Leadership During Hospital Alignment: 6 Points for Orthopedic Groups

Practice Management

Orthopedic groups, especially when they are working in conjunction with local hospitals, can benefit from having a strong leader. However, it can sometimes be difficult to find the right person for that position. "It can be hard to designate physician leaders in orthopedic and spine groups because there is a longstanding camaraderie among them, which really begins in the residency," says Ira H. Kirschenbaum, MD, chairman of the orthopedic department at Bronx (N.Y)-Lebanon Medical Center in New York. "Surgeons need to come to a consensus in their group about who the leader is and give that leader an individual voice. The leader will be someone who has obtained a mandate in some sense from the other physicians in the group, which is a source of power." Dr. Kirschenbaum discusses the best qualities of orthopedic and spine surgeon leaders and how these people achieve the mandate from their fellow physician partners.

Who should lead?

1. Physician employer. If you own the practice or group and employ other physicians to work with you, you'll be the logical leader of the group. "This is the benevolent dictatorship model, which we see in a number of specialties," says Dr. Kirschenbaum. "If the leader is the employer, that's a very powerful mandate. However, the leader has the responsibility to keep their employees happy, and good benevolent dictators stay in power a long time because the other physicians like them."

2. Most experience. In many cases, the surgeon with the most experience becomes the trusted leader of the group. This is a surgeon who has a history of successfully completing several plans and projects, and is able to translate that success into the current group. "This might not always be the oldest or most aggressive surgeon in the group, but the one who has the most experience or best track record," says Dr. Kirschenbaum. "A lot of people don't give enough credit to this aspect of the physician leader."

3. Spearhead the mission statement.
As with any business, orthopedic groups must have a mission statement. In situations where a clear leader hasn't been selected, surgeons in the group can devise a mission statement. Typically, the surgeon or surgeons spearheading the mission efforts are natural leaders in ensuring the practice uphold its mission and meet its goals. When devising a mission statement, discuss what the surgeons want now and what the situation will look like once the goals are accomplished.

Aligning with hospitals

Hospital-physician alignment is becoming increasingly important to maintain a successful orthopedic service line, but in many cases hospital leaders and orthopedic surgeons are struggling to overcome an adversarial relationship. "Hospitals often divide and conquer the surgeons, and the surgeons try to hold back services until they are able to get what they want," says Dr. Kirschenbaum. "This cycle continually reproduces itself, even as hospitals are afraid surgeons will take their cases elsewhere, and surgeons are afraid hospitals will find another surgeon to take their place."

The solution — uniting against a competitor in common (in warfare this would be called a common enemy), says Dr. Kirschenbaum. These entities are often the insurance companies that profit from the hospital and physicians, but do not feed that capital back into the physician-hospital relationship.

"Every dollar and profit going to the insurance company isn't funneled back into the hospital — dollars made from the hospital go back to the hospital, and profits from the physicians go back to the physician or their practice, and in both scenarios they end up profiting patient care," he says. "I'm not saying that insurance companies don't have a role in healthcare, but the reality of it is that a competitor in common breeds for a good relationship."

He says there are three things physicians leaders must understand to build a positive relationship with hospital executives:

1. Terrain. Physician leaders must know how the hospital works, how much money is spent per square foot at the hospital, how patients are processed through, where the patients come from and how hospitals are able to remain sustainable or turn a profit. A further important aspect of understanding the terrain as it relates to the alignment is knowing the implant contracts — how much is your hospital making from each case where surgeons use one implant or another? When surgeons are conscientious of these things, they can begin finding ways to work with the hospital on cost and time savings without compromising patient care.

2. Climate. Stay abreast of the political climate, especially as it relates to healthcare. For example, when Medicare decreases reimbursements to hospitals for the procedures you do without considering the increased cost of implants, you'll have to work with the hospital to find a way to continue using that device despite the low compensation for the case. "You have to figure out how you are going to compensate for the climate," says Dr. Kirschenbaum. "When I leave the house and it's raining, I have to wear a raincoat. Your response to climate change after you understand the terrain defines a leader who is ready to change. A physician has to understand and react to the change."

3. Personalities. Understanding the personalities and motivating factors from the physician and hospital point of view is absolutely imperative for managing a successful relationship. "There are six things that motivate every physician: doing the right thing, making money, marketing their practice, practicing defensive medicine, power and glory and being able to go home at the end of the day," says Dr. Kirschenbaum. "Every physician emphasizes a different motivating factor. If you understand a particular physician's goal — such as going home early — you will focus on how to achieve that goal by improving turnover and start times."

Analyze the mood of the group and figure out what most of the physicians are interested in. Emphasize the overall goals when meeting with the hospital leadership, but also know what their goals are and the different elements that impact their point of view. "If you are going to lead, you have to understand the climate, terrain and personalities of the hospital leadership because you want their buy-in for change," says Dr. Kirschenbaum.

Related Articles for Orthopedic Surgeons:

6 Different Methods for Orthopedic Surgeon-Hospital Alignment

What Percentage of Orthopedic Surgeons Will be Employed in 5 Years? 10 Responses

9 Points for Orthopedic and Spine Surgeons on Forming Positive Relationships With Hospitals

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