I began using the term “co-mentoring” to describe this process because I believe that each person brings valuable knowledge, experience, and wisdom to the table.  Although I was helping physicians with process skills to improve communication, negotiation, and conflict resolution, they taught me things that helped me refine my approach.  One of my physician colleagues has pointed out how important the co-mentoring prinicple is with physicians who are sensitive to hierarchy. 

Some of my most gratifying moments have been in co-mentoring relationships with physicians.  The section chief proved that he was not stupid by crafting a bold and far-reaching vision of where the section of general surgery needed to go.  The colleague who made the comment about sensitivity to hierarchy evolved from a “rock-throwing member of the medical staff to Vice President of Medical Affairs … striving to promote co-mentoring relationships.”

When I helped set up a physician co-mentoring program recently, I asked physicians, “What makes a great co-mentor?” They replied:

• Personal connection
• Passion
• Insight
• Availability
• Active listening
• Mutual respect
• Clear vision and expectations

We agreed that to set up a safe environment for learning, they needed to:

• Learn about each other’s background, training, families, and extracurricular interests during their first encounter
• Reassure each other that there are no dumb questions
• Share painful on-the-job learning moments
• Be proactive, contacting each other frequently in the beginning to ask how they could be of assistance to each other

I have found that through co-mentoring, we can create a new generation of physician leaders who can increase transparency, improve physician-physician and physician-administration collaboration, and minimize physician-hospital battles.

What do you think?

• Do you agree that physicians enjoy learning from fellow physicians
• Have you seen dividends for leadership emerge from physician co-mentoring
• Is co-mentoring a process worth the investment

I welcome your input.

Kenneth H. Cohn

©2012 Healthcare Collaboration. All Rights Reserved.

Collaborative Co-mentoring is an original post from Kenneth Cohn on Healthcare Collaboration - Improving Physician-Hospital Relations

Dr. Cohn’s passion has been helping physicians, hospital executives, nurses, and board members to work more interdependently.  The joy of seeing skeptical physicians act like owners to improve care for their communities has been exciting and fulfilling, with sustainable improvement in clinical and financial outcomes.

For example, at Santa Barbara Cottage Health System, following a clinical priority setting project that Dr. Cohn facilitated, an orthopedic surgeon persuaded his colleagues to consolidate implant vendors from eight to two, saving the hospital $4.2 million over the next three years.  CEO Ron Werft remarked, “Dr. Cohn was instrumental in a successful medical staff planning process at Cottage Hospital in 2003.  He gained the trust of the physicians very early on and helped them establish important clinical priorities for our hospital.

Dr. Cohn helps create a safe environment for learning and reflection despite a rapidly changing marketplace that makes conflict inevitable.  For example, he facilitated a project that allowed a hospital system to partner with its physicians in a way that made a long-term building project successful, as CEO Tom Gagen described below:

We were in a situation where we needed to consolidate two campuses for both economic and quality improvement.  Ken showed us a way to start an interface of physicians and hospital executives, alerting physicians to the complexity of running a hospital and helping hospital executives feel more comfortable engaging practicing physicians.  In addition, even though I have been in Hospital Administration for many years, I now have a better understanding of the complexities physicians face and how to communicate with them with their concerns more in mind.

For the first time in our history, we now have a roadmap written by a consensus of our top clinicians; we also have identified several previously unidentified physician leaders who can help us go forward. Ken facilitated both processes.

Ken accomplished what he did in an atmosphere of integrity and sensitivity, increasing trust and transparency from the physician and hospital administrator perspectives.

Dr. Robert Schott, Medical Advisory Panel co-chair and later VPMA,  wrote: at Sutter,  [Dr. Cohn] successfully brokered a peace by coaxing the disaffected parties into a substantive discussion by helping to define the issues which fueled the mistrust. It was one of the most interesting and helpful processes in which I have had the opportunity to participate!

Dr. Cohn helps hospital executives become more comfortable with clinical issues, allowing them to ask patient-related questions without fear of ignorance or embarrassment, for example:

• CEOs with strategy, culture, and performance issues relating to physicians, physician engagement, conflict resolution, and physician leadership development
• COOs with operational issues that affect physicians’ use of time, ways to reduce the cost of expensive supplies  (such as prostheses), and financial collaboration strategies, including medical staff employment models
• Physician executives (VPMAs, CMOs) to understand the interface of business and medicine and to develop effective communication and conflict resolution strategies with practicing physicians and other C-suite executives, which allows them to be an integral part of the process of change
• Nurse executives to understand and depersonalize physician attitudes and to vent confidentially about male-female behavior differences that affect the workplace environment
• CFOs and CIOs to become more comfortable with clinical issues as seen by practicing physicians, such as ways to engage physicians to adopt and use electronic health records

A hospital executive confided, “If I have a problem with my board, I can resolve it.  But if I have a problem with doctors and they tell other influential doctors, I better dust off my resume.”
(Cohn KH. A Practicing Surgeon Dissects Issues in Physician Hospital Relations. Journal of Healthcare Management. 2009; 54(1):5-10).

