Good evening, everyone. Thank you so much for joining us. We're just going to wait about a minute or two and let everyone join the call and then we'll go ahead and get started. Alrighty, we will go ahead and get started. First and foremost, thank you so much for joining us tonight for our National Grand Rounds event for February. So, this evening's event is titled Leadership Perspectives on Navigating the Terrain of Emotional Intelligence. And this evening we have Dr. James Sliwa, as well as Dr. Rachel Bracke. Great, I'm happy to take it away from here. I'm just, I'm going to transition my slide. I'm having some trouble transitioning. Give me just one second here. There we go. Okay, sorry about that. So, I'm going to just run through a few housekeeping slides. First and foremost, this activity is being recorded and it will be made available on the Academy's online learning portal. So, for the best attendee experience during this activity, please be sure to mute your microphone when you're not speaking. And additionally, you are encouraged, you are invited to keep your camera on and you can select hidden from video participants. So, this will make sure that speakers are prominent on your screen. If you're interested in asking any questions, we do encourage questions and we'll have about 15 minutes at the end of the presentation for a Q&A. Feel free to use the raise your hand feature and you can also unmute your microphone. We do find that the chat feature is the best option though, so we can keep track of those questions. So, please feel free to use that. And we do just want to let everyone know that time may not permit the panel to field every question, but we will do our very best to run through everything that we receive. Let's see if this wants to transition. There we go. So, just a bit about our Zoom features here. We have our mute and unmute, our start video, and then those reaction buttons. This is where you can find the chat. So, if you're interested in typing in a question, feel free to open that chat feature and type your response there. And again, the reactions, you can raise a hand, you can thumbs up, anything you may need to do. And then some more features here to unmute and things like that. Great. And without further ado, I'm going to hand it over to Dr. Brackey, who will be introducing Dr. Sliwa. Thank you so much. Great. Thank you so much. Well, welcome everybody to tonight's Grand Rounds. I'm really excited to hear from Dr. Sliwa on this important topic. As many of you know, emotional intelligence is a cornerstone of leadership training. And so, I think this is a great topic for really anyone, no matter what stage of your career you might be at. Anytime you're hearing a talk on leadership topics such as emotional intelligence, I think it's always helpful to know the background of the speaker. And so, I just wanted to briefly summarize some of Dr. Sliwa's leadership roles, kind of past and present, just so you understand some of the perspectives he's coming from. So, some current roles that he has, he serves as Professor and Vice Chair of Education in the Department of Physical Medicine and Rehabilitation at the Northwestern University Feinberg School of Medicine. He also serves as Chief Medical Officer and Chief of Quality and Safety and Director of the Physician Practice at the Shirley Ryan Ability Lab. He also is a Chair of the Quality and Research Committee of AAPMNR and serves as a board member in that role as well. In the past, he's also had many leadership roles. And just to shortly kind of summarize some of the key roles, he was Residency Program Director for over 30 years at RIC or Shirley Ryan Ability Lab. And has had two terms on the ACGME RRC for PMNR and also has had two terms as Director of the ABPMNR. So, he knows physiatry in and out. And I'm really excited to turn this over to Dr. Sliwa and happy to field questions at the end. Thank you. Let me share my screen here. Here we go. And we want to go to. We're just setting up the slides here. I think it may be under the slideshow tab, Dr. Sliwa, at the top. Yes, on the bottom. We got it. There we go. Oh, great. Thank you. Thank you. So first of all, thank you for the introduction. Thank you for the opportunity to present this at National Grand Rounds. And all of you that are listening, thank you for attending. You know, the topic today is the leadership perspective on navigating the terrain of emotional intelligence. And just by way of orientation, you know, there are experts and consultants on emotional intelligence. There are courses, et cetera, on these topics. Quite honestly, I'm not one of those experts on this topic. What I will share with you tonight, though, is what I have learned over my many years through the experience and kind of self-reflection and self-education. And it's the information that I found very valuable in my professional development. So my goal is to share with you what I have learned over the past 40 years. And if it is helpful to you in your development, or if it stimulates you to pursue more reading in the area, then I feel that I was successful on putting this talk together. I do wanna share one additional thought before we begin, and that is, you know, I will be sharing information about myself and actually some personal examples, situations that kind of highlight certain points, not because they are that remarkable or unique, but I believe meaningful. They were meaningful for me in kind of understanding and developing some skills. And I hope this will serve the same function for you. And