CHEFOctober 20, 2011

Presented byTom Atchison

Physician Integration and ACO Formation:Hospital—Physician Alignment

Dos and Taboos

Aligned Objectives

• Today will be valuable to me if we learn, understand, solve, create….

The Reform Imperative is that

• Physician alignment is the critical success factor!!

Reform Summary-Change will Happen!!

1. Improve patient care as defined by the IM six metrics: care is safe, effective, patient-focused, timely, efficient and equitable;

2. Improve community health;

3. Lower cost per outcome; and

4. Move from volume (input) to outcome (quality) metrics--payments

“Build a Strong Sail Boat”

• You can never predict the direction of the wind,

• Or, the height of the Seas• But, you can control the rudder and the

sails• To reach your destination

Organizational Dynamics Executives---Physicians

Decision ProcessInfluence---------------------------------Control

Perception of TimeLong Range--------------------------------Now

Sense of SelfPart of a Team---Protection of Individual Prerogative

Locus of ControlCorporate Strategy-------------------Practice Needs

First LoyaltyTo the Corporation--------------To the Patient

Note: Physicians may have employee contracts, but will never be employees!

Think partners in care

System–Physician: MantraWhen you are interdependent, the need to cooperate is obvious. Failure to cooperate doesn’t remove the interdependence. It makes it toxic.Physician teamwork-Think Golf!!

Physician Motivational Hierarchy

1. Respect

2. Control

3. Money

TANGIBLESPersonal

IntangiblesOrganizational

Intangibles

INPUTS • Cash• People• Policy/Procedures• Strategy• Plant• Information Systems• Communications• Management

• Meaning• Caring• Giving

• Mission• Values• Vision• Inspiration

• Leadership • Recognition• Motivation

OUTPUTS • Profit• Market Share• Products• Customer Satisfaction• Growth• Productivity

• Quality

• Inner Peace of Purpose

• Joy• Pride

• Culture• Followers• Commitment• Job Satisfaction• Team Spirit• Trust

• Quality

Sources of UncertaintiesContext-------------Content

Non-Linear—Intangibles Linear--Tangibles Leadership StructureCulture StrategyTalent Tactics

Remember

BALANCE

12 Variables of Sustainable Success

ROOTS TO WINGS

Roots

Trunk

Wings

3 - Leadership4 - Culture5 - Structure

6 - Strategy7 - Talent8 - Processes

11 -Pride 12 - Joy

9 - Metrics10 - Environment

1 - Trust 2 - Respect

11 -Pride 12 - Joy

12

Remember

DEVELOPMENTAL SEQUENCE

Trust

“The greatest source of power available to a leaders is the trust that derives from faithfully serving followers.”

James O’Toole, Professor of Leadership Studies, University of Southern California

And, “Our distrust is very expensive.” Ralph Waldo Emerson

Finally, “Trust truly is the one thing that changes everything” Stephen M. R. Covey

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Trust vs. Mistrust

With Trust Without TrustDe-centered effort Self-centered effortGood communication Filtered commHigh innovation potential Minimum behaviorMistakes viewed as learning Blame transferDynamic tension Conflict

Trust-Quick Test

Trust—Quick Test: 5=Strongly Agree to 1=Strong Disagree

1. I am approachable when others have a concern or issue.

2. I encourage honesty and open communication to flow from any direction.

3. I listen non-judgmentally regardless of whether the information is good or bad.

Trust-Test con’t

4. I behave consistently.5. I show interest and concern for others

regardless of their position or power.6. I meet frequently with those individuals most

critical to the achievement of our Mission.7. I make hard decisions about ineffective

people, processes and programs.

Trust-Test, con’t

8. I show genuine regard for others’ knowledge, contributions and experience.

9. I keep my promises.10. I explain decisions non defensively.

Mean score:___

Building Trust

1. Identify the “Stars” and “Skeptics”; (see next slide)

2. Schedule, at least, 60 minutes per day to listen to them;

3. Employ “Active Listening” techniques;4. Target 1 to 3 barriers/goals;5. Execute—give feedback.

Time Spent in Each Cell3

CynicsWho is a low performer, feels undervalued and always complains?

