Nia Thomas [00:00:06]:
Hello and welcome to the Knowing Self Knowing Others podcast where we discuss self aware leadership with thinkers from around the globe. I'm your host, Nia Thomas. Join me as we talk to today's guest.

Nia Thomas [00:00:18]:
Welcome to today's podcast. Our guest is doctor Amanda Brisebois, and she's a specialist in health care coaching, facilitation, and mediation for practitioners and health care teams. Amanda's also known as doctor b free, so it's the letter b free. She's a high level physician executive, and she's dedicated to supporting physicians through conflict. She has a rich background in internal medicine and palliative care and has experienced the unique challenges faced by health care professionals, particularly during the COVID pandemic. Amanda's innovative program guides physicians through 5 modules to address current conflicts, and these programmes focus on recognising conflict early and transforming it into really an opportunity, which allows physicians to reclaim their time and get back to doing what they're good at, which is medicine. With a proven track record in hospital and community based care, communication, conflict mediation, diversity and inclusion, healthcare management, leadership and health information, Amanda is really well equipped to lead and inspire that change. So join us as we explore how Amanda turns conflict into opportunity and to really get back to what matters, which is medicine.

Nia Thomas [00:01:34]:
Amanda, it's lovely to have you here. Please do tell us about your career journey and and how you came to this expertise in facilitation and mediation?

Amanda [00:01:44]:
It's always interesting, this initial question, because it could be a very long conversation. You know, I think a lot of us don't really know what we're gonna do in life. I have 3 sons who are in their twenties, and they still have no idea, and I keep telling them that's cool because I had no idea either. I don't know how I got here. You know, I did a master's in biology before I did medicine and I got into medicine because I thought teaching looked cool. I knew nothing about being a physician. And it's just fascinating now how I actually thought that it would be an easy job. I remember telling my advisor, oh, no worries.

Amanda [00:02:16]:
This isn't gonna be that hard. And so when I got into medicine and was just purely clinical teaching, loved it, thought, I was being hard done by in my job and no one was listening to us as frontline workers and complained a lot, to be honest. And I got into leadership because I started hitting some roadblocks in that maze of life, and I thought, oh, they're doing it wrong. You know, it's easy to think about. It's greener on the other side. So I applied for a couple leadership jobs and kind of went up that ladder and ended up being the medical director at one of the big hospitals in Edmonton in Canada, Alberta during the pandemic. And I had done some coaching along the way for my patients because my specialty is chronic illness care. And I thought, oh, I'll ask better questions of my patients, integrate them into the health their health.

Amanda [00:03:01]:
And it changed my life. So I really learned to ask open ended questions and learn about them. So that was a real starting point of this journey of learning about people. And during the pandemic in my leadership role, there was so much conflict. And I would spend hours, I'd listen, and I thought I was doing such a good job, and I'm trained in communication, and people would still be upset with me. And I thought, what's happening? Like, why are they upset with me? I put so much effort. And I started to think, what am I missing? And it was outcomes. I I wasn't really getting outcomes.

Amanda [00:03:32]:
And even these high level people I was working with to try to get outcomes, it sort of would disappear into the abyss, the problem. And so I went back and did a bunch of training in conflict negotiation mediation in British Columbia here in Canada. And, became a certified mediator, Not because I wanted to be a mediator, but because I was so fascinating that there's actually a process to solve problems. Okay. That's got really is what got me onto this. Hey. We're health professionals. We like process.

Amanda [00:04:02]:
Why aren't we really grabbing onto a process to solve problems in front of each other? And then if we don't do that great and walk away, why aren't we using the process mediators use long before you hire a mediator and a lawyer? Bring it early into our discussions and use a process to get through our issues to create successes. So I started this, Jesus, probably about 4 years ago, this stuff. And I have a role in Alberta now, which has been spread from Edmonton across the province as a physician advisor. And so I see a lot of people in conflict with teams and this stuff really works. So now I'm so passionate about getting it out there and telling people we have power. And it's about how we do things. And it's not necessarily of what's done to us as I kind of felt when I was first in my career. You feel so helpless and unable to move things forward to what we can do.

