I opened the cover of Tom Atchison’s and Greg Carlson’s new book, Leading Healthcare Cultures, with the excitement of a 6 year-old child unwrapping holiday presents (Atchison TA, Carlson G. 2009. Leading Healthcare Cultures: How Human Capital Drives Financial Performance. Chicago. Health Administration Press).  Objectivity aside, Tom is a cherished mentor, with over 30 years of experience in physician-hospital relations, who is a master in helping people focus on important fundamentals, which he calls “blocking and tackling .”

 In this 49-page book, loaded with practical insights, the authors show how to develop cultures that value human capital in the same way that they value financial capital, because both are  critical to long-term success. 

According to the authors, trust is the glue that holds a culture together and reduces friction during stressful times.  Meaningful interactions, characterized by active listening, are the basis of trust.  In “Mending the Gap Between Physicians and Hospital Executives,” Deane Waldman and I wrote that active listening is important because it makes people feel that their concerns matter. A mnemonic for improving listening skills is CLOSE:

• Concentrate on the speaker,  giving the person the feeling that nothing else matters but what the speaker is saying.
• Listen with multiple senses, paying attention to the speaker’s body language, facial expression, and tone of voice, in addition to the content of the message.
• Open one’s stance to convey receptivity to the speaker’s message; avoid crossing one’s arms over one’s chest, which imposes a barrier between the speaker and listener.
• Suspend judgment, to maintain objectivity.
• Empathize, trying to put oneself in the speaker’s frame of reference, with summary comments, such as, “Do I understand you to say…,” to build trust and credibility.

(Cohn KH, Hough D, eds. The Business of Healthcare. Westport. Praeger. 2007, v.2:46)

A strategy that the authors recommend to improve physician-hospital relations is to tear down silos between a hospital and its medical staff by seeking participation and input from a wider group of healthcare professionals than just the medical executive committee.  The practice of inclusion creates a culture of teamwork, participation, and involvement, where physicians develop a sense of ownership and belonging.

In Collaborative Champions, I wrote that physicians can become hospital advocates if they feel that, as physicians, people are listening to them and that they are making their time count.  An abrasive physician from California who had been part of a medical advisory panel (MAP), that helped set clinical priorities for the next three years, wrote:

I enjoyed the data-driven presentations, in which physicians from all major clinical areas discussed strengths, weaknesses, opportunities, and threats that they faced and proposed recommendations to improve care and to enhance physician-physician and physician-hospital communication. In addition, the MAP heard from the hospital CEO, Directors of Nursing and Finance, and the Chief Information Officer and obtained a perspective of the hospital and the complexity of its operations that we never had before.

Our report, presented to the Hospital Board of Directors, represented the first time that the hospital received a consensus report from practicing physicians. Before, the process involved squeaky wheels pursuing individual agendas.

We evolved from a self-interested view of what the hospital should do for us as physicians to a more empowered view of how the hospital could employ limited resources to improve care for our community. Through the process of discovery, we began to think and act more as long-term partners and co-owners than short-term customers and renters.

 The authors define human capital as the collection of contributions that add value to a workplace.  They encourage organizations to track:

• the percentage of payroll invested in lifelong learning
• turnover rate segmented by age, discipline, and work unit
• internal employee transfers, facilitated by referrals by existing employees
• external hires, facilitated by referrals by existing employees
• quality indicators, such as compliance with core measures
• attendance and absenteeism

The authors feel that pride is a more important measure than satisfaction because pride is based on accomplishment in the face of challenge, unlike satisfaction, which is a short-term emotion based on pleasant events.  Their suggestions for building commitment include:

• Develop an inspiring shared vision
• Create a listening environment
• Recognize and reward teamwork
• Promote and encourage change, innovation, and risk-taking
• Celebrate all successes

What do you think?

• Does your organization value human and financial capital equally
• What metrics do you use to track human capital
• How do you demonstrate active listening

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

Kenneth H. Cohn
© 2008, all rights reserved