Communication

Navigating Healthcare: The Importance of a Hospital Advocate

/ Jonathan Sachs

Working for the last decade in large hospitals, I get calls. Even though I am not a doctor or nurse, family and friends call when they get sick. All are experiencing some combination of being scared, stressed, and confused by how healthcare works in the United States. They generally ask for advice about how to navigate being a patient.

I always give them the same advice:

Make sure you have someone advocate for you while you are in the hospital.

I will share in this post why I absolutely hate having to give this advice and what can be done about it.

Why it is Important for Patients to Have a Hospital Advocate

Family and friends can serve as hospital advocates

Hospitals are busy places. They are designed to care for the sickest of the sick. A good rule of thumb is if you feel like you are not getting enough attention at a hospital, it means that your doctors do not consider you among the sickest patients in the hospital.

So that’s the good news.

With that said, it can also mean long wait times for simple tests, bumps in the operating room causing your surgery or procedure to be postponed, and limited face-time with your care team. Unfortunately, these delays are all patient dissatisfiers and the uncertainty involved can be stressful to anyone receiving care.

There are many reasons why hospitals operate this way, many of which are economic and operational, so I won’t get into that for this post. (Although if you want to know, just ask, I’d be happy to hear from you).

Because of these factors, navigating care at a hospital can be difficult. Furthermore, The patient in the hospital is usually in a compromised and vulnerable state. They are sick, medicated, in pain, anxious, bored, and sleep deprived, among other things.

That is why you need an advocate in the hospital.

The Best Hospital Advocates

The best advocate for a patient is generally a family member or a close friend. For more complex cases, there are for-hire patient advocates who are usually trained medical professionals.

Sometimes, there is an employee or volunteer affiliated with the hospital called a “Patient Advocate” or “Patient Representative.” These roles range in functions from risk (Dealing with the threat of legal action) to service recovery (Trying to fix a patient’s experience reactively) to ombudsman (Listening to patients and investigating issues to correct them for future patients).

Unfortunately, many hospitals cannot provide someone to advocate for your needs as a patient like a family member or friend can. The simple act of walking over to the nurse’s station, getting to know them, and asking questions about your loved one’s care can go a long way to helping to improve a patient’s care.

To check myself on this advice, I have asked former colleagues of mine what they think about it. Almost universally, doctors, nurses, and administrations I speak with agree with this advice.

The best thing you can do as a patient is to have someone with you to advocate for giving you care and attention while you are in a hospital.

The Downside to a Friend or Family Being a Hospital Advocate

Within the last 13 years, my father, mother, and sister have all been neurosurgery patients. Without exception, during any hospital stay, none of them were alone for any period of time. When my father had emergency surgery, my mother never left the hospital and vice versa. My mother stayed with my sister during the entirety of her multiple hospital stays as well.

At first, I thought they were crazy. But, having now worked in hospitals, it is clear to me that this had major benefits to each of them as patients. Furthermore, the nurses and physicians welcomed the help. My mother and father refilled water, brought up food, and helped to make sure the room was tidy. These responsibilities almost always fall to a nurse or another member of the care team.

In fact, during the COVID-19 pandemic, we frequently heard from doctors and nurses that patient experience was worse when family members were restricted from visiting.

However, this schedule was not without cost. Both of my parents are self-employed and had to miss work and reschedule other life events. They often slept upright in an uncomfortable chair. They didn’t shower. The stress they felt was palpable. While they appreciated the people on their care team, they didn’t trust the hospital to take care of them.

It shouldn’t have to be like this.

I often say that my life’s work as a leader in healthcare is to create an environment where I wouldn’t have to give this advice.

In this reality, family and friends can stay with a patient, of course, but could feel confident that their love one is in good hands. That they can go home and shower, sleep in a bed, and work knowing that the people at the hospital care about their loved one.

What Can be Done?

Fundamentally, patients need an advocate in the hospital due to a lack of trust.

Hospitals generally don’t do a great job building trust. Hospitals are almost always running late and timelines get missed. Doctors and nurses are overworked, rushed, and often burned out. It is difficult for doctors and nurses to empathize with patients because of the mundanity effect, which happens when something extraordinary (like caring for patients and saving lives) becomes routine.

From my point of view, the solution here is three-pronged:

  1. Fix the aspects of the hospital operation that make doctors and nurses jobs unnecessarily difficult or that take them away from patient care.
  2. Create and enforce behavioral expectations for how doctors and nurses treat patients and family members.
  3. Create ways for patients to see more of their doctors and nurses.

