Physician Integration and ACO Formation: Hospital—Physician Alignment Dos and Taboos

1. Physician Integration and ACO Formation:Hospital—Physician AlignmentDos and Taboos CHEF October 20, 2011 Presented by Tom Atchison

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

3. The Reform Imperative is that • Physician alignment is the critical success factor!!

4. 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

5. “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

6. Organizational Dynamics Executives---Physicians Decision Process Influence---------------------------------Control Perception of Time Long Range--------------------------------Now Sense of Self Part of a Team---Protection of Individual Prerogative Locus of Control Corporate Strategy-------------------Practice Needs First Loyalty To the Corporation--------------To the Patient Note: Physicians may have employee contracts, but will never be employees! Think partners in care

7. System–Physician: Mantra When 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!!

8. Physician Motivational Hierarchy Respect Control Money

10. Sources of UncertaintiesContext-------------Content Non-Linear—Intangibles Linear--Tangibles Leadership Structure CultureStrategy Talent Tactics

11. Remember BALANCE

12. ROOTS TO WINGS 12 Variables of Sustainable Success 11 -Pride 12 - Joy 11 -Pride 12 - Joy 10 - Environment Wings 9 - Metrics 8 - Processes 7 - Talent Trunk 6 - Strategy 5 - Structure Roots 1 - Trust 2 - Respect 4 - Culture 3 - Leadership

13. Remember DEVELOPMENTAL SEQUENCE

14. 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

15. Trust vs. Mistrust With Trust Without Trust De-centered effort Self-centered effort Good communication Filtered comm High innovation potential Minimum behavior Mistakes viewed as learning Blame transfer Dynamic tension Conflict

16. Trust-Quick Test Trust—Quick Test: 5=Strongly Agree to 1=Strong Disagree • I am approachable when others have a concern or issue. • I encourage honesty and open communication to flow from any direction. • I listen non-judgmentally regardless of whether the information is good or bad.

17. 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.

18. 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:___

19. 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.

20. Time Spent in Each Cell Stabilizers Noise Level Contribution to Performance N/600

21. Input context #2: Respect Respect vs. Disrespect Acceptance of diversityPre-emptive behavior SPINS rewards Schadenfreunde Strong ego Big ego Servant leader Titled executive Authentic Counterfeit

22. Respect-Quick Test • I am known for showing gratitude to my peers and staff. • I schedule time each day to find individuals who behave the way we wish everyone behaved. • My associates know the specific behaviors that are most desireable.

23. 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.

24. 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:___

25. Building Respect • Complete a Trait Analysis of your high performers. • Isolate critical behaviors. • Use these behaviors in employment ads, web site, recruitment, rewards, etc. • Use “SPINS” often. • Use both internal and external reward methods.

26. CHANGE

27. 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

28. Midpoint Iwant, I understand Icontrol Idon’t want, I don’t understand and I don’t control Dynamics of Change The Easy to Hard Continuum

29. The Anxiety/Behavior Continuum Window of Opportunity for Change Angry - individuals resist change Happy - individuals resist change Dynamics of Change

30. “Contrary to popular belief, happiness doesn’t result from relaxation or completely stress-free living, but from meeting challenges with intense activity and interest.” -MihalyCsikszentmihalyi

31. Perception=Reality Critical fact in understanding how to increase physician alignment/engagement

33. REMEMBER • Each person is correct from their point of view; • Collect all points of view; • Find points of greatest agreement; and • Focus of the future.* *You can’t un-ring a bell!!

34. Physician Motivational Hierarchy Respect Control Money

35. Frustration Dynamic • Frustration always leads to • Aggression, which, if not confronted, always • Leads to Apathy

36. Managed Change Vision Think Small Move Fast Evaluate Celebrate

37. Suggestion: Physician Lead Discussion 1.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”

38. Learnings I want to remember…. Application to my current role/responsibilities…. Questions????

39. Tom AtchisonSuggested Readings • 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 American College of Healthcare Executives

40. Thank You