Building Better Relationships with Physicians Twenty Strategies and Action Plans for Board Members and Executives A Presentation for the Ohio Hospital Association Kendall L. Stewart, MD, MBA March 2004

What’s in this for me? Every trustee and executive says good relationships with physicians are desirable. Most would also agree that their current relationships with physicians are not as good as they could be. But many hospital leaders simply don’t know what to do. (Physicians don’t know what to do either, but that’s a separate talk.) Both physicians and non-physician leaders regularly do the stupidest things. This presentation outlines some practical strategies that will help. When practical strategies that work are discussed, it is time to perk up and pay attention. Our relationships with each other can be improved. And they should be. What are the objectives of this presentation? After listening to this presentation, you will be able to –List three things doctors do to damage relationships with executives, –List three things executives do to damage relationships with doctors, –List three barriers to change, –List three practical strategies that will help, –Explain why you should implement those strategies, and –Explain how you can implement those strategies.

What do doctors and executives do to each other to make matters worse? Doctors –Confront and embarrass executives at public meetings –Take completely different positions in public and in private –Feed the lounge lizards with tasty morsels of speculation and innuendo –Complain to everyone but the leader who can fix the problem –Pour gas on organizational fires just for fun Executives –Tell physicians what they want to hear –Avoid taking a position –Fail to take physicians seriously –Leave physicians out of the real decision-making process –After the decision is made, pretend to involve physicians in the decision –Send consultants or subordinates the break bad news

What are some of the barriers to change? We don’t really need each other to succeed. We have not made a compelling case that emotional partnership is worth the effort. We each have a lot of bad role models. We select neither physicians nor administrators for relationship potential. It’s a lot of work. We both take heat for reaching out to the other side. Change is neither easy nor comfortable. There are plenty of distractions to keep us preoccupied.

What practical strategies will work? Create discomfort with the status quo.* Hire executives with servant hearts.* Make better relationships with physicians a strategic priority. Measure physician satisfaction regularly. Use physician focus groups to get to the bottom of issues. Improve key physician relationship processes based on what you learn. Identify all potential physician leaders. Develop physician leaders. Keep physician leaders informed. Engage physician leaders in real work.

What practical strategies will work? Page 2 Hold physician leaders accountable. Meet with key physician leaders weekly.* Include physician leaders in the decision-making process. Give physician leaders the information they need to make good decisions. Stop reinforcing irresponsible physician behavior. Confront disruptive physicians. Make a compelling case for change. Be clear about whether you are informing, consulting or seeking consent. Include responsible physician leaders on all Board committees. Insist that physician leaders go “on the record.”

Create discomfort with the status quo. Why should I? –If you’re coasting, it means you’re going downhill. –Complacency is the mortal enemy of exceptional organizational performance. –Manageable discomfort promotes growth. –People tolerate discomfort a lot better when their leaders embrace it. How can I? –Measure something important. –Publicize the measure. –Push for improvement. –Hold yourselves accountable. –Find comparative data. –Identify benchmark performance. –Beat it. –Sustain it. –Measure something else.

Hire executives with servant hearts? Why should I? –Because it’s hopeless without a genuine commitment to service. –A service attitude can only be faked for short periods of time. –Contemptuous leaders will widen the divide. –When stressed, we all revert to our natural inclinations. How can I? –Ask about values. –Obtain references from physicians. –Describe current relationship challenges, and ask for a consultation. –Find servant leaders to interview candidates. –Avoid weak leaders that physicians can roll.

Meet weekly with key physician leaders. Why should I? –It sends a powerful message to all physicians. –It changes physicians’ perceptions forever. –It includes them in the loop. –It puts them on the record. –It gives them direct input into the decision-making process. How can I? –Just do it. –Include the Chair, the CEO, the CMO the COS, and the COS-elect. –Don’t worry, they will come. –Lead with physician issues. –Invite their questions. –Continue these meetings indefinitely.

What might I conclude from this presentation? Improved relationships with physicians should be a strategic priority. Our relationships with physicians can be improved. –It won’t be easy. –It won’t be quick. But it is cheap, and it should be done. The leaders who have built good relationships with physicians are eager to share their “best practices.” What are we waiting for?

Where can I learn more? Stewart KL, “Leadership: Some Guidelines for Transforming the Organizational Culture,” A SOMC White Paper, Stewart KL, et al., A Portable Mentor for Organizational Leaders. SOMCPress, 2003 Stewart, KL, “Dealing with Difficult Doctors.” This presentation can be downloaded from Click on the SOMCPress link. Stewart, KL, “Bigwigs Behaving Badly: Dealing with Notable Misbehavior.” An SOMCPress White Paper, SOMCPress, This presentation can be downloaded from Click on the SOMCPress link.

How can I contact you? Kendall L. Stewart, M.D. Medical Director Southern Ohio Medical Center President & CEO The SOMC Medical Care Foundation, Inc th Street Portsmouth, Ohio

Southern Ohio Medical Center   Safety Safety  Quality Quality  Service Service  Relationships Relationships Performance  What questions remain?