Communication skills: a prerequisite for leadership

A man once said, "He who would be first among you, let him be your servant." I think he also would have said, "If you would be the leader of the troops in health care, you must be able to communicate." You must be a good listener, be able to facilitate conflict resolution, be a good interviewer, deal effectively with problem physicians and employees, speak effectively in front of an audience, and communicate well in writing. Do not assume that you are good at any of these skills because you went to medical school. All of us need improvement in these areas.     

Can the patient be the focus of managed care?

If the question were simply put: "What is it that succeeds or fails to meet patients' needs in managed care?" Dr. John M Ludden would have a short answer. "It depends. Success depends on whether you are talking about individuals or about populations of patients. And it depends on whether you are talking about meeting patients' needs or their desires. It depends on whether you're talking about well patients or sick patients, young patients or older patients, new patients or established patients, rich patients or poor patients. And it depends on your ability to balance each of these qualities." This article explores how to translate high-quality care for a population to high-quality care for individuals.     

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.     

The evolving role of the primary care physician

In today's climate of health care reform, the title of this article might more appropriately be "Is the Role of the Primary Care Physician Evolving or Going the Way of the Dinosaur?" According to Koop, primary care is in trouble. Whereas only 29 percent of U.S. physicians are primary care physicians, in Great Britain, 72 percent of physicians are primary care physicians and in Europe and Canada the average is 50 percent. Many U.S. primary care physicians are in the later stages of their careers and nearing retirement age. Unless the supply increases, this number will dwindle further. However, in 1992, only 14 percent of U.S. medical school graduates were headed for primary care careers. Even if the supply of primary care graduates were increased to 50 percent of the graduating medical school class, it would be well into the next century before the ratio of primary care physicians to specialists would be equal. Primary care is at a critical juncture and the next few years will decide the fate of the primary care physician. Given the state of primary care today, I believe that a fundamental look at the assumptions regarding the role of primary care physicians is in order. The current health reform movement has placed a major responsibility on primary care to solve many of the problems in health care delivery today, such as cost, utilization, and prevention. Many health care organizations are planning strategies involving primary care providers, and physician executives can play a key role in these decisions.     

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."     

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.     

The purpose of a job interview is a job offer

Perhaps empathy has been overdone in recent years. Most of us would admit to some cynicism or disbelief when we hear the words, "I know how you feel." Having said that, however, I actually do know how you feel. If I can't identify exactly where you are coming from, I do know where you are likely to be going and how bumpy the ride is likely to be. I'm a physician and a physician executive. I am also an executive search consultant who is daily in the field interviewing physicians who may or may not be the right individuals for a client's situation. If I don't exactly feel your pain, at least I know its sources. I know how difficult it is to make the move from challenging clinical work to an administrative role in health care. While, as a group, physicians are multiskilled and multitalented, it's an unfortunate fact that some of the skills and talents that made you an excellent physician may be blocking you from succeeding in an executive capacity. My hope is that, through an occasional entry in this column, I can share my experiences and relate the remarkable wisdom of the impressive physician executives whom I meet every day. The first issue I'm opening up for discussion is employment interviewing: Why the interview is so important, what the interviewing process is, and how you can become more adept in this critical skill area.     

Recognizing the power of diversity

"The trouble with the future is that it usually arrives before we are ready for it." While Arnold H. Glasgow did not have diversity in mind when he made this statement, his thought is relevant to that topic nevertheless. In fact, almost everything in the health care environment of the 1990s is fluid, making the future a question mark. Among these changes is the demographic composition of students entering medical school and of patients. Consider the following. While 14 percent of today's physicians are people of color, that number increases to 25 percent for current medical students. In the past 10 years, the number of female physicians has seen the largest percentage growth, followed by American Indians, Blacks, and Hispanics. Physician executives who have vision and energy can capitalize on this demographic revolution and convert diversity into a competitive advantage once its boundaries are understood.     

Is there a physician union in your future?

Physician unions are in the news. Patient management and patient care decisions are increasingly being taken out of the hands of physicians and put into the hands of "The Suits." To take their case for a return to physician-driven patient care to the people, some physicians are joining unions. Some are even collectively bargaining for salary and other issues that are historically more closely associated with unions. The simple fact is that physician unions exist and the number of physicians joining them is expected to increase. What are the pros and cons of unionization? What motivates physicians to join unions, and what potential negative and positive factors are associated with physician unionization? This article reviews the pros and cons and the issues related to physician unions, for physicians attempting to answer the question, "Is there a union in my future?"     

苏宁易购崛起悬念

上线不到两年,就轻松将当当、卓越等在B2C领域耕耘多年的选手甩在身后。10年3000亿、网上再造一个苏宁,体量千亿的零售大鳄正雄心勃勃地在电子商务的道路上一路狂奔。苏宁易购强势崛起,是张近东与京东商城老板刘强东之     

Innovative leadership: generating ideas.

One of the most challenging functions a physician executive performs is being an innovator--coming up with new ideas to keep ahead of the pack and to solve problems that need fresh solutions. Robert Hodge, MD, CPE, FACPE, and Barbara Linney interviewed Roger Schenke, Executive Vice President of the American College of Physician Executives, and gleaned seven pointers that you might consider to help generate a flow of new ideas or when you get "stuck." They are: (1) read voraciously and link unlike things together; (2) talk to people whose circle is bigger than yours; (3) stop thinking about the problem and focus on something else; (4) care enough to keep wrestling with a problem and not give up; (5) stay open to new ideas even if they are uncomfortable; (6) be willing to risk and take chances; and (7) find a place to carry out the ideas.     

