mailbag is, how do we get them to realize that this is, an issue?

And so, I think the easiest way to get there is to talk very clearly. About the impact and the things that you're seeing and observing that are happening with this other doctor and then have the conversation about how do I help you handle this problem, right? Then it's very, then it's very clear like, Hey, I'm, coming to you.

and help me and it may also be a handle it, but it's like, hey, this problem is occurring and we need to solve this problem because there's potential impact here. So, let's take a quick break and then let's hop into talking about some action steps. Cause I had to bite my tongue not to just jump right in there too.

How do we actually have this conversation? So, let's take a quick break and come back.

Hey friends. I know that Andy and I both talk a lot on the podcast about upcoming events that Uncharted has because A, we love what we do and we have fun talking about it and B, we want you to be a part of it. So we want to make sure that nobody misses out on announcements that we have awesome stuff coming up and C, because our team is freaking rock stars and they make sure that our website stays up to date with all of the information about the events.

So that you can find us and you can join us and you can spend some time working on your business and not just in it with us, with the community, with our awesome outside speakers and more so if you haven't headed over to the website recently and checked out the events page, UnchartedVet.com/events. You should because it is jam packed full of all 2024. We've been talking about some of the awesome things that are dropping this year that are brand new, fresh and exciting for us. We've been talking about the oldies, but goodies, the things that we're continuing to do for our community, for you and beyond in 2024 and.

We're talking about stuff that is yet to come. So head over to Unchartedvet.com/events and check out everything that is on the website. We want to see you there. And now back to the podcast. 

All right. So we are back. And as you can tell, I mean, it took us a little bit to go through the headspace and I think we could, this is such a, I said at the beginning, this is a media episode. There's so many ways that we could go. And honestly, this could have been broken out. I think into like three different Pacific specific directions.

Erica Pounds: I think so. Yes. Because even as we're talking, right, I'm like, oh, that was a really good point. Oh, let me let me walk down that trail. Because there's a lot we could unpack there too. Which is great, but here's the thing, right? Like welcome to real life in leadership, right?

Because there are, in any given situation, there are so many different inputs. There are so many different, you know, people's perspectives to take into account and all of the things leadership is, not easy. I think that we all know that. But this, I think this particular example really puts that on full display just because again, there are so many different ways. 

Stephanie Goss: Moving parts 

Erica Pounds: …you can think through and approach it.

And yes.

Stephanie Goss: Yeah. Yeah. Okay. So from an action set perspective, that leads perfectly to where I think that you have to start, which is you have to recognize that clear as kind. And so when you sit down to have this conversation with your medical director partner. In order to get to the place of kindness, you have to be clear.

So I think you have to have done the headspace work to know where you're trying to go with this conversation. What questions are you trying to ask? And then you need to be crystal clear about how you talk to your partner about this doctor's behavior. And what I mean by that is not only know the pieces that you're going to bring up, but be clear in giving the what has been seen and the concrete examples to your partner, because that's the only way you're going to get to a functional place of problem solving.

If you go to your partner and you say, well, the team is really upset because they feel like the doctor is acting like a bully and she's bad mouthing the team. And she's, you know, disagreeing with clients and she's treating everybody like idiots. That, while understandable from an emotional perspective, the frustration, the anger, the hurt, I could see all of those emotions, I can't do anything with that because I can't, and I shouldn't want to change anyone's emotions.

Emotions, the emotions are not good or bad. They just are. And I, it's not my job to try and help them deal with those emotions or take those emotions away from them. It is my job to be able to deal with the behaviors, the clear, specific examples. And so for me, the clearest kind here has to do with what have I seen? And what are the concrete examples that I can give to my medical director partner about the behaviors. And so if, as the leader, if you're getting all of this from your team and it's second hand or third hand information, well, she said that this happened and I saw it and, you know, do your homework.

Go down, be on the floor. Watch the doctor interact with them. Are they acting the same way in front of you? Do you notice an observable shift in their behavior when the medical director comes on the floor? Because as a partner, I'm going to give much more weight, if I'm the medical director, I'm going to give much more weight To direct observations that you as the manager have been able to make, then I am to the team's second hand information.