Amanda [00:04:56]:
And you can be at any level, if I can say it that way, in our organizations. You don't have to be some, you know, super tippity top high level, organizations. You don't have to be some, you know, super tippity top high level leader to create change. You you be anybody, and so that's how I ended up here.

Nia Thomas [00:05:10]:
I want to go back to something that you mentioned there. Within my research, it became very clear that there was a link between the patient recovery and improvement and their relationship with their physician, and, actually, that self awareness of those physicians had a big impact on that relationship. I'm interested to know what what your findings are as somebody who's practiced medicine and and been at the the very sharp end of those conversations.

Amanda [00:05:38]:
I haven't had a really any patient complaints. I've had one patient concern my whole career, which is 24 years. But I look back on how I did things, and it is so different. Now when I'm in front of my patients, I stick with what, how, and tell me about questions. Very open, very so what's happening today for you? Before I'd come in and say, is your pain better? Closed ended yes, no questions that you're like Yeah. Yeah. And I'm like, I'm amazing, and I'd walk out. Now I say, tell me about your pain today.

Amanda [00:06:08]:
And I you know, all these open things or someone's yelling, I don't say, oh, this must be upsetting for you. I say, what am I seeing here?

Nia Thomas [00:06:15]:
Oh, those those open ended questions are so important, aren't they?

Amanda [00:06:18]:
No assumptions about them. You know, how are how do you integrate this illness in your life? People are shocked. Patients are shocked. And I tell you, this stuff works for your family, works in front of your patients. But so what you've seen in the literature about patients and how they like to have a relationship with their practitioner. The same goes for physicians, interdisciplinary teams, any health care providers, and their team. We walk around not really knowing each other well, and then something happened. We think we know, like, hi in the hall, or we sit at this desk next to each other.

Amanda [00:06:53]:
But, hey. What happened to you in the last week? How are things? And, you know, what's going on in your life? Are you willing to talk? I'd love to know you better. It's those kind of things. So when something comes up, you all of a sudden understand them a little bit more and and you know them better and you're willing to get through something together. And so I think it's quite universal, those concepts.

Nia Thomas [00:07:15]:
You talk of misaligned expectations leading to conflict, burnout, and disillusion. What do you mean by misaligned expectations?

Amanda [00:07:25]:
It's kinda interesting when I think about the wording of misaligned expectations. I don't feel a lot of us have a discussion about expectations. Yeah. So, a lot of people get on their team. They may get some long contract. This is your job. You know, you're a manager. Okay.

Amanda [00:07:41]:
You manage these four people. You've you've got some deliverables. Hey. Make sure that you move patients in these ways. Boom. There isn't necessarily a how often do I get this followed. What does a good performance look like, what does a performance that needs growth look like, how often are we gonna review this. I was in high level leadership roles, and we didn't review.

Amanda [00:08:03]:
I didn't I have didn't have a clue what I kinda got what I'm supposed to do, but I made it up. And I even asked because I do this work. Like, what exactly are my expectations in that meeting? And I did this through the pandemic, and they're like, what? You need to be there. Like, well, what am I supposed to do? Well, they didn't know. And so it's really inter and I shouldn't say they didn't say it like that. You know, I'm kind of being animated, but I didn't really have clear expectations. I wasn't super aligned with what their goals were. I didn't really understand them.

Amanda [00:08:36]:
So how can I understand if I'm misaligned or aligned or where I can improve? And so that's just as much on me as on them. I mean, that's how do we know what we're supposed to be doing? And if we don't know, my gosh, I better ask. And when I was younger, I was very I'm in quite introverted, and I'd be very avoidant in conflict or really hard discussions or any discussion that might make me look that I wasn't intelligent. Yeah. Or if I missed the mark. I I was like, I'm gonna ask this really high level leader what my job is. I can't do it. But a lot of people come to get help from me now, and they're really smart, intelligent leaders.

Amanda [00:09:18]:
And they don't know, and it's not their fault. So I say, hey. You know, if we ask things in a really open way, I'm really worried. I'm not sure what the expectations are. Like, we ask it based on what I'm feeling. You know, not telling someone they're doing you didn't tell me your expectations. That doesn't work. But if I say I'm I really wanna do a good job, and I'm worried.

Amanda [00:09:38]:
I'm not sure what it that a good job looks like.

