Hello and welcome to the AAPMNR pre-conference series, how teamwork and leadership can help early career physiatrists create the career of your dreams. Your hosts for the evening include myself, Dr. Craig DeTomaso. My leadership experience includes being the medical director of PAM Rehabilitation Hospital in Humboldt, Texas, being the chief clinical officer for U.S. Physiatry, being the inpatient rehabilitation chair for the American Academy of PMNR, and in my previous life, I was the former medical director for inpatient rehabilitation for the Baylor College of Medicine. After me, you'll hear from Dr. Victoria Strickland. Dr. Strickland is the medical director at Mercy Anderson Hospital Rehabilitation Center in Cincinnati and the regional medical director of Cincinnati area for U.S. Physiatry. Next will be Dr. Herbert Villaflores. He is the medical director of quality at SSM Health Rehabilitation Hospital in Bridgeton, Missouri. He's also the regional medical director for the St. Louis area for U.S. Physiatry, and he is a member of the SSM Health DePaul Hospital executive leadership team. Finally, a man who needs no introduction, Dr. Michael Lupinacci. He is the medical director of Encompass Rehabilitation Hospital in Mechanicsburg, Pennsylvania. He is the chief medical officer for U.S. Physiatry. He is a former American Academy of PMNR president. It was in 2011, and he's the AAPMNR co-chair of the medical leadership institute. So I very purposely picked this particular quote by Eleanor Roosevelt because I think it stresses the fact that leadership is as much a skill as anything else and that you've really got to practice and get better at leadership over time in order to really hone it, and that'll be a big part of my talk today. So hopefully this quote will get you in that thought process and moving in that direction. Without further ado, allow me to now present my section of this presentation. I will focus on leadership and its role in your happiness and success as a physician, physiatrist, and possibly medical director. Just a quick bio slide on me. I don't mean to focus on this, but I just think the important point here is that I've been in private practice since 2019. I was academic before that. I've worn an awful lot of hats over my career so far. And, you know, the act of being in leadership and practicing leadership and learning from it, I think has been a really, at times, stressful, of course, but also very enjoyable and positive in my career. You've certainly heard enough PowerPoints at this point in your career, and I've certainly delivered enough to know that all PowerPoints have to have an objective section, and this one is no different. For this presentation on teamwork and leadership resulting in happiness, we will understand the role of team and happiness. We will then discuss program building as a way to build a team and some leadership responsibilities. And finally, I'll give an example of a real world team and leadership experience that I've had so that you may conceptualize some of these concepts and how they apply to a real world setting. Yes, and without further ado, let's jump right into understanding the role of team leading and being a leader in your happiness as a physiatrist. Now, I know defining a team for someone who works in rehabilitation medicine is ridiculous, but we've got to have some kind of definition, so here you go. And if you have teams, those teams need to work together, and people work together best when they have some leadership. No, that doesn't mean you have to be a domineering leader. It doesn't mean you have to be a soft leader. You be the type of leader that's right for you. But once you start leading, you've got to do some things right. You've got to keep people on track and on focus, working towards a common goal. You've got to coordinate those efforts so that there aren't too many redundancies and so that people feel like they're making progress and they're acknowledging the progress they are making. And you've got to make sure that those efforts are actually moving you towards that goal as well, right? In addition, you've got to really facilitate everyone working together. That's an essential job of the leader, keeping people interacting and working forward in a positive way. And then you've got to prepare to mediate those disagreements that will, of course, come up. There's no such thing as team or teamwork without some disagreements, and if you're going to be a good leader, you've got to know that, anticipate it, and have a game plan for how you're going to handle that. You know, the world couldn't exist if we didn't have some of it. Now, this is where the topic really comes together because that leadership increases the teamwork, and the teamwork really leads to happiness. And that's what all the studies and all of the think tanks and all of the assessments have shown, is that when people are working together towards a goal in a cooperative, productive fashion, they're just happier, and that's who we are. And I think a lot of that comes back to the fact that we are really social animals, right? I mean, throughout evolution, humans never had the biggest teeth or the strongest muscles or the fastest legs, but we could work together in a group and overcome almost any adversary. Nowadays, we don't have a whole lot of saber-toothed tigers or woolly mammoths walking around, so it takes a strong leader to make sure that we can get all those people with all of those energies and thoughts and strengths and redirect them towards a more meaningful outcome. And, you know, when we do that and we work together and we share those experiences, we really are happy, and at least that's always been true for me in my experiences. In addition, working in those groups gives people a bit of a sense of self and identity and in-group collectivity, and people are really thirsty for that, right? As I'm recording this, I'm watching all these commercials for these political advertisements, and, you know, a lot of that really goes back to the fact that a good leader can really make people feel part of a group and part of something, and people are really thirsty for that. When people have a purpose and a group that they believe in, you know, they'll do really unbelievable things. So I'm not saying too much. I think that's an important part of this whole equation. Now, this might not apply to everyone listening to this talk, but for a large percentage, you're going to get this leadership through your position as a medical director. And I just want to say that, you know, being a medical director is a very interesting position because you really are balancing a lot of things. You're balancing your clinical acume with your responsibility to the financial and business side of medicine. You're monitoring or assessing your ability to work as an administrator within the hospital while often also doing a lot of clinical and bedside activities, and that's kind of an interesting place to be. There's no one right or wrong way to do that, but that will certainly stress your leadership role. But it will also give you some tools that other leaders in the building may not have because no one really straddles that line the way that rehabilitation medical directors do. Let's transition now to how maybe you can use your skills as a physiatrist and as a program builder to really lead a team and improve how you interact with your clinical team and your administration team, and how that really, I think, is the way to be happy in rehab medicine. So, we'll take a closer look at that as we transition on to that next topic. So, creating programs is easy for me, and I think for a lot of us out there, right? Physiatrists, we think about how patients progress through things and what they need and how to support them in a way that I just think other physicians don't often think about. So, creating a vestibular program, a burn program, my favorite, of course, the disorders of consciousness program, those are things that we understand. We see how to find patients with those needs, how to identify their needs, and then bring the rehabilitation team to them, and that's really a skill that a lot of other physicians and most administrators really don't have. So, as a physiatrist coming out of a good, high-quality residency program, you really have a marketable skill that a lot of healthcare systems need, and the more that you can kind of hone that by building programs and creating systems of care, the more valuable you're going to be as your career goes on. There are a few things I think you need to help think about as you move forward in your program building, and we're going to talk about that over the next couple slides. So, if you're still going down this rabbit hole with me, you're starting to build a program or you have an idea of a program in mind, the first thing is what is the program about, right? Some are very concrete, like a prosthetics program. Others can be more nebulous, maybe a vestibular program or a program for patients with complications related to kidney disease, and then the question that comes after that is, you know, what is the goal of the program? With an amputee program, it's probably pretty simple. Identify above and below knee amputees, improve their mobility, maybe prepare them for prosthetics and then get them up and walking in it, but for a nephrology program or a vestibular program, you know, those goals can be much more nuanced and it can really depend on what