And that's not to say that the team's experience is not valid because it absolutely is. But I can't move on something that is secondhand. I need to be able to have the clear conversation. And most of the time in my experience as the manager, the team is coming to you because they don't want to go to the doctor directly.

And so the team always is, okay, well, we have to be able to have the direct conversation because if you've had the direct conversation and now it is a handle it because you've had the conversations, you've talked to them, the behavior is not changing. That's a different story. And you can action on that as a partner, but I don't think you can action on dropping all of the hearsay in somebody's lap and saying, go handle it please.

Cause I can't.

Erica Pounds: Yeah, no, I completely agree. And I think that, you know, the thing is, especially, I'm going to make an assumption here. But, you know, if the medical director is, say, a multi unit medical director. So likely, they are not in that hospital every day and there could be an extreme amount of variance as to how often they are physically present there.

And so, I know in my own experience, that was incredibly difficult to be able to balance being able to hear the concerns that are being brought forward, to be able to provide a path forward that showed that I was hearing them, showed that I just wasn't dismissing, but also holding very, closely to the fact of like, I need to some way, somehow objectively figure this out. And you know, it's hard. It is incredibly difficult. And so that is where I think it's really important then when this manager is coming to the medical director, as much as they can really provide those concrete examples. This was the situation. This was the behavior that I, as the manager observed, and this was the impact.

Now we're able to start drilling it down. The other thing is to, as the manager. Even if they are not the direct line manager of the doctors, is there a moment to be brave and bold in your leadership? If you're seeing a behavior that you're like, you know what? I already know that the team is struggling a little bit with the interpersonal dynamics with this individual and I just overheard a conversation and while I don't think that there was ill intent there knowing the back story of how the team is feeling right now, I could see where this could get very very amplified.

Can I, as a leader, go in and say, you know, hey, Dr. So and so, can I just clarify what you were asking me to do? Just to make sure that we're all on the same page, almost actively diffusing the situation, you know, and then again, seeing what are the reactions, what are the reactions from the team members?

What are the reactions from this doctor? Because then again, I can then bring that to my medical director and say, Hey, I, as the manager, like I overheard this situation sounded similar to some of the things that they had brought up before. This is how I tried to coach in the moment. This is how I tried to redirect.

And then these were the, Exact behaviors that then I saw. And so what do we do, you know, kind of moving forward with this?

Stephanie Goss: Yeah. And I think you know, it's interesting because when we were getting started and, talking through some things you, were talking about the challenges with Having distinct separation. And in a lot of hospitals there is this idea that the practice manager is in charge of, and the direct manager of the, this paraprofessional staff and the medical director is the direct manager of the professional staff.

So the doctors. And I know in a lot of hospitals there is the assumption that the manager likes to stay in your lane. You deal with the team. I'll deal with the, I'll deal with the doctors. And I feel nothing. I feel nothing but sympathy for my colleagues who are in that position because the reality is. Even to your, I love that you brought up the point. It is still my job as a leader to have direct conversations. It is still my job to address the behavior when I see it. It is still my job to coach my team to have the tools in their toolbox to be able to stand up for themselves and say, hey, Dr. So and so, I really don't appreciate being spoken to like that.

It makes me angry or it makes me sad or whatever, the impact to your point of the behavior has been to that person, they should absolutely be able to speak up for themselves. I don't, and this is just a personal preference. I don't and I know I'm ruling myself out of working for a lot of companies by saying this.

I never would want to manage in a place where I couldn't empower my team to be able to do that the same way you're saying as a medical director and as a manager, I should have every ability to be able to say to the medical director partner, here's what I have done to deal with this behavior in the moment and to coach and to try and turn it around both with the team and the doctor.

And I need your help because we are partners and I feel like this behavior is getting worse, not better, or I feel like the behavior is continuing. Please let– can we have a conversation about how you are approaching this with the doctor? Because ultimately you and I talked about needing to be able to get to the end.

