This episode of the MGMA Women in Healthcare Podcast features Adrienne Palmer Lloyd, MHA, FACHE. A frequent guest of the MGMA Podcast Network, Adrienne is with Optimize Healthcare and is also an MGMA consultant. In the future, Adrienne will take on a more prominent role by leading the Women in Healthcare Podcast.
MGMA Sr. Editor Daniel Williams, MBA, MSEM, met with Adrienne to discuss women in healthcare along with leadership in healthcare.
Q. What are your thoughts initially about Women in Healthcare as a podcast format?
A. I think with women and healthcare, there continues to be expanded roles and obviously we need everyone in healthcare regardless of any distinguishing factor. But I think for most women in healthcare, there definitely is a unique trajectory and unique situations that many of us face, and I do think there's a lot of stories that are there to be shared both from overcoming obstacles to functioning in different roles as people have grown and expanded their leadership capacity and find different paths. I'm hoping we'll be able to have lots of different types of input and people who've taken different paths along the way with different journeys. Ultimately, we want to have a platform where people are able to share experiences they've had in such a way that they're going to be able to help inspire anyone who's looking to become a leader and hopefully just continue from there.
Q. Share a little bit of your personal journey and experiences that have led you eventually to the role that you're in now as a healthcare consultant and an expert.
A. I am from a very small town in North Carolina and had lots of interactions with healthcare growing up from my own personal journey with my grandparents and other family members. So healthcare was and will always be a part of who I am and what I do. I started my career with my postgraduate fellowship at Mayo Clinic and was able to work there with a variety of specialties and leadership roles creating operational change. These were some very big jobs very early in my career where I often felt overwhelmed and sometimes underqualified. I hate to say “fake it until you make it” because I don’t really believe that’s what I did and I don’t believe that’s what many do. I think it's about asking questions, looking at information, asking for input, watching the providers and whatever it is you need to do to learn through those experiences. You identify different scenarios and you start to connect the dots of how things work, and if we did this here, it can work like that there. But I've had some amazing experiences.
I was at Mayo Clinic for 10 years in a variety of specialties, then in Minnesota where I froze and in Arizona where I burned up (laughs). I was at Duke Health for seven years working with ophthalmology and was able to do a lot of transformation. In all of my roles, I often found myself in positions of really trying to create change and turnaround in organizations with a lot of great people trying to do the right things but without a cohesive vision, structure and engaging processes to get there. And so I was very fortunate to be able to partner with some great physician leaders and great administrative leaders to really drive those changes, which created not only financial and operational results, but also decreased our turnover, increased the physician satisfaction and all of those things.
I love the teaching process and I love consulting. Going into consulting has been fantastic because I've loved to be able to meet different people in different practices. We all have very similar experiences in many different ways, but being able to go in there and help partner with them to understand what they're working through and what they're trying to change has been fantastic.
Q. What are some of the challenges when you're working with practices and when you're also working as a coach to other leaders? What are some of the pain points that you're seeing time and time again and how do you help them resolve some of those problems?
A. The only constant in healthcare is change, so I think that it is just being aware of the changes that are needed and being able to keep up with the changes that are needed while really driving the change in an organization. It's just an overwhelming amount of information and details of things that need to occur. People outside of the healthcare industry and business leaders also have many changes coming their way as well and sometimes in some ways more rapidly than we do. But there's just so many dynamics. In the last few years, employee retention and now provider retention are very big challenges. People had to increase their salaries over the last two years to retain employees and now they've had regulatory reimbursement impacts that created further squeezes on finances that are creating gaps in terms of margins and improvements that they need — and there's still retention and recruitment issues.
What I've found is it varies depending on what market you're in and what type of organization you have. Some people are struggling more with frontline access and check in areas. Others are struggling more to find qualified specialized clinical team members and even if they're able to recruit a nurse, if they're a cardiology practice, it may be a nurse who's spent most of her career in oncology and doesn't really understand cardiology, per se, let alone working with those specific physicians inside those structures and processes plus all the stuff that comes with it. As we know, there’s still so much uniqueness in practice delivery, so I think really being able to just understand that change is going to be there. But really work to create the vision with your team, the vision for yourself and for your organization, what the priorities are and being able to bring the team along with that.
As we talked about retention and recruitment, I think regardless of their generation, people want to feel that they understand what success looks like in their job. They want to know what that looks like and what that feels like [regarding] what's expected of them. Then they also want to feel valued and recognized in a way that they're contributing to the overall goal. So I think at the heart of it, if you can manage to get clear yourself, create clarity with your team, and then create that engagement and continuous improvement — the culture where people feel like they get to give input and feel valued — that can really get you hopefully 80% of the way there.
Q. As healthcare professionals are facing burnout in record numbers right now, what are some ways that they can prioritize self-care and well-being to help them do their jobs better and feel better inside as well?
