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

© 2009, all rights reserved

©2012 Healthcare Collaboration. All Rights Reserved.

Collaborative Listening: Post 70 is an original post from Kenneth Cohn on Healthcare Collaboration - Improving Physician-Hospital Relations

 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

©2012 Healthcare Collaboration. All Rights Reserved.

Collaborative Leadership is an original post from Kenneth Cohn on Healthcare Collaboration - Improving Physician-Hospital Relations