if it seems this talk is like a little bit of a journey, it's because it probably, it was a journey, this learning and the experiences that I've had. So to start with, I have no disclosures. And these are the learning objectives for this talk. So understand the complementary roles of leadership and management, articulate the principles of emotional intelligence and its role in successful leadership, and apply the principles of emotional intelligence to a difficult conversation. Now, the very first concept that was critical in my kind of leadership development and understanding was an understanding of the difference between management and leadership. And leadership and management are really two distinct and complementary systems of action. Each has its own function activities and both are necessary for success. But if you look at management, it's really more planning and budgeting and organizing and staffing and controlling and problem solving, where leadership is really setting a direction, creating a vision, aligning people and motivating people. So management really kind of brings order and consistency. Without good management, there is chaos. Leadership brings change. And one of the ways that people describe this is doing the same thing 5% better is not always a recipe for success. So the important concept here is that management brings order and consistency and leadership brings change. Now, for most organizations, they need to grow and change to be successful. And again, doing the same thing 5% better is not always the recipe for success. So let me illustrate this with what I would consider to be some extreme examples. Okay. So this was McDonald's in 1953. And what you see on the right hand side is the menu. Things like tempting cheeseburgers, thirst quenching Coke. This was 1959 in McDonald's. Well, they were founded in 1940s by the McDonald brothers who actually worked very, very diligently to kind of improve efficiency and the quality of the burgers. In 1955, Ray Kroc became the franchise owner. And then McDonald's required the rights to the McDonald's brothers company. Well, 1965, they introduced the Filet-O-Fish and 1968, the Big Mac, 1973, the Quarter Pounder, Quarter Pounder with cheese. 1975, they started the Egg McMuffin and in 83, Chicken McNuggets, 1995, McFlurry, 2015, All Day Breakfast. And they went from 15 restaurants to now over 36,000 restaurants in over 100 nations. So if you think of this, you see that leadership is a vision, right? That they had a vision that doing the same thing 5% better wasn't the recipe for success. And that led a change in the growth of not only the McDonald's company, but really when you think about it, the fast food industry in general. Now, think about that and compare it to the McDonald's night manager who really is there for operations, okay? So what does the night manager do? Well, needs to make sure that there's staffing and that is, there's somebody making the, taking the orders at the window, making the fries, making the burgers, managing the drive-through. They make sure that indeed their operations are running smooth. There isn't a backup of patients. They check up on the stock to make sure they have everything they need. And then of course, they make sure that the store is clean at the end of the day and closed appropriately, right? So the manager prevents chaos, right? They prevent poor quality, right? And they ensure that the restaurant operates like it should. Now, when you think about this, most of us, or at least in my role, it isn't quite this distinct and quite this pure. I think we all do a little bit of management and certainly we do a lot of leadership. So then if you look at this concept, managers are really transactional leaders. That is they bring order and consistency to an organization. They oversee processes and we all probably do some of that. But leaders are transformational leaders. That's they encourage, they inspire, they motivate others to create change. And that's what helps grow and shape the future of the organization, just like McDonald's did. A success of the leader is determined by the success of the organization. The success of the CEO of McDonald's was determined by the growth of the organization. So leadership is a process of social influence, which maximizes the efforts of others towards the achievement of a goal, right? So key words, influencing, others, achievement, and a goal. Okay? A leader then gauges him or herself by how well that leader can extract, orchestrate, and utilize all the human talent available to them. It is not, can I always do the right thing myself, but rather how can I provide for the right thing to always be done? So then if we know the difference, right? Between a leader and managers and the overlap between the two, then what actually makes a leader? Okay? Well, first of all, technical skills and knowledge, right? That's creating a vision. But the higher you go, the less variation there is in technical skills or knowing what to do. The second thing is the ability, as we talked about before, influence others towards achievement of a goal. And that is motivating and aligning people. And that's what emotional intelligence is. So go back to the concept of the higher you go, the less variation there is. Think about this. In high school, you're in the top 10% of your class. It's quite a bit of variation in people's performance. And then you go to college and many more people in college were in the top 10% of the class. And the variation between knowledge skills is probably a lot less. Then