Kendall L. Stewart, MD, MBA, DLFAPA June 12, 2012

1. Sandbox HarmonySome Practical Strategies for Encouraging Private and Employed Physicians to Play Nicely TogetherA Presentation for the Ohio Hospital Association 97th Annual Meeting Kendall L. Stewart, MD, MBA, DLFAPA June 12, 2012 1Realizing that you cannot make everyone happy is the first step. 2Making the overall organization less unhappy is entirely possible. 3Only two strategies work—hire only happy people or create a culture where happy people rule.

2. Why is this important? • Many hospital medical staffs now include both private and hospital-employed physicians. • These groups do not always play nicely together in the sandbox. • Diminishing the tension between the two groups confers a considerable competitive advantage on the organization that can bring this off. • It is not easy, but it can be done. • This presentation will offer some practical strategies for doing it. • After listening to this presentation, you will be able to • Identify three common sources of tension between these two physician groups, • Explain how managing the tension between these two groups confers a significant competitive advantage for the organization that succeeds, • Describe three practical leadership strategies for managing this tension, and • Explain how to execute these leadership strategies successfully. 1In my life, I have aspired to be a truth-seeker and truth-speaker. 2This has not made me popular.

3. How do independent docs feel?1,2 • It depends. • They feel unappreciated, taken-for-granted, resentful, jealous and angry. • And they have every right to feel that way. • If you were in their shoes, you would feel this way too. • They have worked their hearts out, and these young whippersnappers are now showing up, making more and working less than they do. • From their perspective, they have made the money that hospitals are now giving to entitled, undeserving, employed physicians. • And what is even more annoying, these employed physicians are taking over the leadership of the hospital. • And they are right. 1Sadly, some of the most successful physicians are just miserable. 2You can give them powerful feedback by allowing employees to rank each physician as a team player.

4. How do employed docs feel? • It depends. • They want to concentrate on the practice of medicine instead of running a business. • They know what they are worth in today’s market, and they intend to get what they deserve. • They are more interested in a balanced lifestyle; they are not interested in an all-consuming career. • It hurts their feelings that their independent colleagues resent them, criticize their choices and refuse to refer to them. • They are puzzled that their wealthy, successful independent colleagues are so miserable. • Their feelings are perfectly understandable. • If you were in their shoes, you would feel exactly the same. • And they are right, too. 1The truth is, all physicians fall somewhere on the Bell Curve in every hospital.

5. What’s a hospital leader to do? • Believe. • Face reality honestly and cheerfully. • Focus relentlessly on results. • Pursue patient-centered perfection. • Clarify your Rules of Engagement. • Provide all physicians with exceptional service. • Select positive leaders and give them the support they need. • Accept everyone’s feelings. • Do what needs to be done in spite of everyone’s feelings. • Grow thick skin. • Design and deploy new strategies. • Improve those that work; discard those that don’t.1 • Never, never, ever give up. 1Let me tell you the amazing story of the SOMC Physician Relationships Leadership Team. 2Teresa Bryan, our Administrative Director of Social Work Services, and Valeria DeCamp, our Director of Nursing, came up with the process that has produced results.

6. What is the current medical staff mix at SOMC?1,2,3 1Southern Ohio Medical Center is a community hospital in Portsmouth, Ohio. 2We have 126 physicians currently on staff as of May 7, 2012. 3We serve some of the most challenging communities in Ohio.

7. What practical strategies1,2 will encourage private and employed physicians to work together more harmoniously? • Deploy decision-making processes that are inclusive, transparent and evidence-based. (CRLT)* • Reward physicians who produce results. (CERP)* • Listen relentlessly. (Physician Forums) • Round obsessively. (Daily Rounding) • Focus on patient-centered perfection. (Individual Physician Dashboards) • Employ exceptional physicians. (Senior Medical Directorships) • Respond quickly to physician concerns. (PREP Process) • Field the best-possible leadership team and provide them with the training and support they need to succeed. (SOMC Leadership Rounds)* • Clarify your expectations for physician leaders. • Encourage prompt decision-making and accountability. (Leadership Teams) 1These are all complex processes that require a lot of time, commitment and energy to deploy successfully. 2But they can make a difference.