While this list is pretty easy to type out, actually making these changes could take decades. Most hospitals are still operating under business strategies and process improvement models from the 1980s. Remember, healthcare is highly regulated and complex. Making change doesn’t take weeks, months, or years. It usually takes decades.

The issues in healthcare are systemic and ingrained. There are many large stakeholders involved in the system today including large care providers, insurance companies, health plan administrators, etc. Large players like Amazon and Walmart are even trying to disrupt this behemoth of an industry, which has been notoriously hard to do.

Trying to change or cure the underlying diseases of healthcare has too long of a time horizon to make meaningful change for struggling patients and families today.

The Role of Technology

Luckily, technology can help with #3 – Create ways for patients to see more of their doctors and nurses.

This is why I made a career change recently.

I recently joined a company called WUWTA (pronounced “What-ah”) as their CEO. I first met WUWTA co-founder and Chairman of the Board, Jock Putney, when I was Chief Experience Officer at Robert Wood Johnson University Hospital.

On the WUWTA platform, physicians can guide patients through their healthcare journey personally from referral to discharge and follow up appointment. When I led Patient Experience, I spoke to patients every day. They desperately wanted more of their physician’s time and often were so excited when the physician spoke to them, they could not retain what the physician said!

WUWTA addresses this patient experience pain point simply. At each stage of the patient’s journey, the patient gets a video from their physician, explaining their next step in simple terms. The WUWTA platform enables doctors to hold a patients hand digitally and at scale.

Platforms like WUWTA are the necessary interim step to helping patients have a better experience without having to immediately address every systemic healthcare system disfunction.

After meeting with Jock, I felt so passionate that WUWTA represented a way forward to make healthcare better for patients, that I left RWJ to join the company.

What’s Next

We are far from my dream of a hospital system where having an advocate would not be necessary. Technology offers an important interim step to achieving this goal.

My belief is that it is a good thing that technology has enabled patients have access to more information. As the healthcare system continues to shift to be more consumer centric, patients will use that information to demand a better experience. That is when real change will happen faster. I am excited to be a part of it.

Key Takeaways

A hospital advocate is essential for patients navigating complex healthcare in the US, ensuring personalized attention and care in busy hospital settings. Technology platforms like WUWTA provide interim solutions by improving patient access to doctors, empowering them with information, and enhancing their healthcare experience.

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Team Accountability Isn’t What You Think it is

/ Jonathan Sachs / 1 Comment

The idea of team accountability is important, but often misunderstood. Many organizations struggle to hold people accountable. Leaders must have a good understanding of accountability to be an effective leader.

Gone are the days of rewards and punishments to drive team accountability. When most leaders discuss “holding people accountable,” they usually mean terminating low performers or punishing them in some other way. Accountability, by this definition, does not work. Instead, it becomes a recipe for turnover and disengagement.

When Accountability is Confused with Punishment

When I speak with leaders, especially leaders in middle management, there is frequent frustration around team accountability. What they tend to talk about as we unpack accountability is dissatisfaction about politics, treatment, and behaviors. Other leaders want to tie accountability to performance, similar to how General Electric CEO Jack Welsh used “Stack rankings” in the 1980s. In this model, the bottom 10% of performers would be fired at years’ end.

Tying team accountability only to outcomes is problematic because it discourages appropriate risk-taking. In addition, even high performers miss targets for legitimate reasons. While there needs to be recognition that the person did not meet their goals, punishing them is usually unwarranted. Tactics like “Stack rankings” are ineffective due to their short term orientation and punitive nature. “Stack rankings” only served to create a cut-throat and disengaged culture.

So that brings us back to the middle manager definition of team accountability. What they refer to when they describe a lack of accountability is witnessing inconsistent treatment based on favoritism, rude behavior, or a lack of performance among their peers with no obvious consequences. Using that as a starting point helps us to better understand how effective leaders understand team accountability.

Working-Definition of Team Accountability

With these leaders in mind, my personal working definition of team accountability involves two aspects: Empowerment and Transparency.

Team Accountability is really about empowerment and transparency

An organization cannot have accountability without empowerment. If leaders are not able to creatively and uniquely develop strategies and tactics to achieve their goals, accountability is not possible. There must be space for leaders to maneuver in an organization. This means that senior leaders need to set clear performance goals and expectations for behavioral standards that all team-members must follow. Leaders should have plenty of room to achieve their goals within those well-defined boundaries without being micromanaged. Creating a clear boundary like this simultaneously encourages mid-level leaders to think more like owners of their book of business, rather than managers executing someone else’s playbook.

