Dr. Cohn discussing physician recruitment and retention at HCA Rural Retreat

This week was formative, as I traveled to the lovely northern foothills of San Antonio, currently the 7th largest city in the US, to speak at the HCA Rural Retreat, sponsored by Methodist Health System .  I was impressed by the sense of possibility among the participants and the way that they welcomed change as an opportunity to improve care for their communities.  At the reception preceding my talk on using physician recruitment to move from me to we, I heard about a hospital in Seguin that has used a physician advisory panel to advise on recruitment for the past decade to improve patient access. 

Dr. Cohn discussing physician recruitment and retention at HCA Rural Retreat

This data-driven process, led by physicians who have earned the respect of their colleagues, builds consensus on both the need to hire additional physicians and, once the process is underway, on whether a specific physician represents a good cultural fit for the area.  As a result, they have had 100% retention of new hires for the last five years.  

In Collaborative Culture, I described the paradox of culture.  As I mentioned in my book, Collaborate for Success! (p. xiv), culture encompasses the beliefs, habits, attitudes, and assumptions that an organization uses to cope with problems.  Executives make time to shape organizational culture because a strong culture allows leaders to delegate tasks and become more productive.

However, most physicians enjoy bottom-up processes more than 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. 

 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.   In that way, they can leave a lasting legacy at a time in their lives when the marginal value of seeing one more patient or doing one more procedure start to diminish. 

 The most fruitful ways to cultivate physician champions include:

• Engaging them in conversations likely to lead to results, for example:
  • What is going well for you?
  • What things are we doing that waste your time?
  • How can we improve care for our community
• Drawing up an action plan that shows meaningful outcomes at 2-week intervals
• Reviewing progress with physicians at least monthly
• Closing the loop
• Celebrating success at least quarterly

What do you think about using a physician panel of generalists and specialists to facilitate recruitment and retention?As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn

© 2010, all rights reserved

©2012 Healthcare Collaboration. All Rights Reserved.

Collaborative Recruitment is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Ken on Twitter, Facebook or Google+.

Community health centers provide care to approximately 20,000,000 patients, which is expected to double in the next five years because of recent healthcare reform legislation, hence the interest in physician recruiting and retention.  

Dr. Cohn presenting at NACHC on physician recruiting and retention; Dr. Yee moderator

After each of my two presentations, I fielded questions, concerns, and comments, to which I replied based on my work in 40 states during the past twelve years.  Dr. Yee provided valuable content from the perspective of a center CMO with 17 years experience, as the following examples show:  

Physicians, Administrators, and Board members attending NACHC session on physician recruiting and retention

• An administrator from Detroit asked how to recruit to areas that are traditionally hard to recruit to.  I mentioned building on strengths, such as the cost of living and affordability of housing; I also encouraged her to ask new hires to talk up their work environment with physicians from their residency programs before the residents made decisions on where they wanted to work.  Dr. Yee added that they had equally good results recruiting physicians and dentists from the other end of the career continuum who were nearing retirement and wanted to work part-time.
•  A physician asked about questions of fairness balancing the needs of new hires with those of established veterans.  I encouraged her to keep the process transparent, so that everyone knew the rules for base pay and incentives for productivity, quality, and citizenship.  Dr. Yee said that based on experience, centers needed to look at compensation benchmarks every 1-2 years and bring everyone up as benchmarks rise.
• Another administrator asked about succession for the CMO position at her center as the present CMO neared retirement, concerned that no in-house candidate had the interest or background to step up to the position.  I countered that until physicians had an opportunity to be mentored in a project that builds on their interests, it was difficult to know who might have the interest and ability to step into the role.  In addition to sending physicians to conferences that expand their administrative knowledge and asking them to summarize and apply what they learned when they returned, I suggested sponsoring a physician clinical priority setting task force, in which clinicians from a variety of backgrounds listened to presentations from all the major sections and departments on their strengths, challenges, opportunities, and threats that they face and then recommended the top 3-4 activities that would address the issues that arose.  Dr. Yee succinctly answered, “Help physicians find their niche.”

