One Thing Leads to One Thing Leads to AnotherAnother

Sonya Erickson, MD Sonya Erickson, MD

Robert Flora MD, MBA Robert Flora MD, MBA

Annamarie Connolly, MDAnnamarie Connolly, MD

The ChallengeThe Challenge

One Head Wearing Multiple HatsOne Head Wearing Multiple Hats

• ClinicianClinician• ResearcherResearcher• EducatorEducator• ScholarScholar• OtherOther

Not to Mention Our Non-Professional Roles Not to Mention Our Non-Professional Roles . . .. . .

Session GoalsSession Goals

Pragmatic Approach for Pragmatic Approach for

Converting Problems into OpportunitiesConverting Problems into Opportunities

While Building Bridges Between & While Building Bridges Between & Among:Among:

RolesRoles

Projects & Projects &

PeoplePeople

Session StructureSession Structure

IntroductionIntroduction (10 mins)(10 mins)

Interactive Problem Solving SessionInteractive Problem Solving Session (45 mins)(45 mins)

Report Back Report Back (15 mins)(15 mins)

Wrap-Up Wrap-Up (5 mins)(5 mins)

Building Bridges Between & AmongBuilding Bridges Between & Among

RolesRoles

ProjectsProjects

PeoplePeople

OtherOther

This Approach RequiresThis Approach Requires

Deliberate PlanningDeliberate Planning

CreativityCreativity

OpennessOpenness

This Approach RequiresThis Approach Requires

Deliberate PlanningDeliberate PlanningTime to thinkTime to think

CreativityCreativity

OpennessOpenness

This Approach RequiresThis Approach Requires

Deliberate PlanningDeliberate PlanningTime to thinkTime to think

CreativityCreativityTime to thinkTime to think

OpennessOpenness

This Approach RequiresThis Approach Requires

Deliberate PlanningDeliberate PlanningTime to thinkTime to think

CreativityCreativityTime to thinkTime to think

OpennessOpennessTime to reflect & adaptTime to reflect & adapt

This Approach RequiresThis Approach Requires

Deliberate PlanningDeliberate PlanningTime to thinkTime to think

CreativityCreativityTime to thinkTime to think

OpennessOpennessTime to reflect & adaptTime to reflect & adapt

Did we mention time?Did we mention time?

Setting the Process in Setting the Process in MotionMotion

Facing a Specific Task or ProblemFacing a Specific Task or Problem

Short Term: Regular ResponsibilitiesShort Term: Regular Responsibilities

Addressing Something Addressing Something UniqueUnique

Long Term: Major Research GoalLong Term: Major Research Goal

Obtaining PromotionObtaining Promotion

Setting the Process in Setting the Process in MotionMotion

Being cast into a group such as a:Being cast into a group such as a:

Pre-existing CommitteePre-existing Committee(Curriculum Committee)(Curriculum Committee)

Existing, But Loosely Structured NetworkExisting, But Loosely Structured Network(Clinical partners, APGO Colleagues, FF Grant)(Clinical partners, APGO Colleagues, FF Grant)

Group Created De NovoGroup Created De Novo

Example - Summa Health Example - Summa Health System/NEOUCOMSystem/NEOUCOM

The Challenge: The Challenge:

How to improve the clinical experience of How to improve the clinical experience of the Family Medicine residents?the Family Medicine residents?

The ProblemThe Problem

• FP rotation on Ob/Gyn most disliked FP rotation on Ob/Gyn most disliked rotationrotation

• Ob/Gyn residents did not enjoy having FP Ob/Gyn residents did not enjoy having FP interns on serviceinterns on service

Getting To YesGetting To Yes

1.1. Separate the people from the problemSeparate the people from the problem

2.2. Focus on interest, not positionsFocus on interest, not positions

3.3. Invent options for mutual gainInvent options for mutual gain

4.4. Insist on using objective criteriaInsist on using objective criteria

Roger Fisher and William Ury - 2nd ed 1991

Co-opetitionCo-opetition

1.1. A revolutionary mindset that combines A revolutionary mindset that combines competition and cooperationcompetition and cooperation

2.2. The Game Theory strategy that’s The Game Theory strategy that’s changing the game of businesschanging the game of business

Brandenburger and Nalebuff 1996

StepsSteps

1.1. Separate people from problemSeparate people from problem• Removed emotionsRemoved emotions• Defined issues from both departments Defined issues from both departments

2.2. Focus on interest, not positionsFocus on interest, not positions• Focused on needs for both departmentsFocused on needs for both departments• Used objective criteria - RRC requirements, current Used objective criteria - RRC requirements, current

shortfalls in Ob experience requirementsshortfalls in Ob experience requirements

StepsSteps

3.3. Invent options for mutual gainInvent options for mutual gain

4.4. Insist on objective criteriaInsist on objective criteria

IssuesIssues

FPFP• Not meeting their RRC Not meeting their RRC

requirementsrequirements• Competing with ER and Competing with ER and

medical studentsmedical students• No direction or goalsNo direction or goals• Unfriendly environmentUnfriendly environment

