Tom has an innate ability to simplify complex processes.  He sums up hospital-physician relations as “blocking and tackling,” meaning that paying attention to fundamentals matters.  In his ACHE Congress seminar on Hospital-Physician Relations: Dos and Taboos, he said, “Engagement is the process.  Commitment (Pride, Loyalty, and Ownership) is the outcome.

In a slide on respect, he mentioned that giving must precede receiving and that respect increases with meaningful rewards and recognition.  Active listening builds trust and failing to deliver on promises decreases it.

In The Answer is Meaning, he wrote:

Common questions that healthcare leaders are asking these days are: How can I get more productivity? How do we get more innovation from our employees? Can we do something to increase accountability in our staff? What can be done to get more commitment to change management?

Meaning is the answer to each of these questions, and any other question about why people behave the way they do.  Organizational performance today is typically expressed in financial terms—for example, “We had a good year, we made 3.2% on operations.” To a very large degree, finance is the dominant dynamic in healthcare. This has resulted in an unintended consequence of money trumping meaning in work.

We humans seek, in fact need, meaning in our lives. Individuals who gravitate to healthcare as a career have a very high need for opportunities to help others.

In  Leading Healthcare Cultures, (Atchison TA, Carlson G. 2009. Leading Healthcare Cultures: How Human Capital Drives Financial Performance. Chicago. Health Administration Press), the authors  defined human capital as the collection of contributions that add value to a workplace.  They encouraged 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 felt 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

As always, I welcome your input to improve healthcare collaboration where you work. Please send me your comments and suggestions for improvement.

Kenneth H. Cohn

© 2013, all rights reserved

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

© Healthcare Collaboration. All rights reserved. A Tribute to My Mentor, Tom Atchison is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Dr. Cohn on Twitter, Facebook or Google+.

Dr. Cohn presenting at ALFA on the Playbook for Partnering with Hospitals

I felt honored to give three presentations at the annual meeting of the Assisted Living Federation of America (ALFA) last week.  My titles included The Playbook for Partnering with Hospitals in an Era of Outcomes-Based Payment Reform, Past, Present, and Future Challenges of Healthcare Reform, and 21st Century Healthcare Economics.   I entitled this post Collaborative Playbook because ALFA members asked for a 10-step guide for partnering with hospitals in this era of outcomes-based payment reform.

In times of heightened focus on coordination, hospitals seek the following characteristics from long-term care providers, which leads to opportunities at multiple levels:

• Aligned mission, vision, and values: (the opportunity) to learn more about potential partners through their websites, annual reports, and comments from patients and families about unmet needs
• Commitment to quality and patient safety: (the opportunity) to collect and share data relevant to re-admissions and other key quality and safety indicators
• Customized, patient-focused experiences: (the opportunity) to deliver on promises of timely, seamless transitions
• Risk-sharing that improves patient care: (the opportunity) to find a common platform that moves beyond risk-shifting to partnerships that improve care for community residents

The first steps in this journey involve ways to build credibility and trust, such as:

• Reaching out to one (or two) hospital(s) where people have a relationship(s)
• Connecting at multiple levels, such as the case manager and/or discharge planner, utilization review, hospitalist, nurse manager, C-suite level, and Board
• Partnering on pilot projects that produce wins for the hospital, assisted living community, and residents (e.g. web-based discharge planning and reducing re-admissions within the first week after transfer)
• Making it easy for  strategic partners to know the assisted living community with capabilities, such as a:
  • Hotline or designated connection number
  • Informative, interactive website with headings such as about us, history, awards & recognition, comments from residents and family members on video
  • Thought leadership, such as blog posts, monthly newsletters, and “water-cooler” links to current events that showcase differentiated value, repurposing content on social media, especially LinkedIn

I felt pleasantly surprised that over half of the participants asked me at the end of my talk for a pdf of my slides.  As I wrote in Collaborative Gnosticism, we need to move away from tired arguments about needing more resources to deploying our resources more wisely.  My mentor, Lee Kaiser maintains that there is no economic, social, or political solution to our current healthcare crisis.  Spirituality, based on abundance, collaboration, and sharing provides the only solution because it makes problems disappear.

