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42. Tough Love and Social Capital with Jim Adams, MD

Updated: Mar 21

Jim Adams, MD is direct, transparent, and unapologetic in his ‘tough love’ management strategy. In this episode, Jim breaks down: how setting expectations early helps to manage complaints later, managing those who degrade social capital, redirecting conflict to mutual benefit, and how understanding what motivates others’ behavior keeps you from taking things personally.


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Guest Bio: Jim Adams, MD is professor and chair of the Department of Emergency Medicine at Northwestern University Feinberg School of Medicine. He is also the senior vice president and chief medical officer at Northwestern Medicine.


This episode is in support of World Bicycle Relief. World Bicycle Relief delivers specially designed, locally assembled, rugged bicycles for people in need. They’ve developed an efficient, innovative, and scalable model to empower students, health workers, and entrepreneurs in rural developing regions with life-changing mobility.

Donate here. We will match donations up to $1,000.


Essentials of Emergency Medicine, the conference I host each year, is happening May 25-27, 2021. Early bird discount ends April 3. For an additional $100 off registration, use the code 'orman' at the bottom of the checkout page.


We discuss:


Zen and the art of scheduling [05:30];

  • Adams coaches his chief residents on making the work schedule. He has some unique ideas and approaches that are well thought out and have years of field testing.

  • He recommends that they lay out the ground rules and expectations in advance (ie. how many days off will be honored), arguing that this is an enormously important part of management (and of life).

  • He also makes sure everyone understands that life’s not fair (and maybe your schedule won’t seem fair as well).


Why you might not want to be a complainer [07:05];

  • When making the schedule for the attendings, Adams makes sure everyone understands that he’s going to give the extra bad decisions (for example, fewer weekend days off) to the person who’s most likely to complain.

  • “The complainers are going to complain no matter what. I might as well give you something to complain about.”

  • We can extinguish those behaviors (and the tendency to complain) by not rewarding them.


“You can't reward bad behavior. Otherwise everybody's going to behave badly. That's tactical management rules.”

The benefit of assuming people are unreasonable and crazy [08:10];

  • If your expectation is that it’s normal human behavior to be unreasonable, then you won’t be perturbed or irritated when someone acts that way. And you’ll be pleasantly surprised when instead they’re nice and reasonable!


A strategy for handling people who degrade social capital [10:30];

  • You’re either building social capital or degrading it. People who send nasty emails, are the target of complaints, or talk negatively in the ED are not building culture or camaraderie. They’re degrading social capital.

  • Adams charges those people at an hourly rate for the time it took him to handle the complaint. Then he distributes the money back to the people who never complain.

  • “If people are creating problems, we charge for the cleanup of the problems because that takes time away from us building and advancing the department”.

  • Since enforcing this a decade ago, the department rarely gets complaints and morale has improved significantly.


“It starts with extinguishing the negative behaviors and rewarding the heck out of good behavior.”

Blend and redirect, a technique for negotiation and collaboration that’ll make you much happier than combat [14:00];

  • When confronted with a conflict, instead of fighting and butting heads against the other person, blend your ideas and put them on the same frequency. When you're on the same frequency, you redirect in a way that's in everyone's interest.


“You can be right or you can be happy. Choose a path that is not going to cultivate resistance. Try to solve the problem together, because combat's not going to make you happy.”

This idea: “People are not against you. They're just for themselves.” [16:15];

  • When you realize that people are just asserting something for themselves, then you don't take it personally. You don't get angry, feel belittled, or offended.

  • When you don't act offensively or angrily, you can get to better solutions.


“Nobody's against you, they’re for you. Everybody's on your team, they just don't know it yet. You can get them there.”

And more.


Shownotes by Melissa Orman, MD

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