Authority, Autonomy, Accountability

The sort of weather we’ve experienced lately prompts contemplation. I thought we were in the warm South until last week. What is all this “polar vortex” stuff about?

Since I can’t seem to figure out the weather, I have been thinking about the work that is being done to implement our new faculty compensation plan. The objective for this work is to fairly measure clinical and educational efforts with logical parameters, then link compensation with value.

We have been through one cycle of this with the faculty. I am forecasting it will take several cycles for us to become completely familiar with all of the nuances.

To facilitate that process, I have appointed a Compensation Advisory Committee chaired by Senior Associate Dean for Academic Affairs Dr. Elizabeth Baxley. The team is broadly constituted to bring a variety of perspectives to the work. Despite all the support and thought that went into creating the compensation plan, implementation still has been a significant challenge.

A compensation plan is not just a data-driven exercise. “Culture” also comes into play. Compensation is clearly linked to money and pay, but that is not all.

When I was in Syracuse, I helped develop and implement a physician compensation plan. It was a culture-changing exercise.

Physician Compensation PlansThe picture illustrates the relatively thick book titled, “Physician Compensation Plans – State-of-the-Art Strategies,” by Bruce A. Johnson, JD, MPA, and Deborah Walker Keegan, PhD, FACMPE. It is published by the Medical Group Management Association.

I bought this book in Syracuse, and even though it is a few years old, it is still relevant. The book describes all the dynamics and complexities likely to occur with any rationally-conceived compensation plan.

To quote a couple of sentences from the introduction:

“Why would medical directors or practice executives decide to champion a new compensation plan for their medical practice? Just the mere thought of tackling the complex, emotionally laden, legal minefield of physician compensation puts fear in the hearts and minds of otherwise rational beings. It is fully recognized that the process of changing a physician compensation plan may not be top on the list of career-enhancing events.”

Now that is encouraging!

But having a well understood and implemented compensation plan is essential in the orderly execution of our mission. It goes well beyond the satisfaction of individuals. This is a hugely important cultural transformation for us all.

Most of us speak about transformation in the third person. The reality is that the landscape we’ve become accustomed to is changing all around us, and we must individually accept this in order to prepare ourselves for our shared future.

We must personally adapt.

Which leads me to the concepts of Authority, Autonomy and Accountability.

Each of us “wears a hat” in the organizational structure. It is the authority vested in us by the organization. Similarly, as professionals we wield a significant amount of autonomy in our practices. Likewise and inevitably, each of us is accountable. We may point defensively to someone else, but in reality, in reflection, who is that someone?

This is where individual and personal introspection in these last (hopefully) dark days of winter may bear fruit.

We have full authority to support our mission, individually and collectively. We have autonomy that is evidenced by the faithful execution of our medical profession. We are accountable for the financial viability of our school. We are fully accountable for our individual actions.

Because excellence is our only acceptable standard, we are accountable for activities across the whole spectrum of work – not just the clinical activities. We champion graduate medical education and the advancement of science itself. All of this, of course, is intimately linked with our own personal desires for achievement and success.

Obviously, most of us balance these three principles in very practical and acceptable ways. The exciting challenge is when we all commit to converge our energies and actions for the most superlative implementation of winning strategies. That is how we can remain competitive in a volatile and complex medical world!

The weather has clearly complicated all of our lives, but it is nothing compared to the hugely transformative changes we have purposefully implemented. I also realize that “change happens at the speed of trust.”

As spring arrives, I am confident we will enjoy a renewed sense of commitment and all of the courage necessary to embrace a bright future of opportunity.

I hope to see you soon. Stay warm! And dry!



The humerus is a funny bone.

Being totally fascinated by everything to do with the human body, I am trying to fully understand the functional anatomy of this bone. It’s designed to transmit energy from the largest muscle masses in the human body, and to conversely transmit and dissipate reactive forces. This is a wonderful thing.

In times of complexity, there are a few approaches I find helpful. I’ll list them here:

  1. Study, explore to achieve understanding.
  2. Take postitive action to work on and resolve the complexity.
  3. Recognize the very irony of life itself – there is always humor in it!

Using these approaches, I have found it is possible to create valuable meaning, even in the presence of immense challenge. This is the secret to being “undaunted.” It is not about laughing off challenge, it’s about being in touch with reality in the most meaningful way. It takes hard work and effort to understand.

Our administrative team had the opportunity to meet with professor Dan Ariely at Duke University. He is in charge of the Center for Advanced Hindsight. Yes, that’s funny! (He is quite a serious person, ironically.)

Please consider taking a moment to watch one of his talks on TED: “What makes us feel good about our work?”

With all the stresses we have experienced over the last year, this talk provided me some insight and understanding, supported by data.

Ariely explains:

  • We should probably add all kinds of things to (our understanding of work): meaning, creation, challenges, ownership, identity, pride, etc.
  • People seeing the results of their labor – even for a short time – is important.
  • The less appreciated we feel our work is, the more money we want to do it.
  • Eliminating motivation seems to be incredibly easy, and if we don’t think about it carefully, we might overdo it!

Without meaning, most of us would not do much of anything – it’s certainly true of me. And I appreciate all of the folks here who display their pride and commitment to the mission and the meaningful work of “the Brody,” right here in Greenville.

Take care,




What Do You Want To Be?