Nia Thomas [00:09:41]:
As you're saying that, I'm reminded that I had a job, not so long ago where I didn't have a job description. And I remember asking for it 2 or 3 times and being told, that actually I have an expectation that my senior leaders write their own objectives. And I thought, I'm sure that's not how it works. So that idea of you have to have some direction and that has to come from your your strategy through your senior leaders, and it doesn't mean that asking the question means you're incompetent or incapable. It means you need clarity on the direction that they want to go because your guesswork might be quite different.

Amanda [00:10:20]:
Exactly. And if they do want you to write your own objectives, cool. Like, I'll go write them. What would it look like then to get input on those? If I'm in the right direction, you know, relative to what people around me want, leaders around me want, I would like some feedback. How do I get stakeholder input on my super well thought out objectives? Because then you might get a complaint later because you weren't on the mark.

Nia Thomas [00:10:44]:
Yeah. Indeed.

Amanda [00:10:46]:
And that's all process. It's all it's all kind of a definition of what what does the process look like to align expectations.

Nia Thomas [00:10:52]:
Or has your your extensive, you know, education and experience in conflict resolution, equity, diversity, inclusion, how has all of that really shaped your approach to leadership in health care?

Amanda [00:11:07]:
You know, it's funny because I when people read my bio, it's just embarrassing. I'm thinking, why did I do all that? I know why I did all that. I felt incompetent. And there's a principle. It's called Peter's principle where you just keep getting hired into higher level positions, and then at one point, you can't do it anymore. You don't have the training you need. And I I a lot of us as leaders don't actually have the training that we need to be in that position. I don't didn't have to be a mediator.

Amanda [00:11:34]:
I've got a health care, leadership masters. I have all this training in equity, diversity, and inclusion. I didn't need to get certifications and all that. I I was a physician. I'm a physician. That's what I'm trained at. We're all trained in different things. I really needed someone to say, hey.

Amanda [00:11:51]:
It's okay that you don't have a degree in all these things. What you need to know is who around you to reach out to. So this is about knowing your teams. Who is there that can help you understand that piece? If you're having an issue with conflict and aren't finding you can reach an outcome, what's the piece that you're maybe missing, or how can you fill in that stuff that you need to know to be successful? And it's not necessarily that you're incompetent. And I'm I now recognize that, and that's why I laugh. I think I wasn't incompetent. I'm a very good physician. I'm a we're a very good leader.

Amanda [00:12:25]:
I just had a lot of gaps and wasn't sure where to reach out and blame myself because that's a lot of our natural tendency to say, oh, hey. You know, I can't do it. So what my training has taught me is that I don't think you have to necessarily go and do the all that training. Training is great when when you wanna do it. I think it's important to know the people around you and find out who your resources are and and learn on the job and allow yourself some grace. And you don't necessarily have to be. I stepped out of all of my high level leadership roles to do this physician advisor role because I want to be right in front of the people I'm helping. That's where I'm happiest.

Amanda [00:13:04]:
Some other people are happiest, you know, as medical leaders, huge, you know, chief medical officers and all these different things because that's their passion. Some people wanna be, like I was at the beginning of my career, frontline and wanna be there, but also wanna have some impact.

Nia Thomas [00:13:22]:
I wonder as you as you were thinking about being an introvert, do you think that that has impacted this idea that you had gaps and you didn't feel quite confident in being able to ask others, where do I get this information? How do I help to fill in my knowledge gaps? Because I I I've spoken to a couple of people who talk about introversion versus extroversion and the differences between people with those different skills. Do you think your introversion has influenced or impacted the the learning that you've gone on to do?

Amanda [00:13:56]:
I think it has because I tend to learn by myself that, you know, I never liked working in big groups when I was going through university, like just doing it on my own, relying on myself. But I think whether you're introverted, ambiverted as they call in between, or extroverted, I don't really think it matters. I think we all have we all question ourselves. We have that, am I doing a good job? Am I not doing a good job? We just we just approach it in a different way. But I do think it's impacted. I read the book Quiet. I think it's by Susan Cain or something. But I love that book because it says like, you don't it doesn't matter what your vert is.

