Finding Common Ground : Inside The Physicians Mind

1
Finding Common Ground Inside The Physicians
Mind

• Joseph S. Bujak, MD, FACP
• MHA Leadership Forum
• Branson, MO
• June 12, 2009

2
Market Place Realities

• Progressive specialization
• Demand for technology
• Societal issues (death as an optional event)
• Rising costs

3
Market Place Realities

• Shrinking margins
• Acute vs. chronic disease/diagnostics
• Access
• P4P
• RACs

4
Provide higher quality care to more people for
less cost!
5
How to simultaneously specialize and integrate
6
Technology is changing medical practice more
rapidly than the duration of training of a
physician.

• The doubling time of knowledge is
• less than four years.

7
The Pace of Change Is Progressing Exponentially

• Survival is a function of adaptability and
  capacity to sort substance from form.
• Need to appreciate the dynamics of the creative
  process The Importance of Vision.

8
The private practice of medicine is unsustainable

• Young physician preferences
• Inefficient and too costly
• There are only so many RVUs/day
• Reimbursement declining, overhead increasing
• Income is at an inflection point

9
SGR is Threatening the Traditional Solo/Small
Group Model (Kaufman)

• Next Target In-office Imaging and Outpatient
  Rates!

10
Physician-Hospital CollaborationCan Solo/Small
Group Practice Survive(Nate Kaufman)

• What Physicians Need What Physicians Do
• - Efficient workshop - Semi-efficient
  hospital
• - Sophisticated IT/infrastructure - Lack
  resources to invest
• - Premium managed care rates - Too small
• - Succession planning - Ill-equipped for
  new generation
• Efficient/standardized processes - Town Hall
  democracy
• and no fiscal discipline
• - Team approach to increase throughput -
  Obsessed with autonomy
• - New business Model - Status quo with a
  hospital subsidy

11
Are hospitals/health systems and physicians
mutually interdependent for success?

• If so, the need to cooperate is obvious and a
  failure to cooperate is toxic.

12
The Physician Culture

• Autonomy
• Absence of collective identity
• Leadership is illegitimate
• Town hall democracy
• Collective decision making

13
Generational differences as relate to employment

• Attitude
• Teamwork
• EMR
• Loyalty
• Deference

14
There is no such thing as physicians

• Age
• Gender
• Generation
• Personality
• Primary care/Specialist
• Town/Gown
• Loyal/Splitter

15
In the physician community, who has signature
authority?What are the consequences?
16
Can you integrate across the divide? I to WE to US

• How?
• What will cause an individual to subjugate
  self-interest in deference to the whole?

17
Reclaiming the Common Ground

• Dialogue
• Ownership
• Relationship
• Communication
• Vision beyond the money

18
The Language of Finance versus The Language of
Clinical MedicineApostrophe S versus S
apostrophe
19
Communication and Trust
20
Facilitated dialogue The avenue to mutual
understanding, trust, and creativity
21
Physicians and Dialogue

• Linear
• Time sensitive
• All-knowing
• Quick to judge
• Difficult to express vulnerability
• Need control
• Predisposed not to trust

22
Facilitated dialogue

• Self organizing
• Non-linear
• Emergent

23
The pool of shared meaning is the birthplace of
synergy. Crucial Conversations
24
Attentive Listening while suspending judgment
25
The process transforms the conversation

• Attentively listening validates the speaker
• Expressing vulnerability creates empathy
• Feeling heard and understood defines effective
  communication
• The process builds vulnerability trust generating
  respect, understanding, mutual appreciation, and
  teamwork

26
In the absence of a great dream, pettiness
prevails Peter Senge