As always, I welcome your input to improve healthcare collaboration where you work. Please send me your comments and suggestions for improvement.

Kenneth H. Cohn

© 2013, all rights reserved

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

© Healthcare Collaboration. All rights reserved. Collaborative Playbook is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Dr. Cohn on Twitter, Facebook or Google+.

As described in Part I, the theme of the 2013 ACHE Congress was “Changing Healthcare Design.”  My reason for writing What I Learned from ACHE Congress, Part II is to share insights with those who did not attend this year’s session.

I. Innovation: Hot Topic Session with Dr. Molly J. Coye,

Chief Innovation Officer, UCLA Health System

Using a 7-step framework, Dr. Coye pointed out the importance of tying innovation to strategy:

• Define the opportunity to accelerate what strategy?
• Design the innovation to answer how would it function?
• Charter the innovation to obtain commitment from the executive ranks
• Pilot the innovation and build a prototype
• Deploy the innovation
• Evaluate the innovation and test its impact
• Disseminate the innovation and exchange learning

III. Physician Employment and Compensation Models:
Mickey Bilbrey, James Daniel

The authors described the guiding principles based on realistic, business conditions, including:

• clear definition of requirements and expectations
• terms, calculations, and methodologies that are transparent and understandable to physicians
• financial sustainability
• favorable recruitment and retention

An ideal compensation model, aligns strategic incentives for providers to care for patients in a way that optimizes quality, improves patient and provider satisfaction, and rewards mission-based activities, such as teaching, research, outreach, and citizenship (defined as timely medical record completion, coding accuracy, committee participation, electronic medical record usage, continuing education, and compliance with the code of conduct).
They feel that pay for performance will undergo three iterations:

• Pay for reporting
• Pay for improved performance, as defined above
• Pay for delivering value that reduces errors, costs less, and coordinates care, which CMS will require by 2017

This intriguing presentation described the journey of a midwest faith-based hospital to break out of the confining silos of the past. Using the model of a life raft and the Fleetwood Mac song, “Don’t Stop Thinking about Tomorrow,”  they made a series of  hospital videos (the nuns did a great job) that took people from a risk-averse culture to one that was more humanistic, supportive, participative, self-actualizing, and joyful.
They enlisted physician champions like Dr. Stockhausen and created physician-administrator dyads to redesign care and provide exceptional experiences.  They started with Why: “HFM was founded in 1899 by the Franciscan Sisters of Christian Charity to create a human ministry to help our community lead healthier lives.”  They developed a compass to hardwire improvement and innovation into the HFM culture, sharpen leadership focus, raise the bar for success (“We are what we tolerate… we become what we reward”), and accelerate transformation through multidisciplinary teams.
Since 2008, employee pride has risen from 71% to 87% and the number of people who recommend HFM’s care to friends and family increased from 58% to 82%.  Accountants have tracked the savings resulting from improvement at over $10,000,000 since 2009.  They are a Solucient 100 Top Performance Improvement Leader and in the Top 25 Most Wired Small and Rural Hospitals, at HIMSS Stage 6, which involves physicians using structured templates and electronic tracking of clinical variation.  They feel that their success resulted from:

• Asking the question regarding the impact of culture on strategy and clinical outcomes
• Engaging employees and providers in their strategic plan
• Explaining the rationale for what they do during the process of shaping the culture

© Healthcare Collaboration. All rights reserved. What I Learned from ACHE Congress – Part II is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Dr. Cohn on Twitter, Facebook or Google+.

The reason for writing “What I Learned at ACHE Congress,” is to share insights with those who did not attend this year’s session.  I feel especially for the healthcare executives in the military and VA medical centers, for whom the sequester made it impossible to obtain funding for travel and registration.

