Anybody who has worked with physicians has heard the comment, “Organizing doctors is like herding cats; you just get scratched.”
When I finished business school a decade ago, a physician asked me, “What is the difference between business school and medical school?”
I replied, “There was a lot more memorization in medical school than business school. Also, 30-50% of my grade in every course that I took in business school came from team projects.”
I have asked over 2,000 physicians how much of their grade in medical school came from team projects and have heard, “Zero,” every time. However, rather than bemoan how difficult it is to get some physicians to work in teams, we can use healthy competition to advantage:

• A cardiologist kept track of start times in the catheterization lab and used healthy competition to motivate other cardiologists to show up on time. He noted, “Cardiologists are a lot like alpha dogs who, when a bone is tossed their way, are eager to fetch.”
• Another cardiologist asked for input from his colleagues. He showed simple bar graphs of procedure time for balloon dilatation and stenting by anatomic location and number of stents for each of the cardiologists by number. Only he knew which name corresponded to each number. The cardiologists agreed that they could see widespread variation.
  He continued by showing them data on who used which supplies, again showing widespread variation. He ended by displaying data on simple outcomes like myocardial infarction and death according to American Heart Association category and elective vs. emergent status, and they agreed that their practice exhibited widespread variation. He encouraged the group to share their thoughts in subsequent group meetings on how they might limit variation, improve outcomes, and cut supply costs, telling them that they would re-examine the data in another four months, hoping to see progress. If they could not come to consensus on how to limit variation and improve outcomes and profitability in six months, he would put names above the individual physicians’ numbers and post the data on a bulletin board in the catheterization laboratory in full view of the entire staff.
  The medical director’s clinical credibility, integrity, and sincerity were unchallengeable. Within four months, procedure times and outcomes for the entire six-person group were within one standard deviation, and they had decreased their vendors to two and cut costs substantially, all while improving outcomes. As one of the cardiologists explained, “None of us wanted to be an outlier, except on the positive side.”
  (Case reprinted with permission from Cohn KH, Lambert M. “Engaging Physicians in Hospital Operations,” in Cohn KH. Better Communication for Better Care: Mastering Physician-Administrator Collaboration, Chicago: Health Administration Press, 2005, 47-48. http://www.ache.org/pubs/redesign/productcatalog.cfm?pc=WWW1-2038)

What do you think:

• Is engaging physicians like herding cats?
• Do physicians respond to healthy competition?
• What stories can you share about physicians working collaboratively to improve care?

I welcome your thoughts

Kenneth H. Cohn