Satisfying values--yours and theirs: a talk with Manny Elkind. Interview by Richard L.Reece

Richard Reece, MD, interviewed Mansfield (Manny) Elkind on September 22, 1999 to talk about satisfying values and flexible thinking as keys to influencing physicians. Manny discusses why it's difficult for people to create lasting change in the workplace without recreating themselves. The effort to influence others often focuses on getting disciplined about changing behaviors, with the hope that feelings and attitudes will also change. This approach rarely works because behavior is changed only when values or beliefs change. People will get passionate and committed to achieving the organization's goals when they believe that their values will be satisfied as well. The leader's responsibility is to find ways of satisfying people's values, in addition to convincing them to use the organization's values as guides for behavior. A process is explored that helps people discover each other's values and preferences and transforms resistance to commitment.     

A new industrial order for physicians: a talk with Jeff C. Goldsmith, PhD. Interview by Richard L. Reece

Richard L. Reece, MD, interviewed Jeff C. Goldsmith, PhD, President of Health Futures, Inc. on October 12, 1999 to discuss how the Internet will affect health care delivery in the millennium. One of the most profound changes that he sees is how the relationship between physicians and patients will be altered. Empowered consumers are where the real revolution is happening--a trend sometimes overlooked by physicians. Goldsmith says, "The key thing physicians have missed is that the patient is in charge of the process.... The Internet has enabled patients to aggregate their collective experience across disease entities." But there is too much information. "It is almost universally acknowledged by patients and physicians that there is a terrible quality problem. Getting from information to knowledge is a huge commercial opportunity for somebody." He doesn't think that people have put enough emphasis on the collective learning part of this new technology.     

Renegotiating health care. Interview by Richard L. Reece

Richard L. Reece, MD, interviewed Leonard Marcus, PhD, on May 21, 1999, to talk about his book, Renegotiating Healthcare, Resolving Conflict to Build Collaboration, and the Program for Healthcare Negotiation and Conflict Resolution he directs at the Harvard School of Public Health. Dr. Marcus discusses conflict management and negotiation in an industry besieged by change . He says, "we are, in effect, renegotiating the very assumptions and premises that have guided the health care system over the last few decades." In such a turbulent environment, it is crucial that all stakeholders can move to higher ground and resolve their differences instead of escalating the war. The key, Marcus says, is providing options through interest-based negotiation and mediation, so that the parties can look at the bigger picture and reconnect with what they are all committed to accomplishing in health care. While conflict can be destructive, it also can provide opportunities for people to look at where there are problems, to identify and correct those problems, and achieve something even better than what they began with through the process.     

Equity, equity, that's our cry. Interview by Richard L. Reece.

On February 11, 1999, Richard L. Reece, MD, interviewed J.D. Kleinke to talk about his new book entitled Bleeding Edge: The Business of Health Care in the New Century. A medical economist and author living in Denver, Kleinke advocates a true partnership between hospitals and physicians--a marriage with both parties contributing equally to the relationship. He believes that "physicians and people who are running the administrative infrastructures of hospitals and other facilities need to recognize that they are equal partners in a death struggle against the insurers for ultimate control of the premium and the consumer." Though physicians are sure to balk at the suggestion that they become "captive" to the hospital, Kleinke explains that, "captivity is a necessary condition before they can work functionally together and take on managed care and contract directly with consumers, employers, and the government." Kleinke discusses five trends that he explores in his book: risk assumption, consumerism, consolidation, integration, and industralization.     

Physician behavior at the e-technology/learning intersection: an interview with Elliott Masie. Interview by Richard L. Reece

Richard L. Reece, MD, interviewed Elliott Masie on January 16, 2001, to talk about the Internet learning world--that vast intersection of e-technology, learning, and human behavior. He describes how he looks beyond the hype of technology into how human beings behave and what they crave in social experiences. The real question, he says, is how do we have knowledge experiences and blend them with social experiences to achieve the optimal mix? Masie emphasizes, "The magic of learning is in the mix--what happens online and then what happens informally when we have a cup of coffee with a colleague." He continues, "Many of the capital market folks hate to hear about the human element, because they want to believe we'll be able to do everything from our PCs. But that's not how humans behave. It's the mixture that gets results. That's where the real excitement occurs."     

Physician anger--Part 1. Changing perception: an interview with Charles E. Dwyer, PhD. Interview by Richard L. Reece.

On January 21, Richard Reece, MD, interviewed Charles E. Dwyer, PhD, to talk about solutions for changing the perceptions of today's beleaguered physicians. He discusses the state of affairs of physician executives in this turbulent industry and how they need to move beyond their thinking about organizations and their current responses to change. The key, Dwyer emphasizes, is influencing people to do what you want them to do. "If you want somebody to do something other than what they are doing now, then you must bring them to perceive that what you want them to do is better than what they are doing now in terms of what is important to them." He also explores how physicians can change their responses to the health care environment: "You can actually decide how you are going to respond conceptually, emotionally, and behaviorally to anything that happens in your life." Part 2 of this interview will appear in the upcoming May/June issue and will provide hands-on strategies for dealing with physician anger, fear, and resentment.     

