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Collaborative Mentality

I heartily recommend that you read Inside the Physician Mind: Finding Common Ground with Doctors by Dr. Joseph Bujak, a physician executive and ACHE faculty member from Idaho.  In his new book, Dr. Bujak distills a lifetime of experience into 127 pages of practical insight.

The central point he makes is that the longstanding distrust between physicians and hospital administrators stems from interpreting events through different frames of reference.  When speaking, physicians use words like “I” or “me,” but rarely “we” or “us.” Physicians tend to see themselves as members of a competitive, individually focused, outcome-driven expert culture, where the word “team” conveys an image of a golf team.  Winning a match accrues points for the team, and at the end of the day, the team with the most points wins the competition.

On the other hand, hospital administrators tend to see themselves as members of an affiliate culture that is mission-driven and pays careful attention to process issues to establish and maintain consensus.  Teamwork within a healthcare organization is like volleyball (dig, set, spike), where team members function more interdependently than a golf team.

The process of obtaining organizational consensus can be frustrating to physicians who interpret the word “now” to mean immediately, in contrast to hospital administrators for whom the meaning is more contextual.  For example, in the context of capital budgeting, now might mean the next budget cycle.  That difference in meaning can give rise to physicians’ feelings that administrators are not acting in good faith.

For physicians trained in the scientific method, problem solving is deductive and linear, leading to one best diagnosis and treatment.  In general, physicians lose patience with an administrative approach that seeks multiple correct answers (options).  Dr. Bujak quotes David Eddy that this distinction can be viewed as “the problem of the apostrophe.”  Physicians learn that they have an ethical obligation to serve as the patient’s advocate.  However, hospital administrators expect to serve as the patients’ advocate, i.e., the community.  Each of these perspectives reflects a valid but distinct set of ethics, background, and training.

What do you think?

• Do you experience fundamental differences between physicians and hospital administrators where you work
• Do the different groups view change differently
• What has succeeded where you work in helping both groups move from “us vs. them” to “we”

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

Kenneth H. Cohn

Posted in Physician Engagement

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