Taking the Time To Recognize Physicians

Exemplary leaders understand the need to recognize contributions and are constantly engaged in these essentials: 1) focus on clear standards; 2) expect the best; 3) pay attention; and 4) personalize recognition. --The Leadership Challenge, Kouzes and Posner¹

Many business leaders today recognize the importance of acknowledging good results and reinforcing positive performance. But, to get results, leaders must also create a work environment where staff members enjoy coming to work and want to contribute and do their best.

In the personal-best case studies conducted by Jim Kouzes and Barry Posner for their book, The Leadership Challenge, many people reported working very intensely and for long hours--and enjoying it. However, to persist at such a pace, people need encouragement. Or, as Kouzes and Posner say, they need the heart to continue the journey.¹ One important way that leaders give heart to others is by recognizing individual contributions. Many people rate "having a caring boss" even higher than they value money or fringe benefits. By putting these four essentials into practice and by recognizing contributions, leaders stimulate and motivate the internal drive within each individual. All of these learnings apply to frontline physicians as well as physician-leaders.

"Physicians are often thought of as being autonomous and self-motivated," notes David Shearn, MD, Director, The Permanente Medical Group (TPMG) Physician Education and Development. "The fact that, as physicians, we continue to do fantastic work, whether we're recognized or not, is hardly justification for not taking notice. There's no doubt that recognition makes a difference."

Recognition can range from a simple thank you to a formal award. There is also a proven correlation between recognition and staff member satisfaction, and recognition is seen as a key driver of overall satisfaction as measured on both the Physician Work Life Survey and the Kaiser Foundation Health Plan (KFHP) People Pulse Survey. So, what are some ways to recognize our colleagues?

Professional Development

Facilitative Leadership, Interaction Associates: Boston, 617-234-2700; or San Francisco, 415-241-8000
Center for Creative Leadership: 336-545-2810 or www.ccl.org
Play to Win: 1-800-Play2Win or www.pecosriver.com
Medicine and Management: for new chiefs and physician leaders. Contact Associate Executive Director (AED) for Professional Development
Middle Management Leadership Program:
Contact AED for Professional Development
Permanente Federation Continuing Education (information on Middle Management and Medicine and Management):
http://kpnet.kp.org/permfed/Education
TPMG Physician Education and Development: www.tpmgphysicianed.org
CPMG Department of Education: www.kpcolorado.net/ed_cme/ed_index.htm
NWP Continuing Medical Education and Professional Development: http://internal.or.kp.org/cme/index.html
TSPMG CME Learning: http://kpnetz.kp.org/ga/learning/cme.html
HPMG: http://web.hi.kp.org/med-education/
Contact Debra Mipos, Director of Physician Training and Development at The Permanente Federation, 510-271-5845, to arrange training for teams or groups

Patty Fahy, MD, Associate Medical Director for Human Resources at Colorado Permanente Medical Group (CPMG) notes that they put a real focus on recognition. She feels that physician recognition has been a big part of CPMG's cultural turnaround in the past four years.

"It's really not part of the physician culture to have a strong propensity for rewards and recognition," notes Dr Fahy. "Our executive team tries to model recognition behaviors. If we hear about an incident that exemplifies exceptional performance or demonstrates an especially caring manner toward patients, we will send a voice mail or a card to that physician," says Dr Fahy.

Tom Janisse, MD, Associate Medical Director at Northwest Permanente Medical Group (NWP) says it's important for physicians to recognize and celebrate their colleagues too. "Authentic celebration is a matter of intention and attention," he notes, citing a reference from the book The Human Equation: Building Profits by Putting People First, by Jeffrey Pfeffer.² The intention of the leader is, to convey appreciation and value; to build others' confidence; to foster a safe and supportive environment; and to model the behavior for others to emulate. The attention of the leader is on things that people do that deserve acknowledgment; finding out and using awards that people value; and acknowledging small successes as well as large.²

Recognition can start as soon as a physician joins the Medical Group, eg, through introductions at a department meeting and communications in a local newsletter. At CPMG, new physicians receive a gift basket. At The Southeast Permanente Medical Group (TSPMG) new physicians are assigned to a physician-sponsor who has been given funds to take physicians and their families out to dinner and personally welcome them.

Some recognition activities are team-based, whereas others recognize individuals for their achievements, either through performance feedback or specific awards. And, sometimes the recognition is serious, such as a black-tie event--others are purposely humorous and downright silly.

Lee Jacobs, MD, Associate Medical Director of TSPMG, believes that the most effective recognition is timely and personalized expression of appreciation. In light of Kaiser Permanente (KP) Georgia's team-based structure, this is best accomplished by team leaders because they are in the best position to recognize their team members on a regular basis.

