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| Dear Friend,
Negotiation: It's not a "place", it's a process. And where it takes place is everywhere, even if you don't realize it.
Picture the following situation:
Working with my client group’s leader, we’ll call him Dr. Bob, we’re deep into the negotiation of a deal with a hospital, one of the elements of which is the intensity of physician coverage, upon which we’ve agreed as the basis for a fair market valuation analysis.
Then, one morning at around 6:15 a.m., the hospital’s COO passed Dr. Bob in a hospital hallway. The COO said a quick hello and then, in a completely off the cuff, chatty manner, said something to the effect of “think we can handle running the new slot until 5?” Dr. Bob said “sure” and continued on his way. In retrospect, Dr. Bob doesn’t think that he even stopped walking, the exchange having taken perhaps 3 or 4 seconds.
A few days later, the hospital’s attorney generated a revised draft of the contract. It now included a 5:00 p.m. end time, a one hour increase in coverage, in connection with the newly added coverage slot. Despite the increase in workload, the amount of financial support from the hospital remained the same.
Dr. Bob was furious. To him, the hallway “chat” was just that: an exchange of pleasantries and an optimistic expression of the growth of the venture. But it was absolutely not a part of the current negotiation process. To Bob, the COO had engaged in “drive-by” negotiation.
The COO, on the other hand, didn’t see anything wrong with the exchange. To him, it was a brief exchange on an important deal point.
What went wrong, and why?
It boils down to a matter of perception of the negotiating process.
Physicians inexperienced in business often mistakenly regard hospital negotiation as a formal process separate from day-to-day activities at the facility. When at the facility, they are on their way to render patient care or are headed back to the office or out the door. Hallways are not negotiation tables. For many physicians, location is a factor in negotiation – the physical context controls the question of whether or not there is intended content.
To a hospital administrator, all discussions with contracting parties, whenever and wherever, are part of the negotiation process. The executive’s office, the board room, the wash room, or the hallway, even the check out line at the local supermarket, are all simply locations – and to him or her, location is not important; it is content, not physical context, that controls.
Because you can count on the fact that hospital administrators are not going to change their perception of the immateriality of physical location to negotiation, it’s incumbent on physicians to learn this lesson and learn it well. Any communication with, or within earshot of, an administrator is a part of the negotiation process. Physicians can never have an “off the record” conversation with an administrator. The only alternative is to have no communication at all; hardly an effective strategy.
Understanding this rule allows physicians leaders to both protect their negotiating positions and to use “informal” communication with administration proactively to inform and dis-inform in the context of a controlled negotiation.
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| | | Tuesday - A Disruptive Physician of Another Sort - Success in Motion
Watch the video here, or just keep reading below for a slightly polished transcript:
Let’s talk about disruptive physicians, but not the usual sort.
When most people think about disruptive physicians, they think about someone who has an aggressive personality. We could call it someone who is swearing in the office. We could call it someone who is a harasser, even a sexual harasser. Those are certainly types of disruptive physicians and there are many more.
But what about the sort that you might create?
Disruptive physicians are often created as a result of poor entity structures, such as upon the merger of groups.
Consider the case in which the merged group's board consists of equal numbers of representatives from each of the constituent groups; let's call them former “Group A” and former “Group B”. In the hope of spreading "fairness" and cooperation (like singing Kumbaya by the campfire), what resulted was a power-sharing standoff, not a complete business marriage.
It many such situations, the group owners, and maybe all group members, don't truly view themselves as owners or employees of a combined group. Instead, they view themselves as members of former Group A and former Group B, and their board representatives continue to govern in that fashion.
Then along comes a disruptor, a Board member from, say, former Group B who decides that he or she wants to take their toys and play in another sandbox. And by their toys, I mean they want to take Group B out of the merged entity, with, of course, him or her as the new leader.
So, he or she does things to disrupt the group's organization. He or she does things to attack Board members from what they still view as former Group A. He or she does everything they can to split the group up.
What do you do to get rid of someone like this before they result in the destruction of the entire business?
Have you created a situation in which you’ve tolerated that behavior for so long that you’ve created a reinforcing feedback loop? The disruptor acts out -- you do nothing. He or she acts out again; after all, there's no downside punishment. This loop continues and worsens because getting away with it has become the status quo.
Even worse, have you created a situation in which your organizational documents don’t permit you to expel disruptor Dr. X without a vote of the members, or even worse, a vote of a super-majority of the owners? After all, if the merger preserves the concept of constituent groups, you shouldn't be surprised that the members of what lives on as Group B will always support "their guy" no matter how big an asshole he is.
Just like Dr. Frankenstein, you’ve created your own monster.
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| | Wednesday - Why the Hospital's Idea of Physician Leader Means Follower - Medical Group Minute
Watch the video here, or just keep reading below for a slightly polished transcript: It was the time that I almost died. The car was out of control and I was headed for a cliff.
Then I awoke from the dream in a sweat. The smell of pancakes wafted in from the kitchen.
I recently read an article about hospitals training physicians for "leadership" roles.
