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.     

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.     

Running toward the roar

How do you embrace paradox, changing and growing without losing your sense of who you are? We talked last time about the paradox of reaching for the new, without losing your ground in the old. Paradox is the place of insight. Accepting paradox, not as a momentary distraction but as a place to live, lies at the heart of dealing successfully with change. We can see this most clearly if we ask ourselves, "What business am I in? What am I about?" In health care, this did not used to be a meaningful question. Today, it is a critical one. But to really develop, we have to seek out the situations that are the most difficult for us, work them through, hang out with them long enough to begin to be at home in the paradoxical, ambiguous, and strange circumstance.     

The best leaders

Today's movements away from authoritarian leadership emphasizes team development. People are experiencing with a leadership that empowers, rather than a leadership that is, itself, powerful. But how do you become a leader who empowers others? What are the characteristics of "best leaders"? From listening skills to getting feedback and including people in the process of change, effective leaders help others move towards the goal, ultimately thinking, "We did this ourselves."     

The MBA mystique

Is an MBA the solution for you? Do physician executives need to have a business degree to compete in today's competitive marketplace? What are clients looking for when they make hiring decisions? The answers may surprise you. This column is an attempt to dispel myths about physician executives and the MBA degree. Clients want to attract and hire physician executives who possess sometimes intangible skills--with or without the MBA credential. These intangible skills include the ability to educate other physicians to the new health care realities, a sales orientation emphasizing effective communication that focuses on patients and payers as customers, comfort with ambiguity, flexibility, and tact and sensitivity in negotiations.     

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.     

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.     

Health care futures, Part 1. The emergence of the new health care consumer. Panel discussion

In Part 1 of this second annual panel discussion, six experts examine the new health care consumer. The whole concept of the patient as consumer still makes people uneasy when it's applied to health care. Whether you prefer consumer, customer, purchaser, end-user, ultimate buyer, or beneficiary, one thing's for sure: Many of us are as different from the bygone patient as an HMO is from the general practitioner who made house calls. One of the reasons for many Americans' new interest, knowledge, attitudes, and expectations about health and health care is the Internet, the second topic in this discussion. In Part 2, physician executives from the three leading physician practice management companies (PPMCs) join Jeff Goldsmith, Barbara LeTourneau, and Uwe Reinhardt for a spirited exchange about this burgeoning new industry in the American health care sector. They will tackle questions such as: Are PPMCs delivering what they promise? What will separate successful PPMCs from the rest? Can PPMCs meet Wall Street's earnings expectations and also help physicians deliver better care? When PPMCs win, who loses? And, what roles will physician executives play in PPMCs?     

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.     

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.     

How to cope with behavioral interviewing questions.

What should a potential employee do when asked behavioral or highly intrusive questions during the interview? Here are some suggestions to help you be prepared should the interviewer ask you personal or objectionable questions: (1) Take some time for introspection; (2) be prepared to draw the line; (3) complain; and (4) write it off. And remember: A show of determination and setting boundaries in an interview may advance your progress. Coolness under fire is an attractive personality trait.     

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.     

Hirer, hiree, beware: new hiring trends

What are the three hiring trends that trouble both human resources people and top management? From the "exploding job offer," to new hires who renege on their acceptances, to "front loading," these trends are predicted to continue, so where does this leave you in the salary negotiation process? From communicating often to interviewing more carefully, some suggestions are explored to help physician executives address these disturbing trends. There's still a sub rosa theory that only undesirable candidates back out of an offer. But that's no longer true and that attitude may make you short-handed!     

Fired? Here's an exit strategy

Who gets fired in a boom job market? People are fired more often for things they failed to do than for mistakes they made. The new rules of engagement are: There is no probationary period; resistance to technology is a quick ticket out; a lack of emotional commitment to the role you're hired to play is usually fatal; personality defects that keep others from producing are not tolerated. The most common reason for being fired, however, is lack of fit. Whether you're laid off or fired, don't ask for explanations. The fact is, the people with the power to get rid of you don't want you to stay. What matters is maximizing what they'll do for you on departure. To get the most favorable terms with the least financial and ego damage, here's a game plan: (1) Get a favorable reference--in writing--from your boss; (2) gather work samples and good performance appraisals you've received; (3) negotiate for as much severance pay as possible; (4) negotiate for outplacement assistance; (5) gather contact names from co-workers; and (6) leave in style.     

Someone promised mentors: will you deliver?

What are recruiters promising? Many new hires say that they accepted a job because of a promised mentoring program--one that never materializes, and one that the manager doesn't know was part of the discussions. Where does that leave the manager who may not be aware of this expectation? Faced with anchoring mobile Gen Xers, organizations are exploring mentoring as an inexpensive way to improve retention. But mentoring is not a technique that can be applied like a warm blanket to solve the problems of orientation, training, skills development, and retention. There are two reasons why mentoring isn't foolproof--the mentor and the protégé. If you are considering a mentoring program, or becoming a mentor yourself, here are some points to ponder: (1) If you can't (or won't) do it, give convincing reasons up front; (2) establish the rules of engagement; (3) a mentoring relationship doesn't guarantee loyalty; (4) having a protégé has political risks; (5) you can't force anyone to take advice; and (6) expect a quid pro quo.     

Finding the essential difference

The idea of what is essential and what is peripheral is basic to all intelligent management of change. At the core of all our resistance to change is the fear that we will lose something of ourselves, something unrecoverable. "Touching ground"--gaining clarity on what we are truly about, and shaping our strategies around that core--is a key skill of the change master. What is the most important element in helping people deal with change? According to Roger Fritz, President of Leadership by Design, Inc., a St. Louis consulting firm, "Helping them recognize what's essential. There are two kinds of change: Technical change and profound change. A technical change asks you to learn something different. A profound change ask you to be someone different." Too often, we confuse the two and are met with resistance.     

Targeted searches: a double-edged sword

Besides being discriminatory, there are short- and long-term problems inherent in targeted searches. What are the issues rarely considered by companies looking for a quick diversity fix? (1) Internal candidates will bolt when they figure out what's going on. (2) Most top candidates hate targeted searches. (3) Many search firms don't like targeted searches, and some won't even participate in them. (4) Targeted searches can set up new hires for failure. These issues are useful to consider when you begin the search process for your next star.     

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.     

Acing the 'chemistry' test

With the right boss, you can go far and learn much. The wrong boss could actually slow or even stall your executive career. When you interview for a job, you're also interviewing for a boss--and it's in your own interest to try to find the individual who is the best possible fit with your own management style. This is a matching process--not quite a courtship, but with some of the same characteristics. What can you do to ensure a good match with your new boss? (1) Do your homework; (2) Make your interview a dialog; (3) Use subtle strategies, too, such as watching for body language; (4) Ask the employer for references; and (5) Know yourself.     

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.