you make it to medical school and probably the majority of people in medical school were in the top 10% or the top of their college class. And the variation between the level of knowledge is much, much less. And the same is true with CEOs of hospitals and department chairs, right? So to get to that level, to be a department chair, you have to understand the position. You have to have the technical skills and the knowledge. You have to understand what is needed. Absolutely, right? If you don't, you probably wouldn't have risen to that level. If you don't have it, you may not stay at that level, right? But what separates people is once again, the ability to influence others towards the achievement of a goal. So what is emotional intelligence then? Well, emotional intelligence is a type of social intelligence that involves the ability to monitor one's own and others' emotions. Your emotions, the others' emotions and to discriminate amongst them, okay? Because to discriminate among them and to use this information to guide one's thinking and actions. And that was actually a concept that was developed by two psychologists, Meyer and Salovey. And they developed this console after studying politicians and in struggling with the concept of individuals who are very intelligent and bright, but were not able to get things done. Well, this whole concept was really popularized by Daniel Goleman, who was a writer and applied this to the business world. And what he studied, he studied very, very successful business leaders. And he wrote in his article, What Makes a Leader? When he compared star performers with average ones in senior leadership positions, nearly 90% of the difference in their profiles was attributable to emotional intelligence factors rather than cognitive abilities. Again, they all knew what to do, but they needed to know how to do it. And he said, analytics and technical skills do matter, but mainly as threshold capabilities. That is, they are entry level requirements for executive positions. Emotional intelligence is a sine qua non of leadership. Without it, a person can have the best training in the world, an incisive analytic mind and endless supply of smart ideas, but still won't make a great leader. So emotions are a part of most, if not all interactions. And these are the major concepts of emotional intelligence, right? And we will talk about some of these in more detail, but things like self-awareness and knowing yourself, self-regulation, controlling or redirecting your impulses. And then there's the concept of management of others to get them to move along, influence them to achieve the goals that you want. And these are things what they call empathy or social awareness, considering others' feelings along with other factors in the process of making decisions. And then social skills, and that is the relationship management or building rapport with others to move them in the right direction. Now, a major, major concept here is self-regulation. And I'm gonna spend a little time talking about that right now, and that is controlling or redirecting your impulses. And reacting to what someone says can shut down the interaction and result in not achieving any good outcomes. So a major take-home point here is you want to respond to conversations and requests and not react to them. And let me give you a quick example of kind of running through this. So many years ago, I was approached by one of our clinicians who came up to me in my role as chief medical officer and said, you know, it seems like I'm getting more late admissions than everybody else. And I don't think that's fair. And I said, well, listen, I don't think it's fair either. I said, I would really like to look into this. You have any data? You have any data to help me support this so that I can then try to go back and figure out what's going on? And this was the email I got about four hours later. And the email said, well, what are you looking for with late admit data? I have raw data with my daily organization sheets, but I don't want to waste my time extracting info you do not want. Will this be utilized? Because again, I do not want to waste my time if it was just an off the cuff request. Now, I said earlier that there are emotions in most interactions. Well, yes, you know, and this evoked an emotion in me. But the point was, is that I didn't want to react to this email with my emotion. I wanted to respond to the email, right? So this was a trigger for me. And you need to identify what your triggers are when you start to feel you're reacting and not responding. This was a trigger. When someone questions my initiatives or my integrity, it is a trigger for me. When someone questions my initiatives or my integrity, it is a trigger for an emotional response. If I reacted with an emotional response to this, I would have shut down the interaction in the process immediately. However, what I want to do is then control my emotion, respond to the request, not react to it, and understand where this person was coming. They're probably frustrated by the late admissions. I can understand how they're frustrated, right? And for me then to actually move this person towards accomplishing the goal, I responded to the email in just that way. Now, of course, it took me a couple of hours till I got over the emotional reaction, but I did. I didn't respond. I didn't react whether I responded. And I said, I understand your frustration. Please know that my intention is legitimate. I really want to help you. I'll do what I can to help you with the data too. And