Rural Physician Leadership Curriculum

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Rural Physician Leadership Curriculum

• West Virginia University
• Rural Family Medicine Residency Program

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Rural Physician Leadership Curriculum

• Module 7
• Organizational Politics

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Description
Rural Physician Leadership Curriculum

• Funded by HRSA Grant D22HP00306
• Objective 1
• Develop a competency based longitudinal
  curriculum in Rural Physician Leadership

Konrad C. Nau, MD
Principle Investigator Chair, Dept of Family
Medicine-Eastern Division WVU Rural Family
Medicine Residency Program
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Learning Objectives Module 7
Rural Physician Leadership Curriculum

• Understand the difference between power and
  authority
• Conceptualize the two networks of organizational
  politics
• Identify the four elements of organizational
  politics
• Apply organizational politics to strengthen your
  systems-based approach to problem solving

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CASE STUDY- The Hospital

• Back Creek Memorial Hospital
• Rural - 100 Beds
• 24 Hour ED coverage
• 4 FM, 3 IM, 2 GenSx, 2 OB-GYN, 2 Ortho, 2 Peds, 2
  EM, 3 locum tenum
• 18,000 annual ED visits

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CASE STUDY- The People

• CEO Carla E. Owens
• Chief of Staff Stan Pioneer, MD
• Emerg. Dept Director Joe Stat, DO
• ED Staff Member- Mark Mergency,MD
• Others
• READ CASE STUDY NOW

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CASE STUDY- The Problem

• Emergency Dept Patient Complaints
• Unprofessional dress of Emergency Department
  staff
• Grumpy behavior of some Emergency Department
  physicians

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CASE STUDY- The Solution

• Stan Pioneer (Chief of Staff) proposes
  implementing a professional dress code for
  everyone who works in the Emergency Department
• Joe Stat, DO (ED Director) speaks with a senior
  ED physician, and the ED Nursing Supervisor

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CASE STUDY- The Results

• Carla E Owens, CEO calls Stan Pioneer, MD Chief
  of Staff to her office
• Stan, Im disappointed that you let this get so
  out of control.
• I thought you had a better feel for our
  organization.

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CASE STUDY- The Analysis

• What did Stan do ?
• Why did Mark do what he did ?
• Who made the best use of Back Creek Memorial
  Hospitals organizational politics ?

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Stan - Chief of Staff

• Quality Assurance issue discussed with CEO and
  felt he was authorized to to a job.
• Thought he had a good solution to the problem
  (made assumptions).
• Didnt seem to really talk to enough people
• Assumed is position gave him the power to act

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Mike Med Staff Member

• Saw the Quality issue differently.
• Used his non-official relationships to his
  advantage.
• Did an end run around the authority.
• Past issues seemed to fuel his fire
  (assumptions).

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Leadership Choices
Developing Issue
Early Recognition
Ignore Organizational Politics
Take Action
Current Mess
Thoughtful Resolution
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Politics

• Derived from the Greek roots
• poli
• many
• Tics
• Blood sucking insect thats hard to kill and
  spreads disease

James Carvele
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Politics

• Competition between competing interest groups or
  individuals for power and leadership

Mirriam-Webster Dictionary
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Power

• The potential to cause certain things to happen
  or not to happen
• Power is value-neutral

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Authority

• Status granted by an organization (eg. Title)
• May or may not include power

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Why dont we get it

• Young physicians are somehow taught that power
  is bad
• Administration runs this hospital they have
  the power to get us more nursing staff but wont.

Robert Hodge MD,FACPE
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Organizational Politics

• Unauthorized uses of power that enhance or
  protect ones own or ones group personal
  interests.

Robert Hodge MD,FACPE
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The Gap

• Divergence (gap) between the mission of the
  organization and that of the individual or group.
• The bigger the GAP the greater the organizational
  politics.

