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Regardless of the brilliant strategy or the fantastic business plan – if the people in a business deal “don’t work”, then the deal won’t work. Savvy hospitals and physician groups understand this phenomenon as they approach negotiation. Their conduct facilitates a good outcome and an environment in which the new relationship can create value in their merged approach to the business of healthcare.

Although hospitals and physicians are differently oriented, it has been surprising to me how little they understand each other’s perspective. That lack of knowledge is often the source of unnecessary misunderstanding and relationship gap. Programs that purposefully aim to fill the relationship gap have better alignment and achieve excellence more than those who do not.

1. Listen: What is important to physicians and what is important to hospitals is not necessarily aligned. Administrators who are typically responsible for a physician negotiation are not those that also have operations knowledge relevant to the negotiation. Physicians are concerned with things that affect their day-to-day ability to practice medicine in the facility; I have seen negotiations that dismissed these types of items as “operational” and therefore trivial. Of course to a physician, operations are what they do. The administrator who is able to listen and understand the nature of an operations issue can quickly become a problem-solver for the physician and not a “suit”.
2. Provide documents and agendas in advance: Information that is commonplace to administrators is typically not familiar to physicians. For example, the value of a solid line on an organization chart to a dotted line doesn’t have intuitive meaning to physicians. Without preparation, there is often little feedback to issues presented – which is interpreted as agreement. When the issue later resurfaces, administrators are frustrated with the physician’s continual expansion of the negotiation horizon. Providing the physicians agendas and documents in advance allows them to be prepared for the negotiation. Think about it, how would the administrator do reading an echocardiogram on the fly?
3. Give direct answers: Physicians believe that administrators are the master of the “slow no.” In fact, they believe that there is a manual somewhere that teaches administrators how to both not agree or make promises, but also not irritate the physician – by saying no. The resulting elongated conversation that typically extends over several meetings, often months, to end in a “no”…is the slow no. Giving direct answers to the physician with a straight forward explanation and timeline for resolution – and sticking to it, will build trust in the relationship.
4. Understand their world: Administrative rounding in hospital departments is a proven effective leadership tool for many hospital executives. But, how about rounding with a clinician in the hospital? Rounding with a physician will enhance the administrator’s understanding of how the hospital staff, processes and information technology impact the physician’s ability to be effective. It will benefit the administrator in multiple ways, not least of which is gaining an understanding of alignment opportunities. I can say with certainty that a hospital executive that rounds occasionally with their physician leaders will have a better platform to align with them than those who do not.
5. Ask them: We were in the second hour of a meeting with a physician group discussing potential collaborative models to align the hospital and physician strategies. Several organization models were illustrated. We covered in brilliant detail the benefits of collaboration and the theoretical success that it could bring both parties. Finally, when the physician leader had a chance to speak, off the top of his head, he rattled off 5-7 initiatives that could be pursued to improve the hospital’s program. The implemented initiatives would result in immediate program improvements and literally millions of dollars in positive financial impact to the hospital. I wonder if the hospital had been asking the physician for his ideas and offer to collaborate in their 20 year history would they already be providing the expanded program he described.

Of course there is another blog on the smart things that doctors could do to close the knowledge gap between hospitals and physicians…that is a blog for a different day.