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Dear Friend,
Yes, another medical staff is trying to fire the hospital CEO.
I can’t be sure that anyone on the medical staff at St. Mary’s Medical Center in Long Beach, California read my 2017 post, What You Need To Know About The Flea That (Metaphorically) Killed The Medical Center CEO, but they appear to be following the same strategy in an attempt to eject a hospital CEO, Carolyn Caldwell, in whose leadership ability they have no confidence.
In that 2017 post, I recounted the story of the “no confidence” action by no more than 37 medical staff members that brought down the CEO of Ohio State University’s Wexner Medical Center, Sheldon Retchin, M.D.
I analogized the action of the few handfuls of physicians to guerrilla warfare as described in the seminal work by Robert Taber, The War of The Flea. Taber wrote about how a small band of guerrilla fighters could emerge victorious in a conflict with a larger, well organized enemy.
“Analogically, the guerrilla fights the war of the flea, and his military enemy suffers the dog’s disadvantages: too much to defend; too small, ubiquitous, and agile an enemy to come to grips with.”
In the “Battle of Long Beach,” the opening salvo was fired in February this year when the Medical Executive Committee sent a letter to all members of the medical staff that they were initiating a dispute resolution process with the medical center’s administration centering around what appears to have been their learning, through the “grapevine,” that St.Mary’s was about to end very long-standing contractual relationships with the anesthesiology and radiology groups covering the facility.
In that letter dated February 6, 2019, the MEC stated their contentions that the administration had violated both Joint Commission requirements and California law pertaining to a medical staff’s rights of self-governance, (1) by refusing to discuss with medical staff leaders who will be providing contracted clinical services, (2) by initiating steps to terminate existing clinical services contracts and to award alternative contracts in retaliation for medical staff leaders’ advocacy for improved patient protection and peer review policies, and (3) by taking steps to terminate contractual arrangements with the Vice Chief of Staff so as to interfere with the medical staff’s right to select its leadership.
Although it’s unclear what, if anything, happened to the radiology group providing services at Saint Mary’s, the hospital initially granted an extension to the current anesthesia group, Long Beach Anesthesiology, which had held the contract since the 1990s. Then, in mid-May 2019, the hospital announced that it would no longer deal with Long Beach Anesthesiology and that it was awarding the contract to Somnia Anesthesiology beginning September 1, 2019.
The warm war then became hot, with the MEC calling a meeting of the full medical staff on May 21, 2019, at which there were no votes in favor of CEO Carolyn Caldwell’s leadership abilities. 58 physicians added their names to the no-confidence letter delivered to the hospital, with others, according to Chief of Staff, afraid to sign-on publicly due to fear of retaliation from the administration.
So far, CommonSpirit, the system that runs St. Mary’s, has refused to cave in to what is essentially the Medical Staff’s demand that Ms. Caldwell be terminated.
What does this mean for your organization and for you, personally?
From the organizational perspective, as in a guerrilla war, change within the organization, as well as within a domain in which the organization interacts, can occur as a result of agitation, even by a vocal minority. Just as no vote was required for a dictator like Casto to take over Cuba, no medical staff vote, no survey by Press Ganey, no long and drawn out process among “stakeholders,” is required to topple the status quo.
What you think is permanent is only temporary. How temporary is the question.
What you do, and how you do it, within your organization, and how you project it to essential third parties (e.g., hospital-based medical group to hospital) is all-important in maintaining relationships, contracts, and even existence. That’s the flea collar.
And, just the same, from the perspective of the individual, the small, the “out group,” the “flea,” a steadfast, vocal, and somewhat intransigent minority, can kill the dog. The large group can be made irrelevant. The hospital CEO can be forced out. The small organization can ingest the larger. Yes, the dog bites back. No win is guaranteed.
In the Ohio State/Dr. Retchin situation, just 3 letters signed by, at the most, 3% of the medical staff, were unable to unseat the king. Chalk up one for the flea.
Many say that the world is a tough place. Maybe it is, because it’s not just dog-eat-dog. In Dr. Retchin’s and Wexner’s world, it’s flea-kills-dog as well.
In the St. Mary’s situation, it appears as if 100% of the medical staff wants to unseat the queen, but the administration is pushing back. Perhaps it’s chalk up one for the dog.
But only time will tell. And, unlike at a state-owned academic medical center with hundreds of employed physicians, at a community hospital like St. Mary’s the huge majority of the staff have the ability to refer their patients elsewhere. Ms. Caldwell may indeed remain queen, but perhaps as the queen of a ghost ship. So, perhaps it will end up as chalk another one up for the flea. |
| | Tuesday - Success in Motion Video: Why You Must Instantiate
Watch Tuesday's video here, or just keep reading below for a slightly polished transcript: |
| | I'm thinking today about, well, you might call it “making it real.”
