Collaborative Critters: Accelerating Physician-Hospital Integration

August 11th, 2010 by Kenneth Cohn

Dr. Cohn Facilitating Physician-Hospital-Board Retreat

I spent a wonderful weekend in Florida with an outstanding hospital that desired to accelerate its physician-hospital integration progress. As facilitator, I presented an analysis of strengths, weaknesses, opportunities, and threats (SWOT), discussed medical staff integration models, and concluded with strategies to enhance physician engagement.

Then, I watched with pride as groups of physicians, administrators, and board members broke into groups of eight to discuss topics such as medical staff models, improvement incentives, recruitment and retention initiatives, physician engagement strategies, and guiding principles. Their body language was engaged. Their tone was respectful, curious, and at times playful. Physicians summarized the major points of their breakout sessions in approximately five minutes each, which made me even more proud.

The presentation that I will never forget came from a pathologist, who taught me a mnemonic for prerequisites for accelerated physician-hospital integration, CRITTERS:

Communication
Representation
Incentives to improve
Transparency
Trust
Engagement
Reimbursement
Speed

I know that this hospital will thrive for two reasons that I have discussed in previous posts:

1) They are becoming comfortable with paradox: they have moved beyond finger-pointing and blame-storming toward embracing a common vision that requires both-and rather than either-or approaches;

2) They have a collaborative culture: although physicians are not known for team behavior, they can accomplish great things together when they feel that they are making their time count.

What do you think?

What variations of CRITTERS have you tried where you work?
Are you reaching a balance between problem-solving and becoming more comfortable with paradoxes that you cannot solve
Are you building a culture of collaboration from the ground up?

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

Kenneth H. Cohn

Disclosure:

I received compensation for facilitating the hospital-physician-board retreat to accelerate physician-hospital integration. I have a warm, proud connection to the hospital mentioned herein.

Posted in Physician Engagement

Comments

Comment from alan
Time: August 21, 2010, 6:15 am

Love the acronym. We have lots of pieces in place at our hospital in NJ related to CRITTERS (although it is more CRITTER for us.) Being part of a Medicare Gainsharing demo project is probably the most tangible component. We also have Primary Care Counsels, very focussed Quality improvement efforts and you can never communicate enough.

Comment from Ken Cohn
Time: August 21, 2010, 8:43 am

Thanks Alan

Great to hear from you
I agree that we can never over-communicate
The S for speed is an ongoing journey
Congratulations on your work to date

Comment from Mark Metzler
Time: September 6, 2010, 3:58 pm

Here is a useful new website you might want to consider:

Biomedical Device Integration Tech Corner
http://bmdi-tech-corner.com

“An archive of technical documents, protocols, standards and procedures useful for clinical engineers and IT professionals involved in biomedical device integration and connectivity to electronic medical records (EMR)”

Comment from Laura Braeunig
Time: September 27, 2010, 9:46 am

I love the acronym too. While it doesn’t surprise me that these are listed as prerequisites for accelerated physician-hospital integration, I think it is exciting that physicians are articulating these concepts and thinking about solving problems in this way.

What’s more, the idea of becoming more comfortable with paradoxes and embracing the both/and approach to problem solving speaks to me of David Cooperrider’s Appreciative Inquiry approach to change where finger pointing and blame storming are replaced with a understanding the organization’s positive core (what we do right) and then discovering our common themes.

One more thought: When I was working on my thesis, I discovered the concept of “voice ” in organizational (procedural) justice literature. The basic premise is that in order to have procedural control (a concept born of the judicial system) , an individual must have “voice” in the process. An individual’s viewpoints need to be considered in an exchange and the listener must be able to suppress their own biases. Further, in order to stay engaged in an organization, quality of information matters. This speaks to informational justice – information given in a timely, honest, thorough, candid, and reasonable. When I look at these prerequisites, I think of concepts associated with organizational justice literature.

Comment from Ken Cohn
Time: September 27, 2010, 3:17 pm

Thanks Laura for making the time to comment

All great insights; your knowledge of organizational behavior applied to complex healthcare settings definitely adds value

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