as a result of that, I wanted to move her towards, move this person towards actually solving the problem. So, let's talk a little more detail about what self-awareness is and what self-regulation is. And again, for self-regulation, you can see the words there, transparency, adaptability, achievement, initiative, optimism. But again, one of the take-home messages here is respond, not react. And that's what I tried to demonstrate for you, how reacting to an email, reacting to a comment, reacting to a situation, shuts the whole thing down. The other very important component is self-awareness. And let me just share some of these with you, and we're gonna go into a little more detail with some of the others. So, for example, core values. I know that I have a really strong sense of right and wrong, and sometimes it's probably to the extreme, and sometimes it could possibly get in the way of making a decision. I need to be aware of that. I need to be aware that that is something that could interfere with getting the outcome I want. Strengths and weaknesses. I know I am not a last-minute person. If I am required to do something at the last minute, typically I get panicky. I don't pay a lot of attention to detail. I feel like I have to hurry up. I miss things, and ultimately, I don't do a very good job, and that's important to me because I know in what I have to do every day, I do deal with individuals who actually do their best work at the last minute, and so I need to make sure that I am in touch with what they're doing and that I can then make sure that I have the time and the opportunity to review their work if I need to and do so in a way that I feel comfortable that I can do the best job. Emotional triggers. I kind of already shared one emotional triggers for me, and that is, you know, I understand that I don't always get things right, but I always try to do the right thing, and so when someone questions my integrity, I do get an emotional response. Now, for me, it's very, very easy to tell. I feel my heart rate going up. I feel my face flush. I start talking higher and faster, and that's a trigger for me that, oh my goodness, I am starting to react and not respond, and I need to work on self-control under these situations because if I react, I'm going to shut down the conversation, and we're not going to make any progress here. So let me spend a little more time talking about personality. Now, you know, there are many different personality scales that you can use, and I have always used the Myers-Briggs. It was an aha moment for me when I kind of understand personality types and how you interact with them, and so for the sake of conversation, I'm going to share with you the Myers-Briggs, which some of you may be familiar with, and of course, there are four domains there, and one of the domains is being introverted or extroverted, and the understanding of these personality types is not only important for you so that you understand how you deal with things, but the personalities of the individuals that you're going to be working with because, again, you are going to have to influence those individuals to move them along towards achievement of a goal. So introversion and extroversion, just talk about the two main categories there. Introverts, they sit, they're quiet, they think, they pay attention, and then they may speak. It's the extrovert who will be the first person to speak, and maybe they're thinking through while they're speaking. Now, introverts are quiet, they listen, they may speak, extroverts speak up as as they are speaking, they're thinking. I am an introvert. I need to learn to speak up. Many times I have something I think I should say, and historically in the past, I would not necessarily speak up. I understand that that's a personality type, that I need to be able to work past that to be successful and to interact and influence people. Sensing and intuitive. Sensing people ask questions. How many? How will it impact me? They want data, they want specifics. Intuitives, the big picture, the big idea. I am an intuitive person. I am always thinking of the big picture. I am coming up with ideas. The problem with that is if I am not careful, I will not necessarily pay attention to detail, and I can miss important details if I am not careful. I know I am intuitive. I know I have an issue with making sure that I think of the big picture, but I have to pay attention to detail, or otherwise I can miss important points. Thinking and feeling. This was critical for me. Those people that are thinkers, they are direct. I mean, they will tell you what they think. They will disagree with you in a conversation, they will disagree with you in a meeting, in front of people. People that are feelers like harmony. They don't like to disagree. They have a hard time disagreeing with people. Again, I am a feeler. I thought that people that were disagreeing with me in public or in a meeting were being rude. Well, no, they weren't being rude. They were just thinkers, and I didn't realize that. As a feeler, I need to make sure that I can express my feelings and know that not everybody else is going to feel that way. I will give you examples of these. Then there is the approach to life. Some people are perceivers and other people are judgers. Perceivers, they are spontaneous, they live with ambiguity, they tolerate things in flux, they are okay when things are ambiguous. Judgers, oh my gosh, they want decisions, they want structure. I will give you an example. We had a physician who was retiring. The person that