Rural Physician Leadership Curriculum

1. Rural Physician Leadership Curriculum West Virginia University Rural Family Medicine Residency Program

2. Rural Physician Leadership Curriculum Module 7 Organizational Politics

3. Rural Physician Leadership Curriculum Description • Funded by HRSA Grant D22HP00306 • Objective 1 • Develop a competency based longitudinal curriculum in Rural Physician Leadership Konrad C. Nau, MD Principle Investigator Chair, Dept of Family Medicine-Eastern Division WVU Rural Family Medicine Residency Program

4. Rural Physician Leadership Curriculum Learning Objectives : Module 7 • Understand the difference between power and authority • Conceptualize the two networks of organizational politics • Identify the four elements of organizational politics • Apply organizational politics to strengthen your systems-based approach to problem solving

5. CASE STUDY- The Hospital • Back Creek Memorial Hospital • Rural - 100 Beds • 24 Hour ED coverage • 4 FM, 3 IM, 2 GenSx, 2 OB-GYN, 2 Ortho, 2 Peds, 2 EM, 3 locum tenum • 18,000 annual ED visits

6. CASE STUDY- The People • CEO – Carla E. Owens • Chief of Staff – Stan Pioneer, MD • Emerg. Dept Director – Joe Stat, DO • ED Staff Member- Mark Mergency,MD • Others READ CASE STUDY NOW………

7. CASE STUDY- The Problem • Emergency Dept Patient Complaints • Unprofessional dress of Emergency Department staff • Grumpy behavior of some Emergency Department physicians

8. CASE STUDY- The Solution • Stan Pioneer (Chief of Staff) proposes implementing a professional dress code for everyone who works in the Emergency Department • Joe Stat, DO (ED Director) speaks with a senior ED physician, and the ED Nursing Supervisor

9. CASE STUDY- The Results • Carla E Owens, CEO calls Stan Pioneer, MD Chief of Staff to her office • “Stan, I’m disappointed that you let this get so out of control. • I thought you had a better feel for our organization.”

10. CASE STUDY- The Analysis • What did Stan do ? • Why did Mark do what he did ? • Who made the best use of Back Creek Memorial Hospital’s organizational politics ?

11. Stan - Chief of Staff • Quality Assurance issue discussed with CEO and felt he was authorized to to a job. • Thought he had a good solution to the problem (made assumptions). • Didn’t seem to really talk to enough people • Assumed is position gave him the power to act

12. Mike – Med Staff Member • Saw the Quality issue differently. • Used his “non-official” relationships to his advantage. • Did an “end run” around the authority. • Past issues seemed to fuel his fire (assumptions).

13. Leadership Choices Developing Issue Early Recognition Ignore Organizational Politics Take Action Current Mess Thoughtful Resolution

14. Politics • Derived from the Greek roots • “poli” • many • “Tics” • Blood sucking insect that’s hard to kill and spreads disease James Carvele

15. Politics • Competition between competing interest groups or individuals for power and leadership Mirriam-Webster Dictionary

16. Power • The potential to cause certain things to happen or not to happen • Power is value-neutral

17. Authority • Status granted by an organization (eg. Title) • May or may not include power

18. Why don’t we “get it” • Young physicians are somehow taught that power is “bad” • “Administration runs this hospital – they have the power to get us more nursing staff but won’t.” Robert Hodge MD,FACPE

19. Organizational Politics • Unauthorized uses of power that enhance or protect one’s own or one’s group personal interests. Robert Hodge MD,FACPE

20. The Gap • Divergence (gap) between the mission of the organization and that of the individual or group. • The bigger the GAP the greater the organizational politics. Robert Hodge MD,FACPE

21. Organizational Politics • Conceptualize two teams at play • Informal Network activities • Formal Network with organizational goals or objectives Robert Hodge MD,FACPE

22. The Formal Organization • Formal – follows established form, customs, or rules • Formal often implies static • Example : The Organizational Chart Robert Hodge MD,FACPE

23. The Informal Organization • Informal – follows no established form • Informal often implies dynamic • No Organizational Chart • Common mode of communication • The Grapevine Robert Hodge MD,FACPE

24. Back Creek Memorial Hospital

25. Back Creek Memorial Hospital

26. Back Creek Memorial Hospital Executive Secretary

27. Back Creek Memorial Hospital Administrative Assistant

28. Back Creek Memorial Hospital Family of Med Staff Medical Staff Member

29. Back Creek Memorial Hospital Hospital Board Member

30. Back Creek Memorial Hospital Hospital Board Member Executive Secretary Administrative Assistant Family of Med Staff Medical Staff Member

31. Analyzing Organizational Politics

32. Analyzing Organizational Politics

33. Analyzing Organizational Politics

34. Analyzing Organizational Politics Four Elements of Organizational Politics • Meaning • Communication • Relationships • Power Robert Hodge MD,FACPE

35. Analyzing Organizational Politics I. Meaning • What is the motivation on each side ? • What are the values ? • What is the perception ? Robert Hodge MD,FACPE

36. Analyzing Organizational Politics II. Communication • Formal • Meetings, Telephone, Voice Mail • Memos, Letters, E-Mail • Informal • The Grapevine Robert Hodge MD,FACPE

37. Face-to-Face Conversation Communicating your message • 10% words • 49% tone of words • 50% body language • Pitfall :can become confrontational Infoworld 9/27/99,p.104

38. Telephone Conversation Communicating your message • 25% words • 75% tone of voice • Pitfall – wrong tone can set wrong tone of conversation Infoworld 9/27/99,p.104

39. Voice Mail Communicating your message • 25% words • 75% tone of voice • Pitfall – not interactive, poor fluency can signal poor competency (be prepared) Infoworld 9/27/99,p.104

40. E - Mail Communicating your message • 100% words • Pitfall – email can some across authoritarian rather than engaging, remember: they can be forwarded to ANYBODY in/out of your organization Infoworld 9/27/99,p.104

41. The Grapevine • The informal person-to-person means of circulating information or gossip • Travels faster than the Internet • Dynamic – connections will vary according to the issue (unlike the formal Organizational Chart) Janet Sandberg Ruthless Rumors and the Managers Who Enable Them Wall Street Journal, 2003.

42. The Grapevine • 82% of the information bits running through one company’s grapevine was ACCURATE • Randstad Study Janet Sandberg Ruthless Rumors and the Managers Who Enable Them Wall Street Journal, 2003.

43. Three Laws of Gossip • You never know how many people are talking about you behind your back. • Thank God ! • As gossip spreads from friends to acquaintances to people you’ve never met – it grows more garbled, vivid, and definitive. Tad Friend New Yorker 7/31/2000

44. The Grapevine • Only 17% of EMPLOYERS think workers get info from the grapevine • but • Nearly 50% of EMPLOYEES credit the grapevine with first message of major company changes

45. Analyzing Organizational Politics III. Relationships • Define the networks (who knows who) • Formal • Informal Robert Hodge MD,FACPE

46. Analyzing Organizational Politics III. Relationships • Define the networks (who knows who) • Formal • Informal • Be aware of the numbers • Dyads - Triads Robert Hodge MD,FACPE

47. Analyzing Organizational Politics IV. Power • Who has the power (the potential to cause certain things to happen or not happen) ? • Formal – don’t confuse with authority • Informal – issue leaders, stakeholders Robert Hodge MD,FACPE

48. Back to the CASE STUDY

49. Back Creek Memorial Hospital

50. Back Creek Memorial Hospital