Strategies for Working with Multiple Physicians and Leadership Styles

1
Strategies for Working with Multiple Physicians
and Leadership Styles

• A Presentation by Polly Walgren for Illinois
  State Medical Society
• September 10, 2009

2
Learning Objectives

• Attendees will be able to
• 1. Recognize different leadership styles and why
  leaders use different styles.
• 2. Understand what circumstances affect
  leadership style.
• 3. Understand the value of physician
  administrator
• teams
• 4. Use strategies to define the leaders
• 5. Use strategies to improve communication and
  
• establish goals and priorities with multiple
  physicians

3
This Presentation is based on

• Pollys 25 years working with physicians in small
  to medium sized practices, who all had different
  leadership styles.
• Research on leadership styles, physician
  interactions, and physician-administrator teams.

4
Definitions and Perspective..Multiple
Physicians

• We will assume that this means working with a
  practice that consists of more than one
  physician.otherwise known as a group practice.
• There are many kinds of group practices
  from cohesive to dysfunctional.
  Relations between the physicians
  themselves directly affect the
  relationship they will have
  with their
  administrator.

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Multiple Physicians.

• Physicians who communicate well, work
  well together, and respect each
  other will be
  easier to work with, than those that
  do not, regardless of
  leadership styles.
• Problem physicians in dysfunctional
  groups, while not
  impossible to work
  with, can be quite a challenge for a
  manager.

6
Definitions and Perspective..Leadership Styles

• Leadership style is the manner and approach of
  providing direction, implementing plans, and
  motivating people. Kurt Lewin (1939) led a group
  of researchers to identify different styles of
  leadership. This early study has been very
  influential and established three major
  leadership styles. The three major styles of
  leadership are
• U.S. Army Handbook, 1973

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Leadership Styles

• Authoritarian or Autocratic
• Participative or Democratic
• Delegative or Free Reign
• Although good leaders use all three styles,
  with one of them normally dominant, bad leaders
  tend to stick with one style.
• U.S. Army Handbook, 1973

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Leadership Style Authoritarian / Autocratic
                                                  
                                                  
                         I want both of you to.
. . This style is used when leaders tell their
employees what they want done and how they want
it accomplished, without getting the advice of
their followers. Some of the appropriate
conditions to use it are when you have all the
information to solve the problem, you are short
on time, and your employees are well motivated.
U.S. Army Handbook, 1973
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Leadership Style Authoritarian / Autocratic

• Some people tend to think of this style as a
  vehicle for yelling, using demeaning language,
  and leading by threats and abusing their power.
  This is not the authoritarian style, rather it is
  an abusive, unprofessional style called bossing
  people around. It has no place in a leader's
  repertoire.
• U.S. Army Handbook, 1973

10
Leadership StyleParticipative / Democratic

• Let's work together to solve this. . . This style
  involves the leader including one or more
  employees in the decision making process
  (determining what to do and how to do it).
  However, the leader maintains the final decision
  making authority. Using this style is not a sign
  of weakness, rather it is a sign of strength that
  employees will respect.
• U.S. Army Handbook, 1973

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Leadership StyleParticipative / Democratic

• This is normally used when you have part of the
  information, and your employees/manager have
  other parts. Note that a leader is not expected
  to know everything -- this is why you employ
  knowledgeable and skillful employees. Using this
  style is of mutual benefit -- it allows others to
  become part of the team and allows you to make
  better decisions.
• U.S. Army Handbook, 1973

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Leadership Style Delegative / Free Reign
                                                  
                                                  
                          You two take care
of the problem while I go. . ..In this style, the
leader allows the employees/manager to make the
decisions. However, the leader is still
responsible for the decisions that are made. This
is used when employees/manager are able to
analyze the situation and determine what needs to
be done and how to do it. You cannot do
everything! You must set priorities and delegate
certain tasks. U.S. Army Handbook, 1973
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Leadership Style Delegative / Free Reign