you and your organization want to achieve, so sitting down, brainstorming, journaling, writing about it, I think it's really important to outline those goals. So, there's a whole lot about this slide that I want to say, but I'm afraid I'll put somebody to sleep. What I'm trying to say here is that, one, it doesn't matter where you build a program, right? I've built programs in acute care, LTACs, rehab, SNFs, you can build a program anywhere. I set this slide up around the fact that you're probably going to build your program in inpatient rehab. When you do that, really think ahead of time of how you're going to answer all these questions, right? Because this is really the essence of what CMS wants to see for patients coming to inpatient rehab. This is how you can try and justify your admissions and your progress to your payers if they're not CMS. And if you start off the bat with a strong plan addressing each one of these topics, then you're just much more likely to do well and to have a productive program and to be able to be paid for all the work. So, after you've kind of sketched out your program, the next thing to look at is making sure that you're being able to build in the way the administration will be able to support, right? So, I really suggest you sit down with somebody who has a good mind for an administration. Maybe your CEO. Maybe it's your director of rehabilitation. And you really try and answer these questions and think about how the hospital is going to grow from a financial and business side. That's, you know, not the driving point. It's not the reason that any of us get up and get going in the morning. But we've got to make sure that we're building a program that's going to have a return on investment for the hospital that will be sustainable and fundable and continue to allow the hospital to grow and progress. So, I think this slide is important for those reasons. So, now I'll use a real world example to try and make these things a little more concrete. And I'll use my favorite topic, of course, disorders of consciousness. And so, I think, you know, one, you've got to have some leadership. And two, you've got to have a little bit of chutzpah and go out there and just try it. And that's certainly been my story through, I guess, four disorders of consciousness programs now and more mentors than I could possibly name. So, this is probably review for most of you. But for those of you unfamiliar with disorders of consciousness, an individual has an insult, almost always a traumatic brain injury or an anoxic brain injury. And they either go into brain death or die or they remain alive. If they remain alive, they then are typically either conscious or unconscious, right? If they're unconscious, they may be in a coma, although that would be for a very short period of time. They then typically progress or are already in what used to be called the vegetative state, which now we call the unresponsive wakefulness syndrome. Or if they're conscious, they may be minimally conscious or fully conscious after their brain injury. Working with these kind of two middle boxes, the unresponsive wakefulness, formerly known as vegetative state, and the minimally conscious is where the disorder of consciousness program really lies. And the goal is to help improve the lives and the function of those patients. The first attempt to really look at patients with severe injuries was this article published in the New England Journal of Medicine in 1994. It looked at people who were unconscious, what they called then the persistent vegetative state at three months, six months, and 12 months. And the surprising thing, I think, for a lot of physicians at that time was that a lot of the traumatics really made a good recovery, right? The other thing I think that was interesting is that these patients didn't take very long These patients didn't tend to stay in a persistent vegetative state of what we would now call unresponsive wakefulness syndrome. They either died or became conscious. So I think that that was a real step forward and people started to acknowledge that, hey, maybe there's more to this than meets the eye. And this slide's a little redundant, but I just wanted everybody to see graphically that again, from the time they started monitoring that patients either got more conscious or more dead, but don't typically stay vegetative or unresponsive wakefulness. So the thought became, well, what can we do to help improve these patients? Well, when physiatrists get involved, you know what we do. We make everything better and we get rehab involved. So a lot of these patients were enrolled in inpatient rehabilitation where they could get three hours of therapy, five days a week. Their comorbidities and the sequelae of the neurological injury were addressed more appropriately. And the patient families and caregivers got education. And here's a slide I stole from Baylor, Scott, and White in Dallas of an individual with a disorder of consciousness who's about to be mobilized. And they have unique setups, as you can see, to help stabilize the head and neck because obviously these patients are unconscious and unable to control that. And once again, from Baylor, Scott, and White, a picture is showing a patient in the disorders of consciousness program being loaded into an exoskeleton and being mobilized that way with a unique head support device. So just to say that, you know, the rehabilitation for these patients, there are simple solutions like the Miami-J. There's complex solutions. But the issue is just to get them up and get them moving, of course. So we'll look at this study published under first author Nakase Richardson from Tampa, but it's model systems data, looking at patients who entered the model system at various locations with lack of consciousness and inability to follow commands. Of note, this was studied in 2012, which was relatively recent. And this is a picture of a patient who was in the hospital for a week or so. In 2012, which was relatively recent for me, but probably a long time ago for many of you. And the results indicate that these patients do very, very well, that they can recover consciousness with appropriate rehabilitation. They can even emerge from post-traumatic amnesia. And oftentimes they do go home. And so really positive results when low-level brain injured patients are admitted to inpatient rehabilitation. But I will say, it's one thing to do this in a model systems where you have abundant resources and academic people around. The question was, could I do this in a small community rehabilitation setting, which was my area of practice? And, you know, Pam Rehab, a hospital of humble is shown here. And that's where I spend most of my time as a clinician. There's a great group of people, though, who were familiar with disorders of consciousness. People, though, who were familiar with disorders of consciousness, either from working at nearby programs or who had read or heard about it. And there was more and more interest in maybe addressing these patients within my standalone rehabilitation hospital. So we started with the simple questions. You know, what is this program about? Who will we serve? And it's obviously the severely brain injured patients. And also the therapists and nurses were excited because it was a chance to build their neuro skills, which had not always been the focus of this particular facility. And so then what would be the goal? We brought these patients in, you know, obviously the initial goal is to establish what the level of consciousness is. But after that, can we improve their consciousness and their quality of life? And at the same time, will this help us to improve our rehabilitation capabilities as a facility? And so the next thing that happened, of course, is we had meetings, so many meetings, lots and lots of meetings, of course. And we discussed what the roles of the different people involved in the program would be. What would be the expectations of the nurses? What were the medical things for the nurses that they'd have to look out for? What would the PT do? What would the OT do? The speech and so on and so forth. We talked about what therapy interventions were appropriate and which ones weren't for disorders of consciousness patients. How do we monitor that? What do we look for? Everyone was reading. Obviously, we all had to read and review the JFK Coma Recovery Scale Revised because that's the primary evaluation tool. But also other journal articles and chapters written on the subject, including some of the work by Joseph Fins, who has written tremendously on this population. We had to talk about the medical management. Obviously, disorders of consciousness is a field that's riddled with medical complications. And there's some data to support how and when and what medical issues arise. So we needed to review that, try and prepare for it. And then lastly, we assigned the specific roles. What would the neurologist be doing? What would the physiatrist be doing? Would be the PT, OT, and speeches roles. Kind of hemmed out how this multidisciplinary team would work and then how we would support each other and make sure that everybody was able to do what they needed to do and had support for what they needed to do. So this is a video slide. I sure hope it plays for you. I think it's a really great video to watch for a lot of reasons. Number one, Danny Fernandez was the gentleman who had a severe traumatic brain injury. He did really phenomenal in