Now is the Time To Develop Physician’s Leadership Skills

Leadership and Management are two separate capabilities and you need to have a balance of both resident within your organization. Numerous writers have drawn distinctions between leaders and managers for many years. A summary of the attributes sited is listed below.

Leaders:

· Take a longer term view and know how to have others “want” to do what they know needs to be done

· Enable people

· Have followers and operate through influencing others

· Focus on “how” work gets done

Managers:

· Take a shorter term view

· Build predictability and consistency in processes

· May utilize position authority

· Focus on “what” work gets done

There is a tendency for some to equate leadership as being better or more important than having solid management practices. Nothing could be further from the truth. The demands of the marketplace, along with the health and ambition of the organization dictate the appropriate mix.

Our clients tell us that healthcare has historically been dominated by management practices.

When organizations have a proper balance of management and leadership, they are able to effectively meet today’s challenges, while adapting to meet the demands of the future.

This is critical for healthcare organizations, given the shifting landscape of the industry. As Warren Bennis wrote in “On Becoming A Leader”, the manager accepts the status quo; the leader challenges it. Clearly, with the accelerating costs, the status quo is not the answer. Healthcare costs have risen 2% per capita over the GDP for the last thirty years. The trend is expected to slow in 2012, due to the slow recovery from the recession but expected to rise again by 2014, due to expanded coverage.

Historically, physicians have been trained to and operated autonomously. In today’s world, they frequently find themselves much more integrated with and often employed by hospitals. As employees, they are expected to work much more closely with and develop mutual respect between themselves and administration leaders.

There is no group more important to future success than physicians. The physician’s pen is responsible for the majority of the costs incurred. They are also pivotal in building an environment of collaboration and teamwork that is key to being successful in an era of Reform.

That is why now is the time to compliment their clinical skills with the Leadership skills necessary for taking our organizations into an uncertain future.

A few health systems are focusing on Physician leadership, with the Cleveland Clinic and Mayo Clinic being the most prominent.

The Leadership skills we recommend for physicians focus on:

· Developing business acumen

· Creating a positive patient experience

· Building teamwork and effectively communicating between themselves and other staff members.

Often, when administrators discuss reducing utilization and associated costs, physicians equate that with “impeding my ability to deliver quality care.” Business education provides them with the knowledge to make more informed choices to maintain quality, while managing costs. We recently worked with a group of Hospitalists, who did not feel respected by the administrators or specialists. Educating them re: “the business of the business” was one of the most beneficial things we did. These Hospitalists became much more confident in their role and delivered care more effectively, including reducing LOS and avoidable admissions.

Creating a positive patient experience relates to having each interaction with your patient is meaningful. Your mere presence is a healing experience for yourself, the patient, and their families.

Teamwork and effective communication is important to ensure that physicians, nurses, and other staff members are able to give their best contributions to the delivery of care to their patients. This calls for physicians to be vulnerable, readily requesting input and taking other’s knowledge into account, as they make decisions re: caring for patients. We have had Nurses tell us “this is the first time I felt comfortable expressing my opinion to a physician.” Physicians relate that “the nursing staff is working much more efficiently with us.” It opens levels of communication that have been dormant.

Hurdles to be overcome include:

• The traditional perception the groups have of each other is not conducive to working together.
• Payors and providers don’t trust each other’s claims-based data
• Providers typically feel payors emphasize reducing cost vs. improving the quality of care

An effective methodology to enable collaboration must:

• Confront  and shift the negative perceptions the groups have of each other and the resulting biases. This is critical for creating a future relationship of collaborating vs. being adversaries
• Establish a vision for what will marry the needs of both groups Ex: Combine the group’s knowledge and attention to deliver care effectively across the continuum. This would align the motivations of both groups, including the Physicians.
• Be a forcing function for decisiveness vs. data “analysis paralysis”, searching for the “perfect answer”. Insisting on analyzing data ad nauseum can be used to avoid changing the status quo.
• Engage all stakeholder groups, so that they own the solution, to ensure an effective, sustainable implementation
• Hold people accountable for results vs. accepting that best intentions are good enough

That proven methodology exists and is called Rapid Cycle Implementation. For more info. visit www.vibrantenterprise.com and click the Rapid Cycle Implementation tab.

Coming next week: Building Physician Leadership Capability

Changing the traditional relationship of payers and providers is a key to achieving and sustaining dramatic cost reduction in healthcare. Insurance companies and healthcare providers have traditionally had a vendor/client relationship at best.

Both groups have historically worked to reduce costs but in isolation. That philosophy is outdated and will not provide the innovation necessary to be successful in the future Reform environment.

Payers and providers have begun joining forces to focus on cost reductions together. In our work, we have found several conditions necessary for the two groups to be willing to truly collaborate:

1. Establish a shared business goal e.g. common competitive threat of the overall market or competitor

2. Transparency and trust from the outset – this could be about sharing financial information or addressing other issues.

3. Data driven decisions – get facts, data and best practices on the table

4. Prepare for entrenched behavior by stakeholders from the start; strategies to impact this resistance must be integrated into implementing any solution

5. Create a deadline as a forcing function for action

6. Get the right people in the room – particularly when a decision has to made

Creating these conditions leads to both groups being able to drop their preconceived ideas of each other, which allows the sharing of perspectives necessary for true innovation to occur.

