Title: From Conflict to Opportunity Creating Competitive Advantage in Hospital/Physician Relations
1From Conflict to OpportunityCreating Competitive
Advantage in Hospital/Physician Relations
- Art Haines, CHE
- Principal
- Integral Strategy Group
2Objectives
- Outline the key forces affecting
hospital/physician relationships - Examine the limitations of typical strategies for
improving relations - Explore the Integral Approach to building
hospital/physician partnership - Understand the application of the Integral
Approach in a case study
3Physicians Under Pressure
- Increasing pressure on costs
- Increasing demand for production
- Declining compensation
- Lost autonomy
- Cracks in the physician/patient relationship
4Hospital/Physician RelationshipsUnder Stress
- Mistrust, conflict and miscalculation
- Dog-eat-dog competition
- Lost development opportunities
- Reduced economic performance
- Risks to community reputation
5The Battlefield
- Skimming the ancillaries
- Demands to limit call coverage or receive
pay-for-call - Ambulatory Surgery Center and Specialty Hospital
development
6Tired Solutions
- Bare knuckled competition
- Lock them out the market
- Legislate/regulate
- Shift the economics
- Jawboning
- Build allies and alliances
- Joint venture
- Recruit new docs
- Complain and blame
Simple approaches to complex situations are not
effective or sustainable
7An Integral View of Complexity
SUBJECTIVE
OBJECTIVE
Attitudes Emotions Aspirations
Skills Behavior
INDIVIDUAL
Structure System Process
Culture Values Vision
ORGANIZATIONAL
8A Recipe for Failure
SUBJECTIVE
OBJECTIVE
- Weak leadership and management skills
- Inappropriate behavior
- Fear and anger
- Desire for independence and autonomy
- Win at all costs
INDIVIDUAL
- Culture of disrespect and mistrust
- Guarded communication
- Win/lose, us/them thinking
- Weak community vision
Compete directly Lock them out Legislate/regulate
Change the economics Joint venture
ORGANIZATIONAL
9Sustainable Integral Solution
SUBJECTIVE
OBJECTIVE
- Group process and conflict management capacity
- Leadership, management planning skills
- Constructive, committed behaviors
- High level of commitment
- High integrity
- Personal and community vision
INDIVIDUAL
- Culture of respect, trust, candor
- Integrated community and individual interests
- Win/win/win thinking
- Sound business structures
- Aligned incentives
- Shared economics and business risk
- Supporting policies, procedures
ORGANIZATIONAL
10Resolving a Pay-for-Call Dispute
- Mid-sized community hospital with strong
performance and CEO - History of mistrust and miscommunication
- Issue had reached the boiling point
- Pay for emergency call or else
- All sides saw community service at risk
11The Flash Points
SUBJECTIVE
OBJECTIVE
- Physician ultimatums
- Board/CEO stonewalling
- Strong, successful CEO
- CEO guarding the treasury
- Board member desire for community responsibility
- Physician anger, fear over reimbursement,
autonomy - Chief of Staff exhausted from call schedule
INDIVIDUAL
- Resentment over hospital profit
- Anger over past wrongs
- Moralistic position taking
- Distance between physicians and Board/CEO.
- Iron clad staff bylaws
- EMTALA requirements
- Limited numbers in some specialties
- Few facts known to all
- No structure for addressing the problem
ORGANIZATIONAL
12Integral Approach to Pay-for-Call Breakdown
- Starting with the Integral View,
- Create common ground
- Envision success and design a process for
achieving it - Address critical personal, business and clinical
issues - Design for sustainability
13Step 1Creating Common Ground
- Performed integral assessment of situation
- Team-formation retreats
- Reported findings
- Established overarching goal
- Provided competency-building education and
coaching - Created core working group to craft a solution
14Aligning Competing Values
Do what is right, Follow the rules.
How can I excel,win the game?
15Step 2Envisioning and Design
- Created group ground rules and behaviors
- Defused anger about past wrongs
- Created shared commitments around the current
situation and the future - Developed shared principles for a pay-for- call
solution
16Shared Principles
- The responsibility for emergency medical care is
shared between the hospital and the physicians - There is an interdependent relationship between
the hospital and the physicians. - The hospital acknowledges there is a reasonable
monetary value for a physician being on call and
providing medical care. - Physicians are valued partners in helping the
hospital make strategic decisions.
17Step 3Address Critical Issues
- Pay for Call Program tied to regional market
practices - Hospital sponsored locum tenans physicians to
supplement call schedule - Physician recruitment package implemented
- Hospital sponsored protocols and financial
support for OB coverage of FP deliveries - Physician commitment to cost management efforts
- Physician/Hospital task force to administer
programs
18Step 4Design for Sustainability
- Task force to continue to develop and fine-tune
program - Developed new Board level committee to identify
and resolve hospital/physician issues - Established informal CEO/physician meetings
- Regular information exchange
- Sound legal and financial counsel
19An Integral Solution
SUBJECTIVE
OBJECTIVE
- Physician leaders promote plan
- CEO shares financial info and speaks personally
- Hospital sponsored leadership development courses
- New skills in communications, negotiations,
conflict mgmt
- Leaders empathy for each others situation
- Emotional connections to past wrongs defused
- New willingness to lead from commitment
INDIVIDUAL
- New level of respect, trust, candor
- Open communications
- Win/win/win thinking
- Physician commitment to cost containment
- Market based system
- Admin/physician task force
- Board/admin/physician oversight committee
- Hospital support for recruitment
- Cost containment program
- Annual leadership retreats
ORGANIZATIONAL
20Results One Year Later
- Pay-for-call system successfully implemented and
on budget - Length of stay and cost reductions
- New physician recruitment
- Formal and informal structures evolving
- CEO and physicians acting as strategic partners
- Docs working for financial/operational
improvements
21Six Keys To Success
- CEO/Physician leaders/Board committed to new
partnership - First opportunities, then relationships
- Align the dominant values
- Structure for accountability
- External support for learning
- Adaptive, sustainable solutions
22Background
23JAMA January 2003
- Physician satisfaction levels declined
marginally between 1997 and 2001. - Satisfaction related to
- Threats to autonomy.
- Ability to manage day to day patient interactions
and their time. - Ability to provide high quality care.
- Source Changes in Career Satisfaction Among
Primary Care and Specialist Physicians,
1997-2001, JAMA, January 22/29, pp 442-449.
24MGMA September, 2003
- New Survey Reports Physician Compensation Flat,
Production Up -
- Many physicians saw slight, if any, increases in
compensation during 2002. The Medical Group
Management Association (MGMA) "Physician
Compensation and Production Survey 2003 Report
Based on 2002 Data" indicates that primary care
physicians' median incomes rose by less than 3
percent between 2001 and 2002. Some specialists
saw increases that averaged 4.3 percent over that
period, while others had their salaries decline.
At the same time, many groups reported larger
rises in their medical production and charges. - Higher costs for labor, supplies and professional
liability insurance, combined with cuts in
commercial and government reimbursement, made it
difficult for many physicians to maintain net
income,
25Clinical Advisory Board
- Physician reimbursement in decline.
- Physician practice costs on the rise.
- Malpractice premium crisis.
- Resurgence of health care inflation, cost
management. - Cracks in the physician/patient relationship.
- Impending specialty shortage.
- Source Clinical Advisory Board, Recovering
Physician Loyalty, 2002