• This is not a style to use so that you can blame
  others when things go wrong, rather this is a
  style to be used when you fully trust and have
  confidence in the people below you. Do not be
  afraid to use it, however, use it wisely!
• NOTE This is also known as laisse faire, which
  is the noninterference in the affairs of others.
  French laissez, second person pl. imperative
  of laisser, to let, allow faire, to do.
• U.S. Army Handbook, 1973

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Leadership Styles What to Use When

• A good leader uses all three styles, depending
  on what forces are involved between the
  followers, the leader, and the situation. Some
  examples include
• Using an authoritarian style on a new employee
  who is just learning the job. The leader is
  competent and a good coach. The employee is
  motivated to learn a new skill. The situation is
  a new environment for the employee.
• Using a participative style with a team of
  workers who know their job. The leader knows the
  problem, but does not have all the information.
  The employees know their jobs and want to become
  part of the team.
• Using a delegative style with a worker who knows
  more about the job than you. You cannot do
  everything! The employee needs to take ownership
  of her job. Also, the situation might call for
  you to be at other places, doing other things.
• Using all three Telling your employees that a
  procedure is not working correctly and a new one
  must be established (authoritarian). Asking for
  their ideas and input on creating a new procedure
  (participative). Delegating tasks in order to
  implement the new procedure (delegative).
• U.S. Army Handbook, 1973

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Leadership Styles

• Forces that influence the style to be used
  include
• How much time is available.
• Are relationships based on respect and trust or
  on disrespect?
• Who has the information - you, your employees, or
  both?
• How well your employees are trained and how well
  you know the task.
• Internal conflicts.
• Stress levels.
• Type of task. Is it structured, unstructured,
  complicated, or simple?
• Laws or established procedures such as OSHA or
  training plans.
• U.S. Army Handbook, 1973

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So

• Leadership styles can vary
• Leadership styles are quite likely a response to
  many factors.some of which may be able to be
  controlledand some not.

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Definitions and Perspective..Working With.

• Not working for but working with
• Working with requires interactions and
  communication
• Working with requires shared priorities
• Working with to accomplish a goal or
  goals
• Working with means developing trust
• Working with means fostering teamwork

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Why Teamwork?The Medical Practice Business Model

• The typical business model has
  employees producing widgets (products),
  with managers who supervise them
  reporting to owners.
• In a medical practice, those producing widgets
  (widgets medical care) are also the owners.
  This creates problems.

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Why Teamwork?Problems Created

• One major problem is a time issue. The physician
  owners, because they are also the producers, do
  not have the time to also be the managers. They,
  therefore, hire managers or administrators to
  help them run their business.
• Another issue is a knowledge issue. All
  physicians study medicine, but not all physicians
  are knowledgeable regarding all thats involved
  in running a business, especially a medical
  practice.

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Why Teams Work

• The Body of Knowledge needed to manage a medical
  practice is overwhelming.not to mention the
  skills and knowledge to practice medicine. With
  a team approach, the administrator and the
  physicians bring their knowledge and skills to
  the table, and neither is required to be an
  expert on everything.

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Physician-Administrator Teams

• A physician - administrator team leadership
  model is uniquely suited to meet the demands of
  medical group practices in todays environment.
  The diverse requirements of the industry, the
  blurring of lines between clinical and financial
  issues, and the quantity and complexity of work
  requires a team approach.
• Gary S. Kaplan, M.D.FACMPE and Sarah H.
  Patterson, FACMPE, The Physician/administrator
  Team, MGMA Connection Vol.2, Issue 1, January
  2002.

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Teamwork takes Time

• It takes time and work to develop a fully
  functioning team. All members of the team must
  value the team concept and must be willing to
  work to create and maintain the team concept. The
  benefits are well worth all the effort put forth
  by each team member.

