Head for open space

Is it possible that the herd mentality, the "Follow The Other Guy" idea is not the golden road to transformation? In fact, the three questions that are most helpful in deciding your path, as a person or an organization, lie almost completely in the other direction: (1) "What am I really good at?" (2) "What am I afraid of?" and (3) "What is no one else doing?" Heading for the open space means looking for the hole in the market, searching for what no one else is doing. Only by going toward open space can you or your organization stay ahead of the pack in a turbulent health care environment. Get out in front of the pack, either as a leader or quarry, and you have a measure of control. How does the quarry control the pack that is hunting it? By choosing the terrain, choosing the ground on which the chase will take place.     

Influence by learning how people process information

To have a successful career in management, you have to pay more attention to refining your communication skills than you ever thought was necessary. In a survey of 100 physician executives, 94 percent felt training was needed in communication skills if you are thinking about becoming a physician executive. When recruiters talk to us about the basic requirements for physician executives, one of the things they say the person needs to have is excellent communication skills. Most people have good communication skills, but what can move you into the category of excellent is paying careful attention to how the person you are talking to processes information. You can only do this if you listen before you do much talking. What do I mean by processing information? When we get up in the morning, the world is out there separate from us. We have to take in information about that world and make decisions all day long. We don't all do this in the same way. In this article, I am going to discuss four ways to process information.     

Medicine, management, and me.

What is medical management? How do you learn about it? How do you get into it? Is there a future in it? Is medical management for you? Can you do it? What will it mean to your original plans for your life in medicine? Is it worth the sacrifice? Get comfortable. I have a story to tell you. It may help if you hear about medical management from a medical director who has preceded you. I doubt I can answer all your questions. I can, however, tell you about one physician's visions, expectations, decisions, experiences, and rewards from what can be loosely called "medical management." If you find something of help in your decision making in this account, my telling it is worthwhile.     

Thriving in change

The turbulent state of health care and the rapid changes that show no sign of abating point to many career-related challenges for physician executives. How can you predict the impact of these changes on your career? What measures can be taken to prevent any negative impact of change? And how can you prevail when dealt a negative blow like job loss? The signs that foreshadow the unraveling of a physician executive's career are described. The warning signs are: Not keeping up with change, losing your influence; getting negative feedback; turning your "concerns" into complaints; the economy working against you; and being blindsided because we think leaders operate logically. Being proactive puts more control in your hands and leaves less to chance. You can prevent being blindsided if you: develop your people skills; get comfortable and involved with e-business; stay abreast of health care trends; pick up the pace; and develop "You, Inc." There is a final component to prevailing over adverse circumstances--find your work-related passion and apply it to your career.     

More skills of the change master

What are the skills of the change master? How can you become better prepared to deal with the change and ambiguity that has become the trademark of the health care industry? From shifting focus, to being able to act in uncertainty, to having a capacity for paradox, here are nine skills to help you deal with change effectively. These are not easy skills to acquire if they are not a natural part of your tool kit already. You can't pick them up in a few hours at a conference, or by reading a few books. It calls for a long-term, passionate commitment to becoming a learning organization, and a willingness on the part of everyone in management to follow that path even when it gets uncomfortable, difficult, and surprising.     

Welcome everything

The failure of management is largely a failure to bring our whole selves to it. What parts of your self do you bring to your work? Do you bring only the management mind, only logic, only the company guidelines? Or do you bring your passions, your values, your soul, your deepest self? Do you react? Or do you respond? Letting go of what you think you know can be the first step to a creative and powerful response. Many of the tools we use in management can actually remove us from the experience and make it harder to respond. Reacting closes down options. Responding opens up possibilities and nurtures trust. This is kindness transformed into a business imperative--responsiveness.     

Watching the falling barometer

How can physician executives create a vision, a strategy, in the face of such overwhelming forces for change? The answer has two pieces. The first is the Weather Channel: scanning the future for warning, for opportunities, for new business possibilities. The second leads us to such questions as: What is your situation? Financially? In market terms? It leads us, as well, back to the question: For you and your institution, what is your reason for being in this business? In other words, what is your foundation? If you can become clear about who you are and what you are here for in the long run, and match that with some sense of the technologies and the political and financial pressures headed your way, then you can begin to create a vision of a future that works for you. In the coming years, we will begin to create entire new ways of doing health care, new roles for hospitals, new types of medicine--and the time to begin the creation is now. If you wait until the hurricane hits, it will be too late.     

Putting "teeth" in your résumé

How can physician executives get the kind of management experience they need to move to the next level? Is the MBA the end all or can significant management experience and top assignments impress recruiters and CEOs? Here are some important questions to ask yourself about each job you have held as you prepare to move forward in your career: How did I improve the organization? How did I contribute to greater efficiency? How did I affect productivity? How did my work increase the bottom line? Thinking about these questions can help you put teeth in your résumé and get you where you want to go. When you can answer those questions from your own experience, you will have created a powerful career track record that is likely to impress the next CEO whose staff you want to join.     

Is it change? Or is it noise?

How can you tell the difference between mere noise, and a profound change headed your way? Your gut instincts may not always be a reliable gauge. It takes a long time for most people to become an executive leader. If you are typical, you were raised and trained in a different era, with different expectations. You see things with different lenses. So what can you trust? You can trust first principles. Ask yourself what you know about the reasons that changes are happening in this environment. Then ask yourself about what is being proposed--how does it fit with the roots of the changes in health care and your organization? The three change filters presented here can help you to figure out if it's change or just noise. Ask yourself: (1) what are the changes occurring in the health care industry; (2) is your organization ready for change; and (3) how likely is it that your organization will easily adopt this particular change? These three filters together will help you decide what is a truly important change, how ready your organization is for change, and whether it will adapt to this change with ease or difficulty.     