Ob/GynOb/Gyn• FP residents have FP residents have

variable interestvariable interest• Cannot depend on them Cannot depend on them

for callfor call• Do not know what they Do not know what they

needneed• Have to do work for FP Have to do work for FP

residents on their residents on their continuity OB patientscontinuity OB patients

• Rotation not contiguousRotation not contiguous

Options for Mutual GainOptions for Mutual Gain

• FP rotation is now 2 month blockFP rotation is now 2 month block

• Place on call schedule as additional Place on call schedule as additional residentresident

• Decrease ED and medical students on Decrease ED and medical students on L&DL&D

• FP residents have to see their own FP residents have to see their own continuity patients. Only consult OB continuity patients. Only consult OB residents if neededresidents if needed

Use Objective CriteriaUse Objective Criteria

• Specific goals and objectivesSpecific goals and objectives– Required readingRequired reading– Specific numbers of procedures identifiedSpecific numbers of procedures identified– Log to be signed by OB senior residentsLog to be signed by OB senior residents– Go to health department prenatal clinic with Go to health department prenatal clinic with

OB residentsOB residents

ResultsResults

• FPFP– Meets RRC requirementsMeets RRC requirements– Positive experiencePositive experience– Increase in Ob in-service scoresIncrease in Ob in-service scores– More residents doing 2nd year electiveMore residents doing 2nd year elective– More congenial atmosphereMore congenial atmosphere

• OBOB– Residents have accountability and ownership for Residents have accountability and ownership for

their educationtheir education– Look forward to having them on call (extra person)Look forward to having them on call (extra person)– ALSO course started in 2000ALSO course started in 2000

Obstetrics and Gynecology

Example: NEOUCOM Wrap-upExample: NEOUCOM Wrap-upBuilding Bridges Among & Building Bridges Among &

BetweenBetweenRolesRoles

ProjectsProjects

PeoplePeople

DepartmentsDepartments

Group ActivitiesGroup Activities

Creating a List of Problems / IssuesCreating a List of Problems / Issues

(10 minutes)(10 minutes)

Work in Small Groups to Convert Work in Small Groups to Convert Challenges into OpportunitiesChallenges into Opportunities

While Building BridgesWhile Building Bridges

(3 sites, 10 minutes each)(3 sites, 10 minutes each)

Group ActivityGroup Activity

The Problem / Issue: The Problem / Issue:

Primary Role in This Context: Primary Role in This Context:

Create a Project Plan or Map which Bridges:Create a Project Plan or Map which Bridges:

Roles - Roles -

Projects - Projects -

People - People -

Other - Other -

Group ActivityGroup Activity

The Problem / Issue: The Problem / Issue: Have to Give Grand Rounds

Primary Role in This Context: Primary Role in This Context: Junior Faculty

Create a Project Plan or Map which Bridges:Create a Project Plan or Map which Bridges:

Roles - Roles -

Projects - Projects -

People - People -

Other - Other -

Group ActivityGroup Activity

The Problem / Issue: The Problem / Issue:

Primary Role in This Context: Primary Role in This Context:

Create a Project Plan or Map which Bridges:Create a Project Plan or Map which Bridges:

Roles - Roles -

Projects - Projects -

People - People -

Other - Other -

Group Activity: Wrap Up ReportGroup Activity: Wrap Up Report

The Problem / Issue: The Problem / Issue:

Primary Role in This Context: Primary Role in This Context:

Create a Project Plan or Map which Bridges:Create a Project Plan or Map which Bridges:

Roles - Roles -

Projects - Projects -

People - People -

Other - Other -

Group Activity Wrap-Up: Product & Group Activity Wrap-Up: Product & ProcessProcess

• First RoundFirst Round

• Second RoundSecond Round

• Third Round Third Round

Group Activity: Wrap Up ReportGroup Activity: Wrap Up Report

The Problem / Issue: The Problem / Issue:

Primary Role in This Context: Primary Role in This Context:

Create a Project Plan or Map which Bridges:Create a Project Plan or Map which Bridges:

Roles - Roles -

Projects - Projects -

People - People -

Other - Other -

Learn to DelegateLearn to Delegate

Develop Yourself and OthersDevelop Yourself and Others

Be EffectiveBe Effective

Embracing & Applying TechnologyEmbracing & Applying Technology

Skype.comSkype.com

Unyte.netUnyte.net

Conference CallConference Call

ReferencesReferences

Fisher, et al. Fisher, et al. Getting to YesGetting to Yes. (1991).. (1991).

Brandenburger & Nalebuff. Brandenburger & Nalebuff. Co-opetitionCo-opetition. (1996).. (1996).

Johnson & Blanchard. Johnson & Blanchard. Who Moved My Cheese?Who Moved My Cheese? (1998). (1998).

Johnson & Blanchard. Johnson & Blanchard. The One Minute Manager The One Minute Manager (1983).(1983).

Covey. Covey. 7 Habits of Highly Effective People7 Habits of Highly Effective People. (2004).. (2004).

Avolio. Avolio. Full Leadership DevelopmentFull Leadership Development. (1999).. (1999).