our rehabilitation program as the first disorder of consciousness patient we took. He left the facility completely independent after testing his unresponsive wakefulness on his first day here. Number two, we were relatively new to the exoskeleton, and so he was a great person to practice with because he seemed to really enjoy being in it, even when he was in a wheelchair. Not so conscious. In particular, this video for me is always really touching because Danny was in bed, really not doing much before he got mobilized in this device. And once you see him up and moving, you're going to really see that boy, he certainly looks very awake, and that is not how he looked lying down. So I think it really speaks to the power of mobilizing these patients. And you know, I think rehabilitation is really the way to cure a coma, so to speak, although that's a silly thing to say. So please watch the video and enjoy. Then this brought happiness to everybody. Danny actually left our rehabilitation about five weeks later, fully independent and able to do all his own ADLs, transfers, and mobility. And the whole team was just ecstatic. It was a really great way to kick off the program. And I think that happiness just ended up being ubiquitous. And the program still brings a lot of joy to everyone's day. Because you do really see these patients improve. And we have a game plan. And certainly not every patient improves. But at least you have a game plan to move forward. We've all learned to problem solve these issues and work together in teams better because of it. And I think that's been very helpful. We've all read and learned a lot more about disorders of consciousness, which for me has been fun. But I'm pretty nerdy. So maybe it's just me. We've been able to improve and revise the program over the years by working through it and understanding different perspectives from different leaders and how we work best together. And then personally, I've been able to connect with other individuals in the field of PM&R and neurology and neurosurgery who are interested in disorders of consciousness. And that's brought me some personal happiness as well. Because I enjoy this kind of networking and collegial events. And this is kind of a feel-good slide. Danny from his initial hospitalization to working here at the rehab center. And then finally in the bottom right, you can see him. He actually came back. He won our patient of the year award in, what year was that? Maybe 2021, I think. And you can see him standing there and totally independent. Yes, I know the left arm needs a little botulinum toxin. It bugs me every time I see the picture. But he's doing very, very well. So it's just a really great, great story. And he was a great patient to kick off the program with, because he did so well. And that's the end of my presentation. I've listed multiple ways to contact me if you'd like. I also am the chair of the PM&R Inpatient Rehab Forum for AAPM&R. So if you have any questions, concerns, or issues that you want to talk about, I think that's a great way to get lots of different opinions and eyes on a topic. Otherwise, if it's something directed directly towards me, my email, Twitter, or I guess we're supposed to call it X now, and Instagram handles are there. So feel free to reach out on social media. Thank you very much. And we will segue you now into Dr. Strickland's presentation on conflict management. Thank you. Hello, everyone. My name is Victoria Strickland. I've been asked to talk a little bit about communication and conflict resolution. So as an outline of my presentation, I'm going to start off by talking a little bit about myself. Then I'm going to move on to talking about the importance of communication, styles of communication, then different perspectives, understanding each other, and then finally talk about some conflict resolution and give some examples. So a little information about myself. I have only been out in the workforce for about a little over three years now. I finished up my residency at Ohio State back in 2021. At that time, I moved down to Cincinnati, and I worked for a private practice. During that time, I worked as a physician on a few different rehab units within the city of Cincinnati, and then found myself as the medical director of the acute rehab unit over at Mercy Anderson. Then in 2023, we transitioned, and I now work for US Physiatry. And in that time, I've continued to work as medical director at Mercy Anderson, earlier this year, I was promoted to regional medical director. My unit, as I have listed there, it's a small unit. It's 20-bed units within a small community hospital. So some of the examples I'm going to be providing are going to be relevant to being a rehab unit within a hospital, but certainly, you could extrapolate my examples and you use them even if you're in a freestanding rehab unit or if you're working in a different field within physical medicine. So point of me kind of talking a little bit myself, again, I've only been out for about three years, so I have limited experience. I don't have quite the experience that some of our other speakers today have. But in the three years that I have been working, I feel that I have learned quite a bit. I'm still learning every day. And this presentation actually is a good reminder for me to implement some of the things I'm going to talk about, work on my communication, and continue to grow. So first and foremost, we're going to talk about conflict. That's the main thing I'm going to harp on in this presentation. So what really leads to conflict? I have found in my personal experience that most of the time, conflict are just misunderstandings. You don't fully understand where one person is coming from. They don't understand where you're coming from. And that's really due to either a miscommunication or a complete lack of communication. So we'll talk a little bit more about communication itself. So why is communication so important? So it's really important because, one, it's going to make your life easier, and then also just by building strong relationships. So you're going to build relationships with your acute care, your administration, the rehab team, referring facilities, all these different parties. And especially it's going to help you a lot within your rehab team. You know, when you think of your rehab team, a lot of people just think of, oh, you know, it's the doctors, the nurses, the therapists. But the rehab team is really, really so much more. And when you think about effective communication, you know, you really, when you think of the team as a whole, it's not only is it the nurses and the therapists, it's the therapy managers, the PPS coordinators, the people involved in compliance, dietitians, case managers, administrators, liaisons, environmental services, dietary services. Everybody's a piece of the puzzle to kind of make things run smoothly. And when all parties are communicating well together, you're able to more, you know, effectively do your job, have a more pleasant experience, and then do better by the patients. So one of the ways to start off with being a good communicator is to be present. Be physically present on the unit. And if you're unable to be physically present, make sure that if you're, you know, if you're on the clock, that you're present via phone. You know, certainly not everybody can be on their rehab unit the whole day. Other people are, you know, have outpatient clinics or are covering for other hospitals. So just make sure that they know that you're there. If you're the physician that's on call, make sure that they know that they can come to you with concerns, make sure they feel comfortable coming to you with concerns, even if they may be small. You want the team to feel comfortable with you. And also take the time to get to know your team. Really, you know, within the realm of being professional and maintaining a professional relationship, get to know those around you, get to know the therapists, the nurses, get to know, you know, the person that's cleaning the rooms. It's really, I think of it as kind of a rehab family. And the more you get to know each other, the more, you know, you find communicating easier. And the whole point of all of this really is just to establish trust. Show the people around you that you value their opinion and they will grow to value your opinion. One of the best ways to communicate, closed loop communication. If it works in the OR, it can work on the rehab unit. So, you know, you always, you know, they have mandatory sign outs and timeouts, I should say, where everybody is on the same page. Everybody understands what the task is at hand and everybody understands what's going on. So I encourage you to practice it and expect it of others. You know, for example, one of the most common things I've gotten as far as feedback from nursing staff is they're saying, wow, Dr. Strickland, you're really responsive when it comes to pages. And I really wondered what they meant by that. And I really, I talked to some of my peers and I found that I wasn't really answering the pages any quicker. It was the way that I responded to the pages. So, you know, we use a platform called PerfectServe. I'm not sure what platform you guys use, but if you open a message, it leaves a red message. And I personally have experienced frustrations when I page other physicians that they'll just leave you on red. Nobody likes to be left on red. You don't know if they accidentally opened the