Submitted by NHSwales on
I'm a hospital manager in the UK. I have been listening to MT&CT for a few months. I started trinity rollout 7 weeks ago to my non-Doctor directs with excellent results.
However I am struggling to apply MT methods to Doctors. I manage 38 Hospital Consultants (senior doctors which I think they are called "attending surgeon" in US) across 6 specialties (e.g. General Surgery, Trauma & Orthopaedics, Urology) plus over 100 doctors under the consultants.
I am dependant on consultants to deliver results such increased operating room efficiency or reduced infection rates. I conduct half of their annual review and can influence their salary. On this basis they are my directs.
I do not interview new consultants. They are on average paid twice as much as me. They are highly educated; understand the services we provide better than I can. They could find a medical safety reason not to do anything I ask. I have limited influence on their long term career. They have a professional accountability to the Medical Director. On average they are 15 years my senior. Most service improvements come from their ideas. Some of them also have regular discussions with Executives. It often feels like they are the boss and I'm the direct.
Each speciality has a "clinical team leader" which is a consultant who is paid the equivalent of 1/2 a day each week to undertake managerial duties. How this role works in practice varies from some acting like my clinical advisor to some acting like a spokesman or union leader. Those who have tried to take on the role of manager have had strong resistance from some their colleagues who either speak to me directly or are of the opinion that no-one should manage them and they should be solely accountable to their patients.
I love my job. I wouldn’t do anything else right now. I have good professional relationships with my Clinical Team leaders plus about 15 other consultants through which I can get most things done. Fortunately most of my objectives align with theirs with the possible exception of cost saving. I have been doing O3s with the team leaders for years recently moving to a 15/15 MT format although some will periodicaly find an emergency that means they cannot attend.
I would like to hear general advice from other hospital managers or anyone with experience of similar managment challenges. Can you recomend any casts? I tend to find CT casts such as dealing with objections more relevant to this group of staff.
The sort of issues I can struggle with include:
· When I have to make a change that benefits one speciality to the detriment of another
· Engaging with Doctors who have never been managed, do not believe they should be managed, and have got away with this for 20 year or more
· Aligning Doctors with organisational objectives especially cost savings
· Explaining to more senior managers (including C-suite) that I, and they, have very little role power over this group of staff. Unfortunately most of my seniors have little or no experience in managing hospitals and consequently over-estimate role power. I can struggle to explain this while retaining some level of professional subordination.
I’m sorry for the long post and potentially confusing use of the word consultant.
Thanks in advance for the advice
Physicians are hard even across the pond
Hello Brett -
I appreciate your predicament and I can empathize that physician are difficult personalities even in the US (where I am). I am in healthcare and have some experience with many of the situations you mention. Influencing physician behavior is very difficult given the default nature of the healthcare economic system, where a "matrix" exists of accountability to many different types of stakeholders. There is no singular "boss" or individual who has hiring/firing authority often in the relationship between US hospitals, insurance companies, patients and physicians.
I would suggest a couple resources and tactics to help improve your results. There is no silver bullet here. I've tried all of these and they've worked in many situations for me.
I suspect you are using the peer feedback model as your relationship isn't quite the straightforward "direct report." I would also guess that will make the "here's what happens" impact portion all the more important. If you can't figure out an impact that the consultant physician will care about, then you probably won't change their behavior. If cost savings doesn't help the physician or the patient, why should they care?
Consider the DISC profile of your physician consults and tailor your feedback to them based on their style. In my experience, providing feedback to folks who are difficult to manage are often not hearing impact that is relevant to them (therefore they dismiss). Figure out if individuals are focused on results or relationships, and that will help immensely. Everyone is motivated differently. Use DISC. There are podcasts that help come up with meaningful impacts.
For larger initiatives, I love the book "Influencer: The Science of Leading Change" - it highlights the various ways to influence change and the importance of using many difference forces of influence (from peer pressure to education). Getting results is often about trying many things together and seeing change happen after lots of effort and many attempts. Figure out how to make a campaign around your organizational initiatives.
Last, I recently finished a book "Difficult Conversations" with some tools and tactics on engaging in conversations that can be hard due to the difference in perspective. I found it helpful, and some of the tools useful in my own managing others who have different views on situations and goals.
I work in a similar atmosphere and we have struggled with this as well. The most important point of the O3 is to give time to your direct. If, by doing this, you'll be in a better position to identify their challenges and act upon them, it's working! Then you'll also be able to communicate your (the organizations) needs. If you're not able to affect change on their day-to-day, one on ones won't benefit you or them. Providers are concerned with patient care; they would rather get a memo of cost saving changes that are coming. We've instituted a weekly best practice design committee of physician champions who understand both the clinical and business end of things. It's the best way we've found to create acceptance and innovation.
Re: managing doctors
Disclaimer: I am not in the medical industry, I come from an engineering service background and I have had experience in the academic environment too.
That said, some of the issues you experience are not pertinent only to that environment. In other words, you are not alone in the challenges you face. Usually the problems are similar but gets worse when strong egos are involved, which is probably what happens in the medical industry (as it tends to happen in academia).
