Physicians On Purpose Podcast 002 - Mark Jaben MD  - Vision Strategy Tactics

Posted by Dike Drummond MD

physicians on purpose podcast mark jaben md vision strategy tacticsPhysicians on Purpose Podcast 002
Dr. Mark Jaben and the Vision-Strategy-Tactics Word Stack

Whenever you want to make change in your life or your practice ...
You are working with a group/team of people and you want to make sure they are pulling in the same direction ...

This Word Stack will Save Your Bacon


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Podcast Transcript:

Hello, this is Dr. Dike Drummond, at the home of in beautiful Seattle, Washington. Welcome to the Physicians on Purpose Podcast. Our guest today is one of our coaches at, Dr. Mark Jaben MD. Mark is a very experienced emergency room physician.

He also here in the midst of the COVID pandemic is taken on a position as the county Health Officer of Haywood County, North Carolina. So he's dealing with a small rural western North Carolina assignment of handling the public in a time of COVID-19 pandemic. He's also the author of the new book “Free the Brain”.

And Mark's got a lovely little twist in his career. He actually spent some time in New Zealand as an emergency room doctor back in the day as well. Welcome to the podcast, Mark.

Mark Jaben MD:
Well, thanks, like really happy to be here.


Dike Drummond MD
Yeah, you bet. And we were talking ahead of time, about one of the tools that Mark and I use a lot in our coaching.

  • It works in when we're helping physicians recover from their own burnout.
  • It works when you're working as a wellness leader inside your organization.
  • If you're a wellness champion, looking to manage your boss, it works in all of these situations.

It's a prioritization tool, and it's actually a word stack and I'm going to give you this word stack right up front. The word stack goes like this. And if you have a piece of paper, if you're just listening, and you have a piece of paper, you might want to write these three words in this order in a stack, a vertical stack.

  • So the top word is the word VISION.
  • The middle word is the word STRATEGY.
  • And the bottom word is the word TACTICS



… in that order.


Great word stack. I've got it written on an index card right here.

So Mark, let's talk a little bit about why we find this such a valuable tool. And at what point in our conversations, for instance, with a physician in a Discovery Session, which is the free session we do to start a free coaching relationship. How this shows up in that conversation?


Mark Jaben MD:
Yeah, so if you just think about it last time that you are in a meeting, or if you sit back and think about you know your daily existence, what comes to mind? It's always about what you want to do or what's not working? What can I do about it?

If you think about discussions that happen, an issue comes up? Where does the conversation go? Usually immediately to what we're going to do. And that's okay, except that my solution to what we should do is often going to differ from your solution about what we're going to do. And that's because we're each thinking about it from the perspective of how we think about the issue or the problem.

And when how two people think differently about what the issue or the problem is, it's going to lend itself to different solutions. And so you get what I call dueling solutions, that really doesn't go anywhere. So the way that our brains are wired to think of everything is a problem with a one-step solution, fix it and there bam, we're off to the next thing. But when that doesn't work, and you're talking at that tactical level, that's where you run into trouble.

So whenever you recognize that in a conversation, You're having if you could pause and think about what are we trying to achieve? What's that vision? Now, if people can agree on that vision, now the solutions will be tailored to what that common perception is. And they tend to be more in alignment, and you get more clarity about what you actually want to do.

So the tactics are always about what do I want to do? strategy is about what are the leverage points I need to address in order to execute on the vision? What do I do is tactics to execute on the strategy that will help me achieve whatever that vision is. And I would say like that, this is not only a structure that works for yourself. It's not only a structure that works in the context of your bureaucracy, try it some time with your patients and try it some time with your teenagers. It works in all those situations,


Dike Drummond MD
Whenever there's disagreement or confusion about what to do, that is a tactical level thought process. The most important thing is to just release your confusion or disagreement and up level your conversation to the level of Vision.

  • What are we trying to accomplish?
  • What is our goal?
  • What is our vision?

Stephen Covey, Seven Habits of Highly Effective People, says, “ begin with the end in mind”. This same concept was originally proposed as in management theory by Peter Drucker in “The Effective Executive”.

So what we do is we run into it all the time when somebody says What should I do? Or when two people are in an argument about how to approach a particular issue. So, and we were talking to I find that I use this word stack, when somebody comes in as a potential coaching client when they say hey, this is how my, my practice and My job sucks. What should I do? You're the coach, tell me what to do?