The theme of the 2013 ACHE Congress was “Changing Healthcare Design.”  Retiring President Dr. Thomas Dolan began the session by discussing four challenges executives face:

• Overconfidence, which he fights by active listening, teasing out the truth, and apologizing when he makes a mistake
• Vulnerability, which he deals with by trying to like the people he serves and be liked in return and by applying the platinum rule: do unto others what they want for themselves
• Honesty, which he operationalizes by telling the truth as he sees it and acting on his insights
• Diversity, which he promotes by going outside his comfort zone to hire people who are different from himself: a multicultural society requires multicultural leaders

I. Five Strategies to Reduce Operating Costs: 2AB by Jon Burroughs and Steven Berger

By 2018, Centers for Medicare and Medicaid Services (CMS) quality payment initiatives will put approximately 12% of payment at risk.  Rather than relying exclusively on traditional approaches, such as downsizing staff and services, consolidating vendors, squeezing third-party payers, improving collections, and postponing capital investments, the authors suggest:

• Optimizing labor management, striving for a labor ratio (labor costs/ net revenue) averaging 51% (best practice 40%), decreasing shift work in favor of productivity demand, and decreasing time spent doing administrative tasks that decrease productivity, such as data entry and stocking
• Aligning strategic and organizational incentives, so that doctors and nurses have at least 20% of pay in incentives that reflect key organizational goals, including quality, citizenship, and patient satisfaction
• Simplifying and optimizing operations to decrease wasted supplies, unnecessary laboratory testing, unproductive staff time, and transport time, for example
• Optimizing supply-chain management, striving for a supply chain ratio (total supply costs/ net revenue) averaging 18%  (best practice 12%), working with distributors to decrease inventory with just-in-time management and engaging cardiologists and orthopedists to decrease the costs of implants, for example
• Creating a culture of customer service with leader-staff rounding, pre- and post-visit calls to patients, and patient navigators, for example

II. Accelerating Change in a Large Integrated Delivery System: 32AB by Chris Van Gorder, Barbara Price, and Jim LaBelle

The authors discussed Scripps’ turn around from a $15 million average loss per year in the 1990′s to a thriving $2.6 billion integrated health system.  They described the Physician Leadership Cabinet (PLC) as the secret sauce because it empowered physicians to provide input in making difficult decisions.

“We have accepted 100% of their recommendations. It is the most powerful and informal entity in our organization,” Mr.Van Gorder said, because it is not listed in the hospital bylaws.  Engaging physicians in dialogue about waste has allowed Scripps to cut out $77 million in non-value added variation in 2011 and another $66 million in 2012, which it expects to match in 2013.  For more information on how to put together a physicians’ advisory group where you work, please click here to download an article about the structured dialogue process.

III. Virtuous Healthcare Organizations: Breaking Away from Blamestorming, Session 37 by Len Friedman and Ken Cohn

When Prof. Friedman asked the approximately 80 people in the audience, “How many of you feel that you work in an emotionally healthy, supportive healthcare organization, only two people raised their hands.  He described their workplaces not only as generators of jobs, reservoirs of revenue, temples of technology, and havens of healing but also as sources of stress.  As summarized in Collaborative Courage, workforce shortages, egos, time demands, and consumer pressures contribute to the stress. The attributes of virtuous organizations include:

• Humanity
• Dignity
• Clearly articulated (and lived) values and goals
• Explicit, equitable reward structures
• Staff autonomy for innovation and service recovery
• Conversations that focus equally on listening as well as talking

IV. Medicare Acute Care Episode Demonstration: Lessons Learned from a Bundled Payment Pilot, 80X by Stephen Forney

Mr. Forney is CFO at Lovelace Health System, Albuquerque, NM.  He described this three-year Medicare Parts A & B bundled payment project for 28 cardiovascular and 9 orthopedic procedures as a work in progress. The providers needed to achieve quality and savings targets to receive payment.  They decided to participate to enhance care coordination, improve quality, heighten collaboration, lower costs, and increase market share.

