EP13 - Turning Conflict into Catalyst: Physician Leadership Strategies with Dr. Andrea Austin

In every operating room, in every ward, in every clinic, and every team meeting, a silent battle brews. Conflict, negotiation, identity. Welcome to the Scalpel and Sword podcast, where I, Dr. Lee Sharma, physician and conflict analyst, Explore the hidden negotiations behind modern medicine. Let's trade burnout for boundaries and learn the art of healing with precision and power.

Hello and welcome, my peaceful warriors. Welcome to the Scalpel and Sword podcast. I am your host, Dr. Lee Sharma, physician and conflict analyst, and I am so thrilled to have on the podcast today Dr. Andrea Austin. Dr. Austin did her surgical training in California, but shortly thereafter she went into the Navy. She has served in Iraq, and she is an emergency room physician and well-versed in simulations. She has been doing simulations and a simulation director in California, but she is about to transition to being an emergency room attending and head of the department, right? Program director in Pensacola, Florida at Sacred Heart, which that's That means she's going to be close to me, so I might get a chance to go down and visit her at some point. She is the host of the podcast Heartline: Conversations with Healthcare Changemakers and the creator of the podcast. She is also the author of a book called Revitalized, which specifically talks about her journey in healthcare changemaking. And I am so thrilled to have her on the podcast today. Welcome, Andrea.

Thank you, Lee. And I don't know if you knew this about me, my middle name Is actually Lee.

Oh cool! Do you spell it L-E-E?

L-E-I-G-H.

Okay, cool, cool. See, so we have that in common too. You're going to be in my neck of the world and we share a name. Welcome!

Yes, it's so great to be here today.

We were chatting before the podcast started and you were kind enough to share with me an article that you had published on Curious talking about Developing the Next Generation of Physician Changemakers. I love the tagline of this because the tagline of this is, you have to love the people to love the process. Tell me where this came from, this beautiful article, and what was the genesis for it?

in the country. And part of my requirement to graduate was to do research. And for many of our listeners, I'm sure that's creating flashbacks, but I discovered the field of qualitative research. And along the same time I was going through my master's, I think almost everyone listening agrees that healthcare needs to change.

Probably everyone.

Yeah. Patients aren't happy. Doctors aren't happy. And as far as like medical education goes, from my standpoint, if we all think healthcare needs to change, then we have to create more changemakers. And not only do we have to increase the number, we should shorten their learning curve. So it took me down this process of if the system needs to change and it's messed up, let's talk to people that are changing it despite Yeah. And so we did a qualitative analysis of 15 attending physician changemakers, interviewing them about their stories, what types of practices they have, how are they able to do the difficult work of changemaking. And then qualitative analysis involves creating themes. So then we did a thematic analysis of that. And it was just this phenomenal process because There were some things that we guessed going into it, but there were some nuances and deeper levels of understanding that came through that paper.

Wow. I think one of the things about doing qualitative research, when you're picking up on words and themes, is you start to see other words and themes come out. I mean, you start mining gold where you didn't maybe think you were going to find it. One of the things that I love about this process, as you were interviewing these changemakers, is a lot of them were having to work on the internal part. One of the things I think you talk about so beautifully in the article, and you mentioned it before we started recording, is that the system that we're trying to change is us, that we are part of that system, that we have to change internally. What kind of things did you pick up on as you were doing this qualitative research that these changemakers were doing internally to get themselves ready to actually be part of creating that new healthcare system?

Yeah, well, universally, I mean, nobody said change is easy. Everybody said this type of work is incredibly hard and it takes much longer than any of us think it will.

Mm-hmm.

And so when you hear something's hard and it's going to take a long time, then you think about what would you need to do if you were like packing character into your bag? Well, you would need to learn Patience, right? That you'd have to learn to set longer timelines than you're anticipating. A big thing that came out of this was the ability to sit with discomfort and to listen to dissent. Also, this emotional agility, this ability to feel really intense emotions. You know, we've all been in a meeting where You think you're presenting this great plan and then somebody just like totally chops it up and maybe undercuts you and even says something that's not really professional during that meeting. And so everybody had stories like that. And so what do you do in that moment? And everyone described this ability to— not that they're all Zen masters and able to handle it at every moment, but when they're in their best And over the arc of their careers, this ability to really withstand those moments more really came through the interviews.

