Physicians often have little or no formal education in leadership or business principles. A group or department leader is often chosen by seniority or even by default and then left to “on the job training”. Clearly a more formal and consistent approach to leadership training is often warranted. This article identifies key attributes which the authors have utilized in educating and training leaders of hospital-based provider groups. Since most group leaders are physicians, in keeping with the predilection of medical students to memorize lists by various pneumonics, these key attributes may be referred to as the 5C;s: Culture, Communication, Consistency, Customer Service and Collaboration.
Culture
Leaders in of organizations must focus on defining the unifying principles of their members. In the world of business, this may involve a clear vision of markets to be served, growth or financial targets to be achieved. A charitable organization may rally around a mission to help certain target groups through education, healthcare, emergency services and so on.
It is no less important for hospital-based groups to have a clear vision of their reason for being. Setting this compass is a fundamental building block of the culture of the group, and it is one of the most important functions of group leaders. If there is no unifying vision, then the group becomes a collection of individuals occupying the same space, not a coordinated entity.
Therefore the first goal of leadership is to establish a culture. First and foremost, the actions of the leader must serve as an example of desired group performance. However, defining a clear direction requires input from group members and should be documented in writing. Focused group discussion facilitated either by the leader or an outside expert should generate a written document delineating fundamental group goals and ideals such as quality metrics and targets, customer service goals, hospital committee responsibilities, response times and reporting methodologies.
Communication
It is generally accepted that shortcomings in communication are associated with a variety of clinical mishaps throughout the hospital. For example, the period of shift change and “clinical information handoff” in the emergency department is fraught with errors which center upon a lack of proper communication between providers. Many investigations of adverse clinical outcomes in the ED uncover a “fumbled handoff of information” as the root cause.
Communication also represents a necessary skill for effective leadership of hospital-based groups. In this context, there are two main categories of vital communication; internal and external. Internal communication refers to disseminating information, policies and protocols to providers and care extenders within the group, while external communication applies to any party outside of the group including other medical staff, patients or members of facility administration. Without adequate internal and external communication, the “business information handoff” may be fumbled, leading to a loss of direction and momentum for the leader.
Leaders must develop regular mechanisms to disseminate information both internally and externally. Monthly or quarterly group meetings supported by a company intranet or regular e-mails present the ideal opportunity to communicate key issues internally. External communication is also best achieved through regular channels such as department of medicine or surgery meetings, operating room or radiology steering committees or monthly meetings with facility administration. In order to optimize internal or external meetings, leaders must work to assure that attendance is adequate and the agenda is well planned with appropriate supporting material available for review prior to the meeting.
Consistency
In most service interactions, customers value consistency, predictability and reliability as a key determinant of satisfaction. Examples abound of service organizations which offer a consistent product and experience regardless of the employee interfacing with the customer. This predictability may be found in places as diverse as Starbucks, commercial airline flights, Disney World and your local bank. Unfortunately, the service delivery from hospital-based groups can often be best described as “provider dependant”. In other words, the experience of a referring physician or their patient will vary greatly depending upon the hospital based providers involved in the care. As one surgeon described the consistency of pre-operative testing at one of his local hospitals “it’s about as predictable as playing the roulette wheel in Vegas.”
Such unpredictability represents an Achilles heel for facility-based groups. While some clinical variability is inevitable, leaders must strive to set and implement policies for handling common situations and conditions. Each facility based specialty will have a unique set of issues, but upon discussion with referring physicians, common functions which result in wide discrepancies in approach and therefore are highly unpredictable will be easily uncovered. Using this set of functions as a baseline, priorities may be assigned based upon frequency and level of importance to patients and medical staff. It is the role of group leaders to facilitate policies and procedures for each of these processes. Each process may have clinical, operational or business components; the approach to each must be addressed and agreed upon by the provider group as a whole.
As processes are improved, the levels of consistency should improve. Equally important, with a written approach documented for a given process, it becomes easy to identify providers who are not operating within the accepted boundaries. Typically it is the role of the leader or designee to educate such individuals in a quest for ever improving levels of consistency.
Customer Service
Leaders must recognize that hospital based providers have several sets of customers. The first and most obvious are the patients who depend on their care. Second is the medical staff, especially physicians who regularly refer patients to the specific provider group. Last but not least are the administrative members of the facility itself. From a customer service perspective, each of these customer groups has unique needs as well as criteria on which to judge hospital based providers.
When we educate leaders, it is stressed that satisfaction of each of these customer groups is vitally important to the long-term viability of the provider group itself. However, each group will respond positively to their own set of actions. Therefore, distinct efforts must be spearheaded by the leader to understand and address the needs of these distinct customers. Such efforts are characterized by delineating the specific customer needs, understanding how the provider group can best meet those needs and documenting procedures designed to institutionalize each component of the agreed upon approach.
Leaders must realize that payoff from improved customer service may be realized in many ways. These may include quantifiable items such as increased market share, case load, satisfaction scores and group revenue. However, a positive customer service approach will often lead to intangible benefits such as improved medical staff relationships and a more harmonious relationship with facility administration.
Collaboration
The fifth “C” tends to tie all of the other leadership attributes together. For it is in collaboration that the hospital based leader reaches out to work with other medical staff and hospital departments to forge new clinical and operational programs and processes. It is through collaboration that integrated delivery of service will be delivered. In such endeavors, a culture of continuous improvement is vital to success. Communication between departments must involve relationship development and tighter bonds. Working together to develop a consistent approach to a mutual issue allows the hospital based group to be seen as a problem solver and innovator in the eyes of their medical staff colleagues. Finally, there is no greater pursuit of customer service than to work hand in hand with a customer to tackle a shared area of concern.
We therefore view collaboration as the icing on the leadership cake. It is encouraged only after the first 4 C’s have been substantially addressed. This is because the first 4 C’s look mostly inward to solidifying a group into a single voice to be heard by the outside world. It is only once this has been accomplished that collaboration with other hospital entities is realistic. However, it is this fifth C, collaboration, which will forge the strongest ties with customers and serve to make both the leader and his or her group indispensable to the facility for the long run.
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