136. The 5:1 Ratio - Key to your Physician Leadership Success Up and Down the Organization Chart

Introduction: The Importance of the Magic Ratio in Leadership

In this episode, you'll discover the magic ratio in your relationships with your direct reports that will ensure your leadership is as supportive, collaborative, and engaging as humanly possible. You must know this ratio in order to support you being the best leader you can be. Check it out.

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Trust as the Foundation of Leadership Relationships

In the last episode, number 135 (there's a link in the show notes), we went over the fundamental currency of leadership. That currency is trust, specifically the trust account that sits between you and all of your direct reports, both up and down the chain of command. I also taught you that the way you make deposits into that trust account is to have regular, positive interactions with your people.

This is the one thing that is most in short supply in the modern healthcare workplace. All of us, in every position in the org chart—from the CEO to the janitorial staff—are completely overwhelmed on any given day. Our profession is reactive. We open the doors, and whatever happens, happens. Whether it's sick patients, injuries, appendicitis, colds, or COVID—it doesn't matter. It lands in our lap. We're always reacting.

Because of this whirlwind of overwhelm, most interactions between leaders either never happen in the first place—because the leader can't find time in their schedule—or, when they do happen, it's a leader checking on a direct report because they’ve done something wrong or are in trouble.

When I train physicians and ask, "If your boss shows up in the waiting room between patients and says they need to see you, is that a good thing?" the answer is almost always, "No." It means trouble. If the only time your people see you is when they’re in trouble, you cannot build trust, and without trust, you cannot build a high-functioning team.

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Discipline and Time Management for Building Trust

What do you do to change this? You must be disciplined. Block out time on your calendar every week to get out of your office. Especially if you're a senior leader in the ivory tower, get away from the spreadsheets and be with your people. Round on them, or better yet, shadow them to understand their frontline experience. Put on your leader hat, ask questions, don’t give orders, and look for opportunities to say, "Thank you." Be specific in your gratitude: "Thanks for your hard work. I really appreciate it because of [specific reason]."

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The Magic Ratio: Five-to-One (5:1)

What is the magic ratio? It’s five to one. This comes from the work of the Gottman Institute, which specializes in relationship science.

The Gottman Institute studies couples by observing them in a monitored environment. They analyze every interaction—grading them as positive, negative, or neutral—and have identified that healthy couples have a ratio of five positive interactions for every neutral or negative one.

This ratio applies to leadership relationships as well. To build trust, you need five positive interactions for every negative or neutral one with your direct reports.

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Calculating Your Current Ratio

Think about your direct reports. Think about those you report to. Can you calculate your positive-to-negative interaction ratio over the last six months? Has the number of times you’ve positively interacted with your people even reached one? For many leaders, the answer is "No" because of the overwhelm of their schedules.

To achieve this five-to-one ratio and build positive trust accounts with your people, you need to carve out time to round and shadow regularly. Even if you were to meet with one direct report once a month—which seems frequent—it would take you six months to build a strong relationship.

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Challenges in Maintaining Positive Interactions

One challenge is the overwhelming number of direct reports many healthcare leaders have. For example, a CMO might have several dozen direct reports and no protected time for leadership duties. If that’s the case for you, it’s time to negotiate protected time and dedicate a portion of your weekly schedule to rounding and shadowing. Defend this time with your life. You’ll be amazed at how this impacts your leadership and your team’s trust in you.

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Proximity and Trust

Trust is also influenced by proximity. The closer you are to someone in your daily work—your receptionist, MA, nurse, or immediate colleagues—the easier it is to maintain a high trust balance through daily interactions. Leadership becomes more difficult as you move outward from your immediate contacts.

For example, if you’re a CMO overseeing a team 10 miles away from your office and you never round on them, trust is impossible to maintain. This is why it’s critical to ensure your leadership tree is fully staffed, all positions are filled, and that everyone understands the fundamental currency of trust and the importance of the five-to-one ratio.

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The Role of Regular Rounding and Shadowing

If I could, I would make rounding and shadowing a mandatory weekly activity for all leaders at all levels in healthcare organizations. Simple positive touches can make a huge difference. Do everything you can to make this a regular occurrence in your leadership practice.

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Conclusion: Trust and the Five-to-One Ratio

The five-to-one ratio is key to creating trust-filled, supportive, and high-functioning teams. By committing to regular, positive interactions and making time to be with your people, you can foster collaboration, creativity, and engagement in your workplace.

That’s it for now. Until we’re together in the next podcast, keep breathing, and have a great rest of your day.