Leadership, Motivation and Transformational Change: What's In It for Nephrologists?

By Leslie Wong MD

Nephrology: Care That Really Matters

The perspective below by Dr. Wong made me consider why I chose Nephrology and, even after so many years in practice, in administration and in leadership, I would enthusiastically choose Nephrology again.

In thinking about why we pursued Nephrology as a career, we should reflect on the fact that dialysis is still the only long term, successful artificial organ replacement therapy for patients who would likely die within a year without it. In addition, kidney transplantation remains, by far, the most successful organ transplant, again for patients who suffer otherwise fatal organ failure. In treating patients with CKD, Nephrologists have better tools than ever to prevent what heretofore was the inexorable progression to uremia and death.

Nephrologists are positioned to be the principal care givers to a diverse and interesting group of patients, for whom our care really matters. Nephrologists have the opportunity to lead a closely knit, highly trained and skilled team that provides lifesaving care.

In short, what Nephrologists do matters. It saves lives. These are the reasons why I chose Nephrology. We must all strive to inspire our colleagues and trainees with these simple truths.

George R. Aronoff, MD, MS, FACP, is a member of the NTDS Project Committee and  the NTDS Quality, Assessment and Education Workgroup and Chief Medical Officer of Renal Ventures Management, LLC

Leadership, Motivation and Transformational change – What’s In It for Nephrologists?

Physicians who practice nephrology are no strangers to hard work and commitment.  But our jobs are becoming more challenging, time scarcer and our professional satisfaction at times in jeopardy.  Traditional fee-for-service is changing dramatically with MACRA and alternative payment models – we’re just not going to be making our living the old-fashioned way. As the healthcare environment changes, many wonder if we have the right tools or mindset to deal with these new demands.

The law of diminishing returns is used by economists to describe the incremental decrease in output observed after an optimal amount of input is allocated to achieving a particular goal.  Once the optimal level of input is reached, an increasing amount of effort is required to obtain lesser and lesser benefit.  Are nephrologists being driven to the flat portion of this curve?

What Motivates Nephrologists?

As many have experienced, there are only so many hours we can work per week until we begin compromising other priorities and making undesirable trade-offs like spending fewer and fewer precious minutes with each patient.  While working harder is rewarded with income, the law of diminishing returns makes it an unsustainable strategy for long-term personal and professional growth.    Certainly every nephrologist wants fair remuneration– but focusing primarily on income without attention to the emotional and aspirational elements of work will inevitably lead to conflict once the point of diminishing returns is reached.  We may not even be conscious of how we feel, but might learn from others who observe us in real-life and choose not to follow our footsteps (1). The maxim that money doesn’t buy happiness is reinforced by management experts who consistently find income a poor motivator or predictor of job satisfaction.

Patients with kidney disease, particularly ESRD, have high rates of complexity, comorbidities and require coordinated care.  The current transformation of healthcare requires nephrologists to broaden, not narrow their accountability for clinical outcomes and costs.  Nephrologists must take the lead in reducing healthcare costs, improving patient experience, aligning interdependent care delivery systems and promoting patient safety.  Can we find motivational value in being thrust into this critical role?

“Nephrologists need to actively define their role in the practice of medicine and look for leadership roles across the kidney care delivery spectrum.”

Eleanor D. Lederer, MD, FASN

​President, American Society of Nephrology

Behavioral scientists have found that extrinsic rewards diminish over time but intrinsic rewards lead to more emotional commitment and engagement.  We need to reflect on the reasons why we chose nephrology and what really inspires us about our work.  A good ethical litmus test is to imagine sharing these reasons with your patients (or your grandmother).  Few, if any would cite money as our raison d'être.  Instead, many would express a genuine desire to help patients and families live better, healthier lives.  We also want to be intellectually stimulated, energized by our work, and have the opportunity to develop new skills and learn. 

In order to retain that motivation, nephrologists need to find opportunities for professional achievement, personal development, and lifelong learning.