When you want to obtain harmony with your practicing physicians, improve performance, and maintain your job security, please contact Dr. Cohn to schedule a complimentary physician relations strategy session.

Mentoring

Dr. Cohn capitalizes on the fact that physicians enjoy learning from fellow practicing physicians, as he helps physicians learn techniques of active listening, win-win negotiation, and conflict resolution that physicians generally are not taught in medical school, residency, or fellowship.  As Dr. Michael Ivy noted:

Ken earned the respect of both groups for his understanding of business processes and his outstanding ability to communicate.  In part, his success is due to his years as a clinician, which gives him a knowledgeable, genuine physician perspective.

The service he provided went far beyond the scope of the project. For example, he mentored a section chief and obtained for him profit and loss figures that the section chief had never seen before.  He was instrumental in helping that section chief craft a bold, far reaching presentation.  He consistently reached out to the other presenters and provided them with invaluable assistance.

Ken’s understanding of the problems facing hospitals and physicians in these challenging times is outstanding. He continually offers succinct, timely advice and brilliant insight, which allowed me to chair a Medical Advisory Panel in an effective and efficient manner. I recommend hiring him because he has done an outstanding job for us on this crucial project.

Physicians enjoy learning from fellow practicing physicians, as this Chief of Staff noted:

I am currently chief of staff at a 350-bed hospital that has been bleeding red ink for two years. In ten months, we lost 20% of our hospital governing board, fired our CEO and CMO and hired a new CEO.  I realized in my first year that I needed an experienced guide to help me with basic survival and to use my experiences for personal and professional growth.

Ken has been a tremendously valuable resource.  He has made himself available when crises loom.  His calm objectivity and talent for reframing issues have helped me find my way forward, and, at times, I am amazed at how much better equipped I feel to deal with my daily duties as a medical staff officer.
Debra Morley, M.D.

Dr. Cohn uses the term “co-mentoring” because it emphasizes that each party brings knowledge, strength, and wisdom to the process:

Over the course of 2 years I have evolved from a rock-tossing member of the medical staff to the VPMA at my hospital, where I work with administration and my fellow physicians, striving to promote co-mentoring relationships.

Co-mentoring implies that the partners in the relationship are on equal footing, which greatly improves communication, particularly among physicians who are sensitive to hierarchy.

Ken Cohn facilitated a dialog between the medical staff and administration in 2005, which was transformational, both for the institution and for me personally.

I recognized that the hospital and medical staff shared an important objective: providing the highest quality patient care, and that we could best fulfill that goal by finding ways to work together. We have identified a new generation of physician leaders that has begun to change the practice environment and our workplace culture.

Ken brought us along with a formidable toolkit that allowed us to define and begin working through critical issues from a starting point where basic civility was not necessarily the norm.
Robert J. Schott, MD, MPH, FACC

Ken Cohn is an inspiring teacher and speaker. He combines self-deprecating humor with infectious enthusiasm for his subject. More importantly, he has penetrating insight into the complicated dynamics between doctors and administrators, as well as between doctors and doctors. His skills were instrumental in accomplishing a significant turnaround in the dysfunctional relationship between our medical staff and hospital leadership.
Chuck Rinker, MD

You are the “can do” physician trainer and consultant. 
Steven BabitskyPresident, SEAK

When you:

• Face clinical resource issues that require partnering with your practicing physicians
• Need to work smarter rather than harder
• Want to create a lasting legacy based on sustainable collaboration

Please contact Dr. Cohn to discuss field-tested ways that he can help you improve performance at your organization.

©2012 Healthcare Collaboration. All Rights Reserved.

Consulting and Mentoring is an original post from Debra on Healthcare Collaboration - Improving Physician-Hospital Relations

Sea of Cortez

Last week, I had the pleasure of facilitating a medical staff retreat in a setting to which I always enjoy returning.

The didactic sessions were great, and what I will always remember was a dinner in which I was seated near an orthopedic surgeon. He said passionately:

I am the problem…. I want to make a difference

He agreed that in the 70’s, when physicians exited the administrative arena because it was not what they were trained to do, they created a vacuum into which people flowed who do not share our values. He admitted that to make a difference and not follow others’ rules, he  needs to stretch his comfort zone and learn skills not taught in medical school, residency, and fellowship training.