this physician reported to said, well, what are we going to do that they are retiring? I said, well, we are going to try to hire somebody and I can maybe move another physician into that role, depending upon what the census is here, or maybe I could do this. I explained all of this to them. Their question was, okay, what should I do for the schedule in July? Well, I don't know, because I don't know what the census is for this person and whether I will be able to move them. Again, the example of somebody who, it is difficult for them to live with ambiguity. You have to be able to say to them, listen, I should know this in two or three days, touch base with me, then I will be able to make a more firm decision for you, because again, I know that I am dealing with someone who is judging. Now, how does this impact you? Knowing yourself, personality types, well, let me share a case with you. You are a member of a large academic PM&R department and a member of a small committee overseeing the development of a new medical staff compensation plan. The new compensation plan moves from a pure RVU-based compensation to a guaranteed base compensation and additional pay based on productivity. However, the plan includes an annual threshold of RVUs that a physician is expected to reach to achieve the base compensation. And you and your committee, the committee you are asked to lead, you are asked to make a recommendation as to what steps should be taken if a physician does not meet the required RVU threshold for base compensation at the end of the annual meeting. So you are in a group of physicians. You have to decide, what are we going to do with physicians who don't reach that threshold? Well, guess what happened? There were thinkers who said, you know what? They didn't reach their threshold, their salary should be cut. Guess what the feeler said? Well, you know, maybe they were sick, maybe there was another reason, maybe we should give them more time. There were those who were perceiving they wanted data, how much did they miss it by? And you could see everybody's personality kind of bleeding into the way they think about things. Now, the point is, is not only do you have to be aware of your personality type, but their personality type, because you are going to have to move this group and make a decision. And you can see where people are coming from, sharing their opinions based on their personality types. And ultimately again, influence others towards the achievement of a goal. So let me share with you another, I think very important, know yourself concept. The neurosurgeons at your acute care hospital are complaining that you are not taking their patients to inpatient rehabilitation. And are threatening not to refer to you anymore. You feel many of the referrals are not appropriate for rehabilitation, but you want to work collaboratively with the surgeons. So the director of the neurosurgery practice schedules a meeting to talk about accepting more of their patients. You walk into the room to meet the practice director who you have not met before, and this is the person you see. So tell me what you notice in your thoughts, and I won't ask you, but now for me, the first thing I notice is the tattoos. Now I know that this is a bias that I have. Biases also influence our ability to interact with others. And it's extremely important in terms of knowing yourself. Why do I have this bias? Well, you know, when I was growing up, tattoos were associated with motorcycle gangs and crime and all kinds of things. That is not the case anymore. But for me, this is the first thing that I noticed. Now, I know it's a bias, and I have, I am now able to move past this. I have daughters who have tattoos. I know that they are not members of motorcycle gangs. They are not criminals. And so I know that good people have tattoos. It's just a bias because of the way I was raised. And now I am comfortable dealing with that and moving beyond it and getting beyond the tattoos and interacting with this person in an appropriate, emotionally intelligent way because of that. How about this one? And what's the first thing you notice here? Well, for me, it's obviously the red hair. Why? Well, again, it's a bias. I know that I have because of the way I was raised. 12 years of private school. Had to wear ties and shirts with collars every day. Hair had to be cut short and groomed. If not, there were consequences. Now, I know that that is not the case anymore. And I realize that this is a bias. But I am now able to move past that and interact with the person and not be influenced by my biases. Again, knowing yourself, controlling your emotions, responding, not reacting. The first key components of emotional intelligence. So let's talk about the second component of emotional intelligence, and that's management of others. Okay? So we talked about self-awareness, strengths, weaknesses, triggers, personality types, biases. We talked about self-control, responding, not reacting. Social awareness. Thoughtfully considering the feelings of others along with other factors in the process of making decisions. Considering what other people think as you're moving them along towards a goal. Feeling of others. Understanding the social networks and the structure that you need to make decisions and focusing on the correct outcome. And then, of course, relationship management. Working together as a team. Influencing and inspiring others because, again, we want to influence others to move towards achievement of a goal. Okay? So let me give you an example of how this