Like what is the end goal? Where are we trying to get to? And part of this is showing up with your own ideas. Or your own solutions and things that you have tried because if you just show up and you just sit down with your medical director and you're like, here, let me dump the team's problems in your lap, that's going to be a non starter for a conversation because I would look at you and be like, it's not my problem.

Go like, you know, if, but if you come to me as a partner and you say, Hey, Erica, I, like, I need to sit down with you and have a conversation. Cause I'm really struggling with Dr. A. You know, we have been experiencing some negativity with the team. I've had some one on one conversations with some of them.

And as a result of those conversations, I'm concerned. So I spent some time on the floor and here's what I observed and here's how my interactions went. And I need us to, I need to understand what you're currently doing to address the situation and how I can help address it differently and further in the future.

Because by having that conversation, that's opening the door to say to the medical director, hey, I need your help. Hey, I need you to realize that this is an issue and I'm not just dropping the pile of crap in your lap. I am saying this is what I've done to already problem solve. Now, let's work together to move it forward and you're not really, by presenting it that way, what you're doing is not really giving them an out to say, Oh, it's fine.

They're a super producer, so I'm just gonna ignore it because you have brought to them what you are already doing and it then would be perfectly acceptable to say, I don't think that's a viable solution. I don't think that we can just choose to ignore this because they're producing, because here's the impact that it's having to the team and I could, you know, here's how I see that playing out. I really need us to work together to come up with a solution here. And I recognize that I might not be the appropriate one to address it with them. That may be your responsibility. But I need us to work together to come to whatever end place it is that you as the manager need the team to get to.

And so if the team is at the point where they are refusing to work with that doctor, where they are quitting or have already quit as a result of that doctor, it is. Absolutely your job as the hospital leader to manage the partnership with your medical director and have that hard conversation of like, Hey, I'm doing all of these things.

The team is doing all of these things and I need you to show up in this as well. And this is what I need from you because. The next step, and this is a step that a lot of people, when you have a hierarchy structure, I see a lot of people, and I have done it myself, skip the step of having the conversation with the person and go straight to the boss because you think that the boss can actually do something about it.

And any boss is actually a leader is going to turn right back at you and say, how did that conversation with that person go? What came out of that? And if you can't answer that question, you were not, you're just trying to dump your monkey in somebody else's lap. And the reality is if you may need to have a conversation because you may not be able to work it out between yourself and your medical director.

Ultimately it is possible. I could hallucinate a scenario. It makes me sad, but I could hallucinate a scenario where they are afraid of conflict and don't want to talk to this doctor or they do talk to the doctor and the doctor is just sweet as pie to their face. That's still a problem that has to be solved and that problem may need you as a team or individually to manage up and have conversations with their boss.

Or whoever your field support is, if you're in a corporate structure or, you know, it's going to look different for everybody, but it may be asking someone else for help. And if you can't say these are the steps that we have walked through to get here, any leader at that level is going to have their hands full and is going to be, is going to be really busy.

And so they're going to want to know. What, and rightly so, what you have, what you guys have done to, to, you know, solve the problem together.

Erica Pounds: Going back to kind of where you started, like, I think that the point is, and I will say this. You know, forever. The importance of partnership, my goodness gracious, it's so vitally important. When I was managing multiple, you know, overseeing multiple hospital units, the impact that my relationship with my partner had on whether or not we were going to be successful in certain things was huge and it cannot be understated and you know Speaking of medical director summit coming up in just a little bit this was something that we spent a lot of time talking about in my workshop last year which is again like medicine and Operations or a medical director and practice manager or whatever the title is that you know, your hospital may have, that like when we siloed them Incompletely No wonder it feels like there's tension, but there really is this wonderful way in which medicine supports operations and operations supports medicine.

And that is really reflected in our partnership with one another. And so I think that, and again, we're making an assumption in this situation that these are equal counterparts, practice manager and medical director. That may not be but again, for ease. Let's consider that they are equal level partners.

