I don’t see why we should need to resort to degrading, immature tactics to get doctors to do what everyone knows they should do in the first place.

This comment, from a VP at a midwestern hospital during a discussion of healthy competition at a recent ACHE seminar that I taught, surprised me.  He was the first to protest the strategy of using competition whenever people felt frustrated by the difficulty of herding cats, in reference to physicians’ different concept of teams compared to administrators.

He was a veteran of the corporate healthcare industry at General Electric, where people performed according to expectations or disappeared.  The concept that administrators had influence but lacked control over physician behavior was foreign and still unsettling to him.

I explained that physicians are not alone in their feline DNA.  University professors also tend to display greater interest in and loyalty to their subject matter and colleagues than to the setting in which they teach.  So do most members of professional guilds, who derive prestige, income, and autonomy from mastering their craft.

We ended the discussion by agreeing that in environments in which he had worked previously, CEOs shaped the culture more by a top-down approach than by bottom-up strategies like healthy competition.  In Collaborative Culture, I wrote that most physicians prefer bottom-up processes to top-down edicts. They have told me that they much prefer being inspired to being supervised.

The only way that I know to develop a common culture is to allow physicians to play a role in shaping it.  One of the barriers to improved physician-hospital collaboration lies in overcoming physicians’ skepticism that they are invited to meetings to bless decisions rather than to provide input into making decisions. 

As I mentioned during my ACHE seminar, we can:

• Build on areas of agreement rather than argue about what we feel is right
• Focus on how we can make better use of scarce resources like physicians’ time
• Celebrate all wins to build lasting partnerships that improve patient care 

Perhaps the recent unanimous recommendation of a Massachusetts state panel to switch from fee-for-service to global payment will spur improved physician-hospital communication.

 What do you think?

• Do contentious issues like billing offer the potential to bring physicians and hospital leaders closer together
• Is some provider autonomy necessary to provide individualized patient care, mindful of the risks of heightened variability
• Do you know of any techniques more effective than face-face conversation in rectifying our differences and improving patient care

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

Kenneth H. Cohn

© 2009, all rights reserved