Yeah.

I love that part of what you picked up on was listening for dissent, that you actually verbalized that, you put that in the paper. A lot of times when we start getting dissent, number one, we don't want it. We're afraid of it. We don't like it. We tend to let that affect our identity. And as a result, sometimes the tendency is to want to ignore it. But actually, in terms of being good changemakers and really conflict resolvers, because that's a big part of this process, is you have to actively engage that dissent. And that is something that we are not good at. Just as human beings, we're generally not good at that. A lot of us are conflict avoiders. So, the fact that these changemakers were actually actively listening for it, you're encouraging them to don't just Tolerate it, actually actively cultivate it. And that takes a lot of resilience to be able to listen and actively do that. One of the things that I think was really cool also, as part of listening for dissent, is that you talk about using narrative as part of a strategy that a lot of these people verbalized. How did you, in terms of listening to narrative, did a lot of these people talk about sharing stories? They even talked about some recall bias, but they were definitely using stories to illustrate their points.

Yeah, absolutely. I mean, one participant went so far as to do the Toastmasters program to get better at being able to tell evocative and also short stories, right? We're living in a very time-pressured era and everybody wants you to get to the point. So I think it's a real skill and it's different than what we're programmed to do as physicians, because we're generally programmed that you pull all the evidence and you have all these evidence-based medicine articles and you create a very long and oftentimes dry presentation. And when you get into the change-making space in most healthcare organizations, you're not going to be speaking to only physicians. You're frequently speaking to people in the C-suite, that may have more of a business background, and they're not used to hearing a super dry 45-minute talk. They're used to things being crafted in aging, fast-paced. I didn't know what a pitch deck was until a couple of years ago. That's more of the language, the energy associated with change-making on the business side.

You also talk about the steps that people have to do to really start to affect change. And number one on that list was being emotionally invested, feeling a sense of This is important for patient care. This is also important for physician and professional health, professional wellbeing. But you have to have that emotion attached to it because that's kind of a good starting place for all of this. I think one of the things that's also really cool about being emotionally invested is even if you're telling a 2-minute story to somebody, if you're emotionally invested in it, that person will get that emotion. Is there a difference, you think, between being emotionally invested and being really angry? In terms of approaching this process?

Yes. Yeah. I think anger is a really good activation energy, but you have to learn to work through it. And I think about one of the participants in the study talked about some of the witnessing discrimination of her own family members in the healthcare system. So she could have been very angry. And resentful. And I don't think that would have led her to be the type of leader that she became. So I think you have to go through that emotion. I mean, she has every right to be angry after witnessing discrimination, but getting to that place where you can be productive. You know, I was angry a lot of the pandemic. I don't think I was super productive while I was angry. But getting to the point where you're activating your agency and you can see a path. And I think a lot of times anger kind of blinds us and prevents us from having that more expansive mindset.

Absolutely. I think it's really hard to engage in any kind of productive resolution or management of conflict when we're in that space of anger. Like you said, it's very blinding. There's just not much we're going to be receiving at that point. And part of being a changemaker is you are, like you said, listening actively for dissent, but also receiving those different points of view. Because you need to be able to incorporate all of those things in terms of resolving a conflict. You said something earlier when we were talking about that we are part of the system, as being part of the system, that as we see these conflicts, we can't avoid them. We do have to actively engage them. And part of that is taking ownership.

Yes.

for some of these changes and these problems that are in our system. Did you find that the changemakers were also actively involved in taking ownership of these issues?