He actually said, “That would be cool,” when we discussed additional leadership development training focused on problems that he faced at work that interfered with his efficiency and effectiveness.

It reminded me of what a fellow general surgeon told me nearly a decade ago: “We’re not stupid. We just need to be trained.” As a result of our mentoring, the general surgery section crafted a bold, far-reaching Medical Advisory Panel report to meet the needs of referring physicians and patients.

As I described in The Lifelong Iterative process of Physician Retention, where we reduced physician turnover from 10% per year to 0 by teaching physicians to be better mentors, I believe that mentoring is a great way to make a difference. None of us got to where we are now without help. Mentoring appeals to the most noble of our instincts: to reach out to others and be a part of something larger than ourselves.

Mentoring teaches us collaborative skills and enhances our leadership skills in areas that build cohesion. The problem with the leadership roles to which we are exposed during training is that they sabotage teamwork:

• Command-and-control may be called for when a patient is in shock and needs rapid attention, but overuse leads to tyranny, resentment, and revolt.
• The pacesetting approach, where a leader sets the example, does not create a safe climate for reflection and learning when it is overused.

Every hospital leader I know needs physician champions in leadership roles to improve quality and safety and meet increasingly stringent regulatory mandates. It seems ironic to encourage hospital leaders to invest in executive coaching for themselves and their teams and let physician leaders develop administrative expertise by attending committee meetings, which one physician described as “a life sentence,” and another as “an experience that took minutes but robbed hours.”

What do you think?

• Have you witnessed physician champions emerge at unpredictable times to lead your organization during difficult times
• Is mentoring their development a strategic use of your resources
• The comic strip Pogo showed a character waving a tattered flag that said, “We have met the enemy, and it is us;” Does the Pogo epiphany apply to healthcare collaboration where you work?

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

Kenneth H. Cohn

© 2011, all rights reserved

Disclosure:

Although I received compensation for facilitating the medical staff retreat, I have not received any compensation for writing this content.

©2012 Healthcare Collaboration. All Rights Reserved.

Making a Collaborative Difference: The Pogo Epiphany is an original post from Kenneth Cohn on Healthcare Collaboration - Improving Physician-Hospital Relations

In their survey of 549 surgical oncologists, 24% reported emotional exhaustion, 15% feelings of depersonalization (decreased empathy), and 10% low personal achievement.  These three domains of the Maslach burnout inventory are the antithesis of job engagement, energy, involvement, and a sense of efficacy, according to the authors.   Not engaging in research, perceiving a lower quality of life (in surgeons who reported performing on average 11 or more operations per week), and age younger than 50 were twice as likely to be associated with burnout.

That those older than 50 were less likely to experience burnout may be multifactorial:

• natural selection: those who experienced burnout may have left already for other settings and thus were not included in the survey
• entitlement: professors, section chiefs, and/or or department chairs, who tend to be older surgeons, may have more resources for being productive, such as secretaries, nurse practitioners, and laboratory technologists
• privilege: older surgeons may have shifted clinical burdens, such as the bulk of night and weekend call, to younger surgeons to allow them to “build their practices”
• travel: older surgeons may be traveling more to other settings to speak and attend meetings

Why should performing research be associated with lower burnout scores?  Surgeons who perform research usually have protected time, i.e. days when they are not responsible for seeing patients.  While their full-time clinical colleagues (aka “the grunts”) may feel that they are in a state of siege from the time that they arrive at work until they leave, surgeons who do research may have time to reflect, that they can decide how to spend, rather than be on the “electronic leash,” a term of (less-than) endearment for the beeper. 

I know because I am a “recovering academic surgeon,” who used to perform grant-funded research in the molecular biology of colorectal cancer (Cohn K, Macnab J, Ornstein D, Wang F, DeSoto LaPaix F, Phipps K, Edelsberg C, Zuna R, Stein J, Mott L, Tosteson T, Dunn J, Steeg P. Association of nm23-H1 allelic deletions with distant metastases in colorectal carcinoma: Results of a 5-year follow-up study. Cancer, 1997; 79:233-244.)

Standard intrapersonal recommendations to combat burnout include (Cohn KH. Better Communication for Better Care: Mastering Physician-Administrator Collaboration, Chicago, Health Administration Press, 2005.):

• Cultivating a sense of perspective and humor
• Vacation
• Exercise
• Meditation
• Seeking counseling when feeling the need to treat symptoms of burnout with alcohol or other habit-forming substances

Standard interpersonal recommendations to treat burnout include:

• Respecting colleagues’ nights and weekends off duty
• Sharing feelings with others who have related a stressful event or multiple events
• Showing concern when colleagues exhibit symptoms of burnout and helping them obtain assistance before patient care suffers

The authors admit that controversy persists over whether “systems” need to be changed or whether we need to provide more opportunities that faculty perceive as professionally enhancing and intrinsically rewarding.  Why not do both?  In Collaborative Learning: Becoming More Comfortable with Paradox, I  quoted F. Scott Fitgerald that “the test of a first-rate intelligence is the ability to hold two opposed ideas in the mind at the same time and still retain the ability to function.”

