Perhaps traveling to our nation’s capital is hazardous to one’s health.  Two weeks ago, I had the pleasure of speaking before approximately 50 physicians in an executive MBA program in Washington.  I was impressed with their energy and eagerness to learn new approaches.  They gave me hope and made me proud to be a physician.  Three days later, I awakened with a sore throat that progressed to chills, aches, and congestion.  I looked at it as Nature’s way of telling me that I had to slow down.  I canceled or postponed my non-essential activities and took decongestants for the rest.  I also redefined my expectations; it was great to take a day off from e-mail, and nobody complained that I did not reply to their messages in a timely fashion.

One day, I went through a stack of articles that I had filed under blog topics, finding a post by Tony Chen entitled,”Are Administrators from Mars, and Clinicians are from Venus?”. Tony dispelled the common stereotypes and talked about how to turn the tide:

• Empathy: spend a day or even an hour shadowing a counterpart to begin to understand what the other person faces
• Proactivity: come to know the other person behind the role, including family, hobbies, and personal interests
• Vocabulary: learn their acronyms, slang, and inside jokes to avoid misunderstanding what others are saying
• Slack: give people the benefit of the doubt; not knowing what issues they are facing should make it more difficult, rather than less difficult, to judge them
• Interdependence: realize that we need each other to provide care that is safe, effective, patient-centered, timely, efficient, and equitable

Through a process I have dubbed “co-mentoring,” I have benefited from my association with a skeptical curmudgeon, whom I have nicknamed, “Dr. Hrrmph.”  When we first met, his abrasiveness made me feel that coarse sandpaper was preferable to the tone of his voice.  I will never forget his admonition, “Don’t waste my time!”  Eventually, we learned that we attended the same medical school and that our spouses grew up in the same town and became ICU nurses.  We now enjoy our time together; I benefit from his clinical insights, and he has become an integral member of his hospital’s strategic planning efforts after 25 years of avoiding the hospital because previously he did not think that any physician could really influence a hospital’s course.

In “Turn Irritation into inspiration,” I identified six ways to put physicians’ perspectives to work:

• Engage physicians in dialogue to determine clinical priorities; this process gets physicians out of the past and into creating a sustainable future
• Implement physicians’ recommendations in a timely fashion; physicians can bring focus to decision-making with a fix-it-now mentality, just as administrators can prevent costly errors by seeking to understand contingencies before making major decisions
• End meetings with task lists, with individual accountability for outcomes rather than processes; this process is what we learned during residency with our scut lists that outlined the task, deadline, and person responsible for performing the task on every patient on whom we made rounds
• Use a timetable showcasing progress at regular intervals, not longer than monthly; chunking a long-term task into steps can bring a sense of transparency that can build trust
• Close the loop; make physicians feel that they are using their time productively and avoid death by the slow no
• Celebrate progress and successes often; celebrations bring people together and make them feel like they are an integral part of the organization

Although communication may be a problem where we work, it can also be the solution.  What do you think?

• Are physicians and administrators different people
• Even though we work in the same communities, care for the same patients, and are attracted to healthcare to make a difference in people’s lives, do we have irreconcilable differences in our backgrounds and outloook
• By following Tony Chen’s advice, coming to know others proactively, and working more interdependently, can we develop improved processes of care for our patients

As always, I welcome your thoughts.

Kenneth H. Cohn