Absolutely. So I think if you want to be a changemaker, you have to both own your own role, and you're going to make some calls, you're going to propose some things, and sometimes it's going to work and sometimes it's not going to. You know, there was definitely a theme of Failing fast. So, when you make a mistake, own it. But the ownership went beyond the individual. It also encompassed owning organizational failures. And what I mean by that is when you walk into a new space, like saying you're a new program director, new department head, Mm-hmm, right. A lot has gone down before you got there, and you may have been brought in Because some stuff had gone down before you got there. And, you know, the self-protecting is, well, that— I didn't make those decisions. I wasn't in charge when that happened. Nobody wants to hear that. Mm-hmm. If they're in your office and you're trying to tell them about a new thing that's happening, expect maybe the first 5, 10, depending on how much trauma happened in that organization, you may have to just listen the entire meeting to all the hurts, all the things that they felt wronged by your organization or your company. And that is part of being a leader. Sometimes it's appropriate to say, I'm sorry. Sometimes it's just holding space that, wow, that really Wow, that had a really profound impact on you and the department. And you can also say, I'm sorry, without saying it was your fault.

Mm-hmm.

So I would really encourage people that a lot of times, especially in our current healthcare system, there's been so much trauma that has happened that your first job is really just going to be holding space for people to release. some of the hurts that have happened.

That's wisdom. I think that's so hard to learn. I think the ability to respond and not react.

Yes.

Probably one of the core tenets of being a good conflict manager and conflict resolver is our natural tendency, if we are— and you verbalize it beautifully— someone comes into your office, this may be your first week on the job, they come and they sit down and it's 3 months of experience that they are venting and laying at your feet. And our sometimes natural tendency is to react to that. It's like, that wasn't my fault. I wasn't here. I didn't have any part in making that conflict or problem. Please don't drop this at my feet because we are feeling attacked. We are internalizing that energy instead of, as you say beautifully, holding the space for it. That's all that person may need right then is for you to actually sit there, Make eye contact, listen to what they're saying. And there can be a space where you say, I'm really sorry you experienced that, without saying, I'm sorry because it was my fault. So there is a way to do that. And I actually think when you hold that space, when you respond and don't react, you get buy-in from that person. So whatever you do after that, it's like, this is what we can do going forward. This is how I'd like to approach this. This is how I see us maybe working on these issues. If you were able to hold that space for that person and respond rather than reacting, you are going to get them to buy into whatever it is you're doing going forward. So I think that's such a beautiful piece of advice, asking people to do that. And it's something that I think takes practice. It's not something that comes naturally, creating a pause to let people have that space. We really sometimes do have, you have to tell yourself, OK, be quiet, be quiet, be quiet, be quiet. Don't say anything. Don't say anything. Let's just let them go. One of the best stories I I think I've ever heard. I saw a patient that had two really bad pregnancy outcomes with another practice, and she had changed to another physician practice, and she gave that physician her history. And when she gave that physician the history, the first thing the new physician said to her is, "I would like to apologize for the entire healthcare system for what you've been through. I want to apologize to you." For every single doctor you've seen. Now, the previous doctors were not in her practice; she was not affiliated with them. But the first thing she did for that patient is I would like to apologize to you. And when she told me the story, like she's in tears because she said that moment to her was so beautiful that somebody actually offered her an apology, even though it wasn't theirs that they needed to offer. So that ownership, that extreme responsibility the physician showed. Literally let that patient buy back into the healthcare system because somebody reached out to her and took accountability. And you really do, I think, talk about that as part of a physician's job. And you have this in the article, and I love this quote, and I want to say it because I'm reading it because I want to get it right: that physicians are the glue that binds together elements of a dysfunctional system.

Yeah, that was actually a quote from another article that I reference in there, and I do think that. quote sums up the way a lot of us feel, um, that the system is crumbling and that, you know, we see the human impact of that as physicians. So we try to wrap ourselves up and hold— Sisyphus trying to push the boulder up the hill. Um, there's so many different metaphors for what we're all feeling. Yeah, 100%.

Yeah.

And it is this idea that we are not fighting the system, that we're actually working within it. And so, one of the things that you talk about in the article that changemakers do, that they really develop a knowledge of how the system works. They start with an internal exploration. They're looking at what's going on in here. And there's no question that as we learn about what's going on on the inside of us, we are more able to engage in conflict successfully because so much of the barriers to conflict resolution are internal. It's our worldview, our identity. You know, you talk about being sort of defensive. A lot of times, if we have people coming and dropping These things at our feet that we take that personally, that becomes something that we turn into an identity-based process, and that's not what's going on. But we still have to be cognizant of the fact that we can do that. But you also talk about making sure we understand the system that we're in. How did some of these changemakers go about making sure that they understood organizationally where they were?