message and they actually comprehended the information or if they're gonna do anything about it. Now, certainly you can always respond to the page and say, you know, okay. So like if a, for example, if a nurse pages you and they say, the family's really concerned that the patient's more confused tonight. And let's say they're like a stroke patient on your unit. You could leave them on red or you could respond and say, okay. And then, you know, maybe you do go through a whole workup and you're doing what you're supposed to be doing, but you haven't really effectively communicated to the nurse that you have acknowledged their concerns and that you're going to do something about it. So, you know, a more effective way of approaching that is, you know, maybe the nurse doesn't realize that you collected a UA earlier. You could respond to the nurse and say, hey, you know, someone else had mentioned urinary frequency. I'm waiting on the results of the UA. If it's positive, I'm gonna start antibiotics. If I roll out other, you know, infectious etiologies of their increased confusion or metabolic causes, you know, maybe I consider getting a repeat scan of their head because maybe therapy said that they were having increased difficulty today. So really closing that loop, kind of making sure that they understand where you're coming from. And then, like I said, you know, expect it of others too. If I ask somebody to do something or follow, you know, like for example, like let's say a patient has, is a cardiothoracic surgery patient and their wound looks like it's dehisced. I say, you know, reach out to cardiothoracic surgery. I expect the nurses to in turn page me back or call me back or come back to my office and say, hey, I got a hold of cardiothoracic surgery. They're gonna come evaluate the patient. I just don't wish that information into the universe, hoping that something comes of it. You know, I like to make sure that everybody is demonstrating follow through. Another aspect of communication, understanding different perspectives. You know, this certainly everybody comes into the rehab world or the work world with the different idea of, you know, they have different goals and different metrics that they're trying to be measured on, they're being measured on, that they're hoping for. At the end of the day, we all have the same goal. We want the best outcomes for the patient, but understanding where other people are coming from is really gonna be beneficial to you. So before you even get to the conflict aspect of some of these scenarios, there are ways to avoid conflict and I think one of the best ways is to set expectations and provide education. And what I mean by set expectations is kind of, you know, meet with different teams, meet with your team, therapy, case management, and let them know kind of what your expectations are, find out what their expectations are. So for example, meeting with your team. So a lot of places do this. I know not every place does this, but me personally, I have a daily 815 meeting with my team and that team consists of the nurse manager, the case manager, the rehab manager, and the liaisons. And we kind of go over all of the people that are going to enter or exit our rehab unit for that day and then everybody kind of can comment on any barriers. And that's a good opportunity for us first thing in the morning to say, okay, well, we don't have enough nurses to bring anybody yet, so maybe don't bring anybody till 3 p.m. Versus having your liaison set someone up for 1 p.m. and then everyone's panicked, trying to backtrack, trying to readjust transportation. So avoiding those conflicts to begin with. Now, the meetings with therapy and case management. I actually meet with therapy at my hospital and case management at my hospital about every six months. I've also met with therapy teams at our sister hospital, and I've met with case management at other hospitals as well to kind of talk about what we are looking for when we're talking about a good rehab candidate. And that's a great way to kind of explain things that they're not taught in school or they don't experience in their day-to-day. And it's a good opportunity for them to ask you questions and you can provide clarification on certain things that maybe they've been wondering about who's appropriate. And again, understanding each other's perspectives. Another, aside from kind of setting expectations, I think once things are happening on the unit, there are ways to participate. Everybody participates in team conference, right? I think that's a great way to get everybody together to collaborate and kind of everybody express their concerns and how their feelings about things. So other ways are, participate in business meetings with administration. So I know some, it's always frustrating as a doctor to have to engage with administration, but you also have to understand where they're coming from. Medicine, the goal is to help the patients, but it's also a business. And there's quite a few metrics, especially in the rehab role that we are held to and we're compared to. So knowing what metrics you could be approving on and what metrics, getting feedback from administration, like, hey, we're doing really well on these metrics. So being able to have those conversations, involve yourself, know the financials of your unit so that you can make more educated decisions. And then also involving yourself in quality improvement meetings, for example, readmission meetings. You know, if there's perpetually conflict about why does every patient of ours with heart failure present back to the hospital within a month? Well, let's figure it out. You know, instead of the doctor feeling like they're beating their head against the wall, let's find out like, how can we provide better education? How can we work together better as a team, therapists, everybody providing education, making sure that we're setting the patient up for success versus constantly being in conflict with each other about whose fault is it. But at the end of the day, conflict does happen. So I was gonna hit on a few examples of times that, examples of conflicts that I come across, unfortunately, frequently, and kind of how ways that I've handled it and ways that I've learned are better ways to handle it. So the first example I have here is acute care slash referring hospital versus the admissions team on medical readiness. So, you know, sometimes you find that the referring facility or acute care says, oh, they're ready to go for rehab. And your liaison or admissions team is like, well, their, you know, their blood pressure was, you know, 190 over a hundred a day, you know, and you're thinking, well, is therapy gonna be willing to participate? You know, am I gonna have to hold therapy on day one? Well, maybe instead of just getting frustrated and saying no, have a conversation, say, you know, these are our concerns. We're worried that we're not gonna have, the patient's not gonna be able to participate in therapy. These are our rules. Maybe the referring physician comes back and says, yeah, well, you know, they're, they have this sort of medical issue where if their blood pressure is low, you know, they can't have, they can't go hyperperfuse or something if they've got some sort of stenosis or I've adjusted their medications or nephrology is closely following it. You know, we're on it. Next example, administration versus rehab on appropriate patients. A lot of times people will get pushback on, well, why aren't you bringing this person? Why aren't you bringing this person? This person's got straight Medicare and they're going, you know, they're going to another facility. Sometimes it's just a matter of educating on, you know, admission criteria. You know, the administrators aren't, they're not physiatrists. They don't know what is the Medicare guidelines are. So providing them education on that. And, you know, maybe them providing you education on, well, you know, we deny a lot more people than other places. You know, why are we different than other places if they have those sorts of statistics? So keeping an open mind. And then lastly, therapy versus the medical team on therapy tolerance. So, you know, let's say the patient gets to the unit and they're really, really sleepy and they can't participate and therapy's frustrated. They're wondering, well, you know, this person can't even keep their eyes open. I don't think that they're appropriate to be here. They're not going to be able to tolerate their three hours a day. Well, maybe it's an agitated TBI and maybe they had a rough night and they ended up having to get some sort of sedating medication. And you anticipate with your adjustment to their agitation regimen that they're going to provide, they're going to have better participation. Or maybe they spiked a fever overnight and you've not newly diagnosed a pneumonia. And so they're sick today. And so you anticipate with more medical management that things will get better and they'll be able to better tolerate therapy. So really it's kind of understanding their perspective, you providing education and working together as a team to kind of resolve these sorts of conflicts. At the end of the day, I'm harping on it. Communication is key. Like I said, we all want the same things. We all want, we want to have happy, healthy patients with good outcomes. We want successful businesses. We want everything to go well. Unfortunately, there is always conflict, but really through