Tackling the Challenge of Physician-Hospital Relations (Part II)

William K. Cors, MD, for HealthLeaders Media, February 7, 2008
Editor's note: This is the second section of a two-part series. For part one, visit www.healthleadersmedia.com/PartI.

Step 5: Invest in Medical Staff Leadership
Leadership is a developed set of competences that includes behavioral attributes, knowledge, skills and tools that enable an organization to effectively and continuously adapt to changing internal and external environmental requirements. Physicians do not learn about or develop the requisite leadership competencies as part of their medical education, and this is reflected by the cultural conflict between medical staffs and hospital administrations. Some further thoughts show that the leadership challenges for physicians include:

  • Commitment--effective leadership requires a major commitment of time, professional interest and energy. It cannot be done in the time available between patients or the occasional day off.
  • Competency--requires physicians to acquire and learn a new set of behaviors, skills and tools not taught as part of their medical education.
  • Cultural conflict--requires physicians to understand and be able to effectively mediate differences in values, communications and behavioral norms between clinical medicine and administrative leadership.
The key to success is physicians learning the competencies of leadership.

Step 6: Invest in Social Capital
Social capital is characterized by the networks, processes and trust that help to facilitate coordination and cooperation for the benefit of individuals that are part of a larger group. Physicians and hospitals form a social unit. The strength of relationships and good will that comes from physicians, administrators and boards spending time together in social activities both in and away from the hospital can be enormous.

Step 7: Hold Regular Meetings and Retreats
Successful relations are characterized by the development and implementation of multiple points of structured access between physicians and hospital. The following are some examples of best practices seen in organizations that might serve as examples to others. These include:

  • A biweekly lunch of the "C" suite of the hospital with key medical staff leaders to discuss issues on an ongoing basis
  • A bi-annual off-site retreat attended by the hospital board, administration and medical executive committee, with a portion of each meeting devoted to education on collaboration
  • Annually, the hospital sends a board member, a hospital administrator and physician leaders to a national meeting on medical staff and hospital governance and leadership.
  • Structured but informal physician-hospital social activities. Why make this investment? Trust grows from structured access. Social capital allows the resolution of collective problems more readily and in a less costly fashion.

Step 8: Establish a Written Conflict Resolution Mechanism
Because of significant fundamental differences, conflict is inevitable even under the best of circumstances. A process for resolving conflicts between physicians and hospitals must be planned and agreed upon by both parties in advance of any conflicts. A formal policy should identify the process that shall occur and the leadership tools to bridge the gap.

Step 9: Maintain Excellent Communication
Communication is the active process of exchanging information and ideas. An excellent communication process needs to be planned, open and frequent. Communication competencies need to be learned, practiced and implemented. Those competencies include:

  • Active listening characterized by the principle of listening to understand.
  • Observe the fundamental elements of a message in which non-verbal behaviors account for 55 percent of the message, tone of voice 38 percent and the actual words used 7 percent
  • Provide feedback by paraphrasing what you think you heard to check for understanding.
  • Ask good questions using words that are factual rather than emotional.
The success of every step in this process for improving physician-hospital relations is dependent on effective communication.

Step 10: Celebrate the Successes
The journey to improving physician-hospital relations can be long and arduous. In fact, at times it can be downright contentious. But along the way, some short and long term wins have been realized. Some of the successes to celebrate include:

  • The first session of the newly created Medical Staff Leadership Institute with a delineated application process, a formal curriculum with external experts and attached CME hours, as well as a clear criteria for advancement.
  • The mechanics of a joint venture ambulatory care center have been worked through and construction is in progress. This only occurred after an intense period of discussion employing the principled negotiation approach.
It is increasingly important to celebrate the successes. A list of successes should be created--no matter how small--and examined to find ways that can be celebrated. By celebration, appropriate recognition is given to the successful improvement and by highlighting it, hopefully allows it to be repeated.

Summary and Conclusion
This monograph has outlined a ten step approach developed by The Greeley Company to improve physician-hospital relations. The monograph began by keeping the end in mind. What would it look like after the multi-year process necessary to achieve different results? Let's take a look:

Step1: Acknowledge physicians are customers, partners and competitors. Physicians and hospital now have a better understanding and appreciation that the old social contract between the parties has expired and conversations about a new order can begin.

Step 2: Heal the past. Physicians and hospitals have been able to name perceived past injuries and have agreed not to play old tapes. This has allowed the physicians and the hospital to begin to work through the dynamic of impact and intent. Because of this, the healer's wounds have been acknowledged and the past can be appropriately mourned. An emerging light from this storm is that a rediscovery of the "joy of medicine" is occurring.

Step 3: Create a shared vision of mutual successes. The medical staff and hospital, having each crafted their own mission/vision statement and a joint strategic plan that is multi-tiered and flexible.

Step 4: Develop mutual expectations for physicians and the hospital. The physician-hospital "compact" has served the parties well in focusing, aligning and advancing the diverse groups in search of their mutual interest to provide better and expanded clinical care to patients and communities.

Step 5: Invest in medical staff leadership. The formalized Medical Staff Leadership Institute, with its delineated application procedures, formal curriculum and criteria for advancement, has graduated its third class of present and future physician leaders.

Step 6: Invest in social capital. Physicians and hospital have increased play together and now have a harder time fighting than those who don't.

Step 7: Hold regular meetings and retreats. Increased trust has definitely grown from structured access.

Step 8: Establish a written conflict resolution mechanism. The written conflict resolution process and the investment in training all leaders in both principled negotiation and Polarity ManagementT have helped guide physicians and hospital through multiple conflicts.

Step 9: Maintain excellent communication. Active listening has become the norm. In seeking to first understand, the parties are now are finding that they are being understood.

Step 10: Celebrate the successes. Along the way, successes were identified and celebrated in public ceremonies recognizing the change agents and minimizing the naysayer.

William K. Cors, MD, MMM, FACPE, is Vice President of Medical Staff Services for The Greeley Company, A Division of HCPro, Inc., in Marblehead, Massachusetts.
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