And I think that's where it really is coming and saying, Hey, while, you know, from the last time that you were here you know, this situation came up, these were the things that I did. This was the impact. This is what I saw. I really do feel based on X, Y, and Z, again, really making sure that you've removed your story and you've really been able to pull objective examples forward ahead of time.

This is what I see the impact and this is what I think is at risk if we don't have a conversation and if we don't do that. And again, what is the path forward? Is this us having a conversation as hospital leader partners together with this doctor so that everyone is on the same page? Is it you having it on your own, but bringing back the commitments to me?

So it's very clear. What am I as the manager going to do when you're not here? With this associate right because very much and this was something that I said to my doctor teams This is something that we said to the whole team in general, right? I wanted them to feel comfortable. If I was not in the building, they knew that they could go to my manager and that she was going to support them and vice versa.

If my manager wasn't there, the para team felt as if they could come to me. While yes, we did have different direct reports and we were accountable for different things. At the end of the day, it was the relationship and partnership and that united front. Together, that really helps the entire team to see themselves truly as a team and not doctors

Stephanie Goss: versus,

Erica Pounds: and the rest of the team. Yeah. And so I think that is a really important thing to have. And then also again, just making sure that the intent with what you're wanting out of that conversation is very clear. And so as the manager, you know, medical director. You know, this is what I'm looking for as we come out of today's conversation.

And I would really like for us to go ahead. And make this time bound, right? Like, can we follow up on this at the end of next week? Just to see, do we need to check and adjust and make any different plans? Don't just throw it out of like, this was a one time conversation and then feel like both of you had the same expectations moving forward.

Like, let's check in again and let's be very clear with when that's going to happen.

Stephanie Goss: Yeah. I love that. And I think the other, the place where I will end from an action step perspective is, and it's a little bit headspace, a little bit action steps. One of the things that I think you have to do when you're in a situation like this, that is a meaty one. Like there's a lot to pick apart here, recognizing that this could be sit down and have a four hour marathon conversation.

I have been there and I have done that and it is never really successful. It is ugly, messy. You don't get to the heart of things. And so I think part of that headspace perspective for this manager is figuring out what are the different. Conversations that need to be had because reading this it sounds like yes, they are asking the question how do I get my medical director to realize the impact that the behavior is having on the team and the consequences that are already happening and that are could continue to happen if we don't do something about this doctor. That is one conversation that is the direct, like, here's the behavior.

Here's what I'm doing. Here's the impact to the team. And how are you going to handle it? That's one conversation. The other conversation to your point is how do I support you in handling it? And those might be able to go hand in hand. If you have a pretty good partnership, like you might be able to have that in one conversation.

It sounds like there is a big disconnect in this relationship. And it, so it sounds to me like there's probably some conversations that need to happen between this manager and the medical director to strengthen their partnership and figure out how do they support each other? How do they work together?

How do they, how does the manager support the accountability of the doctors and how does the vice versa to your point, how does the doctor as the medical director. How do they support the behavior and the job and the expectations of the manager with the paraprofessional team if that's how the division goes?

But I think there could be role clarification. Is this your job? Is it my job? Like who, you know, who's supposed to be doing what and what is the end result expectation? So I think remembering that. When you do your pre-work, part of your job to get into the headspace is to figure out what is the actual problem here.

And then once you figure out the problem, if you really truly go after the root cause here, you may only have to have a couple of conversations. But if you keep having conversations about the symptoms themselves,

Erica Pounds: You'll never get there.

Stephanie Goss: going to be having, yeah, you're going to be having the conversation until the end of time.

So you have got to figure out what is at the actual cause here, both of the dysfunction within the relationship between this Leader or the potential dysfunction between this leader and the medical director. And also, the root of where is the bad behavior and the naughtiness with this doctor coming from, and how are you going to address THAT root problem?

And really pull it out and deal with it. So, I think Recognizing from an action step perspective, clear as kind, you've got to have a plan, and part of that plan has to be able to use SBI, use the situation, use the behavior and the impact to be able to talk to your partner about what you have seen, what you have observed, and what your concrete examples are so that they understand what you have observed.

