As I described in Dealing with a Medical Staff in Crisis, I have witnessed the power of independent community physicians to affect hospital revenues and hiring.  The quickest way to explain how we got to this point, is to refer to Maslow’s Pyramid, where each party took a lofty view of its own goals (self-actualization, at the top of the pyramid) and a skeptical view of the other side, dismissing their concerns as selfish and disrespectful.  In retrospect, each party faced survival issues (at the bottom of the pyramid).  The community physicians cannot pay their practice expenses based on outpatient visits alone because of the payor mix in this urban community; the hospital relies on admissions from indpendent community physicians to provide inpatient care to community residents and workflow for its employed physicians and allied healthcare professionals. 

As I mentioned in Collaborative Uncertainty, hospital leaders walk a tightrope of providing leadership and reassurance in times of crisis while showing that they are listening actively and remaining open to new ways of thinking and acting.  During this engagement, I learned the importance of acknowledging past perceptions of injustices and at the same time, moving forward.  The physicians whom I interviewed stated repeatedly that they did not want to hear more words, but wanted to see action to improve their situation.

In Collaborative Revolution, I alluded to Peter Senge who wrote that rather than tell people that their thinking is outmoded, we need to reflect on our assumptions, so that we can see the underlying forces and the opportunities on which we can capitalize rather than resort to blame-storming and finger-pointing. If it were easy, there would be no need for consultants and blog posts like these.

In Collaborative Learning, I pointed out that physicians’ training to make a unifying diagnosis makes it difficult for us to deal with occasionally conflicting polarities like long-term and short-term or patient survival and organizational survival.  Becoming more comfortable with paradox is a lifetime learning journey.  Collins and Porra in “Built to Last: Successful Habits of Visionary Companies” quoted F. Scott Fitzgerald, “The test of a first-rate intelligence is the ability to hold two opposed ideas in the mind at the same time and still retain the ability to function.”

What do you think?

• Can a modicum of physician dissatisfaction drive productive change that improves processes and care for our communities
• Is some of our current dissatisfaction rooted in non-medical issues, like the recession
• If we are all in this boat together, where do we go from here to refocus on the patients and families who rely on our teamwork

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

Kenneth H. Cohn

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