Moving Nephrology Forward

Russel Ackoff, the father of systems thinking, described leadership as a creative pursuit concerned with reaching new ideals that improve a current state (2).  Ackoff stressed the importance of leadership to promote “doing the right thing” by creating a vision or roadmap for the future (2).  A leader inspires others to work together to achieve this goal, and helps others understand the vision cannot be attained without abandoning the status quo - e.g. transformative change.   Importantly, leadership also had a restorative function whereby the pursuit of a vision could be satisfying, fun as well as fulfilling (2).

No better example of the potential for nephrologists to lead is the Nephrologists Transforming Dialysis Safety (NTDS) initiative by the ASN in collaboration with the Centers for Disease Control and Prevention (CDC).  The NTDS has identified nephrologist leadership and engagement as the key elements to promoting a culture of safety and eliminating infections in dialysis facilities.  Much of this comes from a realization that leadership and role modeling strongly impacts behavior of personnel in dialysis facilities. In order to change the status quo, nephrologists need additional training and skills, but above all they need inspiration and a larger call to action.

The NTDS goal to “Target Zero Infections” is a bold statement that is launching transformative change in dialysis.  ASN is committed to helping those nephrologists who possess the courage to lead and inspire others by “doing the right thing” for patients and themselves. The intrinsic rewards of new skills and knowledge for nephrologists who commit to this learning will be readily transferable to their careers as the need for leadership and systems thinking expand in healthcare.  Those who answer the call may be surprised at how emotionally rewarding achieving “infection-free” clinics could feel.  

Nephrologists who answer this call to lead will support restorative, value-creating approaches that foster personal development and meaningful improvement of care for kidney patients. Let us work together to transform our profession, the nephrologist way.

References

1. Parker MG, Ibrahim T, Shaffer R, Rosner MH, Molitoris BA. The Future Nephrology Workforce: Will There Be One? Clin J Am Soc Nephrol 2011; 6:15014-1506.

2. Ackoff RL. A Systemic View of Transformational Leadership. Systemic Practice and Action Research 1998; 11:23-36.

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Leslie Wong MD
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Nephrology: Care That Really Matters

The perspective below by Dr. Wong made me consider why I chose Nephrology and, even after so many years in practice, in administration and in leadership, I would enthusiastically choose Nephrology again.

In thinking about why we pursued Nephrology as a career, we should reflect on the fact that dialysis is still the only long term, successful artificial organ replacement therapy for patients who would likely die within a year without it. In addition, kidney transplantation remains, by far, the most successful organ transplant, again for patients who suffer otherwise fatal organ failure. In treating patients with CKD, Nephrologists have better tools than ever to prevent what heretofore was the inexorable progression to uremia and death.

Nephrologists are positioned to be the principal care givers to a diverse and interesting group of patients, for whom our care really matters. Nephrologists have the opportunity to lead a closely knit, highly trained and skilled team that provides lifesaving care.

In short, what Nephrologists do matters. It saves lives. These are the reasons why I chose Nephrology. We must all strive to inspire our colleagues and trainees with these simple truths.

George R. Aronoff, MD, MS, FACP, is a member of the NTDS Project Committee and  the NTDS Quality, Assessment and Education Workgroup and Chief Medical Officer of Renal Ventures Management, LLC

Leadership, Motivation and Transformational change – What’s In It for Nephrologists?

Physicians who practice nephrology are no strangers to hard work and commitment.  But our jobs are becoming more challenging, time scarcer and our professional satisfaction at times in jeopardy.  Traditional fee-for-service is changing dramatically with MACRA and alternative payment models – we’re just not going to be making our living the old-fashioned way. As the healthcare environment changes, many wonder if we have the right tools or mindset to deal with these new demands.

The law of diminishing returns is used by economists to describe the incremental decrease in output observed after an optimal amount of input is allocated to achieving a particular goal.  Once the optimal level of input is reached, an increasing amount of effort is required to obtain lesser and lesser benefit.  Are nephrologists being driven to the flat portion of this curve?

