leadership of organization

Physicians have extensive education and are likely to work in a position that entails the exercise of a

great deal of operating autonomy. Yet many characteristics that make for an effective high-skill

professional, such as independence, also tend to make that employee difficult to manage at times. While

it is certainly important to cultivate independence in those persons who are on their own much of the

time, at times even the lone operator must be counted on to be a team player.

Physicians also have a healthy ego to be able to operate as a visiting expert. The high-skill professional

is indeed one who may often be viewed as needing to be in control of the situation. The healthy ego, so

helpful to the professional while on assignment, can sometimes be troublesome to the manager. The

successful manager of the high-skill professional must adhere to a number of guidelines:

 Consider what most strongly motivates the individual; it is often income or scientific data

 Thoroughly orient each physician to the organization, its policies, and its goals

 Encourage physicians to take part in determining the scope and direction of each change

 Encourage physician self-governance and innovation

 Develop a trusting relationship to assure confidence in physicians ability

 Learn and educate yourself about their profession and/or specific clinical topics prior to discussing them

 Understand the differences in communication styles between administrators and physicians

 Recognize the common goal is to provide the best care for patients

 There is a patient at the end of every decision you make An important aspect to consider is that administrators and physicians have different motivations.

Administrators tend to focus more on documentation and physicians care more about face-to-face time

with their patients. However, there are also differences in motivations based on the level of physicians.

Front line physicians care more about the instruments they use, their staff, and operations aspect of

patients. Conversely, the chair is more interested in balancing the demands and keeping everyone happy

by providing feedback and conducting surveys. Finally, the chief is focused more on keeping all

positions filled. They want to be able to manage their physicians and their residents in order to maintain

a good program. Due to the fact that documentation is not a priority for physicians, administrators must

continually remind them of the importance behind it and assist them by streamlining any processes that

would make this easier for them.

Educate them on the organization’s vision in order to align goals. It is crucial for physicians to

understand the culture that the facility promotes. This can be achieved by familiarizing them with the

facility, staff, and providing background information, such as previous breakthroughs.

SKILLS PRACTICE 3.10 – PARTNERING WITH PHYSICIANS

 Close the loop between healthcare executives and physicians

 Practice interacting with physicians and to evaluate the encounter.

 Increase awareness of your style of communicating with physicians.

The little things matter. Every act and conversation with physicians can help to develop a trusting

relationship. Initially, you must work hard to earn their respect and trust. This can be achieved by

working towards fixing any issues they are currently facing and making their issue your issue. Instead of

just pointing out the problems, take the initiative to assist with resolving it together with the physician. It

is maintained by continuously communicating with them. Make the effort to get to know them on a

personal level and what they do as a professional. Make employee rounds and attend staff meetings

regularly. Put scrubs on and spend time with your physicians and their staff. This will not only help you

understand more about what they do and who they are, but it will also help to break down any future

barriers that may arise. Barriers may include implementing new policies, creating a new vision, or

expanding services offered. If a trusting relationship is there then changes will be easier to address to

your physicians.

Educate yourself. Physicians and administrators have their own language and ways of communicating.

It is difficult for an administrator to speak and/or think in a clinical aspect. Be sure to educate yourself

about their profession and medical terminology before approaching any situation. Your interaction will

be much better off with a result you are both happy with. To better understand the physician’s role,

remember that few medical schools prepare physicians with interpersonal communication skills as part

of a curriculum. Therefore, the interpersonally skilled manager is often in a much better position than

the physician to deal with role and interpersonal problems and conflicts and can serve as a role model

for communication patterns. Since assertiveness skills are often tested in the manager-physician

relationship, it is particularly important to trust oneself and one’s professional expertise.

Overall, remember that you each share a common goal fundamentally; the patients. Any problems that

arise are due to the distractions on the way to getting there. You each bring something important to the

table that cannot be substituted. In order to get the best end result, take your expertise into consideration

while also asking the advice of your physicians. Remember, physicians have human traits as well with

all of their failures, personality and needs. Don’t forget to praise them, thank them, ask for their

opinion, appreciate them, assist them, and even get mad at them.

Key Behaviors for Communicating with Physicians

1. Consider yourself and the physician equal partners of a health care team. 2. Provide data from a reliable source 3. Listen and be considerate of their needs and/or desires 4. Reflect confidence and be assertive 5. Be honest and transparent without disclosing unnecessary information 6. Be responsive and follow-up

Administrators and physicians have different but important knowledge and skills that play a key role in

decision making. An administrator must feel that he or she is an equal as a professional and as a person

to physicians. Carefully examine your thoughts and feelings about this. Would you have difficulty

disagreeing with a physician? It is important to gain an understanding of their profession and respect it.

Let the data speak for itself. It is crucial to present data in order to avoid any further arguments. Do not

explain the data in a defensive manner but rather use it as a tool. Be sure to understand the data you are

presenting and be able to point out the important metrics pertaining to the physician. Only use

trustworthy data from a reliable source.

Be open to what physicians have to say. Let them share their side of the story without any interruptions.

Understand that physicians deal with an array of matters and need to vent. Even if they approach you

with outrageous requests be sure to listen.

Earn respect, don’t demand it. Assertiveness, a firm and positive expectation of respect, and an ability to

empathize with physicians will most often lead to successful administrator-physician relationships. Be

confident in your ability to manage and make decisions.