I was pleased that Kuerer et. al. discussed “the critical importance of mentorship,” both to the mentor and mentee: “there is no greater joy than helping others to find their way and feel wanted, understood, and supported…. Receipt of mentorship is not limited to any particular point in one’s career, and mentees can concurrently or consecutively use a broad network of mentors to develop different kinds of expertise.”

Building on Kuerer et. al., I wrote Collaborative Co-mentoring, to point out that each person brings valuable knowledge, experience, and wisdom to the table.  When I helped set up a physician co-mentoring program recently, I asked physicians, “What makes a great co-mentor?” They replied:

• Personal connection
• Passion
• Insight
• Availability
• Active listening
• Mutual respect
• Clear vision and expectations

What do you think:

• What can we do to monitor and deal with burnout proactively?
• Do we currently acknowledge healthcare professionals in distress without penalty?
• If not now, when?

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

Kenneth H. Cohn

©2012 Healthcare Collaboration. All Rights Reserved.

Collaborative Reflection is an original post from Kenneth Cohn on Healthcare Collaboration - Improving Physician-Hospital Relations

Why is it that women hold nearly 80% of healthcare jobs but occupy fewer than 15% of senior leadership positions?

Isn’t it time for that to change?

The confluence of healthcare reform, budget deficit cutting, and the transition to more value-based metrics is causing disruptive changes in healthcare that affect all of our communities. Women who value relationships and who embrace change as an opportunity to improve have the power to transform the way that we care for patients.

Learn from women who have been there and succeeded how to:

• Navigate the labyrinth of your healthcare career
• Leverage your strengths in networking and mentoring
• Use the rules of the game to your and your organization’s advantage
• Engage physicians, especially those who are reluctant to be engaged

Click to pay and register »

Join Kathy McDonagh, Nancy Paris and Ken Cohn in a series of audio conferences for aspiring women healthcare executives.

We’re so confident that you’ll enjoy all four conferences, we’re now giving you the first AND second session recordings for free! Fill out the following form to receive these recordings Navigating the Labyrinth/ Engaging Physicians and Leveraging the Power of Women’s Leadership Skills:

* - required

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Event Highlights

Watch a short video for more information on this program:

http://www.youtube.com/watch?v=ieA5GSZpw1Q

Secure your spot in this unique professional development audio conference for women healthcare executives. By attending this online conference, you will:

• Understand why the term “labyrinth” describes the interactive learning journey better than a “glass ceiling” that conveys the risks and fears of broken glass
• Utilize techniques that come naturally to women who are socialized to value relationships
• Develop proactive strategies to engage physicians to improve processes where you work
• Learn cutting-edge practical strategies, tactics, and tools to accelerate your career progression from successful women healthcare executives.

Click to pay and register »

Who: This course is for aspiring women healthcare executives and for men willing to embrace the 23 chromosomes that derive from their mothers. Learning more about successful women’s leadership skills can help both sexes improve their ability to obtain results.

What: You receive four hours of valuable information, the PowerPoint slides and an MP3 recording of each conference. Participants are also eligible for one (1) hour non-ACHE continuing education credit per audio conference. Sign up for the series even if you cannot join us live for all the audio conferences.

Where: Attend this live event at your home or office – no travel required!

When: Thursday, 12 to 1 PM eastern time (9 to 10 AM Pacific). All sessions are recorded and each attendee receives an MP3 recording to keep.

• January 5, 2012
• February 2, 2012
• March 8, 2012

Why: Anyone who wants to further her career and, at the same time, improve efficiency, teamwork, and collaboration, especially administrators responsible for clinical departments and service lines. Everything that you learn in this audio conference series can help you increase your organizational effectiveness and improve care for your community. One of the most important investments that you can make is in your career development.

How:

Click to pay and register »

We offer a money-back guarantee if you are not satisfied with what you learned.  Just let us know your reasons for dissatisfaction, and we will refund your payment.