In 2000, CPMG created an annual dinner celebration geared to recognizing CPMG as a whole and celebrating the achievements of individuals. "It's a very upbeat celebration of the talents of our group, where we give out serious and fun awards, such as 'rookie of the year' or 'best-dressed male or female physician.' They are designed as a series of lighthearted awards with a quite explicit message that these are superior Permanente physicians, who exemplify the character of the doctor's doctor," explains Dr Fahy.

After the fun awards, the celebration continues with awards for diversity champion, teacher of the year, and then culminates in the Permanente Awards, their highest recognition, which are awarded to several CPMG physicians a year for superior performance. Photos are taken at the event and are then displayed in the physicians' work area and at the regional offices.

NWP created a service milestone recognition program about five years ago to recognize physicians who had reached a milestone. Milestones are marked at five-year points and there is an annual retreat for physicians who have 10, 20, and 30 years of service. The milestone program features a dinner where families are invited and each physician is given a personalized ceramic (celadon) commemorative plate. The message conveys, "What you do every day, all day long, is outstanding and includes heroic moments. We want all our physicians--not just committee chairs or physicians in leadership positions--to know we recognize them for their outstanding work with our patients and members," says Dr Janisse.

The final part of the milestone award is when Dr Janisse personally sends a card to the physicians noting their milestone and thanking them. If a physician can't attend the milestone ceremony, Dr Janisse will find them at work and present them with their milestone plate and a thank you. This personal visit has now expanded so that other NWP physician-leaders also deliver the plates and a thank you. Notes Dr Janisse, "This is an example of how to integrate recognition into our work as leaders."

TSPMG also has an annual black-tie event, the Medical Group's primary KP recognition event. The highlight of the awards is the award for the "High-Performing Team," and the winning team receives a Medical Director's Cup that rotates among the winning teams each year.

The KP Colorado Region has had an extensive rewards and recognition program on the Health Plan side for some time. One of its key recognition programs is the Summit Seeker Program, an informal immediate recognition certificate (with room for a personal handwritten message) which recipients can then use to trade in for a gift certificate. CPMG leaders have now distributed Summit Seekers certificates to physicians and physician-leaders and are actively encouraging them to use this informal recognition, especially with their nursing staff. "We take them [the certificates] on the road with us and give them to physicians when we are invited to a clinic meeting, and we distribute them at our management training classes," notes Dr Fahy. CPMG has also created "recognition toolkits" for physician-leaders to use. The toolkits contain thank you cards, "Way to go!" certificates, and many recognition ideas and reminders. "My favorite line," Dr Fahy says, "is that recognition should be personal, timely, specific, and linked to organizational goals."

Also, executive team members at CPMG, hand out fleece jackets or long-sleeved polo shirts to physicians who have received top Art of Medicine scores from their patients.

Eight Great Things You Can Recognize

When a colleague goes above and beyond to help a patient or fellow colleague.
When a colleague does something that helps you directly.
When a colleague makes a difficult diagnosis or performs a tricky procedure.
A positive comment a mutual patient makes about a colleague.
A colleague's academic accomplishment, such as publishing a journal article or giving a lecture.
A colleague or mentor who has been supportive over the years.
A Module Leader, Chief, or PIC who shows effective or inspirational leadership.
A simple act of kindness or thoughtfulness.

Another important piece of recognition is performance feedback. As noted in The Leadership Challenge,¹ people's motivation to increase their productivity on a task increases only when they have a challenging goal and receive feedback on their progress. Here is where the importance of performance feedback comes in. Encouragement is a form of feedback. It's positive information that tells us that we're making progress, that we're on the right track, and that we're living up to the standards.¹

As Dr Jacobs notes, "You can't put yourself in the position of giving only negative feedback unless you also give positive feedback." He adds, "The real appreciation is the sense that you are valued at the local level--regional recognition is a bonus."

At CPMG, Dr Fahy says that after reading performance evaluations, executive team members will often send personal notes or voicemail to the physician and a copy to the person who wrote the evaluation. "I think it's important on a number of levels," says Dr Fahy. "I believe it reinforces the behavior of completing performance evaluations, and when someone has excelled in their performance, it lets them know we are paying attention. Sending a copy to the physician-in-chief also reinforces the leadership qualities we ask of our physician-leaders."

Eight Easy Ways to Recognize a Colleague

Thank them in person.
Drop a handwritten thank you note in their mailbox.
Send an e-mail.
Make a phone call--leave a voice mail message if necessary.
Mention their accomplishment(s) at a department meeting.
Treat them to a cup of coffee or lunch.
Send a note to their Chief.
Use an existing program in your region, such as CPMG's Summit Seekers.

Another way to provide recognition is by offering professional development opportunities such as having a physician represent a specialty or region in an interregional problem-solving team, seeking out internal development programs through regional training and development departments (eg, the Medicine and Management program), attending clinician-patient communication workshops, or having physicians attend a valued external program, such as Play to Win.

Recognition can be as easy as a simple thank you. Be creative. Be spontaneous. Find people who are doing things right.


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