The disruptive physician. A quality of professional life factor.

Medical leaders need to understand that attending to quality of professional life issues includes dealing with the insidious costs and stress associated with disruptive physician behavior. The disruptive physician or professional undermines practice morale, heightens turnover in the organization, steals from productive activities, increases the risks for ineffective or substandard practice, and causes distress among colleagues. Physician executives need to help reduce or prevent this behavior and develop accepted systems in which to manage, confront, and rehabilitate the person labeled "disruptive." Suggested strategies to consider in developing a system include: (1) Defining reasonable and competent interpersonal behavior; (2) educating in interpersonal skills; (3) evaluating interpersonal skills; (4) developing disruptive policy; and (5) assessing, confronting, and rehabilitating.     

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.     

Developing an in-house physician advisor program

The rapid rise in health care costs during the 1980s has led to a growing demand for utilization management companies, supported by teams of physician advisors. The increasing involvement of physician advisors in day-to-day case review has also led to a growing necessity for their being hired on an in-house basis. This article attempts to show a basic process for developing a functional and efficient in-house physician advisor program.     

Performance evaluations of physician executives. Interview by Barbara J. Linney.

Six senior physician executives were interviewed to see how they were doing or not doing performance reviews in their organizations. There seems to be a trend toward doing them, but it is in the beginning stages. Of the physician executives surveyed, the experience ranges from formal lengthy evaluations with rating scales to reviewing a short list of goals. Several are in the process of developing new systems or revising old ones. Probably the most useful part of a performance evaluation is the conversation between the physician executive and the person he or she reports to. If you can stop approaching performance evaluations as passing negative judgments on people, but as having a conversation to hear their concerns, learn what their goals are, and offer ways to help them achieve their potential, they can be useful, enjoyable experiences for both people.     

Win/win with an improved appeals process

In the past, decisions on what services were appropriate and/or desirable were made between the patient and the physician. In most cases, the cost of services was ignored. Lately, concern for cost containment has introduced a new person into the health care decision-making process: the managed care monitor/planner. The appearance of this new person has produced ambivalent feelings among patients and physicians, from joyful approval for those concerned with rising costs to extreme anger for those whose services are denied, while perceived by them as absolutely necessary. Thus, appeal mechanisms have become a way of life. This article explores ways in which the appeals process may be used as a tool to improve satisfaction levels among providers and subscribers and still fulfill the cost containment and efficiency goals of case management.     

A matter of degree: the trend toward physician executives' pursuing master's degrees

As the health care delivery system continues to change, there is certain to be an increasing demand for the services of physician executives. For the moment, potential employers seem to be seeking managers with solid physician credentials and proven management experience. But will the criteria remain at this level, or will employers demand more formal management credentials? And if the latter is likely, what credentials will best serve the physician executive in the employment marketplace? Those and other questions are explored in the following article through interviews with physician executives and recruiters.     

Should the physician executive be the physician's advocate?

Medical staff commonly want to know if a prospective physician executive will serve as their advocate to management. A successful physician executive must like and respect physicians. But the question of advocacy must be answered thoughtfully, because the candidate must not imply that he or she will defend any action by any physician. A three-part conditional response is advisable.     

Physician leadership. An emerging leadership position

Demand is growing for Vice Presidents for Medical Management. This is a new physician executive position that enhances the ability of hospitals and health systems to more fully integrate delivery of care and thus attract managed care contracts. Located at a hospital, a health system's headquarters, or at a hospital's MSO, this position complements the traditional role of a hospital Vice President for Medical Affairs (or Medical Director), as well as the role generally played by the Medical Director in a managed care organization, linking them via a continuum of responsibilities. Compensation and prospects are high for qualified candidates.     

Making a match: inexperienced physician executives and the job market

Hospitals and other health care organizations are adding physician executives at such a rate that demand is outstripping supply-there are more opportunities for seasoned physician executives than there are physicians with track records as medical managers. It is possible that hiring management will have to consider the employment of a physician who wants to be in management but has no track record as a physician executive. In some cases, it may even be preferable to employ a neophyte physician executive, especially when the physician is a respected clinician already on the organization's medical staff. In selecting such a physician, however, an evaluation must be made of the probability that the physician will be successful in the new role. The author points to 10 criteria that the hiring organization should observe in hiring inexperienced managers.     

A pivotal role for physician executives

Physician leaders are needed to fill a pivotal role in the health care industry of the '90s. Medical education based solely on traditional scientific methods will continue to produce physicians with excellent clinical and research skills. However, study of science alone will not produce physician leaders. Effective leaders will also need to understand the tools and concepts of organization and management. These leaders will need to participate in the process of formulating and implementing policies to promote the development of economical financing and delivery arrangements while simultaneously improve the quality of care provided.     

Negotiate the salary you want

How can physician executives negotiate the salary and terms that they want for a new position? The idea of negotiation raises the anxiety level of all but a few people, those who thrive on the thrill of competitive bargaining. Most physicians do not relish the process and view it as a type of conflict. But without knowing what you want to accomplish and preparing to ask for it, you may well leave the meeting frustrated and unhappy with the offer. Determine what you want before you get into an important negotiation. You will get clear on what you want much quicker and you will remember the points better when you talk to the other person.     

