Helping physicians manage challenging patient encounters. Part II

In the Nov.-Dec. 1990 issue of Physician Executive, the author discussed some of the problems and effects of poor physician-patient interactions and described a program designed to develop physician skills in dealing with challenging patients. In this issue, the author details a method for implementing this program in a health care provider organization.     

A survey of physicians in a large group practice

Job satisfaction surveys among physicians, a recent phenomenon, are a very important managerial tool to determine the work motivation needs of physician-employees. The first MD Job Survey was done in 1984 by Lichtenstein on physicians employed by prisons. The largest survey of salaried physicians to date has been the 1987 Health Services Research Center of Chapel Hill survey of physicians employed in group practices. Currently, individual group practices are surveying their staffs with job satisfaction questions in order to enhance the work environment.     

Negotiating. Biases physicians bring to the table

What are some of the obstacles that physicians face as they seek to become more effective at the bargaining table? The author's thesis, based on experience in both the classroom and the front lines of medical practice, is that physicians face a set of systematic "biases" derived from physician training and professional culture that make negotiation especially difficult for them. They outline the biases they have observed, explore some possible explanations, and suggest solutions for physicians who wish to negotiate more effectively.     

领导工作中如何抓落实

抓落实,既是工作作风问题,也是工作方法和领导艺术问题,还是一个领导者的政治责任感问题。解决不落实问题,转变作风是前提,改进方法是重点,强化责任是关键。那么究竟如何抓落实呢?一、围绕重点,组建一套专门班子抓落实的关键是抓重点落实,即抓主要矛盾、抓重点工作,通过重点带动全局,这是马克思主义领导科学的基本要求。对一些重点工作、重大事项、重点工程的落实,实行专门机构、专门人员,集中办公、协调解决,不仅是一些发达地区的重要经验,也是抓落实的必然要求。当前,机构设置不科学,责权划分不明确,职能交叉重叠,工作互相扯皮,是一个不争…     

Part 2, Conflict management. How to shape positive relationships in medical practices and hospitals

Managing workplace conflict is one of the most important, stressful, and time-consuming tasks faced by today's physician leaders. In Part 1 of this article series, the authors describe how to assess an organization's interpersonal dynamics. True change comes from interventions that help an organization to become a positive interpersonal culture, one that fosters cooperation and collaboration. Part 2 offers seven steps to solving the disruptive physician problem: (1) provide protection to complainants; (2) listen, empathize, and avoid communication triangles; (3) confront offenders with data, authority, and compassion; (4) if needed, get outside help; (5) offer workplace training and experiences that foster positive relationships; (6) follow-up; and (7) practice what you preach. The self-assessment and intervention guidelines discussed in this series of articles can help physician executive move beyond struggling with episodes of conflict to shaping stress-resilient medical organizations.     

Medicare's ESRD program, Part 2: Transplantation.

In Part 1 of this discussion (Long, H. "Medicare's ESRD Program, Part 1: Dialysis. "Physician Executive 15(2):24-26, March-April 1989), the focus was on the various forms of dialysis for patients with end stage renal disease (ESRD). In this article, we turn our attention to the alternative therapy-transplantation.     

Cost-effective rehabilitation: Part 2--Approaches to patient management problems

Part one of this two-part series discussed general principles of cost-effective rehabilitation: Patients in rehabilitation programs should be working toward achievement of real-world functional goals. Goals should be realistic, and reachable in a reasonable amount of time. Rehabilitation services should be provided at the lowest safe and effective level of care appropriate to the patient's needs. Patients should be participating to their full potential in an active therapy program. Therapy intended to maintain a patient's current condition should be carried out by nonprofessionals who have had training sessions with rehabilitation professionals as needed. Discharge planning begins on the day of admission to the inpatient or outpatient rehabilitation program. This second of the two-part series will focus on individual patient management issues. It discusses circumstances in which the principles of cost-effective rehabilitation may need to be modified. It also discusses approaches to remedy patient management problems that may lead to excessive or ineffective utilization of rehabilitation services.     