Honesty is the best policy. Be open and transparent with your physicians by openly communicating and

allowing them to do the same. One way of accomplishing this is having an open door policy. While it is

crucial to lay out all of the facts, be sure not to disclose unnecessary information. Too much information

may end up creating additional conflicts.

Close the loop. It is okay not to know the answer to every question immediately. For any unresolved

issues or questions, be sure to get answers and convey them to the physicians in a timely manner. Be

sure to follow up in order to assure physicians that you have not disregarded the situation. Your

responsiveness will reflect your reliability as an administrator. Do not agree to terms that you will be

unable to deliver. In other words, under promise and over deliver.

Partnering with Physicians Table

There are two different types of scenarios that could occur and may require different reactions. These

two scenarios involve you, as the executive, approaching a physician, or the physician approaching you.

The following table alludes to common situations that occur. The first row of each table has a general

description for each type of approach.

Executive Approaching Physician:

Situation Approach Key Points Solution Close the Loop

When

executive

approaches

physician

Non-

defensive;

listen;

explain;

professional;

be honest;

provide data

Refer to all key

behaviors listed

above.

Explain situation, give

them a chance to speak

and explain their opinion.

Discuss matter and be

straightforward. Make

decision as team and

convey it to make sure

they understand it.

Follow up with them

about decision made.

If no decision was

made, then regroup to

make decision in

timely manner.

Patient

complaint

Non-

defensive;

calm; listen

They care about

patient input

since this is their

compassion; they

will get

defensive; do not

procrastinate on

Discuss complaint

received from patient

without adding personal

comment/opinion; allow

them to explain their side

of story; Be stern enough

for them to understand

Make sure physician

follows up with

patient; make sure

physician does not

repeat behavior

communicating

complaint

this type of behavior is

not acceptable, but

compassionate towards

their views/ response

Nurse/staff

complaint

and/or

harrassment

Non-

defensive;

calm; listen

Some don’t

consider

nurse/staff

opinion crucial;

administrators

job to help them

realize how

much it matters

Discuss complaint

received from nurse/staff

without adding personal

comment/opinion; allow

them to explain their side

of story; Be stern enough

for them to understand

this type of behavior is

not acceptable, but

compassionate towards

their views/ response;

encourage building

relationship with

nurse/staff member

Make sure physician

follows up with

nurse/staff member;

make sure physician

does not repeat

behavior

Discuss bad

outcomes/num

bers

Informative;

professional;

listen

Be able to

provide and

explain data;

data should be

from reliable

source; matters

how data is

presented

Discuss matter in

professional manner,

without pointing fingers

or adding

comments/opinions; let

the data do the talking

Continue providing

data over time;

acknowledge

improvements made

Physician to

Physician

conflict

Help them mingle; set

up group

dinners/lunches

Compensation

/recontracting

Professional All inputs and

outputs of figure

are transparent;

some will argue

for a higher rate.

Explain all inputs and

outputs of how figure

was calculated; show

volumes and all finances

related to figure

Physician Approaching Executive:

Situation Approach Key Points Solution Close the Loop

When

physician

approaches

executive

Listen; calm;

be honest;

under promise,

over deliver;

be assertive

Allow them to

finish presenting

and explaining

prior to speaking

your opinion. Do

not feel

obligated to give

answer right

Observe data and plan

they have to offer. If

definite about an answer,

then discuss it and

thoroughly explain it. If

not definite, assure them

you understand their

desire and will follow up

Perform additional

research and obtain

outside opinions if

needed. Follow up

with them in timely

manner regarding final

decision. Make sure to

present data and

away if unsure. with up in a timely

manner.

reasoning behind

decision.

Unsatisfied

with certain

process

Recruit staff

or physician

Capital to

invest in

new

program,

expansion,

or

equipment

Different situations will arise throughout your career that will involve conflict with physicians. The

guidelines and key behaviors are important to remember when working with them. Refer to the table

above. Provide a brief script for each situation that explains your approach, solution, and actions in

closing the loop.

I. Executives Approaching Physicians

Situation 1

You are an administrator. One of your younger head nurses on a busy surgical unit comes to you,

complaining about one of the surgeons who brings the most patients to her unit. She states that he is

rude and hostile to her at times and, at others, treats her in a condescending, paternalistic manner. She is

frustrated with trying to have a professional relationship with him. You must talk to the physician.

Situation 2

As the administrator, you are continuously looking at the data making sure that your hospital is

competitive with others in the area. You notice a particular physicians numbers have dropped which is

bad for the hospital. You decide that you need to talk with the physician in order to determine what is

causing the drop in numbers and to let them know that they need to be improved.

II. Physicians Approaching Executives

Situation 1

One of your oncologists schedules a meeting with you about starting a breast cancer program that will

require expensive equipment and additional labor. However, it will bring up costs and the volumes and

growth rate for breast cancer patients are not high; but rather have decreased. As the administrator you

are well aware of the passion and dedication they have for this cause. However, there is no evidence of it

being profitable. Therefore, you cannot approve this program.

Situation 2

An internal medicine physician that has their practice down the street from the hospital meets with you

to discuss a process issue. They complain about the inefficiency of the hospital’s direct admission

process. They give several examples of how difficult it has been for them to admit patients. However,

this is the only physician that has ever complained about it. You must discuss this situation with the

physician and your staff involved in the matter.