Yeah, I mean, I think this is something physicians really need to hone in on because a lot of times we work for a physician group. And we don't work directly for the hospital, and some of us are dual-hatted that we then sit on a hospital committee or somehow involved with trying to make change within the hospital. So it's really important that the rules of the road—what are the policies and procedures? How does something get changed at this hospital? Are memos a form of communicating change? And also, what are the regulatory bodies that we answer to? Because sometimes when you're trying to make a change and you're hitting a lot of resistance, you find out like, okay, well, this is actually an ACGME requirement. So then that conversation goes a lot differently with an administrator because of course they want to meet the accreditation standards. So I think the more you can learn about how is change enacted here, what are policies and procedures, and then who is involved. I mean, the how is one thing, but the who is probably the most important. Who are the influencers? Who's been here? You know, who's the past chair of medical staff or two chairs ago? Because those are going to be your guides and also have a lot of the historical knowledge. Big sign of going from, I think, somebody really novice to more experienced in this space is recognizing historical context and seeking out. Because a lot of times, honestly, if you've had a brilliant idea. Somebody else did too. And so, yeah, maybe they're not as brilliant as you and you are going to get it over the goal line, but it probably would still be a great idea to, you know, find out what they were doing and why it didn't work before you go charging in.

Yep. That's so beautiful because a key part of the process, I think, of being a good changemaker, being a good conflict resolver, is humility. You have to be able to look at that. And like you said, it's like, you know, this is a great idea. I'm sure I'm not the first person who thought of it. And having the ability to step back from that and say, I wonder who else has tried this. Let me talk to other people who may have tried this. Let me learn from them. And it really becomes so important. And part of being successful in that way is understanding that I have to be humble about who I am. what's gone before me, and then being receptive to how can I take that history? Like you said, how maybe I can accomplish something that hasn't been done before, but I'm not doing that alone. I'm learning from other people who have tried it. I'm learning from other people's perspectives. And so, going into that with that humble mindset makes such a big difference in terms of accomplishing that. I think that's really important. This is a very personal book for you. This is a very personal journey for you in terms of being a changemaker. This was something that Was born out of your experience as a physician?

Yeah, I would say it's born out of necessity and being in the fire. You know, in 2021, when I was considering leaving medicine, there was a part of me that was like, I can't believe that I would consider leaving. I was a high achiever. I wanted to be a doctor since I was a little girl. It didn't make sense. But I really had to find a new identity. And for me, that is the changemaker physician, recognizing that there's so much going wrong in healthcare that in order to stay, we have to be leaders and we have to be advocates for ourselves, our patients, and our colleagues. And so it was really adopting that new identity that allowed me to stay in medicine.

Wow.

You really took a very personal responsibility, but also you had to do some radical work to do that.

Yeah.

Takes a lot of courage. I think that's hard for a lot of us to really wrap our brains around what it takes to actually step back and say, this is something that's very important to me, to be a person that's actually creating a better healthcare system. And that process was from the inside out. I think that's a great perspective too for people who want to make change. It's very different to approach that process from saying, I got to change first. Be the change you want to see in the world. Now, it's easy to say that quote. It sounds very flippant. You can buy that on a coffee mug, but to actually embrace that is so much harder. You really got a very neat and eclectic group of specialists to do this work. In looking at the different professionals that you had here, it was cool to me to see all the different types of doctors and professionals that you A lot of them had gone and done other types of education. They had done different types of fellowships and master's and things like that. And you've done that too. You have really tried to broaden your education to get where you can actually be that changemaker. Is that something that you saw kind of universally in all of these specialists or all of these people that you interviewed, that they all took some extra steps to build that skill set?

