LBS

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Speakers Series Il Mondo della Sanità
Esperienze Internazionali di Eccellenza Luiss
Business School Area PA Sanità
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Primo Seminario
Leadership e collaborazione tra medici e manager
in sanitàcomunicare, facilitare,
negoziare Prof. Kenneth R. White, PhD,
FACHE Visiting Professor presso Luiss Guido
Carli Luiss Guido Carli, 9 maggio 2007
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Administrator- Physician Relationships

• Are undergoing radical changes
• A source of frustration for managers
• A source of frustration for physicians
• We need each other, and we speak different
  languages
• How can we master physician-administrator
  collaboration?

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Background

• Some of the earliest hospital managers were
  physicians
• As the business grew more complex in the mid-20th
  century, physicians turned over the business
  affairs to trained managers
• Government regulation creates competing
  incentives for managers and physicians

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Competing Incentives

• Manager incentive cost containment
• Physician incentive patient care
• But they needed each other, so . . .
• Managers began to share some of the decision
  making authority with physicians
• Physicians began to exert more control over the
  use of resources in the hospital

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Contributions to Complexity

• Government regulatory pressures
• Payment mechanisms
• Malpractice costs
• Competition
• Professional role differences
• Scarcity of resources

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Economic Perspective

• Physicians demand and purchase hospital services
• BUT, when the purchase is made, physicians do not
  take full responsibility for the transaction (as
  in ordinary buyer-seller transactions)
• RATHER, they delegate the authority back to the
  hospital

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Agency Perspective

• Managers are physicians agents to purchase
  supplies and technology
• Physicians are managers agents in attracting new
  patients to the hospital
• BUT, physicians act as patients agents
• SO, we have a case of
• DOUBLE AGENCY
• Creating problems because different and opposing
  demands are required by each role

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Organizational Perspective

• Managers and physicians have their own values,
  goals, and expectations
• With interdependent needs
• Each gives up something
• Managers give up some control over the hospital
• Physicians must give up some of their
  professional autonomy

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Professional Model

• Doctors constitute an occupational community
• Boundaries are set by physicians
• Possession of unique skills
• Other physicians are primary reference
• Self-control over other physicians
• Regulation, licensing, and certification
• Motivated by achievement

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Administrative Model

• Not an occupational community
• Entry highly nonrestricted (various educational
  backgrounds)
• Much less cohesive identity
• Motivated by promotion and advancement

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The Perfect Storm

• The environment is creating waves
• The vortex is swirling with competing motives
• The patient is often in the middle
• How can we stay on the boat?
• STAY TUNED . . . .

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New Ways of Collaborating

• Find common ground, while acknowledging
  differences
• Improve communication
• Financial collaboration
• Engaging physicians in hospital operations
• Foster transparency
• Engender trust
• What physicians and managers can learn from nurses

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Find Common Ground

• Structured Dialog
• Increases physician-physician communication
• Increases physician-administrator communication
• What is it?
• Process
• Medical Advisory Panel
• Consensus
• Patients needs are first priority

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Improve Communication

• Medical Advisory Panel
• One-on-one
• Whose job is it to communicate with physicians?
• Answer Everyone, but they want to see and hear
  from the administrator
• Develop physician leaders

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Financial Collaboration

• Are joint collaboration models possible?
• How can physicians be rewarded for outcomes?
• Are service contracts possible?
• Medical directors
• Physician panels (i.e., EKG interpretation)
• Exclusive
• How to retain good physicians?

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Engaging Physicians

• Doctors want to know that you care about what
  they care about
• Doctors want administrators to be visible
• Doctors want to know that adequate support
  services are available
• Doctors want to know that their patients receive
  good nursing care
• Ask doctors for their opinion!

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Foster Transparency

• Data sharing
• Find out what data they need and give it to them
• Involve physicians in designing ways to measure
  clinical effectiveness
• Orient new physicians

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Engender Trust

• Communication techniques that engender feelings
  of partnership
• Do what you say you will do
• Demonstrate respect
• Cordiality and empathy are essential
• Recognize interdependence

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Learn from Nurses

• Leaders should be available on the floor to field
  problems
• Leaders should create a safe environment
• Leades should create and maintain effective
  processes

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Advice for Managers

• Learn the language of health care
• Respect physicians time
• Always do what is best for the patient
• Do what you say you will do
• Reward quality and achievement
• Hire great people
• Have a sense of humor

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Advice for Physicians

• Appreciate the grey areas, even though aspects
  of medicine may be black and white
• Teach and explain new procedures, technologies
• Learn the language of business
• Be loyal
• Refrain from disruptive behavior
• Have a sense of humor

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In Summary

• Promoting effective communication is in both
  physicians and administrators self-interest
• Obtaining quick wins in streamlining processes
  and improving operations is crucial to building
  momentum and credibility
• Seek others opinions on issues