Audio Conference Agenda

September 8, 2011: Navigating the Labyrinth/ Engaging Physicians

Listen to a summary of this audio conference

Nancy Paris and Kathy McDonagh review practical strategies for navigating the labyrinth of healthcare career progression and Ken Cohn reveals secrets for engaging physicians, especially those who resist engagement. You will learn:

• How to navigate the labyrinth of women’s healthcare leadership roles from people who have been there and succeeded
• Effective strategies for leveraging systems, culture, and relationships
• Ways to engage physicians, especially challenging physicians who resist engagement: insights from a fellow practicing physician

October 6, 2011: Leveraging the Power of Women’s Leadership Skills

Listen to a summary of Maureen’s audio conference

Maureen Bisognano, CEO of the Institute for Healthcare Improvement discusses ways that women can leverage strengths, such as networking and nurturing to be more successful. You will learn:

• How to leverage the power of nurturing to maintain effective organizations
• Effective strategies for mentoring and being mentored
• How maintaining focus on improving organizational safety can benefit both patients and one’s career

Maureen made the cover of Modern Healthcare April 18, 2011 as one of the the Top 25 Women in Healthcare.

January 5, 2012: Play Like a Man, Win Like a Woman

Listen to a summary of the audio conference

Gail Evans, Associate Professor of Business, Georgia Tech School of Management, previously EVP at CNN and author of the New York Times, Wall Street Journal, and Business Week bestseller, Play Like a Man, Win Like a Woman, discusses how the game is played and how you can win at it without compromising your values. You will learn:

• The rules of the game as men play it
• To love the game
• How to set up your own winning team
• Ways to use the resources already at your disposal much more powerfully
• Rainmaking, and why it’s absolutely essential to women’s success
• When to stay quiet and when to share information
• Why women should forget networking and start “webbing”

February 2, 2012: Pathways to the Journey of Success and Sustainability

Ninfa Saunders, President and COO of Virtua Healthcare System speaks on how she balanced learning, performance, and sustainability to become president of a four-hospital system in New Jersey. You will learn how to:

• Prepare yourself technically to become a healthcare executive
• Differentiate yourself in the marketplace
• Have in place a system of values that projects your authenticity, balance, and sustainability

March 8, 2012: Systematize Your Way to the Top

Beth Schneider, CEO of Process Prodigy, works with high-achieving professionals to:

• Work smarter rather than harder
• Get more tasks accomplished in a shorter period of time
• Keep important items from falling through the cracks

Beth will discuss patterns that she has noted in women career professionals that have stymied their career progression and how adopting a more systems-oriented approach can help women get unstuck and achieve greater career fulfillment.

Meet the Faculty

Kathryn J McDonagh, RN, PhD, FAAN, FACHE is Vice President Executive Relations at Hospira, Inc. She has been a CNO, COO and CEO at such organizations as Saint Joseph’s Health System of Atlanta, Saint Thomas Health Services in Nashville, Saint Clare’s Health Services in New Jersey and CHRISTUS Spohn Health System. She has published extensively and speaks at national conferences about governing board effectiveness and healthcare leadership topics. Kathy won a Telly Award in 2000, a National Cable Television Award, for her role as host and creator of the program Focus on Health.

Nancy Paris, BA, MS, FACHE is President and CEO of the Georgia Center for Oncology Research and Education. She has served as President of St. Joseph’s Mercy Care Services and as Vice President of the Georgia Baptist Healthcare System. In 2002, she was named Woman of the Year in Healthcare by Women Healthcare Executives.

Nancy and Kathy teach the acclaimed ACHE seminar, The Power of the Labyrinth: Women’s Wisdom on Career Advancement in a New Age.

Kenneth H. Cohn, M.D., MBA, FACS is a nationally recognized practicing surgeon and MBA who has worked to promote increased healthcare collaboration for over 15 years. His books, Better Communication for Better Care, Collaborate for Success! and Getting It Done, have sold over 5,000 copies.

Ken is a faculty member of the American College of Healthcare Executives, Estes Park Institute, The Governance Institute, The Healthcare Roundtable, and New England College. One of his seminar participants called him “a women’s healthcare executive’s secret weapon.”

He blogs on physician-hospital relations at HealthcareCollaboration.com Getting It Done.

Questions

Why did you put together an audio conference series for aspiring women healthcare executives?

Because we feel strongly that women have the skills to succeed in today’s complex environment and are under-represented in the c-suite. We want to pay forward by investing our time to help the next generation of women healthcare executives succeed beyond their wildest dreams.

Men who want to learn more about the ways that successful women lead and obtain results are also welcome to attend and participate in these four audio conferences.

I can’t attend all the live sessions. Will I get a recording?

Yes. For each session we’ll provide a recording you can listen to so you won’t miss a thing. If you have other commitments (like a day job) or if a session occurs at an inconvenient time, no need to worry. Even if you attend a live session, you’ll still get the recording. When you sign up for the entire series, you will receive an mp3 file for each audio conference within two weeks after the scheduled date.

What if I still have questions?

If you have other questions, email us at info@healthcarecollaboration.com or call (978) 834-6089 eastern time.

