Medicine, Leadership, and The Beatles

Many of you know my undergraduate degree is in pharmacy from Drake University. I worked in retail pharmacy prior to starting my career at Eli Lilly. As a result, I am naturally drawn to cutting edge stories in the field of medicine.  One that caught my eye recently in the Journal of the American Association (February, 2016) had to do with changing physician behavior when prescribing antibiotics.

Antibiotics are effective for patients only when there is a bacterial infection present. However, research into physician prescribing habits show that they are given to patients for diagnosis such as asthma, influenza, middle ear infections without pus, and viral pneumonia, (all which have an allergic or viral cause), where antibiotics are of absolutely no value to the patient.

According to a recent study by the Pew Charitable Trust, roughly 30% of all antibiotic prescriptions are for improper use, costing the health care system millions of dollars a year as a result. The reasons for overprescribing are probably numerous. I am confident no physician wakes up in the morning intending to do harm, or to do anything but practice the best medicine they know how.

So, it would seem there is a difference between the “intention” of the physician to do no harm and the actual impact of their behavior.

Leaders have misaligned intention, too.

I think many leaders are the same way. No leader gets up in the morning thinking, “You know, I wonder how I can make everyone on my team's life absolutely miserable!” (except Kevin Spacy’s character in Bad Bosses).  Here are just a few examples related to me recently:

  • A friend was telling me a story of how a leader on his team recently called out a follower in public regarding a very sensitive personal matter. This leader is now in a lot of trouble with his board of directors and will likely lose his job in the coming months.
  • A person in a training recently told me that her supervisor would not give her time off work to attend the funeral of a close family member.
  • A manager gave an associate a set of assumptions to run a market forecast. When the results came in, the manager was furious with the results, blaming the associate for not using the correct assumptions. When the associate pulled up the document with the assumptions the manager sent, the manager said the associate “misread what the manager wrote."
  • A female friend’s boss did not want to give her a deserved promotion. When her bosses supervisor intervened and promoted her, the boss actually suggested it was because she was an attractive female and had nothing to do with her skill set.

It is really hard for me to believe that leaders don’t know this kind of behavior is wrong. Yet whether we are talking about leadership or medicine, sometimes really smart people do really stupid things.

Truth is when facts converge on a central point. 

I have been realizing there is a lot of truth told in the arts. While writing this article, I realized how right John Lennon and Paul McCartney where when they wrote, “We get by with a little help from our friends,” as one of the songs done by Ringo Star on the Sargent Peppers Lonely Hearts Club Band album (just be glad this isn’t a podcast and I am not signing this to you!!!)

Perhaps we would all be a little better by practicing impulse control, and before we act, reach out to some peers and say, “Hey, I am thinking about doing [insert behavior here]. Before I do that, what do you think?"

Here is what the data from the antibiotic study says:

Dr. Daniella Meeker MD, associate professor at the Schaeffer Center for Health Policy and Economics, University of Southern California, is the lead researcher in the study I referenced earlier in JAMA. Dr. Meeker and her team set out to see if any of three different behavioral interventions would change physician behavior in prescribing antibiotics. The three actions that the researchers tested were:

  1. Suggested Alternatives - Doctors were given a list of a range of different choices they could make rather than the antibiotic they were going to prescribe.
  2. Accountable Justification - Doctors had to write a justification for the antibiotic they had written. A peer review board reads the justification and determines appropriateness.
  3. Peer Comparison - An email was sent to all the doctors in the study that compared their prescribing behavior to that of their peers. The doctors own prescribing was compared to that of top performers who’s prescribing was deemed appropriate.

Without boring you with all the statistics, the authors of the study concluded, "Among primary care practices, the use of accountable justification and peer comparison as behavioral interventions resulted in lower rates of inappropriate antibiotic prescribing for acute respiratory tract infections.” 1

Let's apply this learning to leadership.  Take the story my friend told me about a leader who called someone out in public over a sensitive personal issue.

What if, rather than calling the person out over the sensitive personal issue, the leader instead:

  1. Suggested Alternatives - The leader took time to journal some possible alternative behaviors rather than just acting impulsively in the moment.
  2. Accountable Justification - The leader had to write a justification that was submitted to a peer review board. This board then would deem the action appropriate or not.
  3. Peer Comparison - An email was sent to all the leaders in a group that documents the behavior and the leader had to see that their behavior was not aligned with top performers in their field.

No man is an island. We all suffer the consequences of our poor leadership actions.

Homework: What would it be like for you to set up one, or even all three, of the metric tools listed above. For those of you who are serious about your leadership, this is a must! At a minimum, find a peer group who can hold you accountable for actions and use them proactively in your practice of leadership.

Meeker D, Linder JA, Fox CR, et al. Effect of Behavioral Interventions on Inappropriate Antibiotic Prescribing Among Primary Care Practices: A Randomized Clinical Trial. JAMA. 2016;315(6):562-570. doi:10.1001/jama.2016.0275.