He reported that quality measures remained strong and that surgical volumes increased 25-40%, yielding a contribution margin of approximately $35 million.  He cited the following lessons learned:

• A case manager is essential to manage length of stay with the clinical team
• A program liaison is also important to interface with CMS and set up systems that work
• Having a cost accounting program that allows for individual patient tracking is critical for managing the process
• Engaged physicians benefit from transparency, so that there are no surprises
• Multi-divisional agreements need to move from dividing the pie to transforming the patient care experience collectively
• The hospital needs to be able to scale up rapidly as market share increases

Conclusion

I hope that this post helps you become more comfortable with leading into ambiguity and improving care for your community in the face of uncertainty.  In part II, I will cover topics relating to innovation, women’s leadership, compensation, culture, and patient safety.

© Healthcare Collaboration. All rights reserved. What I Learned at ACHE Congress March, 2013 is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Dr. Cohn on Twitter, Facebook or Google+.

Dr. Cohn and Prof. Friedman teaching re: Virtuous Organizations

Last week, I had the pleasure of co-presenting with Prof. Len Friedman at the Congress of the American College of Healthcare Executives.  Virtuous Healthcare Organizations: Breaking Away from Blamestorming summarized a case of a CEO who lost the support of his medical staff and Board after a series of actions that led to a suit after he replaced the head of Radiology, refused to seat the elected President of the Medical Staff, and confiscated the Medical Staff dues fund.  He responded, “This is about avaricious, dissident physicians trying to destroy my hospital.”

We had a stimulating discussion with participants about their perception of the causes and what action they would take to deal with the crisis.  In an act of collaborative courage, a CEO in the audience said, “Some times, you need to take action that can lead you to lose your job for the benefit of your community.”

We also celebrated the collaborative courage of the new CEO who turned around the healthcare system.  The first thing that he did was come to agreement with the President of the Medical Staff to work out their issues without their lawyers present.  His Board Chair (an attorney) said, “I think that the medical staff hoodwinked you, but if you believe that this is the right thing to do, I’ll back you.”

The new CEO rebuilt the culture from a top-down-secret decision-making style based on fear and intimidation to one based on accountability, teamwork, and new values:

• Respect
• Integrity
• Service
• Caring
• Excellence
• Transparency

The new CEO was proud of his organization’s capacity for healing: the physicians and employees aligned with both sides have pulled together and come back more connected to their mission to serve their community. The lessons he learned include:

• An organization can heal from a terrible nightmare and thrive
• It takes a long time to heal
• Not everyone can make the cultural transformation

Virtuous organizations demonstrate in their daily actions the values of purpose, safety, fairness, humanity, and dignity.  As such, they represent an alternative to blamestorming, or finger-pointing based on analysis of perceived individual failings rather than on systems that do not measure up to their stated goals.

As always, I welcome your input to improve healthcare collaboration where you work. Please send me your comments and suggestions for improvement.

Kenneth H. Cohn

© 2013, all rights reserved

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

© Healthcare Collaboration. All rights reserved. Collaborative Courage is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Dr. Cohn on Twitter, Facebook or Google+.

 The pope’s job is vastly different than the ones done by cardinals, just as the CEO role is nothing like those of C-Level executives…. He has to decide on all sorts of complex issues, in a volatile global environment, facing enormous pressure.

It sounded a lot like the issues facing healthcare leaders in the 42 states where I have had the privilege to work in this decade of transformation.

As an executive search consultant with three decades’ experience in leader selection and development, Mr. Fernández-Aráoz feels that the principal criterion for success in CEO roles is the person’s potential to perform well in larger, more complex roles, of which there are three central indicators:

• The right motive: Does the candidate display the paradoxical blend of fierce commitment and deep personal humility? Is s/he really committed to building lasting greatness and to make our world a better place, for truly selfless reasons? While many collaborative cardinals and CEO candidates may satisfy this criterion,  some do it better than others.
• Four key leadership assets- curiosity, insight, engagement, and determination: Does the candidate proactively seek new experiences, ideas and knowledge, soliciting feedback and staying open to learning and change? Can s/he gather and make sense of a vast range of information and discover new insights that, when applied, transform past views or set new directions? Is s/he good at connecting on an emotional level with others, communicating a persuasive vision and helping others stay connected with the broader organization? Does s/he seek self-awareness, demonstrate empathy, and inspire commitment? Finally, will s/he have the strength to persist in the face of difficulties and the ability to bounce back from major setbacks or adversity?
• The ability to make great appointments: Electors must carefully analyze candidates’ track record on hiring, promotion and developing people. Have they made good appointments and worked to move or improve underperformers? Have they championed diversity and inclusion? Have they mentored great successors throughout their career?

