I recently facilitated a healthcare solutions workshop for the senior leadership team of an academic medical center. The impetus for the session? The CEO admitted that she has 15 talented people who don’t collaborate well. We started the session by having the group whiteboard all the challenges facing the system. This was an interesting exercise because it was not a concise, coherent list. It was long and diverse and it was clear they did not agree on the list or how to prioritize these challenges. That surprised me…until the next part of the workshop.
Getting to the Heart of Physician-Hospital Alignment
Next, I asked them to list the challenges facing this group – the functional challenges that prevent the group from being as effective as they can be. Some of the usual issues came up – lack of clarity of responsibilities, accountability structures, not enough structure in how they communicate, etc. However, then we got to the heart of the matter: trust. They didn’t trust each other. This meant they didn’t communicate with each other and, when they did, they were not open and honest, and certainly not allowing themselves to be vulnerable. They weren’t particularly sensitive to the needs and feelings of their colleagues.
Their situation reminded me of my work on physician-hospital alignment strategies. In these situations, we were usually working with a hospital to improve the quality, efficiency, and profitability of a particular service line. There were the obvious operational initiatives– the care continuum, cost savings, measures, quality metrics, the patient experience, volume-building strategies, etc. – but none of these worked if the administration and the physicians couldn’t find a way to collaborate and often, both sides saw this as the biggest barrier to success. This was true when working with independent physicians/groups, employed physicians, or a mix of the two.
You Can't Talk Your Way to Trust
I saw a quote on LinkedIn recently that said, “Collaboration can’t happen without trust.” In any of these situations, if we’d have accepted this premise, none of the service line improvements that everyone wanted to see – changes that would benefit the hospital, the physicians, and their patients – would have happened. Here’s why:
I often acted as the “marriage counselor.” I’d work to understand what the hospital wanted to accomplish and what the physicians needed and wanted. Then we’d work to find common ground. When everyone was ready, we’d pull both groups into a big meeting – a meeting many of them dreaded, as these had not gone well in the past. Frequently, the physicians were not shy in stating that they couldn't work with the administration because they didn’t trust them. Then, they'd ask, “How do we get over that?”
My initial reaction was “Well, let’s begin by understanding that we can’t talk our way to trust.” In other words, we could have stayed in that room talking for hours about what had caused the lack of trust, and what needed to happen to build trust, but it would have changed nothing.
Consider this a Business Relationship
After breaking the disappointing news that there were no magic words that would solve the trust problem, we reframed the discussion as a business proposal. This is important because physicians tend to approach these issues from an emotional point of view. Often not trained or experienced in business dealings, they sometimes assume that decisions made by the administration were specifically intended to go against the physician’s interests. They tend to perseverate on slights, real or perceived, even if they were committed by past administrations.
Having worked as an attorney on different types of deals in different industries, I explained that this was like any business relationship. At all times, each party must protect its own interests and must never assume that the one party will work in the other’s best interests unless it’s mutually beneficial.
Focus on Goals
Where do the goals align? What can we work on that is mutually beneficial? Identify a plan and execution strategy. Slowly, in solid business relationships, trust builds from a history of working with each other on initiatives that are successful and from dealing with each other fairly and honestly, but with reasonable expectations. Never assume that the other party is acting purely out of spite – it happens, but it’s rare. This way, the parties demonstrate over time that they are worthy of trust, but always be aware that at some point, your interests may diverge. It may not end the relationship, but it may create issues that need to be dealt with.
Sorry, but there’s no quick, easy way to rebuild trust. It takes time and work. If the parties aren’t willing to do that work, not much is going to get done. You can’t talk your way to trust.
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