With regards to your concerns I will risk answering:
1) When I have to make a change that benefits one speciality to the detriment of another
This problem arises everywhere and it is usually related to not being able to put oneselves in the other person´s shoes. The best way around it is to explain why you made the change and try to convey to them the best you can what the situation was at the other speciality. One thing is certain though, you cannot please everyone. Some decisions will be yours, and you can explain the reasons behind them, but you don´t need everyone´s approval for it.
2) Engaging with Doctors who have never been managed, do not believe they should be managed, and have got away with this for 20 year or more:
it is all about the relationship. You need to develop a relationship with them. If you can do O3´s with them that is the best way forward. Accept it will take time. Go slow. If you want to go faster, one way is if they can see you can do something for them. Try to figure out the ways you can be of help for them, and they will be obliged to pay back (Influence!), and will want to. One book that might also be useful is "Speed of Trust". One great way of gaining trust is through expertise trust or technical knowhow which sound like you are at a disadvantage with respect to the people you manage. But they can also figure out you can help them on getting things running smoother across specialities, on burocratic issues, I don´t know, once you establish that trust, they will be more engage.
3) Aligning Doctors with organisational objectives especially cost savings
I have found 1 in 10 people in organisations will naturally care about cost saving issues and will treat company money is if it were their own. Most people don´t care because they consider the amount small compare to the total profit the company makes and don´t see the impact small costs have when summed together. I have found that it does help if the impact is shared with them. They also usually overestimate company profit. So if you can share the impact and the total numbers I have found that helps.
4) Explaining to more senior managers (including C-suite) that I, and they, have very little role power over this group of staff. Unfortunately most of my seniors have little or no experience in managing hospitals and consequently over-estimate role power. I can struggle to explain this while retaining some level of professional subordination.
I don´t quite understand why you need to explain to more senior people that you have little role power over this group. Are they asking you for something to get done, and you need this group cooperation and you are not getting it done? If that is the case, can it be done differently, with other people? You may need to use more influence and relationship power, but your seniors don´t need to know about it. Rather than disagreeing with your superiors, can you buy more time, and get it done through relationship power rather than role power (but they don´t need to know about it)? Can you think about some individual goals you could set to the doctors that are linked to what you are trying to accomplish? It usually helps to share the numbers too, make a chart of where you are in comparison to what the target is, and who is going in the right direction and who is not. That is usually good if you have most people with you and only a few causing difficulties.
I have read a book called Crucial Conversations which has also been very good in sorting out disagreements and finding common ground.
If you started trinity rolled out 7 weeks ago with excellent results, I wouldn´t draw the conclusion you are struggling to apply MT methods to doctors. Anyone at any industry with 7 weeks trinity (actually it can not be the trinity, only O3´s, you have to wait a good few months for feedback and a bit longer for coaching) would not be getting all the results from MT methodology yet. At the beginning i find it helps to track differential change, not total change. Where are you today with where you were three weeks ago, and not where are you with respect to where you want to be.
Doctors are people too before they are doctors, and my experience has been that even people that like to do stuff on their own and are very confident at what they do, like it when people care about what they are doing. Perhaps you need to show them more you care about them, they may be getting the message you care about the numbers too much?
Good luck! And let us know after a few more months how it is coming along!
Thanks to Dan, Sarah & Nara, for taking the time to reply.
It is reassuring to know there are managers in other countries and industries dealing with these issues.
There is a lot of good advice here which I will try to take on board and I will come back with updates on how it’s going
More from across the water
I am a physician, Chief of a clinical division and Medical Director of Information Services. I have many of the same challenges you wrote about. As a rule, physicians hate being told what to do, especially by non-physicians. Others have detailed some excellent suggestions. The importance of relationships cannot be overstated; the doctors have to eventually agree that you and they have the same goal (excellent patient care), or you won't get anywhere with them. I agree with Dan, that you have to find a way to show doctors how what you are doing will benefit them and the care they provide. You can find ways to help them be more efficient (such as decreasing operating room wait times). Anything that costs them more time will be a very difficult sell. One thing that is helpful, though, is data. Numbers don't lie. We doctors love to be scientific. Find clinically relevant processes or outcomes that you can measure and report on is very helpful. Especially if a change improves patient outcomes. If it saves the doctor time or effort in some way, even better.
Take the time to build relationships, and convince them that you are all on the same side; this will take time. Ask them what would help them do their jobs better and more efficiently. We doctors can be an obstinate bunch, surgeons even more so. Good luck, and let us know how it goes. Feel free to contact me.
Hello Brett As a Health
As a Health Administration Specialist i feel of you . In general , i advice you to discover and practice an effective way and method to communicate with consultants ; you have to communicate with them in a special way . There are many books and research will guide you to do so. I support the view of Glenn .
With best wishes ,
Health Administration Specialist & Faculty Staff Member
The challenges that you face
The challenges that you face may be found in other professions and environments, so I think they are real and relevant to many of us. The medical field not only has cut-throat competition, but also a very demanding environment. Your good professional relationship with your clinical team and consultants is a key factor and a great advantage, be sure to utilize it. I agree with some of the points mentioned above and would like to add that organizing some events on monthly intervals may help to some capacity. Attending events and engaging in open discussions can be a useful tool when managing others who have different perspectives. You can find a lot of resource online for various techniques.