My answer is always I have no idea. And then I whip out the word stack and say, let's talk about your Vision. And from an individual coaching perspective, Mark, what are we call that vision? What is the exact vision we're asking them to create?


Mark Jaben MD
Yeah, we're asking people to think about wiping the slate clean for their current existence. And what would be the ideal practice situation? What would work? What if you could draw it, wipe it clean? How do you want it to be?


Dike Drummond MD
Right? And what I find is that that's not something. You know, that's not something a doctor is used to being asked. No, in an ideal world, if you had a magic wand if you were the king of the forest, if you were the boss. What does your ideal practice look and feel like describe it to me in detail and then what do they do? They go


Mark Jaben MD
It's the open mouth. goldfish stare right? It's usually something like, that's, that's, that's a really good question I never thought about.


Dike Drummond MD
Nobody's ever asked me that before. But just be really clear. Your medical school, your residency program, your fellowship, even your current job is not interested in your ideal job description. They're interested in their job description. But you always have the ability to move in the direction of a more ideal job as soon as you're clear on that vision for yourself. Even if nobody's ever asked you this question before.


So let's talk just a little bit more about how this word stack shows up around an interesting transition in your life around your decision to leave the United States and go to New Zealand. So if you could, if you could just walk us through that experience, and tell us how this Word stack potentially helped you do it even if you might not have known it at the time. That'd be awesome.


Mark Jaben MD
Yeah, I certainly didn't know it at the time. But I've been bibber of a independent private emergency department group for 20 years in a small rural community hospital. And over the last couple of those years, things got pretty contentious inside the organization and ended up with us being summarily fired midway through contract. This was back in 2006. And I think many of you, you are around that. probably remember, there was a lot of this going on at the time. But because I had family and mortgage and retirement and all that sort of stuff, I had to keep working. And so I ended up picking up shifts in other places around my area.

What I found out was everybody was struggling with the same things. And we had always wanted our kids to have an experience living outside the United States. And because my Spanish is just good enough to get me in trouble. It needed to be an English speaking place. Okay, so


Dike Drummond MD
Stop, stop, stop. Okay, here we go. What is he focusing on? He spends focusing on is what he wants. It's a vision. The vision says overseas English. Are you seeing how this is sort of panning out? Did you write it down? By the way?


Mark Jaben MD
I had no idea about this, though. I mean, did you actually


Dike Drummond MD
As a family write down? It needs? We're going overseas and it needs to be in Did you write down criteria like that?


Mark Jaben MD
I think that it was more like a series of dinnertime discussions, where we might head. Okay, cool. Keep going.

Okay, and then New Zealand was a natural choice because we're outdoors sort of people. And so we went over there. And it wasn't so important what the work was like, we were using the work as a vehicle to sort of have this family experience. And what a lovely place to be. And we enjoyed that thoroughly.

What was unexpected was how much I enjoyed working in the little hospital that I was in inside the New Zealand healthcare system. That was just a really unexpected joy. So much so that when I came back to the States, it wasn't clear to me whether it was because of the New Zealand healthcare system or whether it was because of the confluence of people in place, it just all fell in place.

And so I went back a second time just to sort of prove that to myself. And it turned out to be some of some of both.


Dike Drummond MD
Gotcha. And then as you're listening to I just want to point out to the to the folks that are listening here, too, this is one of those interesting pivot points that are available to anybody at any time who happens to be a physician as a career choice. A lot of times people's vision is focused 100% on their career, they come to me and they, they want to make their career ideal because that's a central focus of their life.

But notice how your pivot took the central focus of your vision from your practice to your, to your life, to your family, to the experience of being overseas with your kids when they're young. By the way, I spent my high school years in England so I know what that experience Like as a younger person, so you actually used your career to facilitate a vision that was a larger vision for your family. And a lot of times if we can rebalance, where you are putting your career or kind of pedestal you're putting your career on, and in many cases, it can be a servant to a larger vision. Now, you told me to a little while ago that you came back because your visa ran out, right?  


Mark Jaben MD

Well, yeah, New Zealand, though, with your visa runs out, they come find you. Not many people know about that. But the other things that happened there, you know, part of this process between getting fired out of this work and working for a while and going to New Zealand was trying to come to grips with what actually went on back then. How is it that we managed change so poorly across an organization? You know, we included? What does that really about? And so, one of the things that I learned in New Zealand was that it didn't have to be the way it was in the United States. I was in this organization where we could sit around a table and get things done. And I saw a very different cultural working environment than what I had experienced in the States. So that helped me say, hey, it doesn't have to be like that way, it could be this way. And that was part of that whole journey for me in terms of trying to understand change better, and what actually is really required and what does it take, and that's what led to the book. But interestingly, the whole coach training and development and experience as a coach has just been a further layer upon that. So all this has clarified together over these years.