Mr. Fernández-Aráoz concludes his post with the following aspiration:

When the 118 eligible cardinals cast their votes in March, I sincerely hope they leave aside any personal interests and, following Saint Benedict’s rule of “ora et labora” (pray and work), make sure to diligently evaluate the best contenders for the papacy. While they do the hard work of assessing, I’ll do the praying.

As I mentioned in a Collaborative CEOs, the damage wrought by executives who are not collaborative CEOs is not irreversible.  I have interviewed the CEO who took over from the unsuccessful CEO and turned around that hospital.  Professor Leonard Friedman and I will be presenting those data at the annual Congress of the American College of Healthcare Executives, Tuesday March 12, 2013 at 8:45 am (Seminar 37: Virtuous Healthcare Organizations: Breaking Away from Blamestorming).  I hope to see you there and at my Witt-Kieffer seminar the same day at 4:30 pm, at the Blackstone Hotel (The Zen of Clinical Integration: A Practicing Surgeon’s Perspective).

As always, I welcome your input to improve healthcare collaboration where you work. Please send me your comments and suggestions for improvement.

Kenneth H. Cohn

© 2013, all rights reserved

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

© Healthcare Collaboration. All rights reserved. Collaborative Cardinals is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Dr. Cohn on Twitter, Facebook or Google+.

• Diagnose their organization’s ailments objectively: they constantly push employees to improve or maintain top performance
• Drive variability out of leadership: using the example of the way that meetings run, he mentioned that variation by a single executive can hold back the entire organization
• Align their outlook with their organization’s outlook: according to Mr. Studer, CEOs must communicate the healthcare environment to all stakeholders, so that they can align their sense of urgency
• Understand how the change process affects employees: “We micromanage construction projects but we don’t micromanage human processes,” says Mr. Studer. “That’s a mistake, because human change is the key to everything.”
• Consistently manage employee performance: by communicating and upholding clear expectations for direct reports, CEOs drive a culture of accountability that permeates the entire organization

In “Seven Unhealthy Habits of Hospital Executives,” Tuck Business School Professor Sydney Finkelstein and I dissected a case presentation of a community hospital CEO who was fired because he did the opposite of what Mr. Studer recommended (Better Communication for Better Care, Health Administration Press, 2005, 39-45). People who are not collaborative CEOs:

• See themselves and their companies as dominating their environments: they suffer from the illusion of personal preeminence, believe that that they can create the conditions under which they will operate, and achieve their vision by imposing their will on employees (and physicians whom they do not employ), using intimidation
• Identify so completely with their organizations that they lose sight of the boundary between personal and corporate interests: they develop a private-empire mentality, behave as though they own their institutions, and act as though they have the right to do anything that they want
• Think that they have all the answers: such intransigence drives opposing perspectives underground and dampens creativity and innovation
• Ruthlessly eliminate anyone who is not 100% behind them: by defining reformers as negative influences, they eliminate dissenting viewpoints and cut themselves off from their best chance of correcting problems as they arise
• Are consummate company spokesmen, obsessed with company image: they allow media accolades to cloud their judgment and settle for the appearance of accomplishment rather than substantive change
• Underestimate major obstacles, especially if the organization has enjoyed previous successes: when they find that obstacles are more formidable than expected, they tend to escalate their commitment rather than rethink their strategy
• Stubbornly rely on what worked for them in the past: they fail not because they failed to learn, but because they learned one lesson all too well

Fortunately, the damage wrought by executives who are not collaborative CEOs is not irreversible.  I have interviewed the CEO who took over from the unsuccessful CEO and turned around that hospital.  Professor Leonard Friedman and I will be presenting those data at the annual Congress of the American College of Healthcare Executives, Tuesday March 12, 2013 at 8:45 am (Seminar 37: Virtuous Healthcare Organizations: Breaking Away from Blamestorming).  I hope to see you there and at my Witt-Kieffer seminar the same day at 4:30 pm, at the Blackstone Hotel (The Zen of Clinical Integration: A Practicing Surgeon’s Perspective).