Effective leaders use transparency as the other powerful tool in creating a sense of team accountability. By publishing relevant data regularly, it becomes abundantly clear who is high performing and who is not. In these instances, the healthiest cultures will see high performing leaders helping lower performing leaders. Further, the leaders who are struggling are aware of it and are given additional help and support.

When empowerment and transparency occur together, there is rarely a need for punishment. Everyone in the organization understands the expectations and whether they and their teams are meeting those expectations. In these cases, the conversations around accountability almost disappear. This is because often these organizations are achieving their goals and because the organization’s expectations around performance and behavior are communicated openly and repeatedly.

Using Accountability in your Leadership Practice

When a leader defines accountability as the sum of empowerment and transparency, they can achieve incredible results. I know this from personal experience. I once inherited a team that was low performing and high-drama, often asking for accountability for other team members. When we introduced clear boundaries for empowerment and transparent weekly data reporting, we never heard about accountability again.

The desire for accountability is usually a symptom of under-defined expectations and a lack of transparency. Using this model, leaders can have an immediate impact of getting the team focused on what matters most: Driving results and growing the organization in a way that supports and empowers the employees of that organization.

Key Takeaways

Team accountability is the sum of a culture that has empowerment and transparency. Clearly defined goals and behavioral expectations, coupled with transparent reporting, help to create clarity and focus on results.

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Reconnecting Teams to their Purpose Through Daily Inspiration

/ Jonathan Sachs / 2 Comments

One of the most under-appreciated skills that talented transformational leaders possess is the ability to inspire their team daily. Even some of the most challenging and important jobs, like a clinician saving lives or an engineer working on a spaceship can become routine or monotonous.  Talented transformational leaders help team members see the importance of their work even when it becomes regular and normal to them.

Leaders use inspiration to motivate teams and combat the mundanity effect

This phenomenon is known as the “Mundanity effect.” The “Mundanity effect” describes how an activity can begin to feel less exciting or special and instead seem more routine or ordinary. It has been studied in cases like business ethics, emergency rooms, and Olympic athletes, all with negative effects if not addressed.

That is where the leader comes in. Providing daily inspiration can help connect team members reconnect to the exciting parts of their work.

One of the best examples of using daily inspiration in practice is from Ritz-Carlton hotels. Every day, all Ritz-Carlton employees across the world participate in a 10 minute meeting called the “Lineup”.  The lineup consists of four agenda items: Review the Ritz-Carlton gold standards, share stories of great guest service, celebrate birthdays and work anniversaries, and discuss property specific information. The first two topics are standardized and are usually developed at least one year in advance.

One of the goals of the lineup is to showcase memorable examples of exceptional customer service, a hallmark of the Ritz-Carlton. These include stories like Chris Hurn’s about his son’s favorite stuffed animal, a giraffe named Joshie. Chris’ son accidentally left Joshie behind at the Ritz Carlton in Amelia Island, Florida. When the hotel staff found Joshie, they didn’t simply box the stuffed animal up and send it back to Chris’ son. Instead, the Ritz-Carlton ladies and gentlemen (how they refer to their employees) produced a photo book of scenes showing Joshie having an “Extra long vacation,” like hanging out by the pool or driving a golf cart. This story shared an example of incredible customer service and inspired the team to create moments like this one for other guests.

A leader helps to communicate to team members that what they do matters. Leaders show that the work people do every day has meaning, especially for the customer.

The Ritz-Carlton understands the value of daily inspiration to combat the “mundanity effect,” but most organizations to not provide similar resources to leaders. It can be difficult for leaders to find inspiration to share with their teams daily. Luckily, there are variety of resources to help leaders inspire their teams, such as books of inspiration and daily 365 books like the Daily Stoic or the Daily Drucker.

Still, the best sources of inspiration will come from the leader’s and team’s experiences with their customers or with each other. Leaders should continually keep their eyes open for inspiration, collecting customer feedback that can be shared with the larger team. A leader should know their team members well enough to figure out what material will connect them to purpose and seek out relevant examples.

The ability to inspire is an undervalued characteristic of high performing leaders. While it is not intuitive for every leader to find or share inspirational stories, it is a skill that leaders can certainly use more often. Whether it is a customer story or inspiration from a book, leaders should not avoid this responsibility and fall victim to the “mundanity effect.”