might work. So you are the medical director of a rehab hospital and approached by the director of admitting regarding a potential patient referral opportunity. A healthcare system with four acute care hospitals would like to work with you and refer their complex brain injury and spinal cord injury patients to your facility. They anticipate this would be approximately 100 to 120 patients per year. The healthcare system, however, is located 300 miles away. And with travel time, these patients would likely be late admission. That is late afternoon or possibly early evening. After discussing with your admitting director and the chief medical officer of the referring healthcare system, you realize these patients are appropriate for and would benefit from rehabilitation. If you don't admit them to your inpatient rehab hospital, they will likely not receive the level of care they need. There is a definite potential for growth since other regional acute care hospitals are struggling to find appropriate post acute care for their complex brain and spinal cord injuries. Providing rehabilitation to this population would differentiate your hospital from other providers in the region. You decide in your leadership position that this is the correct thing to do, not only for the patients, but for your organization. And you now plan on communicating this to the medical staff. Well, I can't do this alone. I need buy-in. I need acceptance by the medical staff. That is, I need to influence them to achieve this goal. And this is going to be a difficult conversation. And I know that I'm going to get pushback. Right? So, management of others often begins with the conversation. And here is the second important take-home point. The beginning of any difficult conversation is when you have the greatest leverage to influence the conversation. I'm going to say that again. The beginning of a difficult conversation is when you have the greatest leverage to influence the conversation. Now, let me describe the framework for this. You see, in any conversation, there is your story and there is the other person's story. What you want to do to start a difficult conversation, to influence the conversation, is to start with what is known as the third story. Okay? What is the third story? And that is one that is told from the outside. That is someone with no stake in the outcome. That is, the sequence would be the third story, their story, your story, and then think like a mediator. Okay? So, what would that look like in this case? Well, I know that if I just went to the medical staff and started with my story, and that is typically the way we start all these conversations. Started with my story that, oh my gosh, we have to do this. This is important for the organization. What's gonna happen is I am gonna get pushback, right? I am gonna get pushback from them. Initially, they're gonna say, well, there's gonna be late admissions and I'm gonna have to stay late. So I would start this conversation from the third story. That is, I would start the conversation with the medical staff by saying, we have been approached by a healthcare system that would like to work with us and refer their complex brain injury and spinal cord patients here for rehabilitation. They are 300 miles away. And so with travel times, these would likely be admissions that arrive late in the afternoon or early evening. Okay, the third story would then be, well, what are your thoughts, medical staff? And of course they would say, well, I'm gonna need to stay late. They're gonna be late admissions. I worry about the accuracy of the records. We don't get an accurate MAR. You know, the acute care staff is gonna be gone. And I would say, you know, you're right. Those are all legitimate concerns. Here's my perspective though. These patients are really appropriate. There are no other resources available for them. This would be a tremendous potential for growth here in differentiating our hospital. It would be the right thing to do for the organization. How do we make this work? And so by doing that, what I have done is I have listened to their perspective. I get a sense for what they're thinking, right? And now I have reached out using emotional intelligence to a difficult conversation is, okay, let's figure out how we can make this work because we all know this is the right thing for the organization. One last example. You are the department chair and have consistently received complaints from nursing staff that one of the attending physicians is consistently difficult to work with when on the weekend call. That is, they do not respond to pages. And if they do, it is with significant delay. This is a problem unique to this physician as there are no other complaints with availability of other physicians when on call. Consequently, nurses will at times page other on-call attendings with questions. Now, both attendings and nurses are complaining and both insist that you do something because in their words, this is unacceptable. You schedule a meeting with the physician. Okay, now, how will you be perceived by the medical staff and nursing staff if you don't correct this issue? What emotions are you feeling as you enter the meeting with the attending physician? Well, I'll tell you, you probably would feel a little frustrated, maybe a little angry. This is the only physician that we have this problem with. I want to share, I want to respond to this concern and not react to it. So I want to make sure that I can control my emotion when I do this. And what is my story? My story