A. In terms of burnout, I have been there. I've had roles where I've been leading lots of change. Even early on in my career where I wasn't even sure how much we needed to change, diving into the details or figuring out the problems, you're trying to figure out where to go. I've had 60-80 hour weeks, sometimes multiple weeks in a row and I also know that I've been, at times, not the best role model for my team because I was trying to do those things. So that's not what I want for leaders out there. Often there's the time that we work when we eventually don't have enough time and energy for the things outside of our professional life that we want to have. That's one aspect of burnout — you truly just don't have time and energy to do anything else. But the other piece is within your work, your career and your organization.
When you're doing things that you feel like you're really contributing at your highest level, you're in your genius zone and most of the time as leaders, depending on what position you're in, you're doing things that no one else in your organization can do. You're ideally at the point where you're able to focus on the strategy and higher-level tasks. It really starts first with getting a clearer and better understanding of where your strengths are, because we can't be good at every single thing.
When you can take a step back, assess what you really are great at, identify team members that may love doing that thing that you like so much — or maybe you struggle a little bit more to do — you can really start to build that consistent cohesiveness across the group. It makes it more fun and you can move faster. I think that is a huge part of it.
[There are] different programs that you can offer to help individuals think differently about work-life balance. I like to think of it as work-life integration because I think it just ebbs and flows so much. I think creating more open conversations with your team about what's important to them, both professional growth wise — what do they want to achieve — but also personally … I think creating that environment where people get to be people and not just team members is huge.
Q. Obviously you want a motivated and engaged workforce where you want people to enjoy their lives outside of work so they can hopefully enjoy it in the workplace as well. Are there some effective ways you've seen where you can promote creating such supportive environments? What are some of the things you’ve seen in practices that you’ve worked with?
A. I think just having the intentional conversation about what's important to the individual and then also what’s in line with getting the job done and taking care of the patients [is important]. So having the conversations and opening that door to say, “We want to create an organization where things are more consistent, it's predictable most of the time about when we're going to get out — if we can make arrangements for people to have time away, or we can make arrangements for flexible schedule, or work remotely, all of those things — we want to do that, we just have to work together to figure out how that can work.” If you have those discussions and that environment there, that's a fantastic start and then there are realities of “what changes do you need to make in terms of workflows and processes and just how things are functioning to be able to achieve that?”
I think a lot of times what happens as a leader is you're trying to carry the weight of the organization on your shoulders. With the problems that are coming ahead in terms of regulatory reimbursement, we try to protect our team a little bit. It's not that we want to scare them, but we also try to hold maybe too much. And then we can just start to have those vulnerable, transparent conversations. So being able to share that with the team in this way that says, “Look, we're going to be okay and we're going to figure this out, but we're going to have to improve on customer service and we're going to have to think differently about which types of patients we bring in,” — having those discussions then allows you to create structures and processes that help the organization, the patient flow and everything work more easily. You can then create more of that balance along with collegiality and collaboration with your group.
Q. Do you have some specific examples – anything that you've shared as a coach, as a consultant or anything else – in helping some of those leaders out there strike work-life balance? And how do you find that balance?
A. Well if you think about any of those visuals of a tight rope or standing on a balance beam or sitting in the middle of a seesaw, none of those are stable. It's fluid. You're going to have to continuously be adjusting, so I think just knowing that there is no perfect answer is a good place to start.
But one of the things that I do with most of the groups that I work with, particularly for trying to create strategic change or if I'm working as a coach, is around getting clarity. A lot of times when we do visioning and strategy, we only focus on the professional side if we're doing it as a team. What I like to do is say, “What's working and what's not working personally and professionally?”
I know there were periods in my career where we were driving change and I was working so much that between work and my kids, there wasn't a lot of time for anything else. I didn't have lunch with friends. I had one friend from college that actually lives here in Chapel Hill and I don't think I had lunch with her for two years. That wasn't what I would love to have happened. Sometimes it's going to look differently, but define what you want those things to look like personally and [define] what are a couple of things that are really important to you. Then, as well, do that with your team professionally — what are you trying to create together and what are those goals? So know it's a journey and trust that it's a journey.
We've gotten much more into the mindset of energy discussions over the last few years. I think part of it is about your time and how much time you're spending in those areas that you want, but a lot of it has to do with your energy. When you leave the office and you get home, are you able to really connect with those things — either those people or other hobbies and passions that you have in a meaningful way? So you can still have things that light you up and re-energize you when you come back to the office the next week. And just continuously evaluate that at least every six months, ideally, or quarterly and even [have] monthly check-ins on “how am I doing” and not being judgmental with yourself about it.
But just know there's a lot going on and you've got a lot on your plates. Setting those priorities is very important along with understanding your strengths so that you're focusing as much as you can. The things that you're really adding the most value and are more of your genius areas is really a great place to start. And then just continue to ask for feedback while making others aware of what you're trying to work towards.
The physician business training course is for early-career physicians or physicians who need a comprehensive understanding of the business of medical practices. The course is 7 hours long and broken into 9 modules. It was developed by Medical Group Management Association (MGMA) and leaders from Johns Hopkins University School of Medicine. This course awards 7 hours of CME credit.
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