1. PHYSICIANS AND ADMINISTRATORS NAVIGATING A ROAD PAVED WITH GOOD INTENTIONS

2. PHYSICIANS AND ADMINISTRATORS No conflicts to declare. Michael V. Jackson, MD, FCCP, FAASM Pulmonary Medicine Associates, Reno, NV Clinical professor, University of Nevada School of Medicine Scarred survivor of changes in medical practice

3. MANAGEMENT AND LEADERSHIP MANAGERSLEADERS Planning, budgeting Establish direction Organization, staffingAlign people Controlling, problem solving Motivate and inspire Produce predictability and order Produce change

4. PHYSICIAN TRAINING Science Majors, mostly Competitive, always Some social awareness Little knowledge of business or systems engineering “Rapid decisions based on inadequate data” Patterns of thought

5. THE UNFORTUNATE EFFECTS OF A MEDICAL EDUCATION Clinicians think and communicate differently than business leaders and administrators Clinicians learn from their seniors, inheriting the good and the bad Time frames for decision making in clinical practice are vastly different than those in administration The definition of a team is imprecise

6. PHYSICIANS THINK AND COMMUNICATE IN A DIFFERENT WAY Data analysis - deductive from trials or inductive from trends and analysis Time frames Definition of a team - individual contributions or affiliative interdependence An apprenticeship model

7. EARLY ADOPTION MAY BE A BUSINESS IMPERATIVE BUT IT MAY ALSO HURT PATIENTS

8. THE CAPTAIN OF THE SHIP OR THE TEAM LEADER?

9. THE UNFORTUNATE EFFECTS OF A MEDICAL EDUCATION Clinicians think and communicate differently than business leaders and administrators Clinicians learn from their seniors, inheriting the good and the bad Time frames for decision making in clinical practice are vastly different than those in administration The definition of a team is imprecise and clinical groups are often smaller than organizational teams.

10. THE TIMES, THEY ARE A’CHANGIN

11. AND WE MAY NOT HAVE THE TOOLS WE NEED

12. WHAT IS NEEDED? THINGS I NEVER LEARNED IN SCHOOL Strategic planning Persuasive communication Negotiation, contracting Finance, coding, revenue cycle Team building Conflict resolution Information Technology HR - hiring, firing, performance review Legal issues, regulatory compliance

13. WHAT ARE THEY LOOKING FOR? Beatrice: the ideal administrator A detail-oriented, strategic thinker Understanding of physician personalities Ability to choose one’s battles Communication skills

14. AND WHAT DO YOU NEED? A realistic job description Authority, not just responsibility Treatment as a management partner, especially in staffing issues Latitude to use one’s own methods Full access to financial data Credit for successes

15. HAZARDS TO NAVIGATION WHERE THINGS CAN GO WRONG

16. WHEN GOOD PRACTICES GO BAD Collisions between business needs and quality of patient care Adoption of new systems and processes Transitions from production to quality and value

17. COLLISIONS BETWEEN BUSINESS IMPERATIVES AND PATIENT CARE Scheduling - how many of these increasingly complex patients can I see per hour? Patient Care vs Customer Service - is there a nice way to say that you are overweight and smoke/drink too much? Fitting the variable workflow of individual physicians into a coherent process.

18. ADOPTION OF NEW SYSTEMS AND PROCESSES Information technology Quality and Service Benchmarks Chronic disease management and delegation of responsibility to other team members

19. TRANSITIONS FROM PRODUCTION TO QUALITY AND VALUE How am I measured? Dollars are easier to count than brownie points. What does “value” mean? From the standpoint of the payor, it means offloading risk to someone else. How do we assess which new physicians will fit best into the new care paradigm? And what do we do with those who can’t, especially when they own the business?