effective communication and just taking the time to understand other people's perspectives, understanding where other people are coming from, we can resolve conflict and we can kind of solve these problems. So hopefully this provided some new information to you or at least provided you some real world examples that you can apply to your own practice and you find this helpful. Hello, my name is Herb Villaflores and I'm a physiatrist based out of St. Louis, Missouri. Today I'm here to talk about what are some of the things that early physicians can work and develop on to try and lay a solid foundation for any future leadership positions that may come your way. As I mentioned, I'm based out of St. Louis, Missouri. I work with US Physiatry and we partner with SSM Health, one of the larger healthcare systems in the Midwest. I've had quite a few experience in dealing with different positions to include employed physicians, group practice, collaborations with academia, as well as administrative capacities. All right, so you've now finished med school. You've gone through residency. You applied and you're now finally full fledged and have your first job. You're either doing inpatient or outpatient, working brain injury, maybe doing injections, whatever your path has led you to. After a few years, you finally realize, I think I got this, it's not too bad. You've got the operational part down and then you realize what's next. Well, as your field in medicine continues to grow, one thing's for sure, we have to maintain our skills. We maintain our clinical knowledge. We call these the hard skills. We do this various ways with journals, going to conferences, keeping up with our maintenance of certification. But there is one other portion that many of us neglect and that's the other half, if you will. These are the soft skills. These are the skills needed to make your life, to make your work life run more smoothly, more efficiently. This isn't as straightforward. Some folks will try and gain these through maybe getting an MBA, or maybe seeking mentors in their practice, or maybe even just consulting Dr. Google and doing some self-directed research. Why do you want to develop this? Well, at some point, because we're all physicians here, you're going to get that tap on the shoulder. It's inevitable. Hey, there's a new position for medical directorship, and we're interested and thought you might be a good fit, or, hey, we're looking for a new member for our peer review committee, or even as simple as, hey, we're thinking of forming a group to try and help work on a surgical site and infections, want to know if we can get a physiatrist perspective on this. Regardless of whatever it may be, because of your position, you'll be asked to be part of committees and or lead some type of group. Why else do we want to develop this? We want to prevent burnout. There's a study from the Mayo Clinic Proceedings that mentions if you work on your soft skills, such as emotional intelligence, self-care techniques, it can prevent burnout down the road. And then finally, some folks realize, you know, I'm just not that good at negotiations, or you know what, I'm just not that good when it comes to crucial conversations, and I really need to work on that. And so from a perspective of self-improvement, many physicians will want to develop their soft skills. What is leadership? What is a leader? There are many different definitions and descriptions of what a leader should be, but in short, a leader is someone who can get a group from point A to point B by using their influence. It's that simple. And you as physicians, why are you posed to be a leader? Well, you've got two things going for you. First of all, you have the intellect. You don't get this far without having at least some basic knowledge on some basic sciences. And finally, probably most importantly, is you have the stick-to-it-ness. You have the perseverance. Once again, you don't get this far and finish and start working to where you're at without having to endure and having to have some sacrifices down the road through the many years of education. Note that many healthcare systems now are really looking at physicians to be in their top leadership positions. Why is that? Well, specifically, you have the knowledge, you've got the perseverance. Most of us have the personality, but the biggest thing is we've been in the trenches. We know what it's like where the rubber meets the road. So what are the keys to your success? As I mentioned, through the experiences we've had, specifically with administration or just different physicians that you'll come across, there's always that it factor. It doesn't matter if you're OB-GYN, if you're a hospitalist, if you're a general surgeon. Even if you run where you're not really patient-facing, such as pathology or radiology. What's that it factor? These are the three key things that seem to stand out that help these young physicians really leap forward in terms of their leadership and engagement with groups. What are the skills? Well, first, there's the emotional intelligence. Secondly, early physicians that are able to resolve conflict pretty easily show great promise. And number three, the ability to speak in front of a group. All right, emotional intelligence. What is this? Emotional intelligence, in short, is the ability to read the room, to read the person, to have some type of awareness in terms of where that person or that person in front of you may be positioned. There's a term, the Morabian ratio. And the key thing with this is you as a communicator, as you're speaking to that person in front of you, know that 7% of your communication is only coming through with the words you're using, the specific words and text that you're using. 38% of your message comes across, is conveyed in your tone, in your inflections. Finally, by far, at 55%, your communication, your mode to express your thoughts and feelings across is primarily conveyed through your nonverbal communication, through your stance, through your gestures, your hand motions, your eye contact. Key thing with emotional intelligence is it isn't so much an issue where you're delivering the message as much as how are you receiving, how are you observing. So your listening and observing skills are probably the most key important components for emotional intelligence. The reason being is once you're able to listen and observe and gauge where that person is and gauge where that person may be, it allows you to be able to meet that person where they are. You're able to adjust and meet that person from a maybe intellectual level, maybe from a comfort personality level, whatever it may be. We all hear examples when we're doing our clinical diagnosis, first year of med school, that when we're talking to patients, it's not ideal when we're talking over their heads, standing over their bed, and they're looking right up at you. The best way to do it is if you can, bow down, get on eye level as much as you can. If they're in a wheelchair, maybe squat or kneel on one knee, so to get to one level as to have a more effective exchange of ideas and communication. Conflict resolution. At the end of the day, if you want to be an effective leader, physician leader, you want to be able to, with the person in front of you, if you're having a conflict, get to a common goal. It's a balance. Someone's got to give a little, someone's got to take a little, but at the end of the day, both parties are trying to reach a common goal. And that's difficult. But two key things to kind of help you on your side, so that you're able to see the other person's point of view. First of all, that other person, what's their character? Are they a new person? Are they a new physician? Are they seasoned? Is somebody administration, for example? Where are they in their position? And then finally, what's their intent? What's their purpose? Are they there to learn? Are they there to persuade you? Are you trying to persuade them? Maybe it's a physician that's having some difficulties with their behavior, and now it's your job to be able to kind of discipline and help them see the error of their ways and maybe be a better person. Finally, public speaking. This, for most, is very difficult. There's a study from NIH stating that 73% of the population fears public speaking. They fear it above death, fear it above spiders, and fear it above heights. But there are two simple tenets, if you will, to try and help you with public speaking. Just like with the conflict resolution, you have to know your audience and also know what they're there for. As an example, for you all, maybe most of you are early physicians, right? You're here to learn. You want to get some kind of practical pearls. Or maybe you've been around the block a few times, things are getting stale, or maybe there's some positions that are being offered that require leadership and seeing what things can you use. So knowing your audience and then knowing what their intent is can help you direct your delivery of speech so that it's more effective. So to conclude, probably the first and foremost thing is you have to know yourself. Are you an introvert? Are you an extrovert? Just because you're an introvert doesn't mean you have to turn yourself into an extrovert to be a great public speaker. We all have our strengths and weaknesses. It's important to know how we leverage our strengths, but also if we have weaknesses, what can we do to help bolster that? So in short, working