Robert Hodge MD,FACPE
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Organizational Politics

• Conceptualize two teams at play
• Informal Network activities
• Formal Network with organizational goals or
  objectives

Robert Hodge MD,FACPE
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The Formal Organization

• Formal follows established form, customs, or
  rules
• Formal often implies static
• Example The Organizational Chart

Robert Hodge MD,FACPE
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The Informal Organization

• Informal follows no established form
• Informal often implies dynamic
• No Organizational Chart
• Common mode of communication
• The Grapevine

Robert Hodge MD,FACPE
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Back Creek Memorial Hospital
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Back Creek Memorial Hospital
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Back Creek Memorial Hospital
Executive Secretary
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Back Creek Memorial Hospital
Administrative Assistant
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Back Creek Memorial Hospital
Family of Med Staff
Medical Staff Member
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Back Creek Memorial Hospital
Hospital Board Member
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Back Creek Memorial Hospital
Hospital Board Member
Executive Secretary
Administrative Assistant
Family of Med Staff
Medical Staff Member
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Analyzing Organizational Politics
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Analyzing Organizational Politics
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Analyzing Organizational Politics
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Analyzing Organizational Politics

• Four Elements of Organizational Politics
• Meaning
• Communication
• Relationships
• Power

Robert Hodge MD,FACPE
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Analyzing Organizational Politics

• I. Meaning
• What is the motivation on each side ?
• What are the values ?
• What is the perception ?

Robert Hodge MD,FACPE
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Analyzing Organizational Politics

• II. Communication
• Formal
• Meetings, Telephone, Voice Mail
• Memos, Letters, E-Mail
• Informal
• The Grapevine

Robert Hodge MD,FACPE
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Face-to-Face Conversation

• Communicating your message
• 10 words
• 49 tone of words
• 50 body language
• Pitfall can become confrontational

Infoworld 9/27/99,p.104
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Telephone Conversation

• Communicating your message
• 25 words
• 75 tone of voice
• Pitfall wrong tone can set wrong tone of
  conversation

Infoworld 9/27/99,p.104
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Voice Mail

• Communicating your message
• 25 words
• 75 tone of voice
• Pitfall not interactive, poor fluency can
  signal poor competency (be prepared)

Infoworld 9/27/99,p.104
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E - Mail

• Communicating your message
• 100 words
• Pitfall email can some across authoritarian
  rather than engaging, remember they can be
  forwarded to ANYBODY in/out of your organization

Infoworld 9/27/99,p.104
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The Grapevine

• The informal person-to-person means of
  circulating information or gossip
• Travels faster than the Internet
• Dynamic connections will vary according to the
  issue (unlike the formal Organizational Chart)

Janet Sandberg
Ruthless Rumors and the Managers Who Enable
Them Wall Street Journal, 2003.
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The Grapevine

• 82 of the information bits running through one
  companys grapevine was ACCURATE
• Randstad Study

Janet Sandberg
Ruthless Rumors and the Managers Who Enable
Them Wall Street Journal, 2003.
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Three Laws of Gossip

• You never know how many people are talking about
  you behind your back.
• Thank God !
• As gossip spreads from friends to acquaintances
  to people youve never met it grows more
  garbled, vivid, and definitive.

Tad Friend
New Yorker 7/31/2000
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The Grapevine

• Only 17 of EMPLOYERS think workers get info from
  the grapevine
• but
• Nearly 50 of EMPLOYEES credit the grapevine with
  first message of major company changes

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Analyzing Organizational Politics

• III. Relationships
• Define the networks (who knows who)
• Formal
• Informal

Robert Hodge MD,FACPE
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Analyzing Organizational Politics

• III. Relationships
• Define the networks (who knows who)
• Formal
• Informal
• Be aware of the numbers
• Dyads - Triads

Robert Hodge MD,FACPE
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Analyzing Organizational Politics

• IV. Power
• Who has the power (the potential to cause certain
  things to happen or not happen) ?
• Formal dont confuse with authority
• Informal issue leaders, stakeholders

Robert Hodge MD,FACPE
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Back to the CASE STUDY
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Back Creek Memorial Hospital
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Back Creek Memorial Hospital
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CASE STUDY- Second Chance

• Instead of Stan now you are the Man.
• Devise a plan of how you would have addressed the
  Quality concerns initially discussed with the
  CEO.
• Utilize your knowledge of the 4 elements of
  Organizational Politics