Amanda [00:14:36]:
What really matters is just how you see yourself and how you manage things and how you rely on your different skills in different situations because you can be I I'm actually people are shocked when I say my natural tendency is introversion because at work, I tend to appear very extroverted. I just need that downtime or whatever it may look like. And I I say this with respect to personality profiles, conflict management profiles. It doesn't matter what your profile is, whether you are avoidant or assertive, what your natural tendency is. It's all cool. But we have to know how to morph ourselves Yes. And get out of our natural tendency. If I have to be extroverted and sound stand up in front of a group of people and, or with my patients and say, hey.

Amanda [00:15:20]:
Look. I really know what's going on here. We need to talk about things. I need to morph into a bit of an extroverted state and know how to do that. But then I have to honor that introverted piece and say, okay. Well, after a full day board meeting, I'm gonna go hang out and take a walk, and maybe I'm not going to the event at night. And I actually just say to people, hey. I need that space.

Amanda [00:15:42]:
So whatever that looks like for you, and and people are really receptive when I just put it out there. I used to be afraid to put it out there. So I think that's what I've learned is it's okay for us to say, who we are and what we value. In fact, then the person next to next to us might have more compassion for us too.

Nia Thomas [00:15:58]:
And I think it helps others work with us when they know what our preferences are because they are not we're not making choices because we don't like you or we don't want to be around you. It's more that we need time to ourselves, and and I absolutely agree.

Amanda [00:16:12]:
Oh, yeah. Because people like, oh, Bruce was not coming out to dinner again. That's what I would feel. Oh, you know, they're thinking I don't wanna go. Yep. And I would wanna go. I wanna be social, and I'm like, I'm not going, but I need this so badly to to just have a break. So, yeah, I do think it's good.

Amanda [00:16:28]:
And there's so much more conversations about mental health and taking care of ourselves and what that looks like. And I think that's great. We need that, for our mental health and to function really well. And and then people start doing it differently and realizing, oh, maybe we don't have the 20 hour day.

Nia Thomas [00:16:44]:
What are your thoughts on self awareness and how it impacts and influences the role of health care practitioners?

Amanda [00:16:51]:
Well, I think it's massive. I've always been been a very self reflective person. In this master's degree I did, they separated, our work lives into being, knowing, and doing. The whole first module is about being. So it's this whole self piece. And I thought, oh gosh. I've done this so much. I'm not gonna learn anything, and what a waste of time.

Amanda [00:17:10]:
But it's just so good to sit back every once in a while. We change. We grow. We're different. And really think, who am I now? Yes. And who am I this week? And what matters to me this week? It may be very different than what mattered to me last year. So I think our self changes and how we see ourselves changes over time. That impacts us as a physician, as a health care provider, as a partner, as a parent, you know, whatever your role in life is.

Amanda [00:17:35]:
I I think it really does change as you change, and I think recognizing that is very important. And I I think it's hard to be both a physician and any health care provider without really recognizing self. What do you do when somebody, let's say they're very assertive towards you and you're having a difficult conversation and it's not really a dialogue, you're feeling stuck? How do you do it if you don't know who you are? Like, what your response is when you start to get into that space of feeling you know, I hear people say feeling I'm feeling attacked or I feel paralyzed. I don't know what to do. What is that for you? And if we don't know those things about ourselves or aren't willing to, you know, go home after the event and think, what was that? And what did I wanna do versus what did I do? I think it's really hard to do it. Some people do, and, some people just sort of go through and they deal with the knowing and doing stuff and aren't really as I think a lot of it's learning. Like, how do we really delve into that? I think everyone can do it, but some it's more natural than others. And I've worked with the people where it's not as natural, and they can do it.

Amanda [00:18:46]:
It's just in their own way. So I think it's so important to recognize those three components, and how do we honor each one so that we can do whatever we want in our lives and make it, amazing. What are your thoughts

Nia Thomas [00:18:59]:
on health care and the ability for individuals to find that reflection time? Because my conversations with a number of different people suggest that, especially in healthcare, when you're dealing in crisis and you're and you're firefighting because maybe you just don't have enough staff. How do you get that reflection time?