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Teamwork Success

• 5 key factors contributing to the success of a
  leadership team are
• Clear goals from the organization on major
  initiatives.
• Equal status
• Mutual dependence
• Time to get to know each other
• Shared responsibility / accountability
• Gary S. Kaplan, M.D., FACMPE, and Sarah H.
  Patterson, FACMPE, The Physician/adminstrator
  Team, MGMA Connexion, Vol. 2, Issue 1, January
  2002

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Help with Teamwork

• MGMA offers courses, training sessions, and
  publications devoted to fostering physician
  administrator teams. Check out their website at
  www.MGMA.com.
• They also have an extensive library of
  professional papers and articles, some of which
  are listed in the reference section of this
  presentation.

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A Little About Physicians.based on 25 years
working with them..

• Most physicians care deeply about their patients
  and are very conscientious.
• Many physicians are stressed and have little
  extra time.are always in a hurryare frequently
  late
• Some wont consider a cost benefit analysis even
  when the ROI is significant.
• Most physicians dislike meetings
• Some physicians can be intimidating in their
  demeanor
• Physicians like data displayed succinctly for
• quick easy understanding and reference

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About Physicians

• Physician Work Behavior Pattern
• according to wiki.medpedia.com
• This article suggests that physicians should
  consider these behavior types to give them
  insight into their reactions
• Passive Aggressive doesnt address what he
  disagrees with, then ignores new procedures.
• Dominant interrupts, tries to control
  decisions. Always in charge.
• Out of focus in his own world, distracted,
  doesnt get it. Difficulties working as a team
  member.
• Risk taker pushes the envelope...pursues ideas
  that wont work.

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And more about physicians.

• from The Devil in the Doctor
• Jeffry Peters says that all problem physicians
  seem to exhibit one or more of the following
• Insensitivity
• Selfishness
• Irresponsibility
• Competitiveness
• Need for Control
• And he offers strategies to consider.
• Jeffry A. Peters, The Devil in the Doctor, MGMA
  Connexion, Vol. 3, Issue 2, Feb. 2003

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Insight into physician interactions

• Most doctors are caring, conscientious,
  detail-conscious, independent and robust. But
  under pressure, people can overplay their
  strengths especially if they are not very
  resilient to stress. Then confidence becomes
  arrogance, diligence turns into perfectionism,
  caution into indecisiveness and independence
  becomes withdrawal and resistance to feedback.
  These behaviours typically emerge at times of
  transition, fatigue, anxiety or other stressful
  situations.
• Jennifer King, and Jenny Firth-Cozens, Does
  Your Personality Fit? Pulse, 2/16/2006,
• Vol. 66 issue 7, p61-62.

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Insight into physician interactions.

• So, once again, not only physician behavior, but
  also the leadership style used by that physician
  can be, and most likely is, a result of the
  circumstances such as
• Stress, fatigue, anxiety, time (or lack of it),
  frustration, knowledge, skill level, state of the
  practice, economic realities, EMR transitions,
  and trust in their administrator.

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StrategiesResponse to Leadership Styles or
Interactions

• Identify the style or type of interaction
• The good practice manager understands the
  leadership style, or lack of style, in the
  physicians who formally or informally compose the
  practice leadership.
• Gregory J. Mertz, FACMPE, The Horizon Group,
  Survival in the Practice Management Business,
  MGMA Connexion, Vol. 2, Issue 2, Feburary 2002

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StrategiesResponse to Leadership Styles or
Interactions

• Look for reasons for use of this style. Can you
  address these reasons and perhaps change the
  behavior if this style doesnt work for you?
• Discern is one style used all the time, or do
  styles change? Remember, good leaders vary style
  based on circumstances.
• Decide Can you communicate or work with these
  leaders? Are you willing to work to change the
  circumstances, if needed, and build a team?

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Working with physicians

• If you decide that you are willing to work to
  create positive circumstances, build trust with
  your physicians, and work to build a strong team,
  the following slides offer strategies that can
  help.

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StrategiesDefine the leader

• Establish exactly who you report to as soon as
  possible during the hiring process or immediately
  afterward.
• Many practices establish a CEO
  physician who makes most of the decisions
  and interfaces with the manager.
• Some practices do not do this, but establish a
  physician who is responsible for certain areas
  such as billing, personnel, budget, etc.