This is the time for the traditional New Year’s resolutions. Let me take this one step further.

What do you want to be when you grow up? This is a question I was asked many times in my formative years. This question may not be so personally relevant today, as there are clear signs that my personal “growing up” is not as much of a distant and long term future destiny. However, I think the question still has value – for us individually, and for the organizations we are committed to work within.

Over the holidays, many institutions send their greetings and wishes our way, using the opportunity to brag about themselves and their accomplishments over the last year. To their credit, there are some really good things happening in academic medicine across the country.

We have also realized that it is important to speak about all of the positive accomplishments that are ours to celebrate over the year. It remains an exciting and positive environment for me to have the privilege of leading. These accomplishments are really too numerous to catalog here within the blog, and many, if not all, of these have been acknowledged separately.

We can acknowledge that we have never existed in such highly competitive environments as some of the institutions across the nation. This competition, at the national level, may fuel the need to loudly advertise any advantage that can be perceived in what may be called the “medical marketplace.” Brody’s own Annual Report is linked to the academic calendar and rarely gushes with immodesty. We need to understand that the level of competition in the future will inevitably increase and will occur at the national level. Our benchmarks for performance are no longer measured at the local level.

Our own approach in reporting our performance will continue to be as realistic as possible. This does not preclude championing the positive accomplishments, but we will also fully acknowledge the challenges we must face. To me, this sets the stage for the work that will be necessary to take advantage of the opportunities that we can imagine and see.

One has to work within a strong foundation of reality.

This is why the question – “What do you want to be when you grow up?” – is so relevant. The dynamic of this question focuses attention on the present, and at the same time, projects into the future with anticipation of something rewarding. The future aspiration is what we can become excited about, and is inherently energizing and motivational. The future state is worth the effort as we work towards the goals.

We can all take stock of our many accomplishments over the past several months. Our clinicians have risen to the challenge of increasing access for our patients. This has been close to a “double digit” response over the last six months.

There are success stories from every component of the enterprise. They include our students presenting research, faculty attaining tenure and promotion and staff demonstrating their leadership and loyalty to the mission of the school.

With these in mind, we can commit to working energetically now with a positive vision of the future. Some of our work will consist of “must do’s” and some will be based on our own creativity and imagination.

When the Brody School of Medicine “grows up,” we will be broadly acknowledged as the most effective medical school in North Carolina dedicated to the health and wellness of its region’s citizens. We will be fully recognized as contributing to the economic health of eastern North Carolina in even more meaningful ways. We will be seen as a valuable partner within the state and in all that pertains to the provision of medical care and service and the health maintenance.

I am excited by this continuing work and look forward to all that can be seen as opportunity in the New Year.

I wish you all the very best for 2015!


Wearing Out the Habit

A friend recently pointed me to an article in The New Yorker titled “Better All the Time,” written by James Surowiecki. I subscribe to the magazine, since New York City is one of my favorite places in the world, and there is always something of interest to read.

Like my friend, I was struck by the similarities and parallels that we are observing and learning about our own culture at Brody. So many have clearly stepped up to the plate and have contributed in the most positive way to the work that is at hand.

For certain, I can think of no one who would be satisfied with an average doctor, or a so-so nurse or other provider. Our staff can’t be anything but excellent in everything that we offer. After all, we are dealing with the lives of human beings. This is not merely a game that we play.

Yet, our athletes clearly play their games as if they are engaged in life and death struggles. It’s as if the games that we watch and play can reveal the truths that are embedded in our day to day lives.

I’ll summarize the article here, if you don’t have the time to read all of it:

Professional athletes had always worked out, of course. But historically, practice was mainly about getting in shape and learning to play with your teammates. It was not about mastering skills. People figured that either you had those skills or you didn’t.

Bob Petrich, a defensive end for the San Diego Chargers in the 1960s, told an interviewer that most NFL players of his era even scorned the idea of lifting weights.

“Most of the guys had this mental attitude that if you’re not good enough the way you are, then you’ll never be good enough,” Petrich said. The prevailing philosophy was “What you are is what you are.”

In the summer of 1976, Kermit Washington was in trouble.

What Washington did next changed the NBA: he called a man named Pete Newell and asked for help. Newell had been a legendary college coach, and was working for the Lakers as a special assistant. But his coaching skills were being wasted, because, as David Halberstam wrote in “The Breaks of the Game” (1981), NBA players didn’t want to admit that they “still had something to learn.”

Today, in sports, what you are is what you make yourself into. Innate athletic ability matters, but it’s taken to be the base from which you have to ascend.

You might think that this pressure to improve reflects the fact that the monetary rewards for athletic success have become immense. There’s something to this. It has become economically rational to invest a lot in player training.

Yet money isn’t the whole story. What we’re seeing is, in part, the mainstreaming of excellent habits. Everyone works hard. Everyone is really good.

The value system that we are experiencing and exploring here at the Brody School of Medicine and at Vidant are in parallel with this. There has been a renewed understanding for the value of excellence – not just as a concept, but in practice.

We are on a continuous learning curve. Excellence is the criterion for success in every one of our units and in caring for our patients.

Creating rapport with each of our patients, deploying even the simplest of tasks – it’s all about performing as if this is vital to our game.

How can I perform better today? How proud of the work will I be at the end of the day?

Have a great day, too!


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