Hospital-owned practices succeed with solid teams
Medical-administrative balance crucial
It sounds like the ingredients for a good marriage: trust, communication, and respect.
And in essence, the physician-administrator partnerships at the best hospital-owned practices and health plans are a similar union.
But unlike a good marriage, a good partnership can lead to more quantifiable rewards, such as smooth transitions in changing times, innovation that leads to increasing revenues and profits, and an ability to face down opposition to ideas, whether it comes from the medical personnel or from management.
Just ask Mike Abell, MHA, MEd, FACHE, and Ken Cummings, MD. Abell is president and CEO and Cummings is vice president for physician integration and services at Carondelet Health in Kansas City, MO. The two run a health system that includes two hospitals, three skilled nursing facilities, two home health agencies, a hospice unit, and a primary care network with 12 sites and 32 providers.
Without the trust and respect Abell and Cummings have for each other, Abell says, many innovations over the last nine years would not have happened.
Cummings agrees. "In the last nine years, we have successfully conceived, implemented, and operated a number of new organizational elements that require each of us putting ourselves on the line. We have a unique MSO [management services organization], a PHO [physician-hospital organization], and a really good primary care network," Cummings says.
Abell also thinks the technological superiority of the system comes from the relationships they have built. "If you ask a physician in the community, 'Who has the best setup for technology?' they say us.
Along with the concrete benefits accrued by Carondelet, Abell says there are other pats on the back. For example, Carondelet has 19 hospitals around the country, and it often calls on Abell and Cummings to be members of expert panels at retreats on issues such as physician contracting and MSOs. No program - especially not those requiring changes in attitudes, policies, or procedures - could have occurred if Cummings didn't have the support of Abell and vice versa. Cummings says, "With his support, I have been able to implement programs without his second-guessing me."
Abell was at Carondelet for three years before hiring Cummings from Oral Roberts University in Tulsa, OK. His choice was made after hours of discussion about their different roles and how well they could work together. "I'm Mr. Outside - the politician," says Abell. "Ken knew the medical and clinical activities. But we were both visionaries, so we were a good match."
Good teams build good practices
An example of how their relationship allows new ideas to come to fruition occurred when the system wanted to start its primary care network. The attorneys and board wanted the group to include noncompete clauses in the physician contracts, which would preclude any member physician from practicing at a hospital other than St. Joseph Health Center or St. Mary's Hospital. "My feeling was that if we did our jobs, they'd want to stay, and if we didn't, I wanted them to have the option to get out and work at another hospital," Abell says. "Ken explained it to the board from a physician standpoint. I supported it because we had talked it through before."
In the end, they won out, and only a couple of physicians have been lost.
Thomas Royer, MD, chairman of the board of governors of the 1,000-physician Henry Ford Medical Group and senior vice president for medical affairs for the Henry Ford Health System in Detroit has also built positive relationships with his administrators. Those good relationships, says Royer, have given both organizations a flexibility that has paid off.
"If what you are doing is keeping you too busy, then you have a person you can look to to pick up a piece of the puzzle and know you can count on the result. I have often turned to [my administrators] to staff a function or work on a meeting agenda so I can spend time getting input from physicians," Royer says
The positive relationships Abell and Cummings and Royer and his administrators have are a shift from the past, says Royer, when there were adversarial relationships between administration and medical staff. The conflict revealed itself in three ways, says Royer:
1. Some administrators felt their territory was being invaded.
2. Administrators viewed physicians as arrogant.
3. Administrators have often looked at health administration as a science instead of an art.
"They don't understand the clinical aspects of management - for instance, how a 15-minute appointment can become 30 minutes. All of these issues just beg for teaming. It has become apparent too that you have to have a physician and clinical perspective for administration, and a business perspective for the physicians."
What makes Abell and Cummings a good team is that they are both visionaries and strategists, says Abell. "We can sit and brainstorm with each other, and that's how things happen.
Often, their brainstorming sessions get so intense, they lose track of time and sometimes have to put the brakes on, says Abell.
Cummings says another element of their relationship is their complementary work styles. "We are both committed to being patient, to being in something for the long haul. But even though I have a decent amount of right-brained strategic visioning, I am capable of developing a structure and implementation process and a review of the success. I can easily share the vision, then I operationalize it, bring back the results, and talk about next steps."
A healthy dose of conflict
But no relationship is perfect, and not even Cummings and Abell always agree. For instance, Cummings opposes a plan to sell off the system's MSO. "He doesn't want to, but I have pushed and at least got him to explore the idea of selling it off. I know he doesn't trust the potential buyers. He has his reasons, and I understand them. He fears losing control. But I think we can get our services at cheaper prices and maybe not lose control."
When those disagreements occur, Abell says they don't interfere with an otherwise positive working relationship; in part because Cummings understands that in the end, Abell may opt to do what he thinks is right anyway. "I try to get Ken to understand my philosophy, and I try to get participation in the decision making. But I don't relegate my final say because the buck really does stop with me. I know that and he knows that. I don't often do it, but I have in the past, and I probably will again."
Royer says that some disagreement is not only good, but necessary. "You have to have a healthy tension," he says. "But when that tension goes from healthy to unhealthy, then you have to agree to disagree, collect further data, and then find a compromise. I can only recall one or two times when that hasn't worked."
In those cases, then Royer says medical issues must go to the doctor, and nonmedical decisions to the administrator. "If you go through the right steps, then you never have a loser."
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