Download physicians and administrators

PHYSICIANS AND
ADMINISTRATORS
NAVIGATING A ROAD PAVED WITH GOOD
INTENTIONS
PHYSICIANS AND
ADMINISTRATORS
•
No conflicts to declare.
•
Michael V. Jackson, MD, FCCP, FAASM
•
Pulmonary Medicine Associates, Reno, NV
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Clinical professor, University of Nevada School of Medicine
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Scarred survivor of changes in medical practice
MANAGEMENT AND
LEADERSHIP
MANAGERS
LEADERS
Planning, budgeting
Establish direction
Organization, staffing
Align people
Controlling, problem solving
Motivate and inspire
Produce predictability and order
Produce change
PHYSICIAN TRAINING
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Science Majors, mostly
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Competitive, always
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Some social awareness
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Little knowledge of business or
systems engineering
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“Rapid decisions based on
inadequate data”
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Patterns of thought
THE UNFORTUNATE
EFFECTS OF A MEDICAL
EDUCATION
•
Clinicians think and communicate differently than
business leaders and administrators
•
Clinicians learn from their seniors, inheriting the
good and the bad
•
Time frames for decision making in clinical practice
are vastly different than those in administration
•
The definition of a team is imprecise
PHYSICIANS THINK
AND COMMUNICATE
IN A DIFFERENT WAY
Data analysis - deductive from trials
or inductive from trends and analysis
Time frames
Definition of a team - individual
contributions or affiliative
interdependence
An apprenticeship model
EARLY ADOPTION MAY BE A BUSINESS IMPERATIVE
BUT IT MAY ALSO HURT PATIENTS
THE CAPTAIN OF THE SHIP OR THE
TEAM LEADER?
THE UNFORTUNATE
EFFECTS OF A MEDICAL
EDUCATION
•
Clinicians think and communicate differently than
business leaders and administrators
•
Clinicians learn from their seniors, inheriting the
good and the bad
•
Time frames for decision making in clinical practice
are vastly different than those in administration
•
The definition of a team is imprecise and clinical
groups are often smaller than organizational teams.
THE TIMES, THEY ARE
A’CHANGIN
AND WE MAY NOT HAVE THE TOOLS
WE NEED
WHAT IS NEEDED?
THINGS I NEVER LEARNED IN SCHOOL
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Strategic planning
•
Persuasive communication
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Negotiation, contracting
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Finance, coding, revenue cycle
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Team building
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Conflict resolution
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Information Technology
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HR - hiring, firing, performance review
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Legal issues, regulatory compliance
WHAT ARE THEY LOOKING FOR?
Beatrice: the ideal administrator
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A detail-oriented, strategic thinker
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Understanding of physician personalities
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Ability to choose one’s battles
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Communication skills
AND WHAT DO YOU NEED?
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A realistic job description
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Authority, not just responsibility
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Treatment as a management partner, especially in
staffing issues
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Latitude to use one’s own methods
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Full access to financial data
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Credit for successes
HAZARDS TO NAVIGATION
WHERE THINGS CAN GO WRONG
WHEN GOOD PRACTICES GO
BAD
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Collisions between business needs and quality of
patient care
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Adoption of new systems and processes
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Transitions from production to quality and value
COLLISIONS BETWEEN BUSINESS
IMPERATIVES AND PATIENT CARE
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Scheduling - how many of these increasingly complex patients
can I see per hour?
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Patient Care vs Customer Service - is there a nice way to say
that you are overweight and smoke/drink too much?
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Fitting the variable workflow of individual physicians into a
coherent process.
ADOPTION OF NEW SYSTEMS AND
PROCESSES
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Information technology
•
Quality and Service Benchmarks
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Chronic disease management and delegation of responsibility
to other team members
TRANSITIONS FROM PRODUCTION
TO QUALITY AND VALUE
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How am I measured? Dollars are easier to count than brownie
points.
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What does “value” mean? From the standpoint of the payor, it
means offloading risk to someone else.
•
How do we assess which new physicians will fit best into the
new care paradigm?
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And what do we do with those who can’t, especially when they
own the business?