Amanda [00:19:21]:
The first the first word that comes to mind is it's brutal. That's all I can think in my mind. I'm like, it's brutal. I remember being on call all night. You know, you you're up all night. You get home at 4 AM. You've got kids. You're trying to get them to school.

Amanda [00:19:33]:
I just don't I don't know how you do it. However, you gotta do it. And so what does that look like? I did some group coaching for the Alberta Medical Association recently, and it was all physicians from all diff over the province. And I'm really trying to promote organizations doing things like this for their teams. One of the biggest feedbacks was we never have any time to just sit down and hash through a problem. And same with the physician adviser role that I do. I'll say to them, this might take 4 hours of your time, and they're, like, ripping out their hair. And what I say is, how long have you been worried about this? How many hours has your worry taken? And they're like, oh, way more than 4.

Amanda [00:20:13]:
You know, it's on holidays, all these things. So I think we have to, number 1, get our organizations to recognize that they need to help us carve out space. Because if our employers and this goes back to expectations. If our employers, as physicians, I never had lunch. I barely I didn't drink any water just so I didn't have to go to the bathroom. I mean, it's horrible. So I wouldn't eat all day, and then I drive home and I drive by McDonald's and something and think, oh, I'm starving, and I get 4 hamburgers, and then I feel like throwing up. And so those those things where it's expected that you don't stop.

Amanda [00:20:49]:
So I'm hoping that these kind of conversations, they go back to a team and then a leader saying, I actually need, you know, half of a clinic slot to just sit. And maybe I'm not gonna see 30 patients that day or, you know, maybe my day is gonna be half an hour shorter. So I can actually reflect, and that is just as important in my job as me getting the doing stuff. You know, the being stuff, creating space to do the being stuff is just as important. And I really don't think we're there yet. I see a lot of teams feel that it's just doing I call it getting things done versus team process. Team process being how do we get along, how do we work together, and team action is doing stuff. And in health care, we like to do stuff.

Amanda [00:21:36]:
We wanna get it done. We wanna see the patients, get them discharged, get their Medicaid. Whatever it is, we need to pay, this is my opinion, as much attention to the the being stuff and the get knowing each other stuff because I think these organizations will actually be more effective than they'll retain staff. People will want to work there. Be like, oh, you you get to have a little time at lunch so that you can actually collate what you want to do, today. Or maybe you don't have to take all your charts home and do that all night. You have time to go for a walk with your dogs. So you can actually think, how did I manage things today?

Nia Thomas [00:22:13]:
I tend to describe it as what we do and how we do it, and I'm often talking about we talk about the what, and we're very good that they because I've I've got stuff to do, and I've got a busy schedule and got a to do list. But very rarely do we stop and talk about how we do it. And and I think you're right to prevent burnout and and all those difficult conversations. We need to be talking about how we do things before it gets to that crisis point. I recently had a conversation with Radhika Nair, and she was instrumental in bringing out the civility and respect toolkit for the National Health Service in the UK. I'm interested to know about your thoughts on civility and respect in the workplace.

Amanda [00:22:53]:
There's lots of catch phrases that come up in our worlds, you know, psychological safety, civility in the workplace. There's a lot of talk bullying, you know, all these things. I am a big believer that it's about how do we respect each other's differences and how do we behave 1 on 1. So these unplanned 1 on 1 conversations, and then what do we do if we walk away and we don't think it went well. And this is all about what I feel civility is. Civility is how we treat each other. And how do you respond when I say something that's the opposite of what you believe? And for whatever reason. And I would say if we embrace that, that you are gonna have so many things that you believe the opposite to me.

Amanda [00:23:39]:
And I am really curious about that because I will get a better solution to whatever I'm thinking of doing, like being humble and thinking my solution will be better if I hear everyone else's opposite. And, of course, there's things on all ends of the spectrum, but I believe that this is where civility comes from. And I also talk a lot about being very positional. And what that means in the sort of mediation and coaching world is many health care workers and, leaders are trained to be definitive and positional. And that means it's they say something as if it's a fact. Okay. So you've done a bad job. So that tells the person there is no discussion to be had.

Amanda [00:24:21]:
You did a bad job. It's a fact. There's nothing to do about it. I have a lot of trainees tell me they get told stuff like that. You know, you did you you did a terrible job with that patient admission. And they're like, what do you say to that? So I try to teach people to reframe those things to say, you know, I I've listened to what you've done. You did a lot of hard work. I'm worried that there's something missing.

