Collaborative Control

One of the joys of fall cleaning is finding a post that I meant to write earlier buried deep in a folder labeled “Blog posts.” This post is a tribute to a CEO who had the guts to stand up to the person whose loss of confidence might lead to his firing, the Board Chair.  The context follows.

The hospital, located in a Western vacation paradise, had no competition for over 100 miles until a group of orthopedic surgeons purchased land across the street to build an ambulatory surgery center.  Seeing the threat to the hospital’s mission services, which were subsidized by the margin on orthopedic surgery, hospital leaders tried to make their case to physicians in “town-hall” meetings without success.

At a Board meeting, I discussed the potential of physicians’ being involved in clinical priority-setting via a Medical Advisory Panel of outstanding physicians who heard presentations from all major departments and sections.  The Board Chair interrupted the presentation and summoned the CEO and me into executive session where he asked the CEO, “Are you worried about ceding control to the physicians?”

The CEO calmly responded, “Heck no.  I never had control in the first place.”

I walked back into the Board meeting feeling like I was watching history being made.  The hospital went ahead with the clinical priority-setting project, and in the Medical Advisory Panel’s report, the physicians wrote:

Panel members have had a unique opportunity to consult with their colleagues and take stock of current medical practice.
It has become abundantly clear that we have lost touch with each other. Forces are being brought to bear which many of us have ignored or dismissed, perhaps because we have felt powerless to influence them.
Our professional, ethical charge is to provide our services in the manner which is most beneficial to the welfare of our patients. We are now reminded that the hospital has the same responsibility.
Our task is to work together to find solutions which will benefit all three- patient, physician, and hospital- and in so doing, gain strength from one another.
(Cohn et al. The Benefits of a Structured Dialogue Process in Fostering Collaboration. 2006, in Cohn KH. Collaborate for Success! Breakthrough Strategies for Engaging Physicians, Nurses, and Hospital Executives. Chicago: Health Administration Press, 5-7.)

The Medical Advisory Panel created a safe environment in which a constructive two-way dialogue could take place between physicians and hospital leaders.  The hospital and ambulatory surgical center are now partners.   The panel meets monthly with hospital leaders and has been incorporated into the hospital culture as a forum for dealing with controversial issues.  By reporting to the Medical Executive Committee (MEC) regularly, the Medical Advisory Panel complements rather than competes with the MEC, whose (MEC) members devote their time to quality and safety issues, not strategic planning.

A physician-colleague who is Chief Operating Officer of a midwestern hospital confided to me that what made him feel stupid was taking over 50 years to realize that by surrendering tight control, he gained influence.

What do you think?

• Can you recall times when you gained influence by surrendering minute-minute control
• Do you believe in the self-fulfilling prophecy that if you treat physicians like adults, you obtain adult behavior
• Is the CEO who admitted to his Board chair that he never had control in the minority or majority

 As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn

 

Posted in Learning

Comments

Home | Contact | Privacy © 2012 Healthcare Collaboration All rights reserved.