The New C-suite: Sailing the Seven Cs (Part 2)

Influencing culture

Culture is extraordinarily powerful and has the potential to undermine any leadership efforts and improvement. Recent literature addressing organizational culture has recognized that truly effective cultures must simultaneously embrace and balance interdependent opposites, sometimes called polarities. Common polarities seen in contemporary medical staffs include: 

• Collegiality and excellence 

  We all want to work in an environment that is high on collegiality. Physicians appreciate working within a medical staff in which their fellow physicians work and play well together. Collegiality helps increase the social capital of a group or organization. This social capital is critical for providing the grease that allows smooth relationships and interactions within the medical staffs. In short, people who play together have a more difficult time fighting. 

• Freedom and commitment 

  Physicians need the freedom to make choices about how to spend their time-on their practice, with their families, and on personal pursuits. This creates a dynamic tension that applies to physician participation in the organized medical staff. In this context, freedom means each physician's right to make individual choices concerning how to balance their practice, home, leisure time, and medical staff responsibilities. Each physician is autonomous and free to make these choices as he or she sees fit. Increasingly, medical staff members are opting to spend less time involved in medical staff activities or carrying out the board-delegated responsibilities of contemporary medical staffs. In many organizations, this absence of commitment and leadership has led to a crisis situation. 

• Appropriate independence and mutual accountability 

  Appropriate independence is critical for the practice of good medicine. All physicians value the right to provide care to their patients as they deem appropriate for each case. Appropriate physician independence in the practice of medicine is an absolute requirement for physicians to exercise their clinical judgment and skills in the best interests of patient care. By virtue of training, experience, board certification, and undergoing rigorous and ongoing determination of current competency, physicians exercise their privileges to ensure quality patient care. This is consistent with the fiduciary responsibility of the physician to his or her patient. 

• Appreciation and continuous performance improvement 

  We often fail to appreciate the excellent care physicians are providing already and the sacrifices they are making-attending patients in the middle of the night, dealing with angry patients who threaten to sue, and then coming in the next morning and doing it again. Who is saying "thank you" in your hospital? If physicians only hear from their medical staff about how they can improve, without being appreciated for the hard work and excellent care they are already providing, you won't have a healthy balance between appreciation and continuous performance improvement.

  Once physicians feel appreciated and honored for the excellent quality of care they already provide, they are far more likely to accept constructive feedback and improve their care over time. In this sense, a medical staff culture that embraces appreciation and continuous performance improvement is more likely to be an effective medical staff. 

• Stability and change 

  Culture is not changed easily and requires strong leadership. Leaders must espouse new beliefs and values, often in mission, vision, and value statements. Leaders must walk the talk and lead by example. They must be great communicators and reach out to fellow physicians to communicate about the new culture and the reasons for change. Leaders must also build strong social capital and respect to facilitate the necessary culture changes. 

Cultivating influence

A fundamental principle underlying cultivating influence is that we are often interested in far more than we actually control; however, if we do well with what we control, we are able to increase our influence on things in which we have an interest but no control. Medical staff leaders should understand this dual role and responsibility of the medical staff. This principle applies to all parties. What is the sphere of control of the organized medical staff? First and foremost, it is their board-designated responsibility to monitor and improve the quality of care that is primarily dependent on the performance of individuals' granted privileges.

Because of this, physicians on your medical staff are accountable to each other for the quality of care they provide. This is a given. This is the sphere of control of the medical staff, namely how credentialing, privileging, and peer review are conducted in the organization.

But the medical staff is interested in many other things, including hospital operations (e.g., staffing, cleanliness, timeliness, availability of services, and competency of staff members) and the board-directed strategic development and initiatives of the hospital. To expand our influence, we must begin by doing what is in our sphere of control. Do what is in your sphere of control well, and your influence will expand. Don't do what is in your sphere of control well, and your influence will shrink.

Will your organization be characterized by unmanaged competition and war or extortion and capitulation, or will it be an organization dedicated to collaboration and ensuring physician and hospital success? Sailing the seven Cs offers a step-by-step approach to realizing the latter.

William K. Cors, MD, MMM, CMSL, is the vice president of Medical Staff Services at The Greeley Company. He can be reached at: wcors@greeley.com.