Thread by @cacace_frank

1/ #medtwitter #twitternists #proudtobeGIM

I've been sitting on a @SocietyGIM #sgim19 debrief #medthread since the meeting, and thought I might finally take a swing at it - here goes ..

I am considering whether I can do more division/systems leadership in coming years .. ->

2/ Theme of the conference was 'Courage to Lead', and single best workshop for me was :

Leading Change: Tools/Tips for Change Management

Crediting Alfred Burger, Emily Fondahn, Brent Petty, Nathan Spell, Dan Steinberg - can't find them on Twitter, so giving proper 🗣🗣.

3/ would like to share key concepts for all of us trying to lead in academic medicine or in #advocacy spaces.

First key Slide/thoughts:

The hard stuff - barriers to change .. ->

4/ Inertia - what's 'steady/stable'. Inhibits disruptive thinkers/thinking ... I think often 'steady and stable' for our divisions/departments also means bringing 💲/funds

Change Fatigue - we need to plant the seed of #PDSA #joy, align improvement cycles 2pts/learners to ease->

5/ Complexity - peel back the onion and then attend to each layer w fishbone, e.g.

Call out programmed behaviors not aligned to pt/learner/team centeredness.

Reject misaligned goals counter to the right change ..
-> the CMS CHF readmission penalty program mess comes to mind

6/ real/perceived limitation of resources

The important work of philanthropy

Advocating for reallocation of funds in an organization or society

Transparency of #GME funds within our departments/divisions comes to mind

7/ 'yet another thing to do' fatigue :

Leaders need to state/galvanize for the WHY - what's the patient, learner, physician, team centeredness of the change

Next hugely important slide for change management for me:

.... ->

8/ OK Kotter #leadership for change - LOVE this stuff ... so helpful to clarify my thoughts

Create sense of urgency:

#insulin4all - type 1 DM #patients rationing/dying
#asthma maintenance meds not made affordable
#burnout/#moralinjury statistics in RNs, MDs, ALL of US! ->

9/ lives lost b/c of insistence on military weapon/magazine access

#VaccinesWork - measles outbreaks

Denial of humanity for half our #patients - #autonomy over her body threatened.

How are those for URGENT

10/ BUILD COALITION

So in academic medicine, & 4learner-advocates, have to know stakeholders better - trainees need advocacy curricula to access legislators, administrators. We need 2put HUMAN face to administrative spaces ->

#leadership dyad programs, hi potential programs->

11/ for coalition building, we need training in critical conversation, in leveraging #conflict to generate understanding and team growth, in conducting #negotiation where all parties leave not completely happy, but more aligned to patients, learners, teams ...->

12/ get the VISION right.

What's the right change - the hi value, just, pt driven, systems improvement over chair yoga driven change ....

the right change, not what's maximally profitable or what's status quo convenient

E.g., the vision of equitable leadership, diversity ->

13/ communicate the vision :

Sorta reminded of the #ACA (there's an old hashtag) - the individual mandate, the mechanics, the just outcomes sought, the means of funding were not communicated well enough

Once we've got our change - teach, publicize, use media well, get buy in->

14/ empower others

Change projects need inclusion, valuing of all team/professional perspectives .. need to be led from the bottom up. All patient care interested team members should have leadership skills brought out in them, not just the visioning folks at the top.

15/ find your short term wins & publicize them/make them known - know the folks w talent elaborating/tinkering/overcoming barriers. Once they've set up mini victory targets, pursue them 2build momentum.

Then-don't let up, make it stick. Priotitize sustainability strategies->

16/

Last, I promise - I found this workshop so pivotal, important for anyone thinking about #meded clinical #SDoH #advocacy #leadership, and for working to improve systems and physician influence re: #healthcare policy, just had to share.

Thx for indulging.

Fin/