Amanda [00:24:44]:
How do we talk about that so that you can grow?

Nia Thomas [00:24:47]:
There's a lot about mindset language, coaching language in in what you've just described. So you you talked about that you have trained in mediation. What kind of language or words can we borrow from mediation that helps us tap into maybe phrases when we're in these kind of situations, and we're not really sure how how to how to move away from those difficult situations. What words can we draw from or what questions? Or maybe some stock questions that we can all put in our database so that we can draw from them when we need them or when we're in a in a difficult spot.

Amanda [00:25:26]:
Love it. So I I'll go with 2 different things. 1 comes from the coaching. And as I already mentioned, it's the what, how, tell me about. Those questions are so important. And if you focus them on you, that is even more important. Get away from the who. We don't need to talk of the who stuff.

Amanda [00:25:44]:
It really doesn't matter. You know, you can't talk to me like that. That doesn't go over well. But if you say, oh, I'm feeling really uncomfortable now. Yeah. How could this conversation look different so that I can really hear you? It's totally different. It is. So, you know, how do we say things in that coaching way, very clear, nonconfrontational, and let people know how we feel.

Amanda [00:26:07]:
But we wanna know about the what and the how, not the who. We're not gonna focus on the who. And don't ask 1, ask 3, 4, 5 of those questions, and you will be fascinated how it turns the conversation around. It stops people. And I like very short sentences. What's happening? People are like, what? Like, someone's getting upset with you. You're like, what's happening? And sometimes they'll say it with a smile. Sometimes I have a little tear.

Amanda [00:26:31]:
I'm like, oh, ouch. I'm not sure what to do now. So I'll say say things like that.

Nia Thomas [00:26:36]:
I think we we need to practice those, don't we? So that when so that we can tap into them when we're in emotionally charged situations and and when we have been hurt by something that somebody has said.

Amanda [00:26:48]:
Huge. And I actually tell people because a lot of times there's power differentials, and there's a lot of conversation about this. So I say, go try it in the grocery store when someone's driving by you and they cut you off and you wanna swear at them and say, oh, how's your day going? You know, you start in these really low stakes situations reframing in your brain. So you definitely have to practice. So that's the first piece. And then the mediation piece, it's very interesting. They do things that we do not do. So when people come with a big problem in mediation, they separate it into small, neutral, solvable issues.

Amanda [00:27:22]:
Yeah. Not about the who. It's about the what and the how. And someone may say, we'll have things like, you have gaps in coverage on some team. You can't fill all the gaps. And people are like, okay. Okay. What are the solutions? So we go from, there's gaps.

Amanda [00:27:35]:
What are the solutions? In mediation, you go, okay. There's gaps. What are the issues you are trying to solve? Okay. What we're trying to solve that every person has the equal opportunity to holiday. We're trying to solve that every person has an ability to take sick leave. We're trying to solve so you start separating it. And this big problem is actually 20 or 18 to 20 is the average solvable neutral issues within that. So we don't block off actually the issues very well so that they're solvable and neutral.

Amanda [00:28:06]:
That's the first thing. And then the second thing we don't do in a mediation, you fail your exams if you don't mostly do this in your exam. That's dissecting what we call interests, and that's what matters to the people sitting around the table. So how many times do you sit in a team and say, okay. We need to solve the gaps in care. What do we do? Instead of saying, what matters to you about your call schedule? Oh, well, I have a sick mom at home, and I can't work Wednesdays. Oh, I didn't know that. Or, Or, you know, I have a 2 year old.

Amanda [00:28:35]:
They I have to drop them off at day care or whatever it is, or I need a certain amount of money, or I want a certain amount of money. So you go around the table and you lay out all the different stakeholders and what matters to all of them, and that actually takes time. And once you've got this map, I create this road map with people, and once you have it, the answers and these solutions are so much easier to get to because you actually know where people are coming through. Oh, I have to take this into consideration and that into consideration. So that's where these mediation principles and that process of thinking about what are the issues, what are the interests, who are the stakeholders, what do they care about, and what don't I know? You know? What pieces do I need to put in there? What data do I need? Or whatever it is. And then only then do you think about solutions.