Absolutely. And the first theme that we talk about is insatiable learning. So for anyone listening, I don't think you have to go get another degree. And I'd actually caution doctors from doing that because we already have very advanced degree. What I would like to see happen, and I think this is already happening, is medicine is changing so fast when we think about AI and the digital transformation. And maybe we don't all need to get advanced degrees, but I think we have to rethink our approach to medical education. And I think certificates are an awesome option that are a much lower entry point from time and money. And then I also think looking at our residency training, that there very well may be electives within there that would support people gaining new skills, whether that's leadership, understanding informatics, Innovation fellowships. I was just reading last night about— can't remember where on the East Coast— an innovation fellowship. And I thought, wow, like, that's brilliant. Like, that's such a great idea. And I think when we look at the problems we're dealing with in healthcare, it's going to require more of an interdisciplinary expertise. So I think your degree in conflict resolution, mine, master's in health education, it is interdisciplinary, covered a lot of different topics within that degree. So I would encourage people to think about how do you level up, where are your deficits, and how could you— whether it's reading a book, listening to this podcast, whatever it is— maybe it ends in a degree, maybe it doesn't.

That's such a great perspective. I think there's definitely times that you may want to go back and get a degree if that's within your realm, but you don't have to. There are so many ways to get different knowledge bases. And I also love how you put this. It's like you're What's your strengths and weaknesses? Again, we're sort of back in the space of we got to do some work introspectively to actually figure out what we need to learn. I know from my standpoint, I realized back in 2001 that I really wanted to understand people's perspectives, that I was not good at managing conflict. And I knew that somehow getting some more knowledge was going to help me. And so I actually ended up doing a distance master's where I would do online work and then travel once a month and do an in-person. And I did that for a year and a half. No, actually 2 years. And my kids were little. I'd be writing papers. I'd be on call in labor and delivery and I'd be writing term papers. You know, by the grace of God and a wonderful husband and 2 understanding children, was able to do it. But I think it is a lot easier now. I mean, I don't think we had the breadth of knowledge available from a technological standpoint. The beauty of having AI, there's so much we can get. Very quickly without having to actually go get a degree. So I think it's a matter of what do I want to learn? What's going to make me a better changemaker? What's going to make me engage easily and be able to help people see what I can do to affect that change? I think that makes a big difference. I love that so much. This really is a relationship between introspection and the system. You're actually where you're connecting these. If you could give one piece of advice To somebody who wants to become a changemaker in healthcare? It's like, where's a place people can start? It's like, I want to be that person who's able to create change in the system. How do I even start that?

Yeah, I love the phrase that you said as the lead-up to that question is introspection plus this organizational. So where's the bridge? So the one word I would say is reflection, carving out time. To be reflective. And there's so many moments throughout your day as a physician, as a healthcare professional, to be reflective. You know, how did that patient conversation go? How did that conversation with a colleague go? If it didn't go as well as it could have, why was that conversation upsetting to you? What does that say about your own individual experience? Is there a wound that has to be healed? There's so many moments to be reflective. And I think that was the biggest thing that came out of this paper. And there's this term metacognition, so thinking about thinking. And the people in this study were great. They were great at thinking about thinking. Why did I do that? Why? You know, okay, I tried to do this change and it didn't work. Let me dissect that, or let me reach out to somebody that can dissect it with me. So that would be it. Reflect.

Wow, that's such brilliant advice. I love how you talk about the intentionality of reflection, that it's not something that just happens, that we really have to be very specific about having that occur. And like you said, making space for that in our daily careers and our daily lives. One of my favorite things that I talk about in terms of working through conflict is this concept of compassionate accountability. That when you reflect, let's say I saw a patient and I really don't feel like I interacted very well. I feel like it was not my best moment. I was not as understanding or maybe listening as well as I should have been. And I go back and I reflect on that and it's like, okay, yeah. So that probably was not great on my part and I need to work on that. And If I've taken that time to be reflective, and I learn from it, that a big part of learning from it is I have to be kind to myself in that process. It's like, okay, yeah, that was not great. I'm definitely going to learn from it. But I'm going to get better the next time. I was not trying to be not good in that space, but that's what happened. And so I'm going to be kind to myself. I understand what I did, and I'm going to be accountable for what I did. It's not that I'm not taking responsibility for it. And I think that's why I like that phrase so much. It's not just letting myself off the hook. I'm not just saying, oh yeah, well, it happened. Okay, cool. Duh, move on. I'm not saying that. I'm saying I'm taking responsibility for my actions. This is what happened, but I'm going to be kind to myself in the fact that I'm in this space of reflection and I'm learning from it. So I think if you can combine this beautiful process of metacognition, and as physicians where we can be so hard on ourselves when we make these kinds of errors or when we're in a space of conflict and we don't handle it as well as we feel like we could, to be kind to ourselves as we work through that process. And I think we're much more likely to learn, as you're talking about being reflective and learning from that and making that internal change so we can affect external change, that compassion that we show to ourselves all of a sudden starts to go on to the other people that we're engaging with. If we're engaging with other professionals, if we're kind to ourselves, we're going to be kind to other people. And that to me is one of the fastest ways to work towards conflict management resolution. When people feel that you are being kind to them in the process, they are going to be much more likely to engage with you. So I love that that's the piece of advice that you would impart to people, because that's something that we all need to be good about, intentionally taking that time to be reflective and learning about ourselves internally. I think that's the most beautiful thing that you could offer. I love that so much.