is, hey, listen, timely returning of pages is expected. It's important. It's important for you to work with the nurses. You just need to do this. That's my story. Those are my emotions that I'm going to try to control. Well, you are the attending physician who was asked to meet with the department chair because of complaints that when you're on call, you are not accessible and do not respond to pages. However, you feel staff do not realize that when on weekend call, you are covering multiple services and your responsibility is to address urgent, not routine issues. You feel staff frequently page you about issues that don't require immediate action and should be directed to the primary team. Furthermore, you feel staff do not respect your time because when you return pages frequently, no one answers or when they do, the person who answers doesn't know who paged you. So you wait on hold for long periods of time. This physician is thinking, oh my gosh, how am I being perceived by the medical and the nursing staff? And what emotions do you think this physician is feeling as they enter the meeting with you as their chair? Well, first of all, I would imagine that this physician also feels pretty frustrated, probably somewhat angry, maybe misperceived by the staff. Their story, they're not appreciated. They're wrongly perceived. So what would happen if I started this conversation by saying what my story was? Look, look, you just have to return pages. This is, you just have to do this. It's important that you work with the nurses. I would get pushback, right? The conversation would become confrontational. It would be a very difficult conversation. I would not achieve anything that I set out to do. I would start from the third story. I would start by saying something like, I wanted to sit down with you and get a sense of how things are going on weekend call, right? Or everyone is getting busier and busier on weekend call. You know, I wanted to get your thoughts on how things are going, right? And then of course, after listening to this person, acknowledge their concerns and then begin to think like a mediator. Okay, well, you know, you're right. You shouldn't be waiting on line. Obviously, how can we fix this? How do, you're being misperceived. How do we change this perception? How do we make sure that the nursing staff, you know, they get their questions answered. They feel you're available. And at the same time, we're not abusing your time on weekend call. How can we work together to solve this problem? So in summary, leadership and management are two distinct and complimentary systems of action. Both are necessary for success. Knowledge, analytics and technical skills are critical for leadership, but they are threshold capabilities. It is emotional intelligence that separates excellent leaders from average ones. And the beginning of a difficult conversation is when a leader has the greatest leverage to influence the conversation and the outcome. So always start from the third story. And on that, I went over a little bit, but I wanna thank you for your time and your attendance. Great, Dr. Saliwa, that was great. Are there, I'm gonna look in the chat. I don't see any questions, but does anyone have any questions? Feel free to write it in the chat or raise your hand and we can, you can unmute yourself. So we'll give it a minute to see if anyone has any questions. I don't have questions. I'm Dr. Sarah Hunter. I just wanna thank you, Dr. Saliwa. I worked with Dr. Saliwa a while ago. Love this talk. Needs to be done. Dr. Satcher, how are you? Long time, no see. It's great to see you. Good to see you. Hope you're doing well. Yes, I am. Good, good. Any other comments or questions from anybody? Dr. Saliwa, if no one says anything, I'll ask a question. I'll give everyone a few more minutes. Okay. All right, I'll just shoot and then see if anyone else has any. Here we go. Do we have any recommendations on how to start the third question with the difficult leader, not as a leader? So I wanna make sure I understand the question. Was it, how do you start from the third story with a difficult leader? Not necessarily. It sounds like not necessarily as the leader, but if you're in a position where you're communicating with a leader. Starting from the third story, you can use with anybody at any time. I mean, you can use this with your fellow physicians. If you have a question about something, you start from, listen, maybe we have a different perception on what we should be doing in terms of handoff. Tell me what your perception is. This is my perception. So it's interesting because once you understand this concept of the third story, it is so much easier to start these conversations. It is the thing that I have found physicians avoid the most. I mean, they just can't have a difficult conversation because it's very difficult to start those, right? And just by way of information, if other people have questions, this book, Emotional Intelligence 2.0, Harvard Business Review, 10 most reads on emotional intelligence are very, very good. I would recommend this book, Difficult Conversations. It is by Douglas Stone, Bruce Patton, and Sheila Heen. In my mind, this was a very, very valuable book. It was a tremendous learning experience for me. It's an aha moment. I hand this book out to I don't know how many attendings here in leadership positions. And we go through reading this. I've read it a couple of times and every time I read it, I learn a little bit more. So if you're interested in additional information, these would be the