Once this occurs, the cross-functional group is able to identify unique possibilities to impact the cost of healthcare in areas such as:

· End of life care

· Guaranteed procedures (hips)

· Claims administration

· Integrated business models

· Wellness products

Both groups have historically worked to reduce costs but in isolation. That philosophy is outdated and will not provide the innovation necessary to be successful in the future Reform environment.

Payers and providers have begun joining forces to focus on cost reductions together. In our work, we have found several conditions necessary for the two groups to be willing to truly collaborate:

1. Establish a shared business goal e.g. common competitive threat of the overall market or competitor
2. Transparency and trust from the outset – this could be about sharing financial information or addressing other issues.
3. Data driven decisions – get facts, data and best practices on the table
4. Prepare for entrenched behavior by stakeholders from the start; strategies to impact this resistance must be integrated into implementing any solution
5. Create a deadline as a forcing function for action
6. Get the right people in the room – particularly when a decision has to made

Creating these conditions leads to both groups being able to drop their preconceived ideas of each other, which allows the sharing of perspectives necessary for true innovation to occur.

Once this occurs, the cross-functional group is able to identify unique possibilities to impact the cost of healthcare in areas such as:
• End of life care
• Guaranteed procedures (hips)
• Claims administration
• Integrated business models
• Wellness products

Changing the traditional relationship of payers and providers is a key to achieving and sustaining dramatic cost reduction in healthcare. Insurance companies and healthcare providers have traditionally had a vendor/client relationship at best.

Both groups have historically worked to reduce costs but in isolation. That philosophy is outdated and will not provide the innovation necessary to be successful in the future Reform environment.

Payers and providers have begun joining forces to focus on cost reductions together. In our work, we have found several conditions necessary for the two groups to be willing to truly collaborate:

1. Establish a shared business goal e.g. common competitive threat of the overall market or competitor
2. Transparency and trust from the outset – this could be about sharing financial information or addressing other issues.
3. Data driven decisions – get facts, data and best practices on the table
4. Prepare for entrenched behavior by stakeholders from the start; strategies to impact this resistance must be integrated into implementing any solution
5. Create a deadline as a forcing function for action
6. Get the right people in the room – particularly when a decision has to made

Creating these conditions leads to both groups being able to drop their preconceived ideas of each other, which allows the sharing of perspectives necessary for true innovation to occur.

Once this occurs, the cross-functional group is able to identify unique possibilities to impact the cost of healthcare in areas such as:
• End of life care
• Guaranteed procedures (hips)
• Claims administration
• Integrated business models
• Wellness products

Changing the traditional relationship of payers and providers is a key to achieving and sustaining dramatic cost reduction in healthcare. Insurance companies and healthcare providers have traditionally had a vendor/client relationship at best.

Both groups have historically worked to reduce costs but in isolation. That philosophy is outdated and will not provide the innovation necessary to be successful in the future Reform environment.

Payers and providers have begun joining forces to focus on cost reductions together. In our work, we have found several conditions necessary for the two groups to be willing to truly collaborate:

1. Establish a shared business goal e.g. common competitive threat of the overall market or competitor
2. Transparency and trust from the outset – this could be about sharing financial information or addressing other issues.
3. Data driven decisions – get facts, data and best practices on the table
4. Prepare for entrenched behavior by stakeholders from the start; strategies to impact this resistance must be integrated into implementing any solution
5. Create a deadline as a forcing function for action
6. Get the right people in the room – particularly when a decision has to made

Creating these conditions leads to both groups being able to drop their preconceived ideas of each other, which allows the sharing of perspectives necessary for true innovation to occur.

Once this occurs, the cross-functional group is able to identify unique possibilities to impact the cost of healthcare in areas such as:
• End of life care
• Guaranteed procedures (hips)
• Claims administration
• Integrated business models
• Wellness products

Changing the traditional relationship of payers and providers is a key to achieving and sustaining dramatic cost reduction in healthcare. Insurance companies and healthcare providers have traditionally had a vendor/client relationship at best.

Both groups have historically worked to reduce costs but in isolation. That philosophy is outdated and will not provide the innovation necessary to be successful in the future Reform environment.

Payers and providers have begun joining forces to focus on cost reductions together. In our work, we have found several conditions necessary for the two groups to be willing to truly collaborate:

1. Establish a shared business goal e.g. common competitive threat of the overall market or competitor
2. Transparency and trust from the outset – this could be about sharing financial information or addressing other issues.
3. Data driven decisions – get facts, data and best practices on the table
4. Prepare for entrenched behavior by stakeholders from the start; strategies to impact this resistance must be integrated into implementing any solution
5. Create a deadline as a forcing function for action
6. Get the right people in the room – particularly when a decision has to made

Creating these conditions leads to both groups being able to drop their preconceived ideas of each other, which allows the sharing of perspectives necessary for true innovation to occur.