Yay. And I would just add very quickly that when we're not kind, when you have that bad interaction with somebody, ask yourself what you needed to be kind. And that may have been, well, I needed sleep, um, before I had that conversation, or I needed to have a 5-minute break and eat a piece of cheese. I don't know. You know, or have a cup of tea. Because most of the time, if you go back, what's going to be different? I mean, most of us will say like, yeah, I want to be kinder. Well, that's probably your base tendency, most of us that went into medicine. So if you didn't do it, what needs to change? And for some of us, that might be that you need to schedule 20 patients instead of 25.

That's so wise because again, it's There's an internal response, but there's also a systemic expression of that response. And so I'm going to ask myself, what happened there? You know, was I worried about my kid?

Correct.

Did I have something happen? Is there something else playing into my response that I need to be aware of? And then the next time go, OK, well, this was clearly affecting my response and the way that I managed that conflict. What can I do to change that the next time? I think that's brilliant. Yeah, this has been a joy, Andrea. Thank you so much. If people want to find you and want to ask further questions, or if they want to buy your book, how would they do that?

Yeah, you can head over to my website, andreaustinmd.com, and my handle on social is Andrea Austin MD. I'm most active on Instagram and LinkedIn. The audiobook's out, so just search for my name, Andrea Austin Revitalized, on Audible.

Done. So excited. And we will have those in the show notes as well. Andrea Austin, thank you so much for being on the podcast today. It has been wonderful to talk with you. This has been so educational. I think for all of us who want to affect change in the healthcare system, this is a wonderful place to start. I'm very inspired after listening in our conversation. I can't wait to start trying to— especially you've encouraged me to be more reflective in my daily life. So thank you very much.

I love that. And thank you, Dr. Sharma. And just one last little thing for the person out there, conflict stresses people out. But remember, when conflict's not happening, there's often apathy. And apathy kills change-making. So in order for change to happen, conflict is part of the ingredient. So the next time somebody is coming at you with conflict, tell yourself like, oh yeah, we're about to make some change here.

Oh my gosh, we could totally just spend another half hour talking about that. Thank you for saying that. Thank you for saying that. So often people will look at conflict as a negative indicator.

Yeah.

And the fact that you just presented conflict as a positive indicator, it's like we are on the brink of making change because we are in a conflict situation. If we can just change, and that's the mission statement of the podcast, if we can change the way people look at conflict, If they can look at it as something that can be engaged, that can drive change and potentially be positive. If that's the one other thing that they take from this podcast, then I think the mission has been met. So thank you for saying that.

Yay, I couldn't resist. So go out there and have some kind conflicts.

Yes. Oh my gosh, this was awesome. Dr. Austin, thank you again for being here on the podcast today. We will put the links to your contacts and your website on the show notes. For everyone who joined us today on Scalpel and Sword, thank you so much for being here. We look forward to seeing you next time, and until then, be at peace.

Every episode is an invitation to speak, to negotiate, to choose. I'm Dr. Lee Sharma. Join the dialogue by subscribing to Scalpel and Sword.

Until next time, peaceful warriors.

May your choices be sharp and your voice be even sharper. This podcast is a reflection of lived experience and research in conflict resolution. The Scalpel and Sword is not intended as medical or legal guidance. For personal matters, please consult a qualified professional.