Key Takeaways

Leaders use daily inspirational messages to keep their team members connected to purpose. They can find daily inspiration to share with their teams through a variety of resources like customer stories and books.

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3 Ways New Leaders Can Start Strong

/ Jonathan Sachs

Impactful leaders are usually excellent listeners, able to organize lots of information, and communicate effectively. To master those three skills over time, there are a few things new leaders need to know and understand at the outset.

First, a new leader will usually inherit a team and that team’s current results. In these cases, assumptions are your biggest enemy. Do not assume that because the area you are leading is achieving its desired results now, the success will last forever. Do not assume that the team was achieving results because it was being led well. In fact, assume as little as possible. Learn as much as you can.

How New Leaders Can Start Strong

Build Relationships

The first few months for any new leader is about developing relationships and educating themselves on the department. The first few months will be focused on getting to know your team, supervisor, peers, and customers. By approaching conversations with those groups with authenticity and curiosity, letting them also get to know you in the process, you will be off to a great start. Engage with everyone you can during those first few months. Have lots of coffee and lunch dates. Meet with groups and meet with individuals. Ask lots of questions. Listen twice as much as you talk.

In some cases, a new leader will be starting a new department from scratch. The rules here are a little different. Learning as much as possible about the goals and expected deliverables will serve a new leader well in this context. Action planning based on those goals and resources will be an important next step.

Define the Work

Second, define the work. Answer the following questions. If you do not know the answer, start by asking supervisors, colleagues, your team, and your customers for their perspectives. Remember, these are their perspectives, not facts:

  • What results am I responsible for?
  • How are those results measured and in what timeframe?
  • Who are my customers? What would I like my customers to say about their experiences with my team? How is the team currently meeting customer expectations?
  • What is the value of my area of responsibility to the business? If my area of responsibility did not exist, what would it mean for the business?

Change Your Mindset

Third, a new leader must change their mentality from being that of a guest to that of a host. Simply coming to work, doing your job, and going home will not be enough in most leadership roles. To clarify, I am not suggesting that you will be working longer hours or will never have any time for vacation, but you are taking on a much more demanding set of responsibilities.

Instead, when anything happens impacting your new area of leadership, it is your responsibility to identify problems and come up with solutions. When something is going well in your department, you can explain why it is going well because it was intentional on your part. When something is not going well, you own both the problem and the solution to improving it in a lasting manner.

While you are still expected to operate in your scope, your direct supervisor is likely leading multiple areas of responsibility. The good supervisors will count on you to know what you are empowered to do with your team and what requires your supervisor’s permission. In instances where your supervisor has ultimate decision-making authority, most will appreciate giving them multiple options and thinking ahead about the possible consequences, both positive and negative, for each option.

In leadership, especially in a first role as a leader, it is important that new leaders get to know their area of responsibility top to bottom, which means understanding how each part works separately and together. As a leader learns the different parts of the business, they should also focus on the following areas where results may be expected of them and their teams.

Key Takeaway

Strategies for new leaders to succeed include avoiding assumptions, developing relationships, defining goals and responsibilities, and taking ownership of both problems and solutions. Effective communication, learning, and a mindset shift from being a guest to a host will help new leaders have a greater positive impact in their new role.

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Why Dr. Cox is the Leader in “Scrubs”

/ Jonathan Sachs

One of the goals of this website is to make leadership accessible. The world needs more leaders to facilitate solving our most complex problems as a society, and evidence of quality leadership can be found all around us. By analyzing tv shows and movies, I hope more people will want to learn more about what it takes to be a leader and pursue leadership for a noble cause.

Let’s discuss “Scrubs,” one of my favorite tv shows. Scrubs is a medical comedy-drama television show that aired in the early 2000s. Set in the fictional Sacred Heart Hospital, the show follows the daily lives of the medical professionals, including doctors, nurses, and other support staff.

Among the show’s cast of characters are several who embody different leadership qualities. Dr. Perry Cox, played by John C. McGinley, stands out as the leader of the group. In this article, we will explore why Dr. Cox is the leader of the “Scrubs” characters and what we can learn from his leadership style.