What Dr. Yee said resonated with me because helping physicians find their niche is something that has been my passion for the last twelve years.  As we age, the marginal value of doing one more procedure or seeing one more patient starts to decline.  Being involved in a project that matters to a physician can help them leave a lasting legacy that makes them proud and benefits the community.  In Collaborative Champions, I mentioned: 

• In the first chapter of my upcoming book, “Getting It Done: Lifelines from the Field,” I salute an ICU director who collaborated with middle-level laboratory, nursing, and pharmacy administrators to cut the mortality rate from sepsis in half by improving the timeliness of processes during the critical hour when a patient is suspected of having a bloodstream infection
• In Chapter 7 of Better Communication for Better Care, I discussed a cardiology catheterization lab director who used healthy competition to cut costs and improve outcomes 
• In Chapter 2 of Collaborate for Success!,  a previously skeptical nephrologist, who had avoided participation in hospital affairs for over two decades, became such a convert after serving on a medical advisory panel, that he became the first physician ever asked to serve on the hospital’s strategic planning committee; he also convinced his patients to contribute to the new hospital’s capital campaign.

Thanks to Dr. Yee and physician champions like him who work at community health centers throughout the US.  

As always, I welcome your input to improve healthcare collaboration.  Please comment on what physician champions are doing where you work to improve care for your community. 

Kenneth H. Cohn  

© 2010, all rights reserved

©2012 Healthcare Collaboration. All Rights Reserved.

Collaborative Moderation is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Ken on Twitter, Facebook or Google+.

Those of you who have been with me know that I am on a continuous healing journey from being labeled “the problem” to helping find solutions.  Please let me recount a painful lesson from my third year of residency. At 3 AM, after being up over 20 hours, I was asked to evaluate a patient with acid burns of the face, and when I said that we needed to get the patient to a shower immediately to wash off the acid, the triage nurse told me, “Our protocol does not allow an acute patient to be transported out of the ED.”

I lost it. Instead of saying, “Let’s take care of this patient’s acute needs to get the acid off his face and discuss revising the protocol in the morning,” I let her know what I thought about her protocol and took the patient to the nearest shower in the OR changing room.  When I returned with the patient, I learned that I had been reported for swearing at a nurse in front of a patient.

Caught in a “Gotcha” moment, I apologized to the nurse, her boss, the ED Director, the Chief of Surgery, and my program director, to name a few.  Through this incident, I learned that leaders need to remain calm in crises, so that team members can function at peak efficiency.  I also learned not to fight at night and told the story to all residents who would listen once I became chief resident and Assistant and Associate Professor of Surgery, hoping that they would learn from my mistake.

At the end of my residency, I presented a talk at the Society of University Surgeons, entitled “Misadventures in surgical residency: Analysis of mistakes during training” (Current Surgery 42:278-285, 1985).  It was the only talk in which I had a standing room only crowd.  As one surgeon told me, “Everyone wants to hear others admit their mistakes.” 

When asked to comment on my presentation, my program director, Dr. William McDermott, replied, “I have thought of the third year of surgical residency as the peri-menopausal year because residents are in between, no longer interns or junior residents but not yet trusted to do senior-level work.” Later, he reflected on his distinguished career in academic surgery with this wise counsel:

For all of us in healthcare, it is a privilege to be asked to serve.  It means that someone else values what we do and that we can lend a personal touch to the task which we have been assigned.  But after a while, our eagerness to please takes its toll.  We find that, like burrs, things stick to us, and we cannot get away from them without confronting people or leaving to take another job.  So, you might say that we all have the seeds of self-destruction planted within us.

Then,  he smiled at me and said:

Just because we have the seeds of self-destruction planted within us, does not mean that we need to drink Miracle-Grow.

As Thanksgiving approaches, I feel blessed to have benefited from a wonderful mentor like Dr. McDermott.  He is the principal reason that I have devoted time to teaching fellow physicians how to mentor newly hired physicians and why I was proud to write an article showing that teaching physicians to be better mentors improved physician retention significantly (The Lifelong Iterative Process of Physician Retention).

What do you think?

• Has your career benefited from others making the time to mentor you
• How have you reciprocated
• What stories can you share about the co-mentoring process, in which we learn from sharing knowledge and experiences with others

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

Kenneth H. Cohn

© 2009, all rights reserved

PS: This will be my last blog for 2009.  My son, a senior at Purdue in the Naval Reserve Officer Training Program, will begin his Naval aviator training soon.  Our focus will be on family from Thanksgiving through the end of the year.

©2012 Healthcare Collaboration. All Rights Reserved.

Collaborative Learning: Post 80 is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Ken on Twitter, Facebook or Google+.