34
StrategiesDefine the leader

• Request the physicians to identify who will be
  acting as your supervisor. Do this at a meeting
  where all are in attendance, so there is no
  misunderstanding. Explain why this is so
  important. Provide information from MGMA or
  other organizations that support establishment of
  a clear physician leader.

35
StrategiesDefine the leader

• Consequences of no clearly defined leader
• Confusion
• Conflicting direction given
  to the manager
• No direction given
• Decisions too late to
  be of value

36
StrategiesDefine the leader

• Consequences of no clearly defined leader
• The manager, due to lack of guidance, direction,
  or priorities set by physicians, takes on more
  and more responsibility and begins making
  decisions that rightfully
  belong to the
  physician
  owners. This can have
  disastrous consequences.

37
More Strategies.From Leader to Communication

• Once a leader is clearly identified (or leaders
  for various areas are identified), the next
  strategy to focus on is communication.

38
Communication.who?

• Identify who needs to receive
  regular communication.
• If a group has a strong leader trusted by the
  others, it may be sufficient to communicate only
  with her.
• All physicians may want to have input even if
  there is a clear leader.

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Communication.what?

• Establish with your physician leader, exactly
  what sorts of things she wants to be made aware
  of. Usually, physicians want to be informed
  about
• personnel issues
• financial information
• production information
• patient issues
• projects
• initiatives, etc.

40
Communication Methods

• Work with your leader to determine the most
  effective way to establish lines of
  communication.
• Informal Conversations
• Agendas
• Meetings
• Minutes
• Email Messages
• Memos
• Conference Calls

41
Informal Conversations

• Be ready If your physician leader comes into
  your office and asks, Hows it going?, you have
  a golden opportunity.
• Have a pile or list of things to ask for guidance
  on, or to share with your physician to be sure
  she is aware.

42
Agendas

• If you have agreed with your physician group to
  have regular meetings, it is wise to prepare an
  agenda.
• Let all docs know they can add to the agenda, or
  perhaps you and your CEO physician work together
  on the agendabut reach an understanding
• Get this agenda to those attending by an agreed
  upon amount of time ahead of the meeting.

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Agendas

• It is a good idea to have an FYI section on the
  agenda. Many items that seem a simple FYI, end
  up being items for discussion among physicians.
• Separate action items into another area on the
  agenda. You may have difficulty getting
  physicians to decide on actions / decisionsbut
  it is in your best interest to help your
  physician reach decisions that give you
  direction.

44
Meetings

• Meetings are an excellent way to make sure
  everyone has information and to reach decisions
  which provide direction for a manager.
• One of the most important responsibilities that
  a medical group administrator should be charged
  with is finding times when physicians can meet.
• Nick A. Fabrizio, PhD, FACMPE, Organizational
  and Strategic Factors Impact Group Practice
  Culture, Performance and Practices of
  Successful Medical Groups 2005 Report Based on
  2004 Data.

45
Meetings

• Decide who will chair the meeting. (Note it is
  difficult to chair a meeting and also take
  minutes.)
• Keep the meeting within the allotted time frame.
  Try for short, sweet, and simplestay focused on
  agenda items.
• You may have to use, So your decision on this
  item was..? to be sure you actually get a
  decision instead of only discussion.

46
Minutes

• Always, always, always prepare minutes after the
  meeting. Keep them handy for quick and easy
  reference.
• Distribute minutes to physicians as soon as
  possible after meetings.
• Minutes often end up being your marching orders
  as you steer the practice forward.
• Minutes are often your method of covering
  yourself should disagreements arise, or memories
  fail.

47
Email Messages

• Email messages only work if physicians regularly
  read email. If they do not read email, you
  cannot use this method to communicate.
• Email is a great way to document that you have
  communicated something, or ask for guidance.
• You can attach documents easilylike minutes.
• You can ask for a response, but may likely not
  get one. If you are sure that your physicians
  are reading email, you might use, Unless I hear
  differently, by (insert date), I will..

