You know them when you see them. They stand out. They seem so different – in personality, temperament, even physical appearance – and yet they work so well together.
“They” are the co-workers who get along so well, whose yin/yang is so balanced, who are so much in sync that they sometimes even finish each other’s sentences. They have an enviable working relationship that leaves everyone wondering how they do it.
I have witnessed the best of this dyad teamwork in action, and it’s really something to behold. Two leaders – one, an administrator; the other, a clinician. They have very different backgrounds, styles, and approaches. One is direct, candid, “never met a stranger,” highly-social, informal and conceptual. The other is reserved, laser-focused, concise, more formal, and challenges convention. Even physically, they’re like Laurel and Hardy. If they were married, you might even say that they’re “the perfect couple”.
Obviously, there’s some “secret formula” at play, right? But when you ask them what makes them so effective together, they can’t articulate the reasons (even though they can complete each other’s sentences!). And, to the observer, their harmonious relationship seems extra-ordinary.
Let’s explore the possibilities of what’s going on here, shall we?
PHYSICIANS AND ADMINISTRATORS: FRIENDS OR FOES?
We can all agree that the sterling example outlined above is somewhat of an anomaly in the current state of health care and that the potential for communication/relationship challenges between administrators and clinicians is real and ongoing.
To begin, they operate from polar-opposite perspectives. Their roles and responsibilities evolve with perceived and/or real power of influence. The chart below outlines the diametric approaches of both parties.
|Role||Medical Leader||Business Leader|
|Orientation||Individual Patient Health||Organizational Health|
|Autonomy||Independent Expertise||Dependent Delegation|
|Decisions||Immediate/Near Term||Anticipatory/Long Term|
|Focus||Quality Care Delivered with Well-Managed Resources||Well-Managed Resources Delivering Quality Care|
WHO, IF ANYONE, IS TO BLAME?
In his Forbes magazine article, Physicians and Administrators: Friends or Foes? writer Sachin H. Jain asserts “We are amidst one of the most dynamic moments in healthcare delivery—and the relationship between those who deliver care and those who administrate it has never been more tense, challenged, or fractured.”
Jain explores the reasons why this potentially symbiotic relationship has become so frought with challenges, citing the burnout problem in American medicine today, where over 54% (up 10% from three years ago) of physicians report a loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment.
“The relationship between those who administrate care and those who deliver care has never been more strained because, at a very basic level, both groups don’t understand or trust one another.”
But, where lies the seed of all this dissent? To begin with, for years, physicians have been asking out loud why there are so many administrators involved in their delivery of care when that wasn’t the case in the early days of their careers.
Drawing on his experience as a change leader at CareMore Health System, Jain came up with four, guiding principles aimed at mending the divide between physicians and administrators. These include: Unlocking the Ingenuity of Physicians; Educating Physicians About the Financing of Delivery of Care; Teaching administrators about clinical medicine so they can speak a language on par with their clinical counterparts; and, Referring to Physicians as “physicians”, instead of lumping them into category that includes a variety of health care professionals now known as “providers”.
“These four guiding principles will not, by any means, altogether solve the problems of physician dissatisfaction and burnout. But I’ve seen them begin to reverse some of the smoldering tensions that have overtaken many healthcare organizations throughout the country. Physicians alone cannot solve American healthcare’s biggest problems without the help of talented, dedicated and multi-disciplinary administrators. Nor can these administrators solve the same problems without the robust and thoughtful engagement of physicians.
WHAT’S TRUST GOT TO DO WITH IT?
Mark Hertling, author of Growing Physician Leaders, is senior vice president for global partnering, leadership development, and health performance strategies at Florida Hospital, which has 28 facilities across the state. He provides leadership training that participants say is both unique in its approach and highly effective. Mark believes building trust among Physicians and Administrators is key to successful, workable collaborations. For example, including, rather than excluding physicians more often in management decisions that impact their work is a step in the right direction. “Trust is achieved when integrity, honesty, humility and commitment describe the characteristics of each member of the team, whether it be physician, clinician, nurse or administrator. Trust is what all leaders hope to generate, and it is that element which makes the difference in high performing teams.”