8. Deploy decision-making processes that are inclusive, transparent and evidence-based.The SOMC Clinical Resources Leadership Team (CRLT) Process • Why should you? • Even in a hospital, someone is going to make a decision now and then. • Everyone believes the physicians with the most clout call the shots. • Few understand how important decisions are made. • Few believe their voices might actually make a difference. • Evidence-based decision making is fairly unusual. • How can you? • Email an idea to every clinician and include the evidence for and against it. • Invite public comment. • Include all comments in a presentation to an interdisciplinary team. • Ask participants to assess the worthiness of the idea. • Send the team’s assessment to the executives for a final decision. • Announce the decision promptly to everyone.1,2 1We recently utilized this process to decide whether to provide and launder scrubs. 2One nurse told me she believed she had mistakenly received the email message asking for her opinion.

9. Reward physicians who produce results.The SOMC Community Emergency Response Program (CERP) • Why should you? • Not every physician contributes equally. • Those who go the extra miles should be rewarded more than those who contribute only the minimum required. • Those physicians who respond reliably to calls from the ED are among the most valuable physicians on the staff. • How can you? • Set up a ED call stipend plan that rewards physicians preferentially for coming in promptly. • Reward those with the most onerous call the most. • Consider a deferred income plan that encourages both recruitment and retention. • Fund it at a level that can be sustained.1 1Over the past five years, we have distributed $1.8 million to both employed and independent physicians through this innovativeapproach.

10. Provide the best-available leaders with the training and support they need to succeed.SOMC Leadership Rounds • Why should you? • Effective leadership is the key to your organizational success.1,2 • No matter how painful, field the best-possible leadership team throughout the hospital. • Leaders who can and will produce exceptional results are fairly rare. • Even the most-talented and highly-motivated leaders need training and support. • How can you? • Invite selected leaders to meet with an inspirational executive weekly for one year. • Spend 30 minutes on questions and answers. • Be honest and forthright. • Spend 30 minutes discussing a real leadership challenge. • The insight and relationships you will build—priceless. 1Your front line managers and directors hold the keys to your hospitals success. 2Executives can only select the best, set the tone and give them the support they need.

11. What results have these strategies produced?SOMC 2007 PRC “Excellent” Percentile Rankings1,2 1Professional Research Consultants, Inc. 2This is a “top box” percentile ranking.

12. What results have these strategies produced?SOMC 2008 PRC “Excellent” Percentile Rankings1 1Professional Research Consultants, Inc.

13. What results have these strategies produced?SOMC 2009 PRC “Excellent” Percentile Rankings1 1Professional Research Consultants, Inc.

14. What results have these strategies produced?SOMC 2010 PRC “Excellent” Percentile Rankings1 1Professional Research Consultants, Inc.

15. What results have these strategies produced?SOMC 2011 PRC “Excellent” Percentile Rankings1 1Professional Research Consultants, Inc.

16. What results have these strategies produced?SOMC 2012 PRC “Excellent” Percentile Rankings1 1Professional Research Consultants, Inc.

17. Where can you learn more? • Join the discussion about practical approaches to more effective leadership on the SOMC Leadership Blog. • Learn more about Southern Ohio Medical Center here. • Review and download this presentation and related presentations and white papers here. • Read Results That Last: Hardwiring Behaviors That Will Take Your Company to the Top to review some leadership strategies that successful health care executives have embraced. • Learn more about how to confront others effectively by reading A Portable Mentor for Organizational Leaders. • Review practical techniques for conducting crucial conversations in Crucial Conversations: Tools for Talking When Stakes are High.

18. How can you contact me?1 Kendall L. Stewart, M.D. VPMA and Chief Medical Officer Southern Ohio Medical Center Chairman & CEO The SOMC Medical Care Foundation, Inc. 1805 27th Street Waller Building Suite B01 Portsmouth, Ohio 45662 740.356.8153 StewartK@somc.org KendallLStewartMD@yahoo.com www.somc.org www.KendallLStewartMD.com 1Speaking and consultation fees benefit the SOMC Foundation.

19. Are there other questions? SafetyQualityServiceRelationshipsPerformance 