Physician strives to create lean,clean health care machine. Studies of manufacturing processes may one day help make your practice more efficient

Elisabeth Hager, MD, MMM, CPE, is teaming up with scientists and industrialists to teach physicians how to apply principles of lean, total-quality manufacturing to their practices. She believes innovation and efficiencies can help doctors resurrect their profession's image and their control over it--and perhaps even reinvent American health care.     

Risk of Extreme Events in Multiobjective Decision Trees Part 2. Rare Events

Earlier work with decision trees identified nonseparability as an obstacle to minimizing the conditional expected value, a measure of the risk of extreme events, by the well-known method of averaging out and folding back. This second of two companion papers addresses the conditional expected value that is defined as the expected outcome assuming that a random variable is observed only in the upper 100 (1 −α) percent of potential outcomes, where α is a cumulative probability preselected by the decision maker. An approach is proposed to overcome the need to evaluate all policies in order to identify the optimal policy. The approach is based in part on approximating the conditional expected value by using statistics of extremes. An existing convenient approximation of the conditional expected value is shown to be separable into two constituent elements of risk and can thus be optimized, along with other objectives including the unconditional expected value of the outcome, in a multiobjective decision tree. An example of sequential decision making for remediation or environmental contamination is provided. The importance of the results for risk analyis beyond the minimization of conditional expected values is pointed out.     

Physician anger, Part 2. More on the dance of anger.

This article is a follow-up to an interview with Charles Dwyer, PhD, which appeared in the 1999 March/April issue of The Physician Executive. He described how physician executives can change the perceptions of today's beleaguered physicians and help them cope with change. We then asked him for some hands-on strategies to deal with physician anger, fear, and resentment. After much contemplation on providing a list of "fixes" that will restore each of us to a state of greater satisfaction, Dr. Dwyer concludes that there are no generalizable solutions because there are too many variables that come into play in each organization, individual, or group. Attending to the self can provide both individual rescue from these turbulent times and the best hope for changes in the system from which patients and health care providers can benefit. If physicians are to regain their power and maintain, or even improve, their quality of life, clearly changes are called for. And these are changes that require persistent effort and uncomfortable adjustments.     

Strategic positioning. Part 2: Positioning challenges in an evolving health care marketplace

Why is strategic positioning so important to health care organizations struggling in a managed care environment and what are the sources of value? In Part 1 of this article, entitled "The Sources of Value under Managed Care," the authors presented four sources of value relative to the evolution of the market from fee-for-service to managed care. These value sources are: (1) assets, (2) price/performance, (3) distribution, and, ultimately, (4) capabilities and brand equity. In this article, the authors further elaborate on the sources of value as the market moves beyond the historical fee-for-service position to a managed care marketplace. Part 2 presents the marketing and financial challenges to organizational positioning and performance across the four stages of managed care.     

Department chief roles more clinical in nature.

Earlier this year, the American College of Physician Executives, in collaboration with the Physician Executive Management Center, the recruitment and career counseling affiliate of the College, surveyed the College membership in group practices and managed care organizations. The Management Center was asked to coordinate the project because of its experience with physician executive compensation surveys. A small number of such organizations outside the College membership was also polled. Physician executives in all these organizations were asked about the duties of clinical department heads and about the compensation packages of the physicians that the organizations hired in these management roles. The survey also asked for information about the marketplace for physician practitioners in these groups. This article reports only on the director portion of the survey.     

The future of health care, Part 2. The PPMC debate. Panel discussion

In Part 2 of this second annual panel discussion, Jeff Goldsmith, Barbara LeTourneau, Uwe Reinhardt, and physician executives from three physician practice management companies (PPMCs) examine this burgeoning new industry. They grapple with questions (and occasionally with each other), such as: Are PPMCs delivering what they promise? What will separate successful PPMCs from the rest? When PPMCs win, who loses? What value do PPMCs add to health care? What lies ahead for this industry? Could Wall Street pressure cause PPMCs to put profit ahead of physicians and patients? And, what roles will physician executives play in PPMCs?