Nia Thomas [00:29:18]:
That's such good advice. And and listeners and watchers, you've probably heard me say this before. I think this is one of these conversations you're gonna want to rewind with a pencil and paper, and you're gonna wanna take some notes so that you can work out how to do this for yourselves. Because everything you've said in terms of, we have the problem, we want to get to the solution, but, actually, we haven't really unpicked the problem, and we're trying to go from 0 to hero. And and we're just not gonna get there in a most effective way unless we do the work at the problem point.

Amanda [00:29:49]:
A 100%. And I think probably the biggest thing I didn't use to do as a high level leader is I think, okay. I have to meet with this person about this thing. I'm gonna I'm gonna assertive talk to them. Then I'd book a meeting and I'd go. I don't do that now. Now I think, okay. What's the background? Who do I need to talk to to get the background? What might the issues be? What might they care about? And I think about it ahead of time.

Amanda [00:30:12]:
I map it out, and I plan that meeting. I have an agenda. I share my map with them beforehand. I say, what do you think? This is my guess. And I plan. Never used to put that investment into having sort of conversations or working through issues that I did I do now. And it makes such a difference when I help people plan to go, for example, have a discussion with a leader about an issue they're facing. It's so much more easily solvable because people know what the meeting's about.

Amanda [00:30:39]:
They've they've sort of prepared. They've thought about it themselves. And so the planning is just so critical, and it it takes time. So we tend to think, I don't wanna do it. But you'll get resolution so much quicker, and you'll feel so much more validated and happy and know that you've thought about yourself and them. And it's really the way to go. But it is hard to kinda morph yourself there, and you have to practice.

Nia Thomas [00:31:03]:
Yeah. Definitely. You've really gotta plan, reflect before you go headlong into something. Yeah. I'm interested in your thoughts about physician leaders because I think being a leader and a physician is is a different kind of leadership role, and I think it it really does link those hard skills and those management skills. How do you define a physician leader? How do you talk about a physician leader? Because it's not the same as talking about me. I'm, if you like, I'm I'm an operations lead, but I don't have that clinical element. How do you define that?

Amanda [00:31:42]:
This is a very big question. So I'll just I'm gonna dissect it into something small, I guess. I did my master's thesis on the physician voice in the health care system. System. And in fact, one there was a gentleman from the UK there, so it was really interesting. Physicians, when we finish, so we finish medical school and you're a physician, there's this assumption that you're a leader. Okay. You're in the community and, oh, you're a doctor.

Amanda [00:32:06]:
Oh, you must be a leader. So that's interesting. This definition of physician leader goes all the way just down to someone who's frontline like I was at the beginning of my career to someone that really has a labeled high level physician leadership position. So very different. But I'll stick with maybe the labeled position. So you've got a chief medical officer or zone medical director or something like that. One of the differences with physician leaders is often it's a very small part of your job. So they still do clinical, and then they do these physician leadership jobs off their desk.

Amanda [00:32:44]:
The expectations, though, of many people on the team are that they are full time doing the leadership job. And so there's these discrepancies between operational leaders who probably have a full time job as a leader, and then a physician leader who has this tiny piece. And also the this whole assumption that you are a good leader when you're a physician. So other leaders may get put in their positions because they have leadership training. They've sort of gone into different areas that actually help them be good leaders. Many physician leaders historically have been, as I'll say, tapped on the shoulder to do a leadership job because they're good doctors, or they've been around for a long time. So now you're the leader. But they may not have those same skills.

Amanda [00:33:29]:
So you're gonna have a real different variety of people in these physician leadership jobs. And they're also and this puts physician leaders in a very strange position. They are cross sectional colleagues with all the people that they're leading in general. So, you know, when I was doing, internal medicine and, the facility chief of internal medicine or the medical director of that hospital, all of a sudden, I popped down the next day, and I'd be admitted admitting patients as an internal medicine doctor in the emergency room alongside all the colleagues who I'm supposed to be leading. So it puts you in a very awkward strange position because you are sane yet different.