on your emotional quotient, on your EQ, to be able to have you adjust to that other person so you can meet them where they are can make you a more effective communicator. Being able to resolve conflict is key when it comes to negotiations, when it comes to trying to push a project through, whatever it may be. In leadership positions, conflict is always going to be present and depending on how you're able to resolve that can lead to your success. And then finally, public speaking. Needless to say, if you're able to speak well, if you're able to communicate effectively, not only will that help support and bolster your character as a leader, but also make you more influential. Some resources that may help you. So first of all, you might want to look at your employer. Some healthcare systems may offer leadership for physicians. I know our hospital system here in St. Louis, they did offer a few courses where they would have physician-specific leadership courses almost lasting a semester long. Part of that as well is you also may have mentors inevitably in your practice. It'd be worthwhile to tap into that resource and ask them if they could mentor you or at least if you can run any kind of questions or concerns by them. Second, for conflict resolution, Crucial Conversations is a great read. Very easy, very short. It's probably a hundred and something pages. And you can take some of those pros and use them almost immediately. And then finally for public speaking, Third Party out there is called Toastmasters. They're designed not just to speak publicly, but they also have leadership training in terms of how to run meetings, how to run agendas, how to interview. So they're very much a wealth of information as it regards to leadership in general. So finally, I just want to thank you all for your part, for your attention to the presentation. Hopefully these three skills can lay a solid foundation to make you the future physician potential that you may have. Thank you so much. It's wonderful. You're here with us on this virtual pre-conference course. I want to first thank Dr. DiTomaso for heralding this course and doing all the work for putting it together, bringing us together as speakers. I want to thank Dr. Strickland and Dr. Villapaz. It's really just a pleasure to be working on projects with them like this. And today you've heard discussion on team leadership, the future of team leadership in PM&R. It's very important. It's very important in every field. It's important for us as physiatrists to understand how to do that job better. And certainly in this time where medicine is rapidly changing in a number of different directions at the same time. Like everyone, I have my mentors. I'll introduce you to two of them that I met through the virtual world, who I have a lot of respect for looking at contemporary ways to lead a team. And the information of theirs that I will forward to you has to do with many stories I could tell you about traits and skills that are so critical for PM&R physicians. And I want to talk to you about some of those traits and skills that are so critical for PM&R physicians to have as they move through leadership in any domain. My particular interest is the inpatient domain. So I'm going to introduce you to two thought leaders. One is Adam Grant. He is a clinical psychologist in organizational behavior on faculty at Wharton. And secondly is Simon Sinek. And you may have already been introduced to this echelon of leadership skills mentors online. So I'm going to begin screen sharing. We're going to start initially with some essential skills. And I'm going to go through very briefly what I think is the most essential skill as a leader of any team in any organization. And as I've told you through my experience, most importantly in leadership roles within PM&R at any level, it's the art of listening. So as we go through these sets of skills I'll share with you, you may say, oh, yes, I do that. I do this. Today suspend your thoughts about that and just listen to the presentation and see what things you can absorb that will make you better in each characteristic. So clearly, the best way to open people's minds isn't to argue with them, it's to listen to them. When people feel understood, they certainly become less defensive and more reflective and develop less extreme views and develop more nuanced views, which are very important in any situation. And any disagreement should be productive disagreements that begin with curiosity about the other individual's perspective on an issue. And the effort should not initially be on persuasion, but on understanding. And this is so true in the field of PM&R leadership. One thing to remember is don't mistake someone who's quiet or silent for apathy. When people are quiet, they're usually busy thinking and learning and listening. And you have probably observed this in a group that extroverts like to process ideas by talking through them. And introverts prefer to listen. They're the last to speak. And it's not because they're disengaged. It's that they're listening to your views and formulating their views in consideration of yours. This is Simon Sinek on the art of listening. Listening is about holding space. It's not about agreeing or disagreeing. It's about creating a space in which the other person can feel heard. That's the only goal, right? Responding doesn't always have to be in the immediate, because sometimes when you're in that listening space, it's highly emotional. And the thing that we want to do is correct the facts. Please don't do that, right? So I'll give you two examples. One is a personal one. One is a professional one. The first one is a friend of mine who works for a Fortune 10, Fortune 50 company had an issue with an employee. It got escalated up to HR. HR got involved and told them that they needed to sit in a room and talk this out. And HR was going to be in the room with them. Fairly normal in a large corporation. Corporate environment. So my friend, who was the one who was in the leadership position, who was told that she was being a bad leader, called me up and said, how do I do this meeting? And I explained that all that the person needs is to feel heard. That is the total goal of this meeting. I know that she's seeing the situation differently. I know that it's not exactly as she said it to me. I know that there's facts that need to be corrected. All true. This space is only... They went into the meeting and my friend practiced her listening skills. Go on, tell me more. What else? Go on, tell me more. What else? Until her teammate had nothing else to say. At the end of that, my friend said, how do you feel? She said, thank you. I really appreciate you taking the time to hear me. I really appreciate it. That should have been the end of the meeting. HR said, didn't you have something you wanted to tell her? My friend's like, no. No, no, no, I'm good. HR's like, no, no, no. HR literally was about to break it. They created this container. The time for fact-correcting can come a couple of days later. To go up to her and be like, can I have another meeting with you? I thought about what you said, and can I share with you some of my reactions? Now she's in a rational space. Here's what happened to me that proves the case. I went to see a friend of mine's play. She was an actor in the play. It was easily the worst thing I've ever seen in my life. If I could have walked out twice, I would have. But I couldn't. I had to endure the whole mess because my friend was in the play. At the end of the play, I'm waiting in the lobby with parents and friends and waiting for my friend to come out. She comes out. She's still in costume and makeup. She's still jacked up on adrenaline from being on stage. She knows me to be an honest broker. And she says to me, what did you think? Now is not the time. But I can't lie. So I said, it was so magical to come and see you do your thing. I've never seen you on stage before. And it was really a thrill for me to come and see you do your thing. True. Thank you. Thank you. Thank you. Oh my God. Thank you for coming. Crisis averted. Two days later, I called her up. Adrenaline has gone. Emotions are in normal. And I said, can I tell you what I thought? She said, sure, of course. And I told her very honestly about, I thought the directing was weak. I thought the script was weak. And she was like, yeah, we had a rational conversation about it. And so I think one of the things we forget in listening and responding is we think it all has to be at the same time. It doesn't. The first part is the emotional part. We don't teach that listening skill to create a space in which someone can empty their bucket and feel heard. And then if there's any facts that need to be corrected or conversation needs to happen, it can happen a day or two later when rational, when somebody feels good. And we can actually have a rational conversation because very often we mix the two and they're oil and water. So I think we need to teach the skills. I mean, these are all skills. I did not have them in the past. I'm still working on them now, but I'm better than I used to be because I learned the skills. They're practicable, learnable, teachable skills. We're going to move on to leaders in the quality of leaders. We'll explore a little bit about how one starts and proceeds on that journey. The one thing I want to make pretty overt is that social media certainly has its remarkable, remarkable part. And it also has this unremarkable