Hired, fired, and not retired: an interview with a physician executive who has run the career gauntlet. Interview by Richard L. Reece

Richard L. Reece, MD, interviewed Robert J. Hudson, MD, on April 24, 2000 to discuss his experiences as a physician executive who has made the career transition from practicing physician to managed care executive to biotech entrepreneur. Along the way, he's hired and fired others, and been fired himself. Painful as it is, many physician executives' career realities include being fired. Organizations, after all, are living organizations--they grow, wither, and molt. And as they molt, organizations shed and regrow new skin. What do physician executives do when they've been fired? They go through their own cycle and retreat, reflect, and re-emerge, often reinventing themselves as they go. An essential part of this process is looking within to plumb likes and dislikes, strengths and weaknesses, nightmares and dreams, and positive and negative experiences. For most executives, out of these experiences has come a circle of friends and a Rolodex. Start by reaching out to the circle, by going through your Rolodex, and you can broadcast the news of your rebirth.     

The medical director as educator: an interview with Elizabeth M. Gallup, MD, JD, MBA. Interview by Richard L. Reece

Richard L. Reece, MD, interviewed Elizabeth M. Gallup, MD, JD, MBA, on July 9, 1999, to talk about the evolving role of the physician executive. Dr. Gallup discusses how medical directors have evolved from a purely clinical role to participating in the business side of medicine as well. The traditional medical director, a Dr. No who denies treatment and watches clinical performance, is now becoming an educator helping physicians to manage their behavior and change their practices based on comparative data. Her book, How Physicians Can Avoid Surrender and Lead Change: Gaining Real Influence in Your Own Health Care Organization Before It's Too Late, (American College of Physician Executives, 1996) promotes acting together as a group if physicians want to stay independent and not become employed. Independent physicians can form IPAs and act together as a group, avoiding some antitrust laws. Unless physicians get together and act as a group, she says, they are doomed to further and further erosion of their economic interests as well as their clinical autonomy.     

The rudiments of an Internet-based health plan for consumers: an interview with John Danaher, MD, MBA. Interview by Richard L. Reece

Richard L. Reece, MD, interviewed John Danaher, MD, MBA, on August 16, 2000, to discuss how his new company is preparing for the perfect storm--the looming convergence of demanding consumers, defined contributions, and Internet-based health plans. He describes how his firm is putting financial and clinical tools in the hands of consumers and physicians, so consumers can be more enlightened in their health care choices. Danaher says, "We're not about buying goods and services online. We are transforming the way consumers buy health care and seek insurance. We're trying to be a 401 k where people get on, knowing their risk profile and return horizons. We aim to motivate consumers to be proactive in making health care choices. How do we make consumers responsible and motivated enough to take control of managing their health care costs? How well we articulate this call to consumer action will be the key to our success."     

The JCAH quality initiative: what can hospitals and physicians expect?. Interview by Emily Friedman.

In his new position at the JCAH, Ol'Leary has been shaking things up. His most talked-about move has been to initiate a broad-scale reconfiguration of the Joint Commission's approaches to evaluating quality. The principle element of this effort calls for structural and functional indicators to be augmented by clinical performance and outcome criteria. This is the first of two articles concerning Dr. O'Leary's views of the future of the Joint Commission. In this article, he discusses the new quality assurance initiative; in an article in the September-October issue of Physician Executive, his vision of the future of the JCAH, and the environment in which it will be operating, will be explored.     

Cutting out the middlemen: physicians as providers, direct contractors, and payers. Interview by Donna Vavala

While many physicians and physician groups are forging alliances with other groups, with hospitals, and with other elements of the health care delivery system, an Ohio group decided that the loss of autonomy involved in these approaches was not acceptable. Instead, the group became the core of a new entity aimed at restoring physician control over the provision of and payment for health care services. In an interview with the principal of the new organization, Physician Executive learned the basis for the venture.     

Sage advice. Experienced physician executives share the secrets of their success. Interview by David O. Weber

Seven successful physician executives, now retired from distinguished careers, look back over their experiences and offer advice for those who follow. Be a good doctor first, and never let business interests undermine the ethics of the health care profession. Prepare for management responsibilities with business training. Seek out mentors and develop a network of knowledgeable colleagues and advisors. Exert leadership rather than authority. Expect disappointments and arm yourself for them.     

The physician glut: a different view. Interview by Donna Vavala

An interview with nationally known futurist Leland Kaiser, PhD, on the changes physician executives are likely to face as a result of the coming dislocation in the health professions. Or will there be a shrinking career pie at all? The real question is: What new mental models are we going to use and as a result of the new models, what new jobs are going to be created that will ameliorate some of the surplus we've created in the old model? Dr. Kaiser predicts a model will soon emerge that will open a myriad of new career opportunities for physicians. The new model he foresees is community-based medicine.     

The physicians practice profile: a piece of the quality puzzle

In responding to a New York State law and regulations that essentially mandated high quality and required hospitals to implement a system of physician practice profiles, Genesee Memorial Hospital involved the medical staff at all stages and made heavy use of computers for the ultimate system. The result is a profile system with the backing of physicians and with easy access to maximum amounts of information. Still, the author asserts, such profiles are at best an imperfect response to issues of quality.