©2012 Healthcare Collaboration. All Rights Reserved.

Audio Conferences for Aspiring Women Healthcare Executives is an original post from Debra on Healthcare Collaboration - Improving Physician-Hospital Relations

Those of you who have been with me know that I am on a continuous healing journey from being labeled “the problem” to helping find solutions.  Please let me recount a painful lesson from my third year of residency. At 3 AM, after being up over 20 hours, I was asked to evaluate a patient with acid burns of the face, and when I said that we needed to get the patient to a shower immediately to wash off the acid, the triage nurse told me, “Our protocol does not allow an acute patient to be transported out of the ED.”

I lost it. Instead of saying, “Let’s take care of this patient’s acute needs to get the acid off his face and discuss revising the protocol in the morning,” I let her know what I thought about her protocol and took the patient to the nearest shower in the OR changing room.  When I returned with the patient, I learned that I had been reported for swearing at a nurse in front of a patient.

Caught in a “Gotcha” moment, I apologized to the nurse, her boss, the ED Director, the Chief of Surgery, and my program director, to name a few.  Through this incident, I learned that leaders need to remain calm in crises, so that team members can function at peak efficiency.  I also learned not to fight at night and told the story to all residents who would listen once I became chief resident and Assistant and Associate Professor of Surgery, hoping that they would learn from my mistake.

At the end of my residency, I presented a talk at the Society of University Surgeons, entitled “Misadventures in surgical residency: Analysis of mistakes during training” (Current Surgery 42:278-285, 1985).  It was the only talk in which I had a standing room only crowd.  As one surgeon told me, “Everyone wants to hear others admit their mistakes.” 

When asked to comment on my presentation, my program director, Dr. William McDermott, replied, “I have thought of the third year of surgical residency as the peri-menopausal year because residents are in between, no longer interns or junior residents but not yet trusted to do senior-level work.” Later, he reflected on his distinguished career in academic surgery with this wise counsel:

For all of us in healthcare, it is a privilege to be asked to serve.  It means that someone else values what we do and that we can lend a personal touch to the task which we have been assigned.  But after a while, our eagerness to please takes its toll.  We find that, like burrs, things stick to us, and we cannot get away from them without confronting people or leaving to take another job.  So, you might say that we all have the seeds of self-destruction planted within us.

Then,  he smiled at me and said:

Just because we have the seeds of self-destruction planted within us, does not mean that we need to drink Miracle-Grow.

As Thanksgiving approaches, I feel blessed to have benefited from a wonderful mentor like Dr. McDermott.  He is the principal reason that I have devoted time to teaching fellow physicians how to mentor newly hired physicians and why I was proud to write an article showing that teaching physicians to be better mentors improved physician retention significantly (The Lifelong Iterative Process of Physician Retention).

What do you think?

• Has your career benefited from others making the time to mentor you
• How have you reciprocated
• What stories can you share about the co-mentoring process, in which we learn from sharing knowledge and experiences with others

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

Kenneth H. Cohn

© 2009, all rights reserved

PS: This will be my last blog for 2009.  My son, a senior at Purdue in the Naval Reserve Officer Training Program, will begin his Naval aviator training soon.  Our focus will be on family from Thanksgiving through the end of the year.

©2012 Healthcare Collaboration. All Rights Reserved.

Collaborative Learning: Post 80 is an original post from Kenneth Cohn on Healthcare Collaboration - Improving Physician-Hospital Relations

great faith
great doubt
great resolve

One hand

Hakuin asked students, “what is the sound of one hand?” The master wrote, “When you hear for yourself the voice of One Hand, whatever you are doing, whether enjoying a bowl of rice or sipping a cup of tea, all of it you do in the samadhi of living with one bestowed with the buddha-mind.” Samadhi refers to the highest stage in meditation, in which a person experiences oneness with the universe.

The path to collaboration

As a yet-to-be-enlightened male surgeon, the sound of one hand makes me recall the mentoring of the late Dr. Frank Wheelock, who told residents, “If you don’t use both hands, the Good Lord will certainly take one of them away.”  I think of how much louder and heartier applause is when both hands clap together.

In authentic healthcare collaboration, two or more parties meet in the spirit of inquiry rather than advocacy and come to consensus on solutions that benefit patients far more than either party’s solution would do on its own.  Collaboration may take longer, but provides more lasting and sustainable solutions than command-and-control situations, as evident, for example, from:

• Chapter One, where Dr. Fried and colleagues slashed the sepsis mortality rate to 15%, saving over 200 lives, without adding or changing a single drug
• Chapter Six, where Drs. Wilson, Joshi, Schneller, and colleagues have saved millions of dollars in supply costs by collaborating with practicing physicians
• Chapter Twelve, where Dr. Mandel, OR Director, and Susan Phillips, VP of Surgical Services, turned around a moribund operating room culture to boost case volume, revenue, and clinical outcomes

These chapters receive more detailed coverage in the new ACHE self-study guide, Coordinated Care: Improving Clinical and Financial Performance, from which readers can derive six hours of category I credit until December 31, 2011.