What Motivates Nephrologists?

As many have experienced, there are only so many hours we can work per week until we begin compromising other priorities and making undesirable trade-offs like spending fewer and fewer precious minutes with each patient.  While working harder is rewarded with income, the law of diminishing returns makes it an unsustainable strategy for long-term personal and professional growth.    Certainly every nephrologist wants fair remuneration– but focusing primarily on income without attention to the emotional and aspirational elements of work will inevitably lead to conflict once the point of diminishing returns is reached.  We may not even be conscious of how we feel, but might learn from others who observe us in real-life and choose not to follow our footsteps (1). The maxim that money doesn’t buy happiness is reinforced by management experts who consistently find income a poor motivator or predictor of job satisfaction.

Patients with kidney disease, particularly ESRD, have high rates of complexity, comorbidities and require coordinated care.  The current transformation of healthcare requires nephrologists to broaden, not narrow their accountability for clinical outcomes and costs.  Nephrologists must take the lead in reducing healthcare costs, improving patient experience, aligning interdependent care delivery systems and promoting patient safety.  Can we find motivational value in being thrust into this critical role?

“Nephrologists need to actively define their role in the practice of medicine and look for leadership roles across the kidney care delivery spectrum.”

Eleanor D. Lederer, MD, FASN

​President, American Society of Nephrology

Behavioral scientists have found that extrinsic rewards diminish over time but intrinsic rewards lead to more emotional commitment and engagement.  We need to reflect on the reasons why we chose nephrology and what really inspires us about our work.  A good ethical litmus test is to imagine sharing these reasons with your patients (or your grandmother).  Few, if any would cite money as our raison d'être.  Instead, many would express a genuine desire to help patients and families live better, healthier lives.  We also want to be intellectually stimulated, energized by our work, and have the opportunity to develop new skills and learn. 

In order to retain that motivation, nephrologists need to find opportunities for professional achievement, personal development, and lifelong learning.

Moving Nephrology Forward

Russel Ackoff, the father of systems thinking, described leadership as a creative pursuit concerned with reaching new ideals that improve a current state (2).  Ackoff stressed the importance of leadership to promote “doing the right thing” by creating a vision or roadmap for the future (2).  A leader inspires others to work together to achieve this goal, and helps others understand the vision cannot be attained without abandoning the status quo - e.g. transformative change.   Importantly, leadership also had a restorative function whereby the pursuit of a vision could be satisfying, fun as well as fulfilling (2).

No better example of the potential for nephrologists to lead is the Nephrologists Transforming Dialysis Safety (NTDS) initiative by the ASN in collaboration with the Centers for Disease Control and Prevention (CDC).  The NTDS has identified nephrologist leadership and engagement as the key elements to promoting a culture of safety and eliminating infections in dialysis facilities.  Much of this comes from a realization that leadership and role modeling strongly impacts behavior of personnel in dialysis facilities. In order to change the status quo, nephrologists need additional training and skills, but above all they need inspiration and a larger call to action.

The NTDS goal to “Target Zero Infections” is a bold statement that is launching transformative change in dialysis.  ASN is committed to helping those nephrologists who possess the courage to lead and inspire others by “doing the right thing” for patients and themselves. The intrinsic rewards of new skills and knowledge for nephrologists who commit to this learning will be readily transferable to their careers as the need for leadership and systems thinking expand in healthcare.  Those who answer the call may be surprised at how emotionally rewarding achieving “infection-free” clinics could feel.  

Nephrologists who answer this call to lead will support restorative, value-creating approaches that foster personal development and meaningful improvement of care for kidney patients. Let us work together to transform our profession, the nephrologist way.

References

1. Parker MG, Ibrahim T, Shaffer R, Rosner MH, Molitoris BA. The Future Nephrology Workforce: Will There Be One? Clin J Am Soc Nephrol 2011; 6:15014-1506.

2. Ackoff RL. A Systemic View of Transformational Leadership. Systemic Practice and Action Research 1998; 11:23-36.