references that I would recommend for you. It looks like Dr. Steinberg may have a question. It looks like your hand is raised. Uh-oh, I'm in trouble. Dr. Slewa, thank you. This is really wonderful. My question, I think I have some ideas about this, but tell us a little bit about how you adjust your approach when entering a conversation based on what you know about the other person in terms of you talked about the Myers-Briggs. So if you have a sense, the other person comes at it with a certain perspective or style because you've interacted with them in the past, because I'm sure your approach has to change and flex. Yeah, yeah, so I would go back to their personality types. So, you know, I know that some people are, they're gonna have a lot of questions. They're gonna ask information, data, those types of things. When I meet with those people, I wanna make sure that I have all the facts. You know, if I'm approaching someone, I wanna make sure that I have all the data, I have all the facts because that's gonna be important to them. And then there are other people who, you know, are the big thinkers, the big picture people, and you are going to enlist their help by enlisting their agreement with the big picture. So I guess the answer is, if you know the personality types of kind of the physicians or your team, then you can kind of prepare and adjust for that. See, I know there are certain people of our medical staff that aren't gonna speak up, that I'm gonna have to call on them in a meeting, or I'm gonna have to approach them by saying, listen, may be difficult for you to say, I just want you to know, please feel free to talk, you know, et cetera, because I know it's difficult for them to do. And then I know there are other people that as soon as they walk into the room, I'm gonna get an earful, and then I'm just gonna have to start over and say, wait a minute, we may have a different idea here, let's talk about this. So I think it depends if you understand what their personality types, you adjust it for that. The big ones were thinkers and feelers. I mean, it's just, my goodness, people going at you and people just sitting there and it's quiet, it's quite interesting, but good question. There was a comment about crucial conversations. That is another very good book. I don't know if whoever put that comment, I don't know if you read this one, I actually liked this one better. It may be just a personal preference, I don't know. But this one, this was truly an aha moment for me. Any other questions? I don't know if there were any more in the chat or not. I don't see any more. What are good ways to implement leadership training in a residency program or department? Oh, there's one, there are some in the chat. Actually, that's a very good question. We actually have implemented a leadership training program for our residents, it's optional, it's a leadership track. And what we've done is we've actually sat down, there were like four or five of us, and we've gone through, developed a curriculum, and there's a presentation every month. And the first conversations, the first sessions were about leadership versus management, emotional intelligence, these types of things. And then it just built on it. It's marketing, it's finances, it's branding, it's sponsorship, it's mentorship. So we actually came up with a curriculum, we divided it up amongst four or five physicians. We developed a special track within the residency. And it's a very valuable thing. We probably have 12 or 15 residents in the leadership track. Dr. Cianca, good to see you. He had his hand up, I don't hear him. I think you might be on mute, Dr. Cianca. Oh, I should know that by now. Thank you. When you're at the beginning of a conversation with a group and you're starting to relay the third story, so to speak, how do you anticipate or manage cynical reactions to it? Such that, oh, we know where he's going with this, or that people, and rather than be open, how do you convey that this isn't a foregone conclusion? Yeah, that's actually the key to the third story. You're absolutely right. And if that happens, then I probably haven't phrased it the right way because I have started by sharing my story. So it should be truly neutral. It should be truly the third person. It should truly be from someone who doesn't have a stake in the conversation. That's the way it should be approached. And there are times when I struggle with, all right, how do I make this the third story? How do I make absolutely sure that I present this in a way that I don't share what my story is? And it is, there are times when it's really tough. It's a good question. And again, I would just emphasize that if you've done it correctly, it should be a very neutral statement, like someone you don't have a stake in the conversation. And it's very, very difficult that time. Thanks, sir. Yeah. Love the book, Difficult Conversations. There were a couple of other I might've missed. I don't know. I think we got them all. So I guess on that note, thank you so much, Dr. Sliwa, for this insightful talk. I think this was fantastic. It touched on a lot of topics that I'm passionate about too. So thank you for sharing. Thank you all for attending and thanks for actively engaging with great questions too, everybody. Thanks, everybody. Thank you for your attendance. Take care. Thanks, everyone. Have a great evening. Thanks, Rachel.

emotional intelligence

leadership

management

third story

difficult conversations

personality types

Myers-Briggs model

communication approaches

residency programs