1. Transparency, Communication, and Faculty Motivation Rebecca M. Minter, MD Vice Chair, Clinical Operations and Finance AASA New Administrators Workshop October 4, 2015 Department of Surgery

2. Disclosures  I am a faculty member  I am new to my role in Clinical Operations  I am not new to managing teams  I believe effective communication is critical and transparency is a natural result  I have no financial disclosures Department of Surgery

3. Goals for this talk  Develop an understanding for how to effectively communicate with faculty  Explore the pros and cons of transparency  Broaden one’s understanding of what truly motivates high performing individuals Department of Surgery

4. Communication Basics Department of Surgery Miscommunication Email is not a good medium for complicated or unpopular communications! Effective communication is very time consuming!

5. Communication Basics Department of Surgery No communication

6. No Communication Department of Surgery  Purposeful (not usually)  Path of least resistance  No time “I emailed so and so and I never got a response.”

7. No communication Department of Surgery

8. Finance Speak Department of Surgery / 15%

9. Watch your crowd Department of Surgery Elements of Personal Communication 7% spoken words 38% voice, tone 55% body language

10. Faculty Phenotypes Blissfully Ignorant Department of Surgery Just Want to Understand Everyone is Trying to Screw Me 15% 80% 5%

11. Faculty Phenotypes Blissfully Ignorant  Happy Department of Surgery Just Want to Understand Everyone is Trying to Screw Me

12. Faculty Phenotypes Blissfully Ignorant  Happy  Goal Oriented Department of Surgery Just Want to Understand Everyone is Trying to Screw Me

13. Faculty Phenotypes Blissfully Ignorant  Happy  Goal Oriented  Often Focused in a Particular Area Department of Surgery Just Want to Understand Everyone is Trying to Screw Me

14. Faculty Phenotypes Blissfully Ignorant  Happy  Goal Oriented  Often Focused in a Particular Area  Surprised when they get a bonus Department of Surgery Just Want to Understand Everyone is Trying to Screw Me

15. Faculty Phenotypes Blissfully Ignorant  Happy  Goal Oriented  Often Focused in a Particular Area  Surprised when they get a “bonus” Department of Surgery Just Want to Understand  Curious – “Explain to me how…..” Everyone is Trying to Screw Me

16. Faculty Phenotypes Blissfully Ignorant  Happy  Goal Oriented  Often Focused in a Particular Area  Surprised when they get a “bonus” Department of Surgery Just Want to Understand  Curious – “Explain to me how…..”  Want to feel in charge of their own destiny Everyone is Trying to Screw Me

17. Faculty Phenotypes Blissfully Ignorant  Happy  Goal Oriented  Often Focused in a Particular Area  Surprised when they get a “bonus” Department of Surgery Just Want to Understand  Curious – “Explain to me how…..”  Want to feel in charge of their own destiny  Will respond to data Everyone is Trying to Screw Me

18. Faculty Phenotypes Blissfully Ignorant  Happy  Goal Oriented  Often Focused in a Particular Area  Surprised when they get a “bonus” Department of Surgery Just Want to Understand  Curious – “Explain to me how…..”  Want to feel in charge of their own destiny  Will respond to data  May prefer a more scripted incentive plan Everyone is Trying to Screw Me

19. Faculty Phenotypes Blissfully Ignorant  Happy  Goal Oriented  Often Focused in a Particular Area  Surprised when they get a “bonus” Department of Surgery Just Want to Understand  Curious – “Explain to me how…..”  Want to feel in charge of their own destiny  Will respond to data  May prefer a more scripted incentive plan Everyone is Trying to Screw Me  Suspicious - think you are trying to hide things

20. Faculty Phenotypes Blissfully Ignorant  Happy  Goal Oriented  Often Focused in a Particular Area  Surprised when they get a “bonus” Department of Surgery Just Want to Understand  Curious – “Explain to me how…..”  Want to feel in charge of their own destiny  Will respond to data  May prefer a more scripted incentive plan Everyone is Trying to Screw Me  Suspicious – think you are trying to hide things  Often intimidating

21. Faculty Phenotypes Blissfully Ignorant  Happy  Goal Oriented  Often Focused in a Particular Area  Surprised when they get a “bonus” Department of Surgery Just Want to Understand  Curious – “Explain to me how…..”  Want to feel in charge of their own destiny  Will respond to data  May prefer a more scripted incentive plan Everyone is Trying to Screw Me  Suspicious - think you are trying to hide things  Often intimidating  Generally glass half empty type of folks

22. Faculty Phenotypes Blissfully Ignorant  Happy  Goal Oriented  Often Focused in a Particular Area  Surprised when they get a “bonus” Department of Surgery Just Want to Understand  Curious – “Explain to me how…..”  Want to feel in charge of their own destiny  Will respond to data  May prefer a more scripted incentive plan Everyone is Trying to Screw Me  Suspicious - think you are trying to hide things  Often intimidating  Generally glass half empty type of folks  No incentive plan is fair – others are getting more than they are