48
Memos

• These might be necessary if you have physicians
  who dont read email. The question becomes, how
  to get a memo to them.
• Often desks are a way too messy place on which to
  leave anything of importance.
• Mailboxes are a very handy if you have physicians
  who do not read email. Memos or other written
  info can be left in mailboxes.

49
Conference Calls

• This is a method of communicating when physicians
  are not all in the same place.
• This is usually for only a few people at a time.
• If you have several issues to discuss, an agenda
  is a good idea, and also minutes following a call.

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StrategiesCommunication

• Whatever procedures for communication are
  established, it is likely to be the managers job
  to regularly follow through with the process.
  The physicians will likely focus on their
  patients, and not on when the next meeting or
  conference call is scheduled. You, as the
  administrator, will need to remind them.

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Strategies.Goals and Priorities

• Ask your physicians what your goals and
  priorities should be. On what do they want you
  to spend your time? Ask for a clear list of
  objectives and be sure that both you and they
  understand what these are.

52
Strategies.Goals

• Teams are most successful in organizations that
  emphasize clear goals and expectations, and
  measure progress.
• Gary S. Kaplan, M.D.,FACMPE, and Sarah H.
  Patterson, FACMPE, The Physician/administrator
  Team, MGMA Connection Vol.2, Issue 1, January
  2002.

53
Strategies.Goals and Priorities

• If your physicians have difficulty in
  establishing goals and priorities, they quite
  likely need help with strategic planning.
  Knowing where they want to take their practice is
  the first step in setting priorities which guide
  and direct your daily work.
• Help with strategic planning can be found with
  MGMA, or other consultants. Many administrators
  have experience and are comfortable helping
  physicians with this.

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Strategies.Goals and Priorities

• Once your list is established, make sure there
  are agreed upon time frames attached. It is in
  your best interest to have reasonable time
  frames.and many times you as the manager have
  the best knowledge of what is involved and
  therefore what is reasonable in terms of time to
  complete a goal.
• Be sure there is a responsible person listed for
  each goalsometimes this could be a physician.
• State goals so they can be measured.

55
Strategies..Priorities

• Once goals and priorities with measureable
  outcomes, responsibilities, and time frames are
  established, (and certainly you should have input
  in the discussion as to what you see are
  priorities), find out how your physicians want to
  be appraised of your progress on your goals, and
  then be sure to follow through and keep them
  informed.

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StrategiesInform Physicians

• Keep a to do list with your priorities at the
  top.
• Use a date book, or a calendar on your
  computer and keep yourself organized.
• Keep track of your accomplishments
• Tally up your accomplishments at the end of each
  month and present them to your physicians. (Many
  physicians have no idea of all the tasks you do
  regularly to keep their practice afloat.let them
  know via a list at appropriate times.)

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Strategies..Inform Physicians

• Organize your accomplishment list into the main
  domains of the MGMA Body of Knowledge.
• Use this list when it is time for your review
• All of this goes a long way toward establishing
  trust with your physician leaders.

58
Additional Strategies

• Be appropriate with info you share with staff and
  physicians.
• Have integritydont get caught up in office
  gossip and/or politics
• Develop trust with physicians and staff. Be
  trustworthy.
• Be a resource personif you dont have the info
  someone needs, get it for them.
• Follow through on tasks others are depending on
  you to do.
• Keep your word.
• Be organized and neatknow where things are
• Represent your practice wellbe professional

59
These have been strategies for .

• Setting the tone of the practice
• Creating trust
• Building teams
• Thus.working to control the forces that
  influence leadership style

60
Additional Strategies

• Seek out peer support
• Join professional groups where you can develop
  relationships with other administrators and
  managers who may be effectively dealing with the
  same issues you are.
• Attend seminars
• Seek out information to support you and your work
  on line.

