A hospital CEO wrote me in April 2009:

Thank you for the contact; however, at this time, I do not seem to have need of your expertise.  What practices I don’t own already in the community don’t readily lend themselves to collaboration.  They are staunch, stand-alone, small, independent practices that don’t want to change anything about the way they operate.

I empathize with the way he feels.  My father was a solo-practice neurosurgeon from 1952-77.  One of our favorite stories was that while his car was in the repair shop, he stood at the bus stop and noted colleagues waving to him, but none slowed down to offer him a ride.  When he arrived at the hospital, he complained to colleagues in the physicians’ lounge who told him, “George, you need to learn to hitchhike with your thumb rather than with your middle finger.”

An article helped me think about ways to deal with physicians in small practices (Christensen CM, Marx M, Stevenson HM. 2006. The tools of cooperation and change. Harvard Business Review. 84(10):73-80).  The authors lay out a graph in which the x-axis represents the perceived way the world works (cause and effect), and the y-axis represents what people want (vision for the future).  Near the origin of the graph (where the x-axis and y-axis equal zero) lies a circle labeled “Balkanized States,” e.g. Serbia and Bosnia-Herzegovina, where the desire for autonomy outweighs the benefits of working together.

The authors state that this group responds to power tools, including:

• Command and control
• Threats
• Setting an example

It reminded me of the way that I dealt with my adolescent children, with limited success.  On my better days, I gain inspiration from ways that healthcare leaders who take my seminar have taught me to deal with physicians who do not want to be engaged.  In Collaborative Control, I saluted a CEO who when confronted by his Board Chair with, “Does it bother you to cede control to your physicians,” smiled and replied, “Heck no, I never had control in the first place.”

Here are some replies from practicing physicians to, “What can we do to engage physicians who do not want to have anything to do with us?”

That will only happen if they perceive that you have nothing to offer or they do not trust you….To me it is all about building trust and identifying areas of passion for them, and areas where you can improve their lives (processes) or their incomes (JV’s etc)….you have to come up with something of interest to them…what can you do for them, not what they can do for you

If they do not want to have anything to do with you, ask them why not!!…..that is a definable set of reasons and (mis) perceptions you might have to dig out of them, realizing that you might not like and may not want to hear what they say, but once understood gives you something to work with

We all have crosses that we need to bear. Asking me for my input in helping you solve problems, sharing data with me that will improve care for my patients, or best yet, helping me make my time count are ways to get my attention.

An additional strategy involves getting to know the physician’s assistant, nurse, and/ or practice manager and ask their input on engaging that physician.  As I pointed out in Collaborative Etiquette, active listening requires:

• Concentrating on the speaker, maintaining comfortable eye contact
• Listening with one’s eyes as well as ears to be mindful of body language
• Opening one’s stance to convey receptivity
• Suspending judgment to maintain objectivity
• Empathizing, trying to put oneself in the speaker’s frame of reference, using summary questions, such as, “Do I understand you to say….,”

We all have our own data points, but Brian Wong’s survey of over 1500 practicing physicians (A Prescription for Physician Reengagement. Futurescan 2009:23-26) revealed that the majority of physicians seek:

• Meaningful work that makes a difference in patients’ lives
• A sense of community
• Regular, reliable, positive feedback that affirms their value

I wrote in The Tectonic Plates Are Shifting: Cultural Change vs. Mural Dyslexia that:

• both hospitals and physicians are facing rising expenses, burdensome regulations, heightened consumer pressures, and stagnant or declining reimbursement
• the response to global economic pressures and the need to improve clinical and financial outcomes can bring hospitals and physicians together

Miller wrote, “God grant me the serenity to accept the people I cannot change, the courage to change the one I can, and the wisdom to know… it’s me!” (QBQ: The question behind the question. Putnam, NYC, 2004).

What do you think?

• Do you agree with Tom Atchison that much of physician-hospital relations involves executing basic blocking and tackling
• Do these troubled financial times offer us the opportunity to work together more collaboratively
• Do you have any collaborative examples that you are willing to share in the blog comments section

As always, I welcome your input to improve healthcare collaboration.  Happy Father’s Day.

Kenneth H. Cohn

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