Collaboration Flywheel

• Collaboration is an iterative journey in which a more pleasant, effective practice environment facilitates: 1)improved clinical and financial outcomes,
  2) healthcare professional recruitment and retention,
  and 3) the development of outstanding programs that foster improved clinical and financial outcomes.

As always, I welcome your input to improve healthcare collaboration and get it done.

Kenneth H. Cohn

© 2011, all rights reserved

Disclosure:

I have not received any compensation for writing this content.

©2012 Healthcare Collaboration. All Rights Reserved.

The Zen of Healthcare Collaboration is an original post from Kenneth Cohn on Healthcare Collaboration - Improving Physician-Hospital Relations

• Jeff Fried’s chapter on saving lives by improving processes of care highlights the occasionally frustrating but always rewarding journey on which healthcare leaders embark when something inside gnaws at them that clinical outcomes could and should be better. He reveals how depersonalizing differences and finding common ground can save patients’ lives.
• Carl Taylor applies his experience from the disasters in Haiti and the Gulf Coast to help healthcare leaders plan for an uncertain future.
• Chuck Rinker’s three decades of practice in Montana showcase the dilemmas that rural surgeons face in trying to adopt new standards of care for the approximately 30% of US patients who receive care in rural settings.
• Gary Yates and Carol Sale generously share the secrets of how to improve healthcare outcomes by strengthening the organizational safety culture.
• Phil Newbold and Diane Stover describe a bold experiment to tithe a portion of annual revenue toward innovation and the dividends that result in terms of improved people, processes, and outcomes of care.
• Natalia Wilson, Anand Joshi, and Gene Schneller reveal ways that hospitals of all sizes can collaborate to reduce supply costs, typically the second largest expense after labor.
• Bob Hendler describes the opportunities created with healthcare reform legislation for partnering with physicians to capture the care of patients in the medical record and the revenue that may be lost with incomplete documentation.
• Mike Hogue and Drew Erra provide insight into the complex world of ED-call pay and the opportunities for hospitals and physicians to move beyond ransom to incorporate new programs that improve transparency and build trust.
• Ed O’Connor, Barry Mann, and Marlena Fiol describe how physicians improved their medical record compliance to over 99% under the banner of solving leadership challenges.
• Ralph Jacobson writes about two feuding bureaucracies that broke down barriers to coordinating patient care by framing their differences as a paradox with which they could live rather than a problem that they could not solve.
• Bob Reid summarizes decades of experience as a physician executive using a process of structured dialogue with a Medical Advisory Panel composed of physician champions who helped their hospital increase revenue, cut expenses, accelerate patient throughput, and improve clinical outcomes.
• Stan Mandel and Susan Philips highlight the turnaround of operating room performance, morale, and safety by persuading team members to “get on the bus.”
• Susan Lapenta, Larry Harmon, and Mel Belding describe the steps that all healthcare organizations can and must take to address disruptive behavior.
• Elizabeth Becker and Ashley Wendel summarize the lessons learned coaching a dysfunctional cardiothoracic surgery unit to improved team performance
• Joel Berman and Michael Green, who began the healthcare information technology journey in 1997, summarize the lessons that they have learned to accelerate physician adoption.

Finally, William Thompson and his team at SSM highlight what works in a variety of healthcare settings to facilitate physician integration, especially where physicians do not desire hospital employment.

We have pushed our chapter authors to fit their wisdom into a comprehensive framework that highlights their journey in a case presentation and distills the lessons learned into a multi-step sidebar. We sincerely hope that the benefits to organizations that need to get up to speed rapidly outweigh the occasional chafing that occurred in the process.

About the Authors

Kenneth H. Cohn

Dr. Kenneth H. Cohn

Kenneth H. Cohn, MD, MBA, FACS, is a practicing general surgeon and the CEO of HealthcareCollaboration.

Mission of HealthcareCollaboration

To serve the needs of dedicated healthcare professionals who want to work more interdependently to improve clinical and financial performance.

Vision

To be the go-to organization that stands out in the minds of physicians, healthcare leaders, nurses, and board members who want to collaborate to improve care for their communities.