What you have tried in the scenario and what the team has tried, knowing how you're going to talk to them and how you're going to approach it. And also remembering it is also your job to bring some ideas to the table. So you cannot go into this and just be like here, handle it without really good examples of how you've already tried to handle it.

Or say, I haven't approached this because I, my understanding is that it's your role and I don't want to step on your toes. I have ideas on how we could approach this, how you could try it, how I could try it, and we could try it together. And I need us to talk through that because I need there to be some change to support the team, like figuring out what your ideas are and how you're going to present them.

And then ultimately action step wise, you have, I love that you said this, you have got to leave that meeting with a clear plan of what the, what done looks like, what the end looks like. If this medical director is doing their job and the team and you could look at this medical director and saying they're doing their job, what does that look like?

And then how do you both know that's going to get done? When are you checking back in? What are the follow up points? What are the, you know, what are the places that we're going to, you know, signposts along the way and say, Hey, this is not really getting better, or 

Erica Pounds: Mm hmm. 

Stephanie Goss: or, Hey, it's getting, it is getting better.

And like, let's celebrate those changes, right? Like there has to be a plan for what that followup is going to be. And I think how that plan looks is going to differ depending on what you decide actually the end goal is. You know, are you addressing the doctor's behavior? Are you addressing your perception that the doctor, the medical director is not doing their job? Where are you addressing both? Like where, are you actually choosing to have the conversation?

Erica Pounds: Yeah. And I think the only thing that I would add to that last part is just remembering to hold grace and space for your partner. Remember that like what we're talking about here is not a light switch problem that you are going to leave this meeting with a, who's doing what by when, and just magically in one fell swoop, it's done.

We're talking about human behavior. We're talking about interpersonal dynamics. We're talking about culture and. Let's talk about what incremental success looks like. What are those milestones? Like how do we know that we're moving forward, but then hold grace and space for your partner because if that doctor all of a sudden is just having a really bad day and starts to backtrack a little bit, that does not mean your partner failed you and didn't do their job. Like, so let's just make sure that we're having that open dialogue. We're having those check and adjust and always assuming the best of your partner and holding grace and space for them.

Stephanie Goss: Yeah, I love that. Oh man, this was so fun. Erica, thank you so much for coming on the podcast again and talking through this with me. And if you are listening to this episode and you are in a medical director role, you should come join us at the Medical Director Summit. It is virtual. It is happening May 29th.

And we are going to be on Zoom for a few hours and we're doing some workshops, we're doing a general session and then we're going to dive into some problem solving and choose our own adventures in terms of the conversations we have about the challenges and the joys we're facing in practice as medical directors and it's going to be a blast.

I'm super excited. So, hopefully we see all of you there. And if you are a leader and you are in this position, whether you're a manager or team lead or you know, the other side of this find your community, find your people. Like Eric has said in the very beginning, being able to have that community of people, whether it's a community like the Uncharted community and shameless plug for us, because it is a space that I would not have survived in the clinic without in the last few years. But whether it's your local people, another manager near you, someone you meet through an online group, you know, whether it's an organized, established association, the, you know, the tech association, NAFTA, like, VHMA, wherever you find your peers.

Get a support system because you need someone to be able to bounce those things off of and just like in your personal relationship, everybody needs those friends who will look at you and say, I love you and you're wrong, or I love you and you're being an a hole. Or, you know, like everybody needs those people in their lives.

And our career is no exception. You need to find your people who will say, Hey, and do it with kindness and grace to your point. And that's what I love about Uncharted.

Erica Pounds: Thank you.

Stephanie Goss: Is it like, have you thought about this other or this other perspective and chat, you know, the people who will challenge you and ask you to get curious and ask what else could this mean?

So anyways hopefully we will see you all soon. Take care, everybody, and have a great rest of your week.

And that's a wrap on another episode of the Uncharted Podcast. Thanks for joining us and spending your week with us. If you enjoyed this week's episode, head over to wherever you get your podcasts and leave us a review. It's the best way to let us know that you love listening. We'll see you next time.