Dear Friend,

What happens after you?

That's the topic of this past Monday's blog post, You're Dead. Now What? Succession and Medical Group Leadership. You can follow the link to read the post online, or just keep reading for the rest of the story.

Have you heard the one about the man who doesn’t walk into a bar?

Medical groups generally address leadership and governance from the aspect of current control. That’s the issue of who’s in charge.

I’ve written many posts on what governance structures promote, and what governance structures inhibit, the ability of a group to set strategy, to implement that strategy, and to take action quickly. For example, see Why Your Group Has To Get Out Of Its Own Way. How Not To Make This Governance Mistake, and The Fast And The Dead.

But there’s another aspect of group governance: succession planning and it comes in two flavors, ordinary and catastrophic.

Unfortunately, few groups engage in seriously addressing even the simpler issue of ordinary succession in medical group leadership. Those that do, generally approach it in the contractual sense only. That is, they have a process as a part of their governing documents, their partnership agreement or other organizational agreement, that provides for election of the board and the officers or the managing member and so on. They’re preparing for a smooth transition, for the instance in which Bob’s term as group president ends and Sally’s begins.

But that’s where they stop.

Perhaps it’s because those in power aren’t comfortable with the notion of a catastrophic transition: What would happen to the group if the current leader or leaders dropped dead? Of course, it doesn’t have to be death. It can be incapacitation, or that they quit, or that they left without more than a day's notice to take care of a loved one; the reason doesn’t matter.

The key is to use that possibility as fuel to propel the group to create a broader process of preserving institutional knowledge and training future leaders.

In connection with institutional knowledge, preserve and collect, in a way that can be readily accessed and shared, the group's leadership knowledge: the facts, the experiences, the concepts, the methodologies and other information that the leaders hold.

And then mentor future leaders, for example, junior officers or committee leaders willing to take on more responsibility in the future.

But equally important and perhaps the key to the entire exercise is to frame a part of that mentorship in terms of what roles those juniors would be able to step into immediately if they were called upon to do so. And then, begin to assign parts of those roles to them now.

In addition to being far more effective training for any leadership change, this approach helps future leaders understand that there’s nothing to fear about their abilities or the future of the group in terms of a catastrophic leadership change event.

And, oh, that man who didn’t walk into the bar? He was the bartender.

The expression lead, follow, or get out of the way has more than a kernel of truth to it.

But why hinder your group with a watered down, compromise decision, especially one that takes time to reach, when a quicker cycling of decision-making gives your group a distinct advantage in both the market and in negotiations with contracting opposites?

Note that I am not saying that leaders should not seek input and opinions from other members of the group, from the most senior to the most junior. That's always valuable in that it helps develop new ideas, tactics and strategies. But that is very different from seeking a consensus among those queried.

The next time someone in your group suggests that you build consensus, remind them that the word starts with "con" and that they are just fooling themselves.

Just like in a heist movie, they inspected a few of the shipping containers expecting to find the half billion dollars’ worth of nickel, a metal vital to producing batteries for electric vehicles, that they were all to contain, only to find other metals of lesser or no real value.

That's the story reported on page 1 of the February 10, 2023, issue of The Wall Street Journal in connection with the commodity trader, Trafigura Group.

Not only is all that glitters not gold, shipping containers thought to contain nickel might just contain carbon steel.

So, what does this B-movie plot come to life have to do with you, assuming that you're not a metals trader? More than you might realize.

Here are some rather common examples:

• You enter into an agreement thinking you've obtained, for example, a seven year contract. Nine months later, you realize that it's terminable on 10 days’ notice under some circumstance that just occurred.
• You enter into an agreement to provide all services at a hospital system, only to find out that the system has the right to unilaterally grant carve outs to your exclusivity.
• You think you've solved your financial problems through obtaining stipend support only to realize that the support is actually structured as a loan that has to be paid back, with no hope of ever doing so.
• Just as in the most notorious of "you've got to be kidding me, isn't this a scam" sort of contracts, insurance policies, nearly any form of legal agreement is capable of giving you something on page 3 and taking it away on page 14.

Prepare for negotiations. Negotiate for your best deal. Make sure the agreement reflects that best deal. If the best deal isn't good enough, hopefully you've positioned your business so that you don't have to take it. And in any event, make sure that what you take is consistent with what you believe you've taken.

If a fake "gold" ring can turn your finger green, and if $577 million worth of nickel turns out to be scrap metal, there's no reason why your contract might turn out to be something other than what you expect.