Once this occurs, the cross-functional group is able to identify unique possibilities to impact the cost of healthcare in areas such as:
• End of life care
• Guaranteed procedures (hips)
• Claims administration
• Integrated business models
• Wellness products

The American Hospital Assoc. has agreed with President Obama to take $150 billion of cost out of the system over the next ten years. This will require great change in business processes, and enhanced efficiency. Getting the nurses and physicians committed to making these changes is critical. Great thought and effort will be required to meaningfully engage these groups, so that they truly feel that a solution can be created that works for them and their patients. Without their support, good luck.

Massive structural change within the system is also approaching. Shifts in reimbursement rates, incentive structures, and innovative physician models are all areas to be considered when trying to contain costs.

This brings us back to the topic of engagement. It would be a mistake to assume that professionals will naturally make the shifts in behavior needed to be successful. They are no different than the rest of us when a change comes our way. We resist it to varying degrees, unless it was our idea. The way to navigate these uncertainties is through dialog and engagement of those who will be affected. For more on engagement, see the earlier blog “Engaging Others for Unprecedented Results”

• Tell
• Test
• Co-create. 

Each is appropriate  at certain times. The key distinction lies in the amount the leader involves others in reaching the final decision.

A Tell conversation gets compliance to your request. Ex: “Jim, please  have the ABC report completed and delivered to Susan by Friday.” It also gets you what you asked for and little more.

A Test conversation goes further by engaging others in providing their input into options that the leader is considering. The leader still retains the decision rights. Ex: “I need to have the ABC report completed by Friday. I think we have some options re: how to get it done… What do you think is the best approach and do you see another option I have not considered?” With the opportunity to give their input into the decision, more commitment is built for the process and outcome, within those who will be responsible for implementing the decision.

The co-create conversation builds the greatest amount of commitment and it does so through fully engaging others in defining the process for execution. Ex: “We need to rethink our strategies for meeting the needs of our customers. I don’t have the answer. Let’s figure it out together.” One caution: if you are going to “co-create” with others, you must be willing to trust in the wisdom of others and not use the process to guide the discussion to the leader’s desired alternative.

Remember, each of the three types of discussions can be appropriate for a given result. It is important for leaders to be conscious of what conversation they need to have and be purposeful about it. If you want to develop the commitment for sustained action that achieves unprecedented results, find opportunities to “co-create” with your staff and others. You will also find that you deepen the level of relationship between yourself and those with whom you are working.

The Oxford English Dictionary describes hunker as: “squat, with the haunches, knees, and ankles acutely bent, so as to bring the hams near the heels, and throw the whole weight upon the fore part of the feet”. Is that really what we need to do? Hunker down?

When applied to business hunkering down becomes very restrictive and usually relates to playing “not to lose”, with a relentless focus on managing the cost or expense side of the business. I understand and agree that we need to manage costs. That should be done as a normal part of business and some circumstances require greater diligence.

These current economic conditions call for more than cost management.

I believe America needs to, as my friend Miles Kierson says, “Hunker Up”.

Hunkering up means more than managing costs. It also allows for leadership to emerge. Leadership is critical during times of great uncertainty. Our employees are seeing and hearing bad news and scarcity on every front. Leaders need to convey and build confidence in their organization’s ability to succeed.

If you have ever been part of an organization going through a cost cutting exercise, or a reduction in force, you will recall that it promotes employees being tentative and usually needing more approvals for decisions to be made. Comments such as “keep your head down, fly below the radar, and don’t draw attention to yourself” become common. This type of environment does not promote innovative practices or the cross-functional collaboration that makes a different future possible. Remember, you can’t just save your way to prosperity.

Key steps for leaders to take to foster a “hunker up” mentality:

• Set the vision for people to align with and personalize. This should include defining aggressive, goals. The vision provides meaning and the context for the organization. The aggressive goals require different ways of working together. They also create a sense of pride and achievement as they are realized.
• Engage your organization in achieving those goals, breaking them into multiple, short-term milestones. The short term focus helps to build and then maintain momentum. Great innovation is accessible, when you genuinely involve your staff in contributing to the organization’s success.

Important: Focus on your “informal leaders”. Involve them up front; listen to them and work with them to bring the rest of the organization along. Leaders too often spend time trying to “fix” their complainers. That is not a good use of your time. Use your time to support those leaders that exert a positive influence on the rest of the workforce.

• Hold people accountable for achieving results and not just putting forth best efforts. This includes addressing sub par performance and more importantly, recognizing and rewarding positive performance.
• Take on your own development. If you expect differential behavior from others, they should see it first from you
• Engage with customers to learn how you can shift the way you work to assist them in eliminating waste and adding unrealized value. A large commercial construction firm recently did this and learned that their lack of integration with architects was inhibiting their effectiveness on current projects. Shifting practices has lead to better working relationships and a greater desire on the part of A&E firms to recommend them for future jobs. A health insurance company and hospital system are shifting historic mindsets of suspicion to collaboration and learning how they can work together to achieve goals that are mutually beneficial.

We will talk at length about each these practices in upcoming blogs.

If you know of a leader who is displaying these types of practices, let us hear about them, so everyone can learn. We need good news and stories to inspire us.

Join in this conversation with us. We would love to hear from you.