part. So when one starts out on social media, which happens at a very early age, you clearly see the big blue circle, what other people project that they have. And it's human nature to see, and then you think that's what you want. You want the big blue circle. And your idea of what you have in terms of skills or have in terms of have is a small yellow circle, substantially less than the blue circle. But what you actually want is the purple circle. It's a little bit of what other people have and a little bit of what you have combined in the best possible way. So the point to this slide is just understand this happens all the time with those of us that are on social media or virtual education media. I think it's important for you to have that perspective. It's clear that leaders are not born. They are made. No one comes out as a natural leader. Everybody starts out with shortcomings. Everybody starts out with strengths. And leadership potential doesn't depend on the traits you possess. It emerges from the values you choose, and most importantly, the skills you learn along the way, your experience. So we touched on this a little bit earlier, but it's better to be the wisest person in the room than the smartest person in the room. You have certainly been in meetings where you get the feeling people are proving their intelligence by showing you what they know. But people really reveal their wisdom by integrating what everybody knows. It's the person sitting in the back corner who's listening. And intelligence can be used in two ways. Number one, you can advance your own personal agendas if you're really smart, but wisdom really guides groups to have shared goals that are achievable. The other aspect of leadership we hear about frequently is humility. And humility really isn't at all a sign of low esteem. It's actually a mark of high self-awareness. And the goal isn't to deny your strengths in being humble. It's to see your strengths and shortcomings accurately and clearly. The first rule of improvement is to recognize there is room for improvement in one's leadership skills. Narcissism feeds ego. However, humility fuels growth. And admitting that we have something to learn doesn't just show humility. It really improves relationships. When we acknowledge that we don't know everything, others feel more psychologically safe and become more effective. Expressing our own desire to get better actually shows others how to get better themselves. One of my colleagues told me a story where they had made a mistaken judgment during the COVID times when we were all called on to be leaders of our institutions as physicians in a world where we had no precedent on many things. And they conveyed to me, they had made a decision during COVID that ended up not being the right decision. It was a departmental decision. And this individual told me the story how they got up in front of the department as COVID marched on and they admitted that they made a mistake to the whole department. And I was awed by that story because in essence, their expression of their desire to get better was the same as their own. Their expression of their desire to get better, that they're not perfect, it's an imperfect world, can help others say, yeah, that's great. I'm going to need to learn that in the future. Owning up when you do well and owning up when you didn't make the right decision. It helps other people even more than it helps you. So looking, continuing on the leadership aspects, we all know a boss looks for reasons to say no, right? That's the boss. That's why I don't like being called boss man. A leader looks for reasons to say yes. A boss issues orders and demands loyalty. A leader gives direction and takes responsibility. A boss expects to be the most important person in the room. A leader makes everyone, makes you feel like the most important person in the room. Think about that. And insecure leaders are usually easy to spot. They strive to be the most powerful person in the room. They make others kind of feel a bit weak so they can, said they alone can be the strong one. But secure leaders aim to amplify the power of the room. They use their strength to make all the others in the room stronger. And clearly the best and highest use of power is to share it, to help other people improve their game. So a culture of rapid responding, and we tend to do that a lot in healthcare organizations. So they inevitably prize shallow reactions over deep reflection. We shouldn't mistake promptness for politeness. For instance, if you get an email and you don't think it's urgent, it's not really rude to take some time to reply. And it always is better to be slow and thoughtful about responses unless it's something urgent than fast and careless. So we're going to look at the world of authenticity. And there's so many definitions and paradigms that this has been talked about, which is a good thing. But authenticity is not about being unfiltered. It's about staying true to your principles. The goal isn't to voice every opinion you hold. It's to stand up for the ideas that are consistent with your ideals. Being genuine is closing the gap between what you value and what you express. Sometimes you'll hear from unfiltered people, I would just be myself. I didn't really, it's not an excuse for disrespectful behavior. It signals a lack of concern for others because authenticity without empathy is really selfish. Authenticity without boundaries is careless and reckless. And being true to yourself shouldn't come at the expense of being kind to others. The people who are nice to you aren't always being kind. They're not always being kind to you. I see this often in medical organizations where someone's not pulling their weight for the team, maybe even doing the opposite. And it's really hard for the team members, even the leadership of that team, to give feedback. The sense that they're being mean or critical, the sense that they're being mean or critical, they have to work with this person after that day of reckoning. But saying to someone what they want to hear is nice, but sugarcoating feedback, it's sugarcoating feedback to make them feel good that day. Sharing what you need to hear is kind. People speak honestly to help you do better tomorrow. So, honesty and candor is actually an act of kindness. And holding back and not being brave enough to speak the truth in a reasonable, rational, and supportive way is not an act of care. The team. So, we all work in teams. And all of us get very experienced over the course of time. And we have a lot of opportunity to work with many teams. And acts of kindness, they feel small to us, but have a very big impact on others. Because the research shows that kids and adults underestimate how tiny acts of generosity lifts others' moods. There's no easier way to make someone's day than to offer a compliment, give a little gift, send a handwritten note. I'm sure many of you understand that in a hospital, an organization, and I think physicians in general are more attuned to this than others, but leaders need to be super attuned to this, is to give thank yous to staff at all levels. Ask them how their day is going. Give them recognition. Listen to what they have to say. It doesn't take long. But it has a big impact at every level in an organization. And it's a positive impact. And we need people with lots of positivity providing the level of health care that we provide with a degree of complexity of our patients. And success is not really about winning competition. It's about making a contribution. I'm sure all of you realize that because you're listening to this presentation. Takers aim to be better than others. Givers strive to bring out the best in others. And the most meaningful way to succeed is to help others succeed. The most meaningful way to succeed is to help others succeed. Risk-taking. Well, you're all here on the presentation. So you are, by default, takers of risk to various degrees, but I'd imagine higher than average. What about risk-taking? Well, even though risk-taking is uncomfortable for many of us, we miss out on opportunities because we generally ask ourselves what could go wrong. But it's certainly worthwhile in asking yourself, well, what could go right? Because change actually does carry risk. We might fail. We might fail. We might fail. But sticking to the status quo also brings risk, and we might fail to grow. In one of my recent discussions with a high-level C-suite individual, we were talking about growth of a medical entity, any entity really, but we're going to stick with medicine. That's what we know. And in every entity these days, if you fail to push for growth, you're really spelling the end of that organization over time. And that is just reality. So we're going to need to take risks, and we're going to need to learn to take more risks and maybe bigger risks and not develop as much fear of failure, because it's a changing world in which we live, and the medical world is changing as fast or faster than the fastest. So it's better to test and learn than never to test at all. And refusing to give up on a failing plan, say you're doing something and it's like, we keep doing this and nothing's changing, right? That's not really an act of resilience. It's a display of rigidity. In the word grit, we've all heard grit a lot. It's not about persevering with a route that's not working. It's about staying focused on the goal, but being flexible on the path to get there. So healthy persistence