Convincing Rival Docs to Become Partners

To organize teams of erstwhile rivals, health system leaders must manage egos, negotiate ambitions, and acknowledge that they may be bringing on board some professionals who can't stand one another.

Abraham Lincoln did this in the 1860s as he pulled together a Cabinet that included people who wanted his job, challenged other's authority, and had not much use for the others' opinions. President Lincoln managed to steer his way through by focusing on a bigger goal: victory in the Civil War.

The New York Yankees did it in 2009, winning a world championship several years after Alex Rodriquez, the mega-millionaire shortstop with the Texas Rangers, signed with the club and was forced to switch positions and swallow some ego. Rodriquez then played third base, side by side with his onetime friend, Derek Jeter, who insisted he wasn't going to budge from his shortstop position. There's still speculation about how much they talk.

Like politicians or sports teams, merging groups in healthcare are often forced to work together after being competitors for years. Can physicians who compete and dislike one another put their differences aside and join a hospital organization with the shared goals of maintaining quality and reducing costs? Can they overcome the competitive mindset? Can they achieve championship-quality healthcare?

It is a difficult process that health systems are beginning to grapple with, especially as more physicians become aligned with hospitals, says Lawrence S. Levin, PhD, a leadership and team consultant. Levin, founder and president of the Levin Group in Atlanta, and author of Top Teaming: A Roadmap for Leadership Teams Navigating the Now, the Now and the Next, often works with former competing specialty groups to develop the team mindset he says is needed for a successful practice or relationships with hospitals.

"Sometimes it gets ugly, and it can get ugly pretty easily," he says.

At St. Joseph's Regional Medical Center in Paterson, NJ, things apparently had gotten ugly for a while with doctors and their department chairman, who had apparently announced that he would "separate their skulls from their bodies" if they disobeyed him. The doctors' medical group left the hospital and then sued. A jury decided last month that the chairman and the hospital should pay the doctors $1.7 million.

"When it gets ugly with physician groups and hospital administration, it gets uglier than in a lot of other businesses and it becomes much more personal for some reason," Levin says, speaking generally and not about the Bergen County case. "You have to reset the clock. Why you are there? What do you agree on? It may sound soft and fuzzy but it's not. You understand what everyone's interests are and you proceed forward, then face the dialogue."

Levin discussed some of the moves that leaders must make in creating a functioning team out of once-competing physician groups and hospitals:

1. Forget the vision thing

Levin says that while many groups get together and talk about a vision, few actually realize it. Too often, they rely on a statement without substance.

Levin worked with merging medical groups to make their vision practical. "We pulled together the leadership from these groups, and we really began the dialogue by talking about why the people in the room were there, what they stood for. We elevated the conversation about what their frame of reference was, what they were about. Why did they go into medicine in the first place? What was the most important thing for them?"

"It was about creating a potential vision of what these groups would do," he adds. "It wasn't a vision statement; vision statements are rarely practical. They are aspirational, and when put under pressure, they dissolve pretty quickly. If you don't understand what people want and what their expectations are, what their self interests are, aspirations don't stand the test of battle very well."

2. Act like a hostage negotiator

Oddly enough, Levin finds that some standard hostage negotiation techniques are helpful in dealing with healthcare rivals planning on becoming partners. From the outset, when a negotiator speaks to a hostage-taker and wants him to change his position, "the one thing they do is get to a common ground," Levin says. "They have to agree on something to begin with. In hostage negotiations, they may agree, "It's nighttime, or that everybody is nervous, or "Nobody wants it to get worse than it is."

Once there is a point of agreement, "when you run into difficult issues, then you circle back to what you agreed on," Levin says. The same technique can be used in negotiations with healthcare leaders.

3. Don't pretend you all like one another

Levin worked with a group of hospital and physician leaders who had tried to make a deal, but at the 11th hour, after attorneys, accountants, and various business models, they broke off the negotiation. Some admitted that the deal-breaker was that they just didn't like one another.

Newly formed teams often mistakenly think it's OK if they just set aside their disagreements and not put them out front. That's what happened with this group, Levin says. Eventually, the differences rise to the surface. "What they tried was peace over trust," he says. "Peace over trust rarely works. You acknowledge the issues and make agreements around those issues, and over time you build trust. That's pretty hard to do."

"We acknowledged there were issues that were not going to fully resolve. They had some people who didn't like each other, but they had a working agreement and kept to that agreement," he says.

Why should the group go to so much effort to bridge their differences? Levin's book on "top teaming" discusses the teamwork concept and opportunities, as well as obstacles. "Top teams carry with them tremendous collective intelligence, operating experience, and the ability to exert significant influence over their company's mindset, focus, and performance," he says.

If Lincoln could do it, if the Yankees could do it, then physician practitioners can do it, too. Team-building takes work, but there's plenty of evidence it can result in great outcomes.