Our Values

• Service: as measured by exceeding client expectations and producing delight with the outcomes of our interactions that solve complex problems
• Integrity: as measured by promises made are promises kept and that data provided are true and kept confidential
• Passion: as measured by intensity of energy, spirit, and commitment to achieve outstanding, transformative results
• Creativity and innovation: as measured by willingness to examine and challenge limiting assumptions in a prudent manner that supports people’s self-esteem and builds on their desire to improve the practice environment where they work and to leave a lasting legacy
• Humor: as measured by a fluid perspective that takes the work more seriously than ourselves

Dr. Cohn has been mentoring physicians in leadership development since 1999. He has written or edited three other books and over 45 peer-reviewed articles.

Steven A. Fellows

Steven A. Fellows, FACHE, is the executive vice president and chief operating officer of Cottage Health System in Santa Barbara, California. He is also an adjunct instructor in the Health Services Administration Program at the University of Southern California, Los Angeles. In his role as a thought leader in healthcare administration, he has evaluated programs in the United States, Vietnam, Armenia, and Nagorno Karabakh Republic.

©2012 Healthcare Collaboration. All Rights Reserved.

About the Book is an original post from Debra on Healthcare Collaboration - Improving Physician-Hospital Relations

Part 1:

http://www.youtube.com/watch?v=fLxxepNj09w

Topics include:

• Why physicians struggle to make it these days
• How Dr. Cohn’s being a cancer survivor changes the way he relates to patients

Part 2:

http://www.youtube.com/watch?v=OCfTLDceeb8

Topics include:

• What is wrong with US healthcare
• How we are all in this together
• Why the lines between doctors and administrators are blurring

Part 3:

http://www.youtube.com/watch?v=K1esDfeMzVY

Topics include:

• The challenge of universal healthcare
• Massachusetts healthcare issues
• Insurers in a difficult situation – there are no villains

Part 4:

http://www.youtube.com/watch?v=8yr0sdKYF9c

Topics include:

• Next step: gathering all parties together in a public-private partnership
• Co-mentoring between administration and physicians
• Healthcarecollaboration.com mission

©2012 Healthcare Collaboration. All Rights Reserved.

TV Interview is an original post from Debra on Healthcare Collaboration - Improving Physician-Hospital Relations

It was as though all my past sins came back to haunt me.  I never heard any of their other points as I relived episodes where nurses asked, “Dr. Cohn, can we talk about what happened in the Operating Room yesterday?”  I thought that I was concerned about patient safety when I blew up over an incident, but never realized till that day in Organizational Behavior that nurses may have felt that I was devaluing our relationship.

I was delighted to learn in Leadership and the Sexes by Michael Gurian and Barbara Annis that biological differences may underlie some male-female communication differences:

• Women tend to have more white matter in their brains, which connects brain centers in the neural network; men tend to have more gray matter, which tends to localize brain activity into a single active brain center
• Women tend to have more P ganglion retinal cells, which see color and fine detail; men tend to have more M ganglion retinal cells, which recognize physical motion
• The amygdala is a group of neural cells in the temporal lobe of the brain that helps process emotional reactions; the male amygdala tends to swell during anger and stimulate activity into the brainstem and hence physical activity; the female amygdala, which is smaller than in males, tends to stimulate activity into the cerebral cortical talking centers and hence dialogue
• During stress, males tend to secrete more testosterone, which is associated with assertiveness, aggression, and risk-taking; in contrast, women tend to secrete more oxytocin during stress, which is associated with bonding, keeping tension levels down, and making sure that social connections are secure

The authors wrote that men’s and women’s needs are interdependent. In conflict,  women need verbal encouragement; they equate emotional validation with respect.  In contrast, men are solution-oriented and view dialogue as appropriate only to the extent that it uncovers practical strategies.  The response, “Let’s take note of what strategies you have tried and make a list of alternatives that you can implement right away,” may be calming and allow men to focus on what needs to be done. 

I agree with the authors’ comment, “To mentor and be mentored is a part of the human DNA.”  As I wrote in Collaborative Co-mentoring, a surgeon exclaimed, “We’re not stupid- we just need to be trained!” Some of our need for formal training in communication skills arises from the void in residency, where we emulate clinical mentors who have experienced no formal training in communication skills. I mentioned in Nursing Collaboration that all ten surgical nurses whom I polled on what should be the aims of a residency program in surgery (all of whom were women) cited the development of communication skills.

What do you think?  Do you agree with the authors that:

• Authentic leadership requires taking responsibility for our actions
• We cannot control others, but can only control ourselves

Could biologic differences be associated with physician-administrator communication differences?

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

Kenneth H. Cohn
© 2008, all rights reserved

©2012 Healthcare Collaboration. All Rights Reserved.

Collaborative Gender Issues is an original post from Kenneth Cohn on Healthcare Collaboration - Improving Physician-Hospital Relations