HEALTH CARE TODAY MUST BE PLAYED AS A TEAM SPORT
Despite their opposing perspectives, Doctors and Administrators, together, share the key priorities for patient and family-centered care.
However, the fast pace, long hours and various pressures of the work environment on a daily basis can adversely affect collaboration. Most hospitals have moved or are moving to value-based care reimbursement, demanding that hospital execs and doctors work together more closely in order to develop strategies to deliver high-quality, patient-centered health care.
In a healthcare setting, there are several different teams and groups of individuals who must relate and work together effectively. Physicians and nurses, nurses and patient care techs, pharmacists, dieticians, occupational and physical therapists, all need to collaborate well to deliver quality patient care. Collaboration is especially crucial in healthcare environments where patients depend on a team of experts to address increasingly complex health issues. One of the most critical relationships is that between Physicians who assess and manage medical treatment, and Administrators who manage the day-to-day running of the hospital.
I recently interviewed Jamie Schmitgen (People Services Chair, responsible for oversight of core HR Shared Services across Mayo Clinic) and Nichelle Baker (Mayo Clinic’s People Consulting Lead) to learn about what they do at our nation’s # 1 Rated Hospital to build Physician and Administrator collaboration.
Teamwork is not only highly valued at Mayo but it’s expected – from everyone. As a physician-led organization, patient needs come first. A strong culture of collaboration plays a strong part in Mayo’s employment brand and is sustained through consistent practices. Ms. Baker explains. “We hire for values and manage these values to create our culture. Partnership fit is a big part of it.”
In addition to thoughtful dyad matches aimed at complementing physician and administrator strengths (physicians and administrators at Mayo also rotate assignments), Mr. Schmitgen highlights, “It’s one thing to believe in partnership, but you have to live it, model the values, and hold people accountable.”
Over the course of several decades, Mayo, led by the dyad approach, has refined the art and science of collaboration. Based on observation and experience, Mr. Schmitgen recommends that organizations:
- Clarify and document roles, responsibilities, and decision-making protocols
- Choose the right leaders and explain how each contributes to any department’s success
- Provide orientation with a curriculum that includes expectation setting
- Bring Physicians and Administrators together in formal training to problem solve and collaborate on action/learning projects
- Develop and maintain a culture that spotlights the dyad approach
Within my own business of Executive Coaching for Healthcare Initiatives, I use the model from The Center for Creative Leadership (CCL®), which health systems can use to adapt and thrive in uncertain times by creating direction, alignment, and commitment among doctors and administrators. Here’s the link to the pdf.
My friend and colleague, Cindy McCauley, CCL Senior Fellow, believes that the CCL model “provides a strategic view of key elements to diagnose and target areas for progress. It’s a reminder that we (administrators and physicians) need each other. The healthcare sector has complex issues and no, one body of knowledge or expertise will solve all problems.”
Deborah Torain, CCL Strategic Business Partner, adds, “It helps leaders recommit to the mission, knowing that we’re all in this together serving patients with compassion and a focus on quality care.”
IN THE END, IT’S ALL ABOUT RELATIONSHIP
Here’s my own list of 5, key elements that can help forge successful Physician/Administrator partnerships:
- History – Make a point of getting to know each other better, including work styles.
- Humor – Add some levity and fun to the serious nature of daily operations.
- Huddle – Connect formally and informally to stay in tune and ahead of changes.
- Help – Invest. Proactively offer and receive assistance. It’s currency in the bank.
- Humble – Walk in each other’s shoes to develop greater insight, empathy, and perspective.
Finally, when a trust-based relationship between Administrators and Physicians focuses on shared values, common sense, and quality, patient-centered care, administrators can be trusted to manage the business side, thereby enabling physicians to manage their practices and put their full focus on their patients.
Most important is that everyone remember that what we’re doing is all about getting – and keeping – our patients well.