23. Communication strategies Blissfully Ignorant  Happy  Goal Oriented  Often Focused in a Particular Area  Surprised when they get a “bonus” Department of Surgery Just Want to Understand  Curious – “Explain to me how…..”  Want to feel in charge of their own destiny  Will respond to data  May prefer a more scripted incentive plan Everyone is Trying to Screw Me  Suspicious - think you are trying to hide things  Often intimidating  Generally glass half empty type of folks  No incentive plan is fair – others are getting more than they are

24. Communication Landmines The compensation plan The incentive plan Department of Surgery

25. A Tale of Two Comp Plans Department of Surgery Operating Margin by Division and Department Collections Model CTCRSGSTrBSOVasTXPedPlaDept Oper Margin++++++++++ +++

26. A Tale of Two Comp Plans  Cardiac & Thoracic Surgery (blended)$61.43  Colorectal Surgery$47.83  General Surgery$57.47  Trauma Surgery$55.39  Surgical Oncology$48.79  Vascular Surgery$50.66  Transplant Surgery$59.13  Plastic Surgery$65.40  Pediatric Surgery$81.18 Department of Surgery Median AMGA Compensation to Work RVU Ratio 2011-2014

27. A Tale of Two Comp Plans Department of Surgery Operating Margin with Specialty Specific AMGA wRVU Payments CTCRSGSTrBSOVasTXPedPlaDept Oper Mar - Col ++++++++++ +++ Oper Mar - wRVU ++++ ++---+++ ++++ ++

28. A Tale of Two Comp Plans  Cardiac & Thoracic Surgery (blended)$61.43  Colorectal Surgery$47.83  General Surgery$57.47  Trauma Surgery$55.39  Surgical Oncology$48.79  Vascular Surgery$50.66  Transplant Surgery$59.13  Plastic Surgery$65.40  Pediatric Surgery$81.18 Department of Surgery Median AMGA Compensation to Work RVU Ratio 2011-2014 Blended wRVU payment of $65.00

29. A Tale of Two Comp Plans Department of Surgery Operating Margin with Specialty Specific AMGA wRVU Payments CTCRSGSTrBSOVasTXPedPlaDept Oper Mar - Col ++++++++++ +++ Oper Mar - wRVU +++ ++½ ++ ++

30. So What Happened?  Three years later……..  Annual Faculty Satisfaction Survey Department of Surgery Excerpted Questions20122014 14. I am compensated fairly for my work76% agree54% agree 15. I am compensated fairly as compared to my peers at other institutions 65% agree40% agree

31. In Debriefing…..  Failure to adequately communicate the process, logic, and modeling that supported the decision for a blended model  Failure to engage all stakeholders in the planning and decision-making  What steps were undertaken to address the problem? Department of Surgery

32. The second landmine The incentive plan Department of Surgery

33. The incentive plan  Assure understanding of the source for incentive payments, and the criteria for earning an incentive  Differentiate a bonus plan from an incentive plan – which is it?  You must understand what motivates an individual Department of Surgery

34. What is the source of incentive payments?  Clinical revenue –But at what level? –Department? –Division? –Section?  “The department” Department of Surgery

35. Criteria for earning an incentive  Is it an incentive or a bonus?  Prescriptive versus flexible  Are criteria pre-defined? –At the level of the individual or the group?  How was it communicated to the faculty? Department of Surgery

36. Incentive plans Department of Surgery What motivates an individual faculty member? What are you trying to incent?

37. The surprising truth about what motivates us……… Department of Surgery https://youtu.be/u6XAPnuFjJc

38. Motivation – Take-home points  If/then rewards work for simple tasks –Do more cases, get an incentive payment  Principle of “Pay people enough to take the issue of money off of the table” is important –Opens the door to set the bar high for an incentive to be earned Department of Surgery

39. Motivation  Important to remember – “When the profit motive becomes unmoored from the purpose motive bad things happen.” –Unnecessary procedures –Internal competition –Failure to properly supervise Department of Surgery

40. Motivation  Make the task more complex and empower the faculty to find a solution –Autonomy –Mastery –Purpose  Individuals are internally motivated – and their motivation is hard-wired and unique –What makes them tick? Department of Surgery

41. Downside to Transparency?  Recognize there are pros and cons to transparency –It can be a burden to young faculty members and the “blissfully ignorant” –It takes time and may create less “flexibility” Department of Surgery The positive effects far outweigh the downsides which can be managed.

42. Summary  Communication and Transparency –Tailor your message to the faculty phenotype –Always respond – even if only to say you need more time –Engage the faculty in decision-making (autonomy) –Ensure there is understanding – explain the reason why! –Try to predict the communication landmines and be proactive! Department of Surgery

43. Summary - Motivation  Motivation is individual and unique  Carrots and sticks only work for simple tasks  Try to pay individuals enough to take the issue of money off the table  Set a high bar for the incentive – motivate them to achieve the BHAG Department of Surgery

44. Thank you