My desire to write this piece stems from my recent realization that I wasted a good part of my early career in medicine. While I was happily working in my pathology “bubble,” I was completely oblivious to the great untapped potential I had to affect change not just within, but also outside of, my department. In an effort to encourage other physicians to find ways to make an impact, I am sharing what I have found to be effective in building a relationship with hospital administrators, who hold the ultimate decision-making power on most changes in the hospital setting. My advice is geared towards those early in their medical career, but still applicable to any physician at any point in his or her career. So here it goes:
1. Take time to build rapport. Do not expect that because you are a highly productive and sought-after specialist, administration can or should do anything you ask. On the flipside, just because you are a primary care physician in a remote area that is perceived to be a drain on hospital resources, do not assume that administration does not have an interest in your opinions. No matter what your position on the medical ladder, building relationships is essential to fostering change. Most people are more likely to go out of their way to help a friend than a stranger, and ways to befriend administrators abound.
Volunteer for committees, and come to the meetings. When you attend a meeting, make an effort to listen to everyone’s point of view and to contribute to the conversation. Make the effort to get to know your administrators at a personal level. Make a mental note — or a note in your cell phone — about any upcoming events mentioned in passing, and remember to ask about it the next time you see that individual. A little question like “How did your mother’s surgery go?” can really make a big impression. These reminders of our common humanity help us see each other as people, not just “greedy” doctors who want the hospital to spend more money, or “out-of-touch” administrators who expect doctors to continue to do more with less resources. If you have the opportunity to share a meal with an administrator or even catch one in the hallway for a brief conversation, send that person a quick follow-up email thanking him or her for taking the time to listen to you. Make it a point to write thank you notes. These gestures are not only important to building a good working relationship, but may even be the beginning of a beautiful friendship. Building relationships builds allies, expands your network, and increases your potential to effect change.
2. Maintain a positive attitude. Do you want to listen to, much less help, someone who is always complaining and miserable to be around? Enough said.
3. Be reasonable about your expectations. There are many shiny new toys available in health care that have great potential to improve patient care; many of these toys have very large price tags. Chances are that your hospital has seen an unfavorable shift in payer mix over the last few years, and that your hospital recently purchased an astronomically expensive EMR. The bottom line is that hospitals have less disposable income. Knowing that multiple specialties are competing for the same dollars — not to mention the hospital employees who expect an annual raise, the one-hundred-year-old building that needs structural repairs, etc. — be reasonable about what your hospital can do with limited resources. Explain the value of the new instrument/procedure/process you would like the hospital to purchase or implement. Will a new technology increase your hospital’s market share? Will a new procedure decrease length of stay for a certain condition? Help your administrators understand how what you are asking for can be mutually beneficial.
4. Always assume good intentions. I first read the quote “assume positive intent” from Indra Nooyi, CEO of PepsiCo, in a compilation of advice from successful businesswomen. In the entire compilation, this is the one piece of advice that stuck with me and also where I see many physicians go wrong. I know a number of physicians that tend to think that every decision administration makes is made with the intent of making their lives — either as individuals or collectively — more difficult. This is simply not the case. Administrators have a vested interest in making sure that physicians are happy, because unhappy physicians leave and/or make mistakes, both of which are costly to the hospital.
Knowing that administrators want you to be happy, if you are unhappy about something at work, the onus is on you to let an administrator know why and to offer realistic solutions or suggestions for improvements. If you are able to secure a face-to-face meeting with an administrator to do so, take a moment to remind yourself to “assume good intentions” before the meeting starts, and follow the Dalai Lama’s “one-win-everything” negotiating techniques (you can find these by googling). You will both walk out of the meeting better off for it.
5. Be persistent. Just because you hear “no,” if you believe strongly in your idea, do not give up on it. Find out exactly why your idea is being rejected, and figure out if there is a way to modify it, scale it down, break it into smaller pieces, or make it more palatable. Could you do a pilot project to collect more data to make a stronger case? Do you need to spend more time educating and getting support from the involved parties? Is it all-or-nothing, or is something still an improvement? Be patient — persistence pays off.
If there something you want changed at your hospital, consider the above points and go for it! If you don’t make change happen, who will?
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