It’s the concept of instantiation. That's taking something without substance (i.e., it can't be touched, seen, or smelled) and giving it some.
Let’s say that you're running a hospital-based group, perhaps an anesthesia group or an emergency medicine group, and you have a contract at Community Memorial St. Mark’s Hospital. You’ve been there for five years, and you’re doing a great job.
But how can the hospital's administrators, or, if it's part of a system, the system administrators, know that you are doing a great job? They might not be able to see it.
Even if the administrators have been told that you're performing well, and even if they’ve heard nice things about you, it’s not enough. To them, your service is incredibly intangible, it’s "just the anesthesia service." They might simply decide that it’s time to do an RFP, just to see, as they say, "what other bids are out there," or to see if the fair market value is correct, and so on.
In addition to keeping up, as I mentioned in a video, a constant and regular stream of communication with the C-suite, what else can you do to create something that is tangible and deliverable, to instantiate, to create substance for the administrators out of what is, otherwise, substance-less?
What reports can you create? What slide decks can you deliver? What, tangible items can you present to evidence your value to the facility? What can be held and touched and seen and heard?
At the end of the day, it’s all about value. That value isn’t measured by you, it's measured by the buyer. And in this case, the executives in C-suite are the buyers.
Think about making it real for them. Think about instantiating the evidence of the value you provide them.
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| | | Wednesday - Medical Group Minute Video: Why Speed Saves
Watch the video here, or just keep reading below for a slightly polished transcript:
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| Speed kills. I read it on the message board that stretched across the lanes of the highway. (I suppose that reading message boards kills, too, but they aren’t advertising that.)
That may be true on the highway, but it’s patently untrue in terms of your group’s business. In business you need to be able to make decisions quickly and then act on them. That speed is the one major benefit that the smaller competitor has. Think guerrilla warfare.
Many medical groups destroy their ability to compete through the creation of truly democratic, club-like structures in which every shareholder or every partner gets a vote in respect of almost every business decision.
Opportunities fly past. They don’t slow down for your group to give notice of a shareholders meeting and then take a vote.
The solution is to create a structure with as few leaders as possible and then to let them lead and to even fail as long as they build on that failure. The inability to act due to the fact that your group has tied itself up in knots is not an effective strategy.
In this context, speed saves your business life.
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| | Thursday - Podcast: Thank God, You're About to Be Treated by the Chief Transformation Officer! |
| Listen to the podcast here, or just keep reading for the transcript
You can’t believe your luck!
You’re in the back of an ambulance, its siren streaming as it pulls into the emergency entrance of Big Medical Center of Somewhere, America. You’re quickly rolled inside, in tremendous pain but still conscious. Up walks a physician in impeccable C-suite attire with a stethoscope draped over his neck.
God must be smiling on you, for you’re being taken care of by the highest-paid physician on the hospital’s payroll, yes, the top clinical integration/transformation executive!
What, you’re not lucky?
Hospitals are focusing their hard and few-earned dollars exactly where it counts, spending big bucks on the physician executives who will surely rescue them from nosocomial existential syndrome: chief officers of this or that trendy trend.
According to a recent report, here are the top earning lifesaving physician executives:
• Dr. Top Clinical Integration-Transformation Officer pulls in close to $600,000.
• Dr. Top Quality Executive earns a bit more than $460,000.
• Dr. Top Medical Informatics executive earns close to $380,000.
But don’t feel sorry for them having to spend so much time in meetings, drinking coffee, and having executive lunches. Those dollar figures are just the cash portion of their compensation.
Hey, I’d expect a lot of transformation for $600,000. Change is good, right? Just ask the physician I met from Venezuela. Oops.
Hundreds of hospitals are closing. Others left standing bemoan the fact that they’re broke and often blame it on their greedy contracted physician groups. “You want a stipend so that half your group doesn’t leave? What, are you crazy? We lost $4 million last year and now we have to hire a chief transformation officer and a few MDs who gave up medicine for informatics.”
Does anyone else find this funny? Does anyone else see this as not only rearranging the deck chairs on the post-iceberg Titanic, but spending to parachute in some extra caviar and champagne?
Still conscious as you’re rolled into the operating room and the team gathers around you (yes, you’re still awake . . . couldn’t afford those damn anesthesiologists) you’re baffled as the room gets dark, not light. And then you understand why: Dr. Top This-or-That wants to make sure that everyone can see her PowerPoint presentation, even you.
There’s never a shortage of money, only a question of priorities. And, it’s a heck of a question.
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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 here.
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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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