As always, I welcome your input to improve healthcare collaboration where you work. Please send me your comments and suggestions for improvement.

Kenneth H. Cohn

© 2013, all rights reserved

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

© Healthcare Collaboration. All rights reserved. Collaborative CEOs is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Dr. Cohn on Twitter, Facebook or Google+.

Above all else, do no harm

In Collaborative Co-Mentoring, a general surgeon who was promoted to section chief, noted the importance of collaborative coaching:

We’re not stupid- we just need to be trained

The practice of medicine, as my yoga teacher reminds me, is like the practice of yoga, in that mastery occurs over time, not the first time we see a pose.  Yet, new ways of accelerating learning give me hope.

In 5 Ways Technology Is Transforming Health Care, the author mentions Doximity, whose purpose is to help doctors stay in touch and use social networking to improve patient care.

In 4 fixes that will boost your bottom line, I wrote that the fuss in Washington causes temporary amnesia that healthcare, like politics, has a local focus.  Physician champions networked together, providing formal and informal collaborative coaching, can be a lasting force for embracing and promoting sustainable change:

• A CEO at a Rocky Mountain tertiary care facility asked the Medical Advisory Panel at his hospital for advice on how to cut supply costs. The panel worked together and with an interdisciplinary supply cost reduction group to achieve more than $500,000 in ongoing supply cost savings in the purchase and utilization of orthopedic implants, heart valves, radioisotopes, and anesthetic and cardiovascular medications.  While this task force may not seem novel, it represented the first time that physicians and administrators at this hospital had worked together to improve clinical and financial performance and represented a cultural change. (“Making hospital-physician collaboration work.” Healthcare Financial Management. 2005. 59(10):102-108)
• As I described in Collaborative Compact, a compact is a social contract that clarifies mutual expectations and helps both groups come to a shared vision that will improve care for their community. The compact for Wisconsin’s Wheaton Franciscan Medical Group provides an operational definition of expectations regarding mutual respect, integrity, development, excellence and stewardship. Within two years of adopting the compact, they became a Thomson Reuters Top 100 Hospital System.

Collaborative coaching is an integral part of surgical training.  We all remember trusted mentors who guided us through our first procedures and taught us how to care for patients.  In 21st Century Healthcare Economics: How Will My Practice Change?, I wrote that the collaborative coaching required to get our economic house in order will become an integral part of our lifelong learning process.

As always, I welcome your input to improve healthcare collaboration where you work. Please send me your comments and suggestions for improvement.

Kenneth H. Cohn
© 2013, all rights reserved

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

© Healthcare Collaboration. All rights reserved. Collaborative Coaching is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Dr. Cohn on Twitter, Facebook or Google+.

I don’t understand citizenship.  After all, why should we pay our docs to act like adults?

I empathized with the concern, which I have heard in many of the 42 states in which I have worked.  At the same time, I pointed out:

For the most part, doctors have done everything asked of them.  We studied hard in college to obtain admission to medical school, where we memorized and regurgitated facts on demand to become competititive for residency and then worked 100-hour weeks and did research on the side to be competitive for fellowship.  Those of us who trained in a previous century had no courses in communication, teamwork, win-win negotiation, or conflict management.  We learned informally from clinical role models, who also lacked formal training in these areas.  Hence the sins of one generation are visited upon the next.