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.     

Elected medical staff leaders: who needs 'em?

Authority, influence, and power are not synonyms. In working with elected medical staff leaders, a physician executive who chooses to exert authority may soon find him- or herself relatively powerless. But one who chooses to downplay authority, to influence through persuasion, and to coach leaders to lead effectively soon generates support for his or her ideas. The need to coax, cajole, explain, persuade, and "seek input" frustrates many leaders in all kinds of organizations. It would be much easier just to order people about. It's so tempting to think: "Who needs 'em? I'm the 'chief physician.' I know what needs to be done. Let's weigh anchor, take her out, and do what it takes to sail those rough, uncharted seas." If you really enjoy sailing a large ship in rough seas without a crew, go right ahead. Or if you think it makes sense to run an organization with only an executive staff and no knowledgeable middle managers, by all means let clinician leaders know that, now that you're aboard, they're just window-dressing. If you can make this approach work, well and good. Your life will be much less complicated, each day will have far fewer frustrations, and progress toward established goals will be much faster. However, given the reality of traditionally thinking physicians, it would be best to keep an up-dated resume in the locked lower left-hand drawer of your desk.     

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.     

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!     

Doing or being?

The founder of Aikido, Morihei Ueshiba, would occasionally distill the essence of the art into three simple shapes--a circle, a square, and a triangle. These are three basic ways of dealing with what's coming at you. The square is the simplest. It is about, essentially, doing nothing. The saying here is from the old spiritual: "I shall not be moved." You meet the challenge head on. The triangle is about forward motion--attack, cutting right to the heart of what is coming at you, or cutting right past it to the space beyond. The circle is often the most interesting space. The circle is not about standing ground or cutting through. The circle is about dancing with whatever is headed your way. The real danger lies in being stuck in any one mode--perpetually intransigent, always flailing away in attack mode, or forever slip-sliding through one dance step after another. It is only when our response is embodied in who we are that we will have the power truly to lead other people.     

德鲁克论21世纪管理挑战——信息挑战

彼得·德鲁克在其新著中解释,一个新信息革命正在进行中,它将彻底改变信息对企业和个人的意义。它不是技术革命,而是概念革命。至今,信息技术集中在数据,聚焦在“IT”中的“T”;新信息革命聚焦在“I”。 德鲁克论述了15世纪印刷技术的历史教训,对比了传统成本会计与基于活动的成本核算,说明企业需要的信息,具体提出了管理现行企业所需要的四套诊断工具与战略所要求的外部信息,明确了主观人员工作所需的信息观念,其形成必须由主管提出两个问题开始“我给什么?”“我要什么?”然后论述了组织信息问题,提出若干方法学概念。德鲁克敦促企业与个人必须学会组织信息作为它们的关键性资源,以迎接21世纪的管理挑战。     

The successful physician negotiator

Whether you realize it or not, you are in the middle of a negotiation every time you are asked to do something. Negotiation skills are important for physician executives, both in their professional and personal lives. The Successful Physician Negotiator: How to Get What You Deserve provides useful examples of how to negotiate and helps you get in the proper mindset to get it done effectively. While the book explores the concept of cooperative negotiation, which is important if you want to have a long-term relationship with a person, it's also important to have other tactics. You need to understand your opponent by gathering information about his or her values and work situation. You can gather information when talking to your opponent, but you also need to do some "behind the scenes" preparation before the encounter begins. Other recommendations include: don't negotiate in your office, use time to your advantage, be able to keep silent when necessary, have options, be able to say no and walk away, keep your cool, and take notes.     

Can you take your soul to work?

David White in The Heart Aroused: Poetry and the Preservation of Soul in Corporate America explores ways for professionals to take their souls to work, instead of checking them at the door. "We simply spend too much time and have too much psychic and emotional energy invested in the workplace for us to declare it a spiritual desert bereft of life-giving water." Several ideas are presented to help physician executives preserve their souls in an increasingly corporatized U.S. health care system: (1) Figure out what you are meant to do as your life's calling; (2) know what you think and want; (3) share some of what you think at work, while being careful to not lose your job unless you choose to; (4) be a trustworthy listener and find one; (5) get yourself outside; (6) pay attention to your physical space; and (7) develop some new hobbies or refresh old ones. "One of the disciplines of building a rich soul life seems to be the simple act, on a daily basis, of remembering what is most important to us."     

Becoming who you are.

It's difficult to predict success based only on educational background and career experience, important as they are. More is needed. And one of the aspects that needs to be evaluated is the degree of self-actualization. Self-actualized individuals have worked out their personal issues well enough that their personal life no longer has to intrude into their professional lives and actions. In a word, they are free people. In career terms, self-actualized people are "company people," but not "yes-people." They are executives who have freed themselves to be able to internalize the growth, development, and strategic planning of their organization--because they are able to rise above personal considerations, to shed emotionalism, and see more clearly. Some methods you can use to figure out where you stack up are: Conduct a self-evaluation; identify role models; do what is called "a 360 evaluation."