Hospital medical directors, quality of care, and financial returns

You are a physician executive working very hard within a hospital on all sorts of medical staff issues and quality of care. You answer to the board. The latter, through its administrators, may still have difficulty documenting the precise value of a full-time physician executive. Your hospital is losing money or not making enough profit for capital expenditures and salary raises. It is considering or will have to consider staff cuts. What can you do that will influence the bottom line, produce a quality image, and quantify your value?     

Touching what is, touching what might be

How do you master change? You have to master the paradox of changing while staying grounded. To make use of the power living inside any new thing that comes your way, you first have to touch it--not tentatively but profoundly--at the same time that you maintain a firm connection with that which is deepest and most fundamental within you. Here, some ideas on how to create "touch points," the ability to look at a problem or impending change from many different angles, thus broadening your understanding and possible response. A key tactic in creating a variety of touch points is quite simple: Ask a lot of questions. Ask especially the questions that have difficult answers, or for which you suspect there is no answer.     

Got curiosity?

The newest scientific models of decision-making suggest that the way we actually decide to do something is different from the story we put on it later. Organizations think that way, too. The real process of decision-making is hidden. Management is complex--and a key tool is curiosity. A critical question would be: "What experience are we creating?" When you get curious, separate what you notice from the story you tell yourself about it--even if the story is true. Look for the meaningful experience: your own, your employees', your customers', your physicians'. The essential act of management is to notice, to not look away.     

What do you know?

If you run an organization, what do you know? What could you know? What is obvious--what we take for granted--hides deeper, contradictory realities. Such simple assumptions as "The goal of management is to get things done by motivating people to do them" not only hide a deeper truth, they keep us from getting to what's true. There is no short road to leadership. It is long-term. It is about relationship, in the deepest sense. Leaders don't create energy and momentum, they harness the energy and momentum that already exists in the people that they hope to lead. They connect with people, and they get out of the way.     

How can I motivate you to do it my way?

Want to motivate others? Establish meaningfulness and value to them of what they are supposed to do for you, and provide the tools they need to do it. Until they see the value to them, and that value outweighs their perceived risks or costs of doing it, you may get motion but you won't get motivated behaviors. Without motivated behaviors, you'll waste a lot of time trying to goad them on toward your goal, which they don't share. What we want is bilateral motivation toward a common goal. If we're smart, we don't want to be the only ones who are motivated, and others just move.     

Health care organizational uses of information technology

Let's say that, by having read the many inspiring articles on medical informatics in this issue of Physician Executive, you are now ready to move ahead with some serious applications of information systems in your organization. Or, you were already a believer in the usefulness of information technology (IT), and are wondering how to proceed. What types of systems should your organization be looking at to acquire or build? How should you get to there from here? Perhaps you'll find what you're looking for in what follows--an initial roadmap through organizational "IT Land."     

What's your financial set point?

Motivation is an important career issue, especially in the shrinking health care market. What inspires people to work hard today is often not the same thing that encouraged our parents' industriousness. What motivates you? What motivates your direct reports? Research suggests that people can't be motivated beyond their "financial set point"--the amount of money they need or want which will motivate them to work harder or smarter. The following motivators are explored: (1) Upward mobility; (2) limited goals; (3) need only; (4) revenge; (5) ego nourishment; and (6) time.     

Health care is sales

Health care is all about sales--everyone today in the competitive arena of health care is a salesperson. Your selling days began when you applied to medical school. Your product was yourself, and you worked hard to sell it. That was only the beginning. In your daily work as physician executives, you are selling yourself and your ideas-your ideas about relationships, management structures, partnership issues, merger questions, etc. It's a complicated world, and the concepts are often abstract and difficult. But it is your job to communicate with others to get things done. It is the most important part of your job. It is selling, in fact, at a sophisticated level. How do you communicate and sell yourself and your ideas effectively? Here, some ideas on how to listen and communicate.     

How could I have gotten it wrong?

Can you avoid ending up in a career-denting job: Are there potential pitfalls to recognize on the search for a rewarding position? Finding oneself in an impossible job, working for a boss who brings out your worst qualities and deepest insecurities, or joining an organization that is doomed are nightmare scenarios. How do these judgment errors happen? We asked physicians who've been there and, unfortunately, done just that. What they learned might help the rest of us skip the experience.     

Delegation can make (or break) your career

Delegation is not a soft skill. Physician executives who do not delegate well and strategically cannot expect to achieve the top jobs now or in the future. It's not enough to have great communications skills to convey your vision. You won't achieve that vision alone; you must have a great team to bring that vision to fruition. However, you can't delegate your first and most important step--self-assessment. To maximize your strengths and minimize your weaknesses, you'll need a clear view of what makes you tick. Then start thinking about your executive role in these terms: Conceptualize work mandates as projects; choose people who are better than you for your team; and try to work yourself out of a job. By learning to delegate, physician executives can make their own careers (as well as those on their team) richer and more fulfilled.     

The marriage of risk management and the processes of patient care

So, your organization is considering taking on a capitation contract. Or you have already done so. Sooner or later, most physician executives with whom I have worked have asked the question: "How the hell are we going to manage this thing so we don't go broke?" Good question. Here, in brief, is the answer: Accepting capitated contracts without having the resources to manage both insurance-like risk and the process of caring for capitated patients is roughly equivalent to flying through mountains shrouded by clouds: Sooner or later, a mountainside is likely to appear in your windshield, close up and closing rapidly, at a point where it is too late to do anything about it!