61
Additional Strategies

• If you are uncomfortable in your job, or if there
  is conflict, ask to discuss this with your
  physician leader.
• Express yourself appropriately.
• Use I language.I feel ____
  when you ____, or I need _____.
• Attempt to develop a plan of action which is
  acceptable to you and your physician leader.

62
Advanced Strategy

• If you have worked hard and used good strategies
  to develop a positive relationship with your
  physician..
• If you have tried to discuss issues with your
  physicians..
• And if you are still stressed and upset more
  often than not and feel that this isnt working
  for you.
• You may need to consider that this is not the
  practice for you.and you may have to make a
  decision to move on.

63
In Conclusion..

• Working with multiple physicians
  with different behavior and
  leadership styles requires
• Recognizing and identifying physician
  interactions and leadership styles..
• Realizing why these behaviors and styles are used
  (assessing the environment)
• Working to build good physician-administrator
  teams by

64
In conclusion.

• Using good communication
• Setting priorities
• Building trust
• Creating a positive
  environment that fosters
  appropriate leadership styles.

65
One more strategy.

• Give your physician a gift.
• The Successful Physician,
• A Productivity Handbook for Practitioners
• by Marshall O. Zaslove, M.D.
• If you have a stressed physician, who is
  concerned about his productivity and bottom line,
  this is an easy to read, humorous book, written
  by a physician, and its right on. If your
  physician uses some of these ideas, you and your
  staff will benefit.and it may improve his
  leadership style.

66
Contact Information

• Polly Walgren, MBA, CMM, FACMPE
• Practice Administrator
• West Suburban Womens Health Ltd
• 545 Plainfield Road, Suite C
• Willowbrook, IL 60527
• Phone [phone] x12
• Cell 708-612-4069
• Email pwalgren_at_wswomenshealth.com
• Email pwalgren_at_sbcglobal.net

67
Thank you andGood Luck!!
68
References.

• Beason, Alan J., Building an Effective
  Physician-Administrator Team in a Post-Merger
  Practice, ACMPE of Medical Group Management
  Association, 2006.
• Fabrizio, Nick A. PhD, FACMPE, Organizational
  and Strategic Factors Impact Group Practice
  Culture, Performance and Practices of
  Successful Medical Groups 2005 Report Based on
  2004 Data.
• Freeman, Edward N., An Alternative Approach for
  Efficient and Effective Administrator-Physician
  Communication, ACMPE of Medical Group Management
  Association, 2006.
• Kaplan, Gary S., M.D.,FACMPE, and Patterson,
  Sarah H., FACMPEThe Physician/adminstrator
  Team, MGMA Connexion, Vol. 2, Issue 1, January
  2002
• King, Jennifer, and Firth-Cozens, Jenny, Does
  Your Personality Fit? Pulse, 2/16/2006, vol. 66
  issue 7, p61-62.

69
References

• Medical Group Management Association (MGMA)
  www.MGMA.com
• Menaker, Ronald, FACMPE, Good Leadership
  Requires Good Conflict Management, MGMA
  Connexion, Vol. 5, Issue 6, July 2005.
• Mertz, Gregory J., FACMPE, The Horizon Group,
  Survival in the Practice Management Business,
  MGMA Connexion, Vol. 2, Issue 2, Feburary 2002
• Peters, Jeffry A., The Devil in the Doctor,
  MGMA Connexion, Vol. 3, Issue 2, Feb. 2003
• US Army Handbook, www.nwlink.com/donclark/leader/
  leadstl.html
• www.Wiki.Medpedia.com/Physician_Work_Behavior_Patt
  erns
• www.findarticles.com, Neff, Thomas J., Top 12
  Traits of Todays CEO-Management, The Chief
  Executive, Nov., 1995

70
Professional Groups

• National Medical Group Management Association
  www.MGMA.com
• Illinois Medical Group Management Association
  www. ILMGMA.com
• Professional Association of Medical Office
  Management (PAHCOM) www. Pahcom.com
• Greater Chicagoland Chapter of PAHCOM
  www.gcpahcom.com