Vol. 2. No. 1

The physician is still Captain - but of the team, not ship. This role change emphasizes the need for greater collegiality and respect for the contribution of all players, not the stratified hierarchy of order givers and unquestioning order takers. Let's start with a few bullets about the Captain's changing environment over the last 25 years.

• Changing demographic profile of physicians - increased number of women and minorities
• Changing organization of medical practice - group practice, HMOs, MSOs, free-standing facilities
• Virtual demise of fee-for-service - capitation, withholds, shared risk, bundled fees, salary
• Changing image of physicians in the eyes of the public - trustworthy? paid to provide or withhold care?
• Impact of new medical technology and pharmaceuticals on outcomes and costs
• Impact of information technology on outcomes, costs, consumer and knowledge
• Role and effectiveness of other health practitioners and alternative medicine - complementary or substitutive

Top Ten List

Given these changes, here's my Top Ten List of things I've done or wish I had done to assist physicians to succeed and, at the same time, contribute to the hospital's success.

1. Focus on the patient and clinical programs. In dealing with the majority of physicians, it's not about money and deals. Physicians care most about what you and your organization can do for their patients and, on a broader scale, how you can work together to offer services that enhance both their practices and the organization's bottom line.

2. Share relevant facts and figures. Physicians are information-driven. Today's electronic capabilities allow you to "slice and dice" data to analyze business and clinical issues. Getting them the numbers is mandatory, whether it relates to the feasibility of a new cath lab, length of stay and outcomes variation of specific surgical procedures, or to evaluate the financial impact of acquiring hospital sponsored primary care practices.

3. Shared power is more power. Physicians want and deserve a true voice in matters that affect them. Physician membership on governing boards is no longer the debatable issue it was 25 years ago. However, this power also includes making tough decisions about business strategies, merger partners, resource allocation, and how to change physician behavior and improve clinical outcomes.

4. Help physicians succeed. A major goal for any executive should be to help physicians succeed. Almost always, when they succeed the organization does too. This has not changed over time. A role model is Health Care Hall of Fame member Bob Cathcart, who served for three decades as CEO of the Pennsylvania Hospital. Bob was pictured on the cover of Hospitals 25 years ago as the AHA Chairman. A role model for all eras.

5. Cultivate and develop physician leaders. Formal and "semi-formal" programs give you the opportunity to identify and involve those physicians with leadership potential. This has at least two important advantages. First, it promotes understanding and trust, and facilitates planning and program development. Secondly, it helps to counterbalance a medical staff political process that can produce "leaders" who were the only ones willing to stand for election or who have their own agendas.

6. Stay on the high road. As the Columbias of the world introduced the "do a deal a day" era, many of us were tempted to cross the line to stay competitive. Some are now paying the price. Be especially wary of defectors from other hospitals who bring "big money deals" with them. There are reasons they may not want to remain where they are.

7. Reward loyalty but don't play favorites. Supportive physicians should be rewarded (legally) and perhaps monetarily compensated. However, remember that when acknowledging the high profile physicians, there may be other physicians whose contributions are comparable but who are not as visible or vocal.

8. Optimize the use of information technology. There are many technological innovations that can improve service to patients, reduce the hassle factor for physicians and create a more cost effective system. These include practice management systems, automated drug dispensing systems, electronic access to information, systems to manage productivity and clinical activity - all of either direct or indirect benefit to physicians.

9. Support your troops. There will be times when conflict between physician and hospital employees cannot be averted. In your zeal to be physician friendly, don't fail to support the staff member if, in your judgment, he or she is on solid ground. Failure to do so is devastating to morale and can create organizational backlash against efforts to work closely with physicians. Long-term, respected employees are one prism through which physicians evaluate management. Taking a stand on the basis of principle can enhance management's image with the overall medical community. On the other hand, it is imperative to know when a physician is the victim of administrative obfuscation or anachronistic thinking.

10. A few miscellaneous (personal and maybe quirky) thoughts.

a. I have trouble with the use of the pronoun "my" as in "my shop" or "my docs."

b. Avoid visible perks that are not essential for the job; start with the reserved parking space.

c. Find reasons to get out of your office that are more meaningful than "making rounds." That includes meeting with physicians on their turf, e.g., the Lab, Pediatrics Unit or off-site office.

d. Years ago someone gave me a triadic admonition that seems valid today in dealing with physicians. (1) Give what you gotta give with a smile; (2) Always have an in with the outs; and (3) Never get between a dog and a fire hydrant.

So, there it is. Much has changed but many principles remain the same. There are not too many new ideas as we begin the 21st century. If you have any, please let us know so that we can start a dialog and learn from each other.