Collaborative Steps

Dr. Cohn receiving Dean Conley Award at ACHE Congress

Dr. Cohn receiving Dean Conley Award at ACHE Congress

It’s time for some shameless self-promotion.  Lee Milteer wrote that in difficult times, we must give ourselves permission to have some positive personal awards.

The photo, which I received this week from the American College of Healthcare Executives (ACHE), shows me accepting the Dean Conley Award from Chris Van Gorder, President and CEO of Scripps Health and Chairman-Elect of the American College of Healthcare Executives.  The Conley Award, which honors ACHE’s executive director from 1942 to 1965, is granted annually to recognize the contributions made to healthcare management literature and to encourage healthcare executives to write and publish articles. “The Tectonic Plates Are Shifting: Cultural Change vs. Mural Dyslexia” was selected by ACHE’s Article of the Year Awards Committee.

I wrote the article with Professor Leonard Friedman and Dr. Thomas Allyn to point out that:

  •  a rapidly changing healthcare marketplace
  • a variety of new business models
  • increased global economic competition, and
  • the need to improve clinical and financial outcomes can bring physicians and hospitals together rather than drive them farther apart.

This article outlines strategies hospital leaders can use to engage physicians and work more interdependently, such as positive deviance and structured dialogue. I concluded with a ten-step guide to engaging physicians and improving care:

1.Encourage practicing physicians to articulate future clinical priorities to increase their sense of shared ownership and to improve clinical outcomes.

2. Include doctors who are users of radiology, anesthesiology, pathology, and emergency services when drawing up contract specifications and monitoring performance to improve service; physicians may pay lip service to administrators but listen to other physicians who refer patients to them.

3. Establish a hotline for process improvement issues that is tracked at least monthly in senior management meetings to make sure that the communication loop is closed.

4. Treat the top 20 percent of physicians (by volume or revenue) as partners, and visit them at least quarterly regardless of irascibility.

5. Ask “go-to” docs, “What can we take off your plate?” at least semiannually to monitor
and reduce burnout; a recent poll of over 24,000 surgeons showed that approximately 40% met criteria for burnout.

6. Map out policies and procedures to improve effectiveness and refine handoffs, especially when people complain that they are short-handed. Staff creep often results from workarounds created by inefficient processes. Inefficiencies can be identified and improved by putting each step on a Post-it note and asking members of a group to remedy the gap between what should be happening and what is actually occurring.

7. Have the chief information officer and programmers round periodically with physicians to see how physicians struggle with information technology and how the physicians could use their limited time more productively.

8. Develop a hospitalist surgical service to off-load call burdens for physicians and to diminish the need to pay stipends to physicians for carrying a beeper.

9. Celebrate and reward all healthcare professionals who exceed their job descriptions. Stories of such professionals can become the basis of a positive culture that strives to improve outcomes and service to patients and family members.

10. Establish a pool with fines for using hot-button words (such as “you,” “always,” never,” “but,”) and killer phrases (such as “let’s appoint a committee to study that some more”) and use the money to support a worthwhile service or pay for a celebration.

Those who want to read “The Tectonic Plates Are Shifting: Cultural Change vs. Mural Dyslexia” in its entirety may do so by clicking the link.  I will also discuss its implications, including how to recognize and stop the dance of the blind reflex, use healthy competition to avoid the “herding cats” mentality, develop sustainable medical staff models, implement proactive physician recruitment, retention, and contracting strategies, deal with Emergency Department call-pay, and support healthcare innovation at a 2-day ACHE seminar, Practical Strategies for Engaging Physicians, July 15-16, 2009 in Lake Geneva, WI.

I empathize with the effects of the recession and the limits placed on travel to acquire continuing education.  I hope that the rewards for investing in improving physician-hospital relations will reemerge soon.

What do you think?

  • Do you feel the tectonic plates shifting where you work
  • Does change feel like failure when we are in the middle of it
  • Are any of the ten steps listed above relevant to your work setting

As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn
© 2009, all rights reserved

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2 Responses to Collaborative Steps

  1. Anne June 9, 2009 at 3:52 am #

    Is a very good idea.

  2. Bob Durham August 4, 2009 at 10:49 pm #

    I agree with you that physician collaboration is mission critical with respect to improvement opportunities within inpatient hospital settings. We are often surprised by the nominal accuity healthcare executives we talk with are associating with their understanding of which physicians are in the top 20 percent for their organization, and then drilling down to associated service line clinical/financial outcomes. Thx for your insights – Bob

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