Career paths for women physician executives

The career path leading toward being a physician executive is similar for men and women, but there are some issues that have unique elements for women. Thus, any person interested in developing a medical management career can follow the advice in the following pages, but it is especially useful for women or for those who are coaching women in career development and management.     

Becoming a company person.

Physicians face a management challenge in adjusting to being part of a larger organization. By nature, physicians are not "company people." For physician executives, whose instincts can still lean toward being ferociously independent and individualistic--therein lies the struggle. Here are a few suggestions to help physician executives make the adjustments that are required of a "company person": (1) Be in the right place; (2) abandon critical/negative thinking; (3) focus on the issues; (4) maintain solidarity; and (5) make your boss look good.     

Improving performance in a contracted physician network

Health care organizations face significant performance challenges. Achieving desired results requires the highest level of partnership with independent physicians. Tufts Health Plan invited medical directors of its affiliated groups to participate in a leadership development process to improve clinical, service, and business performance. The design included performance review, gap analysis, priority setting, improvement work plans, and defining the optimum practice culture. Medical directors practiced core leadership capabilities, including building a shared context, getting physician buy-in, and managing outliers. The peer learning environment has been sustained in redesigned medical directors' meetings. There has been significant performance improvement in several practices and enhanced relations between the health plan and medical directors.     

Helping physicians manage challenging patient encounters--Part I

In today's rapidly changing and challenging health care environment, where physicians have limited time with patients who have become more knowledgeable and demanding, the relationship between physician and patient has extra stresses placed on it. Medical malpractice litigation has increased as the physician-patient relationship has become more complex because of those stresses. In this article, some of the problems and effects of poor physician-patient interaction are explored, and a program designed to develop existing physician skills for successfully interacting with challenging patient encounters is described. In the January-February 1991 issue of Physician Executive, the author will describe the method of implementing the program in an organization.     

Wanted--seasoned veterans. Diamonds in the rough need not apply

Health care organizations looking for physician executives prefer seasoned veterans--doctors who have already done the job. They want job-specific experience. Most organizations do not provide training grounds and orderly career ladders for aspiring physician executives. The Permanente Medical Groups, Family Health Plans, and some very large group practices are exceptions, but, for the most part, rising medical directors in these organizations stay with them. Most hospitals are not large enough to have associate or assistant medical directors or an environment that could provide a training ground for rising physician executives. On the other hand, hospitals, larger group practices, health insurance companies, and managed care organizations provide ample opportunities for nonphysician managers to train, gain experience, and climb the ladders. How can the novice physician executive break into the world of management and begin establishing management credentials? The author provides some key steps that can lead to success.     

A protocol for mutual respect and communication

Physicians relating to each other, discussing a patient's problem, needs, and care plans, should be the easiest part of medical practice. Unfortunately, exchanging meaningful information between physicians and their offices is, at times, formidable. This article describes the guiding principles for physician referrals at Hamot Medical Center that were developed to enhance communication between physicians and increase patient care.     

基于消费者隐性需求的营销模式研究策略

消费者隐性需求的相关理论和实践研究逐渐受到国内外学者的重视,这对于营销理论的再造和营销学的演进具有一定的理论价值。本文从营销范式的演进规律归纳得出,营销范式的转换归根结底源于隐性需求的开发。在此基础上,对传统营销模式及营销组合对隐性需求研究的普适性进行了检验,并探讨了基于隐性需求的4Vs营销模式及其现实意义。     

信息不对称下价格随机的应急数量折扣契约研究

以市场需求和市场价格随机波动的二级供应链为研究对象,寻找其在信息不对称条件下绩效优化的路径。通过显示原理分别构建生产成本和销售成本信息不对称时应急供应链的数量折扣契约模型,得到最优订货量与最佳批发价策略。通过具体的算例加以验证,分析了信息不对称程度对供应链上成员及整个供应链绩效的影响。研究结果表明：当突发事件造成市场价格随机波动和市场需求变化时,供应链上的跟随者能从隐瞒私人信息中获利。但当市场需求增大时,整个供应链绩效受损,反之则反是。这与以往研究在市场需求随机、市场价格固定和信息不对称条件下的结论迥异。     

Dealing with the demands of change

If evidence of the changes occurring in and confronting the health care field were needed, it was provided in abundance at the College's Perspectives in Medical Management meeting in Chicago in May. The presentations and the discussions among members buttressed the feeling that the health care field is proceeding through a period of transformation. The evolving system will be anchored on managed care, with special emphasis on the word "managed." The accoutrements of managed care--case management, demand management, utilization management, clinical guidelines and protocols, capitation budgeting, and the like--dominated discussion. The "business" of health care is proceeding apace. Maintaining a balance between the financial and quality elements of health care delivery has never been more important. And the definition of that balance will be determined at the local and regional levels. Federal initiatives are temporarily in abeyance. The challenge for physician executives is to assume leadership in moving their organizations, and thus the health care system, toward a new design that corrects present deficiencies and positions both to respond more effectively to the health care market. While it is not possible to cover all of the more than 60 speakers who addressed the meeting, this report, through presentation of the ideas of some key presenters, is aimed at measuring at least the boundaries of the challenges that lie ahead.