What those hospitals are really doing is training more physicians to become hospital-employed or hospital-controlled managers in order to monitor, cajole and threaten the members of the medical staff to follow mandated cost cutting measures. Oh, excuse me, they called them "quality goals."
Don’t get me wrong, I'm all in favor of better quality. I am in favor of doing things the right way. But who should decide what the right way is for Ms. Betty Bobson, age 47, or Mr. Bob Beatty, age 74, the hospital or that patient's physician?
I've dealt with instances in which a surgeon's orders were changed, without consultation, by a hospitalist engaged by the hospital. When the surgeon complained, she found herself subject to a medical staff investigation. Oops! Just a coincidence!
So, if you’re the hospital CEO, why not put that situation on steroids?
Instead of the sole hospitalist changing orders, the hospital can now instruct all of its employed or controlled physician "leaders" to enforce what the hospital deems to be evidence-based best practices or protocols or whatever the name of the week is for cookie cutter behavior or for using only those products or pharmaceuticals on which the hospital gets the best deal. But the bottom line is the same: Who is making the decision, Ms. Betty Bobson’s physician or the system?
Don't get me wrong, I'm all in favor of physician leaders. In fact, I wonder if an all physician board and all physician top leadership should be requirements for a hospital’s Medicare participation? Think about that for a while.
But in the politically correct patois of Orwellian hospital double-speak, “leader” now means follower.
Is following orders best for patient care? Is it really best for your career?
Your career is in a car and it's heading over a cliff. Ms. Betty Bobson or Mr. Bob Beatty is in the passenger seat. No, it's not a dream. No one is in the kitchen making pancakes. Grab the wheel and do something before its too late.
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| | | Listen to the podcast here, or just keep reading for the transcript.
"I can't put it in the agreement, but trust me on this. You have my word."
Those are famous words from a hospital CEO. And, maybe you can trust him. But can you trust his successor?
Earlier this year, the American College of Healthcare Executives released the results of its annual hospital CEO turnover study.
Job security, or, better said, job insecurity, has held pretty steady over the last eight or so years: There's almost a 20% chance that CEO Rob or Roberta won't be on the hospital's payroll a year from now.
In fact, depending on where in the U.S. you are, it could be a 67% chance.
So, what's this mean for you as a physician group leader? Here are a few thoughts:
1. If you have any type of contract with a hospital, no matter how much you trust CEO Sally to be a woman of her word, you need contractual promises in the contract. "Yes, Sally, I trust you with my life. But, I don't know your successor."
2. Think on the bright side. If the CEO is a jerk he might not be there for long. On the other hand, if the CEO is a wonderful human being, he might not be there for long.
3. You must develop relationships with as deep a bench of hospital administrators, board members, and key medical staff members as possible. When the CEO leaves for her new position in the food services industry, you'll need their backing when her replacement arrives.
4. New CEOs like to put their own stamp on things. That means doing an RFP for whatever your services are. Or, bringing in the XYZ group because they were at her old facility. You can't control the outcome, only influence it. See point no. 3.
5. Buy "Good Luck!" and "Happy Retirement!" cards by the box when they're on sale. CEOs always want you to cut costs and they'll appreciate your foresight. Just don't let them know ahead of time.
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| | | Calibrate Your Compass
Read our exclusive RedPaper to guide you through this evolving situation.
The coronavirus crisis caused a short-term economic crisis for many medical groups. Our RedPaper shows you the way out. Plus, many of the concepts discussed are applicable during both good times and bad.
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| | | | We all hear, and most of us say, that the pace of change in healthcare is quickening. That means that the pace of required decision-making is increasing, too. Unless, that is, you want to take the “default” route. That’s the one is which you let someone else make the decisions that impact you; you’re just along for the ride. Of course, playing a bit part in scripting your own future isn’t the smart route to stardom. But despite your own best intentions, perhaps it’s your medical group’s governance structure that’s holding you back.
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| In fact, it’s very likely that the problem is systemic. The Medical Group Governance Matrix introduces a simple four-quadrant diagnostic tool to help you find out. It then shows you how to use that tool to build your better, more profitable future. Get your free copy Free.
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| | | | Whenever you're ready, here are 4 ways I can help you and your business:
1. Download a copy of The Success Prescription. My book, The Success Prescription provides you with a framework for thinking about your success. Download a copy of The Success Prescription here.
2. Be a guest on “Wisdom. Applied. Podcast.” Although most of my podcasts involve me addressing an important point for your success, I’m always looking for guests who’d like to be interviewed about their personal and professional achievements and the lessons learned. Email me if you’re interested in participating.
3. Book me to speak to your group or organization. I’ve spoken at dozens of medical group, healthcare organization, university-sponsored, and private events on many topics such as The Impending Death of Hospitals, the strategic use of OIG Advisory Opinions, medical group governance, and succeeding at negotiations. For more information about a custom presentation for you, drop us a line.
4. If You’re Not Yet a Client, Engage Me to Represent You. If you’re interested in increasing your profit and managing your risk of loss, email me to connect directly. |
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