The New C-suite: Sailing the Seven Cs (Part 1)

It takes strong leadership skills to navigate the waters of physician-hospital competition and collaboration. The questions to consider are "Where do you want your organization to be?" and "Where is it now?"

First of all, we probably have to invent a new C-suite for the hospital. Currently, we have CEOs, CFOs, COOs, CNOs, CMOs, and so forth, but is this sufficient? In addition to, or in place of the above, what we really need now are the following:

• Chief change officer
• Chief collaboration officer
• Chief communication officer
• Chief competition officer
• Chief conflict officer
• Chief culture officer
• Chief cultivating influence officer

Regardless of the titles used in your organization, the point to consider is that a new set of leadership and management competencies is required to lead contemporary healthcare organizations. These new competencies or the "seven Cs" are:

1. Embracing change
2. Seeking collaboration
3. Increasing communication
4. Handling competition
5. Managing conflict
6. Influencing culture
7. Cultivating influence

Embracing change
Change inevitably causes stress, and different personality types respond to stress differently. A working knowledge of primary personality preferences and their reactions under stress can help leaders diagnose and treat roadblocks in the process of embracing change. Tools such as the Myers-Briggs Type Indicator or the Dominance-Influence-Steadiness-Conscientiousness Profile provide insights into seemingly inexplicable behavior. For example, many physicians using the MBTI show the following patterns:

• Sensing, which is characterized by attention to immediate details and practical applications. When stressed, this style might have difficulty seeing the implications of the big picture and recognizing culture and trends.
• Thinking, which is characterized by a rational and objective approach to decision-making. Under pressure, this style overlooks the effect of decisions on others and values product first and process second (if at all).
• Judgment, which is characterized by focusing on a product that can be implemented and used. Under stress, this style is uncomfortable with uncertainty and might revert to controlling behaviors.

Seeking collaboration
It is important for leaders to understand that how they respond to conflict is a matter of their conflict style. There are two primary responses to conflict. The first is assertiveness, in which you seek to satisfy your own concerns. The second is cooperativeness, in which you seek to satisfy the concerns of others. Within these two primary responses, several outcomes are possible. These include:

• Avoidance, by which neither party satisfies its concerns.
• Competition, in which you seek to satisfy your concerns at the expense of others.
• Capitulation or accommodation, in which you satisfy another’s concerns at your expense.
• Compromise, in which each party gives up some of its concerns to satisfy the other. Although many people view this as the highest form of negotiation, it often leaves both parties feeling dissatisfied or manipulated.
• Collaboration, a preferred method of negotiation in which both parties appreciate the conflict as a mutual problem to be solved. This allows the parties to discover new, expanded, or increased alternatives to satisfy their concerns.

There are different methods for actual negotiation, not all of which will result in collaboration. These include:

• Positional-based negotiation, in which the bargaining occurs around positions. The danger is a tendency to lock in to these positions. For example, the more you clarify your position and defend it, the more committed you might become to it.
• Power-based negotiation, in which one party holds a dominant position over the other either by authority, positional power, or leverage. A threatened pullout of emergency department call within two weeks by your surgical staff when there are seemingly no other alternatives is an example of leverage. This style of negotiation does not lead to seeking collaboration.
• Principle-based negotiation, which is described by Roger Fisher and William Ury in Getting to Yes. This method involves four steps:
  1. Separate people from the problem.
  2. Focus on interests and not positions.
  3. Invent options for mutual gain.
  4. Insist on using objective criteria.

This method of bargaining is designed to facilitate and increase collaboration and should be part of every healthcare leader’s toolkit.

Increasing communication
Communication is the glue that holds everything together. There are two facets to this. The first is the actual method of sending communications. The second is a toolkit of communication skills.

Medical staff members and hospital leaders need to communicate with several stakeholders (e.g., the medical staff, hospital administration, board, and community). A comprehensive communication plan must include multiple modalities, approaches, and channels to communication. Communication, especially in this 24/7 age of instantaneous news, needs to be timely, accurate, and transparent. Constantly trying new methods of communication insures freshness, vitality, and interest.

Effective multichannel communication includes:

• A monthly physician and/or internal hospital newsletter distributed in the medical staff lounge and sent to all physicians’ office staff members by e-mail, fax, or mail.
• A medical staff Web site continuously updated with news, items of interest, and other matters pertinent to the medical staff.
• A letter, fax, or e-mail sent regularly to key stakeholders, informing them of important issues and decisions.
• A "quick flash" briefing letter to address timely issues that need immediate input from medical staff or hospital members. Print the letter on brightly colored paper to get their attention.
• Webcasts, podcasts, or CDs for informing physicians and hospital members about important issues and decisions.
• A medical staff telephone hotline for physicians to call with comments, complaints, or suggestions. This is a useful method for physicians to voice their concerns in a nonthreatening environment.
• Scheduled office hours for medical staff leaders so physicians can discuss suggestions and concerns in private.
• Effective committee and development meetings, with minutes distributed to the appropriate staff members. However, do not fall into the trap of believing that because an issue was discussed at a meeting, further communication is not necessary.
• An idea board at all meetings, which can include a flip chart with several markers so that questions, issues, and suggestions can be solicited, recorded, and researched prior to the next meeting.
• Opportunities for social interaction to increase the social capital of the organization. Multiple opportunities exist, including:
  • An off-site one-day retreat with the medical staff, board, and administration. Regularly scheduled breakfast or lunch with medical staff leaders and hospital administration.
  • Informal quarterly socials with hors d’oeuvres. Invite the medical staff, administration, and board.

An effective communication toolkit must also be developed. Hospitals that train board members, administrators, and medical staff leaders in effective communication techniques will see benefits throughout the organization. Several techniques and resources are available to develop communication skills, including:

• Style assessments. These identify medical staff leaders’ personal strengths and weaknesses. For example, style assessments might identify passive-aggressive communication patterns or a need for skill training in assertive communication.
• Role-playing. This method allows leaders to practice responding to realistic case scenarios in a low-risk environment. This technique can be invaluable in equipping medical staff leaders to deal with the inevitable conflicts that arise.
• Personal coaching. Some physicians and other leaders might benefit from personal coaching that develops communication skills through individualized instruction.
• Formal education programs. Many on- and off-site seminars, classes, and retreats are available to organizations.
• Video- or audiotaped scenarios. Medical staff leaders might be able to identify useful communication strategies by viewing taped scenarios that are similar to situations they might encounter.
• Good listening skills. Effective listening is one of the most important skills of effective communication. It promotes trust, builds relationships, and leads to increased understanding. Good listening is fueled by curiosity and empathy, traits possessed by many physicians.
• Books on writing styles. These are readily available and help hone the development of clear and crisp written communication.

See next week's issue for Part 2 of this series, which will cover handling competition, managing conflict, influencing culture, and cultivating influence.