Dike Drummond MD
And I think that a lot of times when there's struggle inside organizations, a lot of times when they're struggling your life, it's that we haven't got a clear vision. I'm not really it my day to day actions are not in service of a larger goal. Because that larger goal that vision is An organizing principle. And just to be clear, we talked about ideal job description earlier ideal practice description. here's, here's how I ask people to deal with it.

Write it down, first of all, pen to paper, get it out of your head. In an ideal world, what kind of patients would you be seeing, doing what kind of things for what kind of hours? And what kind of pay on what kind of team and what kind of organization where in the world? And typically, all I get is an open mouth stare, because, again, nobody's ever asked you that. That's because again, nobody really cares.

But as soon as you have a bead on your ideal practice, it's like a target in an archery range. You can start planning little movements in that direction, but it all comes when you begin with the end in mind. So I actually keep this on my desk, this little triad card so I can show it to people. If you're listening. You might want to write them down Vision, Strategy, Tactics and if you're ever confused about what to do uplevel your thought process to what's ideal.? What's the ideal outcome I'm looking for?

So, Mark, what else if you were to give us just one little kernel, what else was different about New Zealand that you have done your best to incorporate in the way you are a doctor these days back in the States? Yeah.


Mark Jaben MD

So the best way that I describe New Zealand to folks is your there aren't really four lane roads in New Zealand. There are a few three lane roads. We lived off the main road that traverse the North Island was a three lane road. And if you drove along there going down to the National Park, if two cars were passing, and there was a third car that wanted to pass that maybe there wasn't the third lane there. It's they're starting to pass and you're looking at them coming at you and go, Well, I'm not sure they're going to make it. The two people would actually just sort of separate out to the shoulders and give that person route to pass. If you went to a store and you're standing in line and the cashier is talking to somebody to lie to their character about their grandkids, and whatever, the state's people would start tapping their feet rolling their eyes and zeal, you just stood there and waited because that was an okay thing to do. And so I tried to bring back some of that better balance that I experienced over there. It tried to bring that back to how I encountered my colleagues, how I encountered my patients, I encountered the C suite folks to think a little bit less about me a little bit more about the V aspects, again, vision, trying to coalesce those things together. In terms of moving forward whatever the issue was.


Dike Drummond MD
Right. And you and I have had the benefit to have typically being in organizations that were small, and I think the me versus we met balances easier to find the smaller the organization. Great. Yeah,


Mark Jaben MD
Let me just throw one thing, like because you talk about this, which is what is the notion of consensus. And it's not only consensus in your own head about your ideal, but consensus was somebody else that you're working with, you know, being not your way or my way or some other way, the big something that you can live with and support. And so as you think about your vision, it your ideal, what can you live with in support? As you start to share that in terms of larger decision making? What can we live with and support? I think that's a really important adjunct to executing on this vision strategy tactic. structure,


Dike Drummond MD|
And and the prompt is, raise your hand if you can live with and support this, which does not mean you think it's the best or only solution. And that's a way that I very strongly recommend that people make decisions in meetings, as opposed to Robert's Rules of Order. And we can talk about that because it deserves a little bit of attention right on.


Well, thank you so much, Mark for being on the broadcast today. And if you want to know more about Mark, if you potentially want to interview mark, so to speak, to potentially be your coach, come see us at, punch the coaches tab, you'll see Mark's bio and have a chance to book what we call a Discovery Session. That's the first one hour on the phone with any one of our coaches Actually, that's free, no cost, no obligation 100% confidential, you'll get a strategic plan at the end of that interview, and then you can decide whether or not you want to hire mark as your coach. And Mark's been a member of the coach's group here at the website now for what three or four years now for a nice long time. Yeah, yeah. Yep. And thanks again, mark for being here. And again, Mark and Mark and I use this tool a lot vision strategy tactics.


Mark Jaben MD

Thanks so much. Appreciate being here.



Where can you use the Vision - Strategy - Tactics to get yourself and your people back on track?




Tags: stop physician burnout, physicians on purpose, Podcast