Dr. Cox from the TV show "Scrubs" teaches us lessons in leadership
SCRUBS — NBC Series — Pictured: (clockwise from bottom left) Judy Reyes as Nurse Carla Espinosa, Donald Faison as Chris Turk, Sarah Chalke as Elliott Reid, John C. McGinley as Dr. Phil Cox, Ken Jenkins as Dr. Bob Kelso, Zach Braff as John “JD” Dorian — NBC Photo: Paul Drinkwater

Dr. Cox’s Approach to Leadership

Dr. Cox is a senior attending physician and mentor to the show’s protagonist, Dr. John “JD” Dorian, played by Zach Braff. He has a sarcastic and quick-witted personality. For those of you who are reading this and have watched the show, you may struggle to view Dr. Cox as a leader because of his behavior. However, in spite of some of his course behavior, he demonstrates a strong sense of empathy and commitment to his patients and colleagues. He is the kind of leader who leads by example, inspiring others to be their best selves, and he supports the younger doctors over the course of the show.

To start, Dr. Cox teaches us how leaders are relatable people, who have both strengths and weaknesses. Dr. Cox comes off as mean, sarcastic, and demeaning. For example, he calls JD by a different women’s name every time he talks to him in an attempt to belittle him. While that behavior is clearly unacceptable, the characters largely ignore it because of Dr. Cox’s other leadership qualities. Of the characters in the show, there are things to learn from Dr. Cox about leadership despite his behavior on the surface.

One of the key traits that sets Dr. Cox apart from his colleagues is how he is an effective mentor and coach. While he, at times, belittles JD, he is always there to support him. In the pilot episode, Dr. Cox supports JD to insert an IV into a patient and helps give him the confidence to perform that task himself. Another trait he embodies is how to praise people with impact. Since he does not praise the other characters often, it is special and meaningful when he does so.

Dr. Cox also creates psychological safety for the team. Most characters, including JD, are not intimidated by his prickliness. At one point he tells JD, “I know you’re not technically family, but you’re my family.” This statement shows Dr. Cox’s ability to make others feel valued and included, which is important for building a strong team.

Dr. Cox is also a strong advocate for his patients. He goes above and beyond to ensure that they receive the best possible care. For example, in one episode, he fights to keep a patient in the hospital, despite the fact that the patient’s insurance will not cover the costs. This demonstrates Dr. Cox’s commitment to his patients and his willingness to stand up for what he believes is right.

Why other Characters are not Leaders

In contrast to Dr. Cox, JD does not lead very often during the course of the show. JD, played by Zach Braff, is a well-intentioned but often bumbling young physician, who is still learning the ropes of being a doctor. While JD is a popular and likable character, he does not demonstrate the qualities that make for a successful leader. He is an effective follower though, often following Dr. Cox’s advice.

Dr. Bob Kelso, played by Ken Jenkins, is another character who is not a leader in the show. Despite being the Chief of Medicine at Sacred Heart Hospital, Dr. Kelso’s leadership style is transactional. He is more interested in maintaining his power and authority than in helping his team succeed.

Dr. Kelso is also inauthentic, calling the young physicians nicknames like “Sport” and “Sweetheart,” because he does not want to learn their names. He frequently belittles the other physicians to maintain his power and authority.

Carla, played by Judy Reyes, is a helpful individual contributor, which is noble. The group of characters would not function effectively without her. Carla plays an important role among the other characters usually brokering peace and keeping the group together.

Turk is a surgeon and is probably the most social person in the group. Played by Donald Faison, Turk provides elements that keeps the group together like comic relief, emotional support for the other characters (especially JD), and nurturing his relationship with Carla. Turk is another important member of the group but is not a catalyst for change or a mentor that helps the other characters grow and develop like Dr. Cox is.

Finally, Eliot, played by Sarah Chalke, is not a leader in the show. Eliot lacks the confidence and assertiveness needed to lead others. She is often portrayed as indecisive and passive, and she is not able to take charge when the situation calls for it.

Despite his gruff demeanor, Dr. Cox stands out as a leader among the cast of characters on “Scrubs.” Dr. Cox is a leader because of his ability to connect with his team, his commitment to mentorship and coaching, and his honesty.

He leads by example, setting a high bar for others to follow, and he is unafraid to speak his mind and provide candid feedback when necessary. While other characters may hold positions of authority within the hospital, they are not leaders. By studying Dr. Cox’s leadership style and characteristics, we can learn valuable lessons about what it takes to lead a team to success.

Key Takeaways

Dr. Cox, a senior attending physician and mentor in the show “Scrubs,” embodies certain leadership qualities because he connects with his team, is committed to mentorship and coaching, and creates safety. He leads by example, sets a high bar for others to follow, and is unafraid to provide candid feedback. Examples of leadership can be found everywhere, there are always lessons to learn and reflect on.

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