requires peripheral vision. Central vision is where you are. Peripheral vision is where you likely will need to be to move the organization forward. And our organizations are centered around healthcare, and our goal and mission as physicians, as you know, is the patient's best interest. Trust. That's another hugely amazing word, hard to define, has had multiple definitions. And for a leader, you're going to need to develop trust at every level of your team. I've worked with the Navy SEALs, and I asked them, how do you pick the guys that go on SEAL Team 6? Right? Because they're the best of the best, the best of the best. And they drew a graph for me. And on one side, they wrote the word performance, and on the other side, they wrote the word trust. The way they define the terms is performance on the battlefield and The way they define the terms is performance on the battlefield and performance off the battlefield. So this is your skills. This is, did you make your quarterly earnings, whatever, however you want to translate it, right? Performance. It's traditional. This is, how are you off the battlefield? What kind of person are you? The way they put it is, I may trust you with my life, but do I trust you with my money and my wife? They're SEALs. This is what they told me. Nobody wants this person, the low performer of low trust, of course. Of course, everybody wants this person, the high performer of high trust, of course. What they learned is that this person, the high performer of low trust, is a toxic leader and a toxic team member. And they would rather have a medium performer of high trust, sometimes even a low performer of high trust, it's a relative scale, over this person. This is the highest performing organization on the planet, and this person is more important to them than this person. And the problem in business is we have lopsided metrics. We have a million and one metrics to measure someone's performance and negligible to no metrics to measure someone's trustworthiness. And so what we end up doing is promoting or bonusing toxicity in our businesses, which is bad for the long game because it eventually destroys the whole organization. The irony is it's unbelievably easy to find these people. Go to any team and say, who's the asshole? And they'll all point to the same person. Equally, if you go to any team and say, who do you trust more than anybody else? Who's always got your back? And when the chips are down, they will be there with you. They will also all point to the same person. It's the best gifted natural leader who's creating an environment for everybody else to succeed, and they may not be your most individual highest performer, but that person, you better keep them on your team. You will all encounter toxic cultures along your path of leadership. You will all identify them as defining success as winning a cutthroat competition. They reward people for stabbing others in the back. They throw people under the bus. Healthy cultures define success as making a contribution. They reward people for having other people's backs. And good organizations elevate those who elevate others. And if your organization happens to have toxic stars, you don't just have a culture problem, you have a broken reward system. Healthy organizations, the impact people have on others, the impact people have on others in a positive way is a key factor in their paid performance and promotions. If you're not one of those good guys, you're not a success. Blaming and shaming doesn't stop people from making mistakes. For instance, in rehabilitation, one of our metrics is acute care transfers. There's definitely a better way to have a staff discussion about processes to reduce that. And there are worse ways to have discussions about that. And I've seen both. But it really stops people from admitting a mistake, or maybe not even a mistake, just admitting that they didn't follow a process. And if people can't share their blunders or misinterpretations, they can't learn from them. And neither can the rest of us. And it's all about, obviously, learning to do things better in light of quality improvement of the organization. Absolutely, the best way to prevent errors is to make it safe for people to discuss them and to discuss processes in an open, unblaming, unshaming environment. I wanted to add this toward the end of this discussion, because I think in PM&R, and in many medical specialties, when physicians take on leadership roles, they have a bit of mindset that they're in way over their heads. But imposter syndrome, whether you think it applies to you or not, it's not a disease. It's a normal response to internalizing impossibly high standards. Doubting yourself doesn't mean you're going to fail. It usually means you're facing a new challenge, and you're going to learn. And feeling that uncertainty, which we all have and will as we push the limits of our abilities to make a greater organization to serve the greater good of our patients, it's a precursor to growth. So I have spoken to new medical directors. I would say many, many of them feel like an imposter when they're extremely bright, they're extremely capable, they're extremely patient-centered. It's just something I want you to recognize and to recognize it and dismiss it and move forward. And then you realize when multiple people believe in you, it's probably time to believe them. Adam Grant has a book out I recently finished. It's called Hidden Potential. I highly recommend it. It's a great reader, a great listener if you spend a lot of car time. Bruno. It's healthcare 2024, almost 2025. A busy life is not a status symbol. It's a symptom trying to do too much for too many people. A full calendar brings a surplus of stress and a shortage of energy. And reflecting your relaxation should be major top priorities. Unscheduled time isn't a waste, it's invested in well-being. I think the generational thinking on this is improving and getting healthier. And it should. If efficiency is overrated, what counts is the quality of your work, not the quantity. People may be impressed by the volume you produce, but the impact depends on the value you create. Success isn't about getting more things done. It's about doing more worthwhile things well. Balance really comes from increasing efficiency. It usually involves reducing responsibilities. The more priorities we have, the harder they are to juggle. It's better to do a few things well than to be overwhelmed by many. A key to avoiding burnout is deciding what doesn't matter. And that can be a hard decision. But in the healthcare milieu that we work in now, and I talk to my colleagues in all specialties regularly, they are overwhelmed by the demand for their services. And we carry too much guilt about letting other people down and too little fear of letting ourselves down. We don't fully control whether we live up to others' expectations, but we do decide if we meet our own expectations. The most important commitments to uphold are the ones you make to yourself. Beating yourself up doesn't make you any stronger. It leaves you bruised. Being kind to yourself is not about ignoring your weaknesses. It's about giving yourself permission to learn from your mistakes. And we grow by embracing shortcomings, not punishing them. With respect to relationships, it's complicated for physicians because we're busy people. Whether we try to be unbusy or less busy, we're busy people. But one thing to remember is you're not obligated to maintain a relationship with anyone who treats you poorly on any level. No mentor, no friend, no relative deserves unconditional loyalty. Past help is not an excuse for present harm. If they're having a negative impact on you, you don't have to keep them in your life. A few words on mentorship. I'm a big proponent of that. As I said, I think it's important for relationships and mentorships to thrive, especially in physical medicine and rehabilitation. In our line of work, in the vulnerability of our patients, in the ability to lead organizations that serve them, I am a very large proponent of good mentorship. But there may be mentors that see you as building their own brand, and they may take credit for your success. But in reality, good mentors see you as a younger version of themselves. They help you follow in their footsteps. Great mentors see your potential to be a better version of yourself, and they can help you find your path. I wanted to thank you all for your time, and we've all appreciated working on this presentation for you. Thank you. Well, thank you so much for listening to our leadership panel. I hope you've learned something from all of our different perspectives and that this was helpful to you. Please feel free to reach out to any of us at your convenience. Lastly, if you do have questions, one, I think the FYS forum is a really underutilized way of communication. It's a really great way to get lots of different opinions on topics. Please consider using that if you do have questions. Otherwise, if you want to talk to a specific member of this leadership panel, you can feel free to contact me through all of those different manners, and I'll connect you as best I can. Thank you so much, and I hope that this was worthwhile for you.

AAPMNR

pre-conference

teamwork

leadership

early-career physiatrists

rehabilitation medicine

Dr. Craig DeTomaso

Dr. Victoria Strickland

Dr. Herbert Villaflores

Dr. Michael Lupinacci

emotional intelligence

conflict resolution

communication