2

SKEPTICSWho is very hard-working,

creative, critical and annoying?

4

SLUGSWho is a low performer, but

reluctantly does just enough to stay?

1 STARSWho currently behaves the

way you wished everyone behaved?

Contribution to Performance

Noi

se L

evel

N/600

Stabilizers

Input context #2: Respect

Respect vs. DisrespectAcceptance of diversity Pre-emptive behaviorSPINS rewards SchadenfreundeStrong ego Big egoServant leader Titled executiveAuthentic Counterfeit

Respect-Quick Test

1. I am known for showing gratitude to my peers and staff.

2. I schedule time each day to find individuals who behave the way we wish everyone behaved.

3. My associates know the specific behaviors that are most desireable.

Respect-Test, con’t

4. Our orientation process stresses the importance of caring for others.

5. I treat others the way I wish to be treated.6. I am perceived as fair.7. Behaviors that are inconsistent with our

corporate culture are dealt with immediately.

Respect-Test, con’t

8. Behaviors that reflect our culture are rewarded frequently.

9. Our recognition practices are enjoyed by all.10. We have training programs in “Mouth

Management.”

Mean score:___

Building Respect

1. Complete a Trait Analysis of your high performers.

2. Isolate critical behaviors.3. Use these behaviors in employment ads, web

site, recruitment, rewards, etc.4. Use “SPINS” often.5. Use both internal and external reward

methods.

CHANGECHANGE

Change Quotes“Change before you have to.”“If the environment changes faster than you do, you will be out of business”

-J. Welch

“Manage change or react to change.”-T. Atchison

“All organizations are perfectly aligned to get the results they are getting.”-D. Berwick, MD

“If you change nothing—nothing changes.”-T. Atchison

“Hope is not an effective strategy for change.”-T. Atchison

“Remember, the stone age didn’t end because they ran out of stones.”-Rick

“We cannot solve today’s problems working from mindsets that created them.”-paraphrase from Albert Einstein

The Easy to Hard Continuum

I want, I understand I control

I don’t want, I don’t understand

andI don’t control

Midpoint

Dynamics of Change

The Anxiety/Behavior Continuum

Happy -individualsresist change

Angry -individuals

resist change

Window of Opportunityfor Change

Dynamics of Change

“Contrary to popular belief, happiness doesn’t result from relaxation or

completely stress-free living, but from meeting challenges with intense

activity and interest.”

-Mihaly Csikszentmihalyi

Critical fact in understanding how to increase physician

alignment/engagement

REMEMBER1. Each person is correct from their point of

view;2. Collect all points of view;3. Find points of greatest agreement; and4. Focus of the future.*

*You can’t un-ring a bell!!

Physician Motivational Hierarchy

1. Respect

2. Control

3. Money

Frustration Dynamic

• Frustration always leads to

• Aggression, which, if not confronted, always

• Leads to Apathy

Vision

Think Small

Move Fast

Evaluate

Celebrate

Managed Change

Suggestion: Physician Lead Discussion1. What is currently good and needs to continue to strengthen engagement?

“Sacred cows”2. What is good but could be made better

easily? “Low fruit”3. What doesn’t exist, but would help

greatly? “Mid-range”4. What exist but needs to be removed?

“Toxins”

Learnings I want to remember….

Application to my current role/responsibilities….

Questions????

Tom AtchisonSuggested Readings

American College of Healthcare Executives

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• Jim Collins, Good to Great• Jim Collins, How the Mighty Fall• Steve Covey, Jr., The Speed of Trust• James C. Hunter, The Servant• James T. Philips, Lincoln on Leadership• Michael H. Hoppe, Active Listening• Carson Dye and Andrew Garman, Exceptional

Leadership: Sixteen Critical Competencies• Joe Bujak, MD, Inside the Physician’s Mind• Henry Mintzberg, The Rise and Fall of Strategic

Planning• Patrick Lencioni, The Four Obsessions of an

Extraordinary Executive• Tom Atchison, Leadership’s Deeper Dimensions