As the authors of Crucial Confrontations wrote, the fundamental attribution error is to assume that people’s behavior stems from evil motives. Other variables involving ability and training, perceived differences in social status, and structural incentives or impediments also merit consideration.  When I worked at Dartmouth, I coauthored a study of residency education as a system that can be studied and improved (The odyssey of residency education in surgery: Experience with a total quality management approach. Current Surgery, 1997; 54:218-224) with Dr. Paul Batalden, who taught me:

Every system is perfectly designed to get the results it gets.

Incentives do matter, as my co-editor, Doug Hough pointed out in his review of pay-for-performance contracts in the US and the United Kingdom (Can Pay for Performance Really Pay for Performance? The Business of Healthcare. Westport. Praeger. 2008, 194).  Successful pay-for-performance programs have four characteristics:

• A significant potential impact on provider revenue to make behavioral change worth the effort
• A small number of metrics to make a clear connection between behavior and reward
• Predictable payouts to reinforce the desired behavior
• Sustainable improvement in clinical outcomes

As attention focuses on federal , state, and local deficits, medical unsustainability at the local level will become the subject of increasingly bitter conversations until we change our frame of reference from finger-pointing and blamestorming to empowering and rewarding dedicated front-line healthcare professionals who help us improve processes and reduce waste of time, materials, money (and lives).

In Charting the Course, which I reviewed last October, CEO Will Jenkins told his CFO:

… the front lines can find the 50% waste in our hospital better than you ever could…. we have to stop departmentalizing the budget because each department then seeks to maximize the performance of its own silo, thus submaximizing the whole (p.189-190).

This whole debate is about one thing and one thing only. Control.  And why shouldn’t it be? We’re the chiefs, and we’re all about standing on the bridge and commanding the ship… but if the crew can’t or won’t tell us that we’re hard aground on a sandbar, we’re wasting time and … looking silly (p.187).

As I wrote in The tectonic plates are shifting: cultural change versus mural dyslexia, (Frontiers of Health Service Management. 2007; 24(1): 11-26, 41-43), transformational change is simultaneously exciting and terrifying.  It requires a culture in which people feel safe speaking out on ways to improve care for our communities and a commitment to active listening.

For those who see my comments as young and naive, I reply, “Guilty, as charged, your honor.”  As I wrote in What Physicians and Administrators Can Learn from Nurses (Better Communication for Better Care: Mastering Physician-Administrator Collaboration, Chicago: Health Administration Press, 2005, 63), I take my inspiration from  my late father, a neurosurgeon.  When I asked him from whom his residents learn, he said:

Mainly from me. Only those who are smart enough learn from nurses.

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

Kenneth H. Cohn

© 2013, all rights reserved

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

© Healthcare Collaboration. All rights reserved. Medical Unsustainability is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Dr. Cohn on Twitter, Facebook or Google+.

I enjoyed reading William Jessee’s post, 5 Components for a Culture that Promotes Physician and Employee Engagement, especially the first two:

• Passionate, dedicated leaders
• Incredible persistence
• Communication
• Mutual trust
• Recognition and reward

As I mentioned in a post that I wrote on physician engagement:

• Conflicting opinions in times of rapid change are inevitable.  When properly managed through transparency, predictability, and mutual respect, conflict can build trust.
• A social compact that invites physicians to communicate and buy-in can avoid surprises, set ground rules, and guide daily behavior
• Chunking long-term tasks into 2-3 week outcome-related milestones, quick fixes that are fixed correctly to the mutual satsfaction of both parties, and celebrating success are ways that we can start now to improve physician engagement.

I feel passionately about physician engagement because it can boost revenues, cut expenses, and most importantly, improve clinical outcomes.  In Medical Staff Relations: A Practicing Physician’s Perspective, physician champions discussed orthopedic implants, consolidated vendors, decreased clinical variation, and saved their hospital millions of dollars.

In this decade of healthcare transformation, in which progress is neither linear nor predictable, we need news that gives us hope.

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

Kenneth H. Cohn

© 2012, all rights reserved

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

© Healthcare Collaboration. All rights reserved. 21st Century Musings on Physician Engagement is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Dr. Cohn on Twitter, Facebook or Google+.