Nia Thomas [00:34:11]:
Absolutely. That's right. I've seen medical directors who have had clinics, and not until you're saying that am I thinking, yes. Absolutely. You have to go from being manager of people to being a peer, and you have to keep bouncing between these different levels. That that is complex if you want

Amanda [00:34:31]:
to manage relationships well. So complex because I'd be on one night, and the next night, I'd be calling someone they had to admit someone to their service when they didn't want to. And I'm trying to be cognizant as the night before, I was the person who didn't wanna admit them to my service. And so I'm always trying to think not the who, just like I was saying before. So what is the issue, and how can I get how can we get through it? And that's where the mediation skills really come into place because it's dissecting what is the issue. So whose skills like, what are the skills that this patient needs? And so I can ask each doctor what are the what are the skills that this patient most needs. If you had to, you know, write that down for me, the top two skills that patient needs. This skill and this skill.

Amanda [00:35:18]:
What specialty has those skills?

Nia Thomas [00:35:21]:
And they're like, well Interesting.

Amanda [00:35:23]:
So if it's yours, how do we get them those skills? Even if it's not admitting them to you, how do we get those skills? So, yeah, it's really interesting as a leader. How do you flip back and forth and how do you sometimes do some of the work off the side of your desk because you're in clinic and they're calling you to take care of some issue.

Nia Thomas [00:35:39]:
Yes. Absolutely. Just before we go, my final question, what are your predictions for the future for physician leaders? And in particular, what skills do you think they're they're gonna need for this new workforce that's emerging and our new expectations around our purpose, our value, and our engagement in in the in the decisions that the organization is making strategically?

Amanda [00:36:02]:
Well, I wouldn't be doing this work if I wasn't an optimist. None of my 3 kids are all just finished university, and I no no one wants to go into health care at all. And I truly believe that we can change this system so that people want to work in health care. And I think that's by having people in the system that allow themselves to be vulnerable and to really listen to each other and not be right, you know, not be positional. I can put something out there that people disagree with, and it's gonna be cool. And I do think generations as they come up who have access to all this stuff online. I mean, look at you and I. We're all the way across the pond as you say.

Amanda [00:36:45]:
We're chatting with each other. They have access to all this stuff. How can we get in front of each other and really listen and dissect what each other's going through? I mean, there's a lot of stuff in the world that's bad that's going on. I think each of us can make such a big difference if we just say, I'm okay being maybe not being agreed with. And I think that's hard for people. That means we have to be brave. We have to be vulnerable. And, you know, we can we're fine if we're not right all the time.

Amanda [00:37:16]:
And I try to tell leaders, that's cool. Like, embrace having an idea that didn't work. At that, you learn the most from that. The best parts in my career when I failed, I've learned the most and they've turned out to be the most valuable. So what I would say is we there's a lot of hope. And if we really look at ourselves and I remember once person said to me when I first became a leader, he said, don't take yourself too seriously. And I'm like, that's great advice. Enjoy your life.

Amanda [00:37:44]:
You know, carve out time when you need it and ask for time if you don't have it and just respect yourself and trust yourself and, have some vulnerability that you don't always have to be right and ask lots of good questions. And I think we'll be we'll be good, but it doesn't mean that we won't have any blocks in our maze of life. And that's the blocks that are the coolest. You just have to take a few breaths as you hit one of those and think, okay. What are the issues? And have a process to get around the block and then, move on. So those are my thoughts, but I am very hopeful. And when I hear people like you reaching out to people like me, I think there's we all make a difference, all these pieces, and I really truly believe that.

Nia Thomas [00:38:26]:
Yeah. That's brilliant, and that's a wonderful way to finish our conversation. Doctor Amanda Brisebois, well, I've really enjoyed the conversation. I think the the clinical leadership and people leadership coming together is a very interesting model. So it's been brilliant learning from you. Thank you very much for joining me.

Amanda [00:38:43]:
Thank you so much for having me. It's been great. Love it.

Nia Thomas [00:38:47]:
Thank you for joining me on today's episode where we aim to develop self aware leaders around the globe to generate kinder, more respectful and creative working relationships through reflection, recognition and regulation. Head over to my website at knowingselfknowingothers.co.uk to sign up to my newsletter to keep up to date with my blog, podcast and book. Looking forward to having you on my learning journey.