| "I didn't know that you were expecting a | | | | accountability for health.We must do the same for |
| response from me." | | | | our organizations, making the radical assumption |
| "The Emergency Department was just insane last | | | | that the outcome is what we collectively intended |
| night." | | | | or else take the steps to create a different result. |
| "I can't control how the doctors talk to patients." | | | | Otherwise, the game continues. Following are |
| Sound familiar as you walk the halls of your | | | | some questions that increase accountability and |
| hospital and medical center? Have you, perchance, | | | | engagement: |
| uttered these very words? One of the biggest | | | | • What is it about my attitude or behavior that |
| frustrations in healthcare today is lack of physician | | | | keeps this going? |
| engagement and accountability-terms frequently | | | | • Do I have a hidden, unexamined personal |
| used to suggest what somebody else should do. | | | | agenda? |
| Accountability and engagement, though, result | | | | • Is there anything I'd like to communicate but |
| from the interaction of everyone involved in any | | | | haven't? |
| issue. | | | | • Have I broken or missed any agreements? |
| When administrators talk about physician | | | | • What about this situation feels familiar? How |
| engagement, they are generally speaking in code | | | | do I con-tinue to create this problem? |
| for what they would like physicians to do but | | | | • What can I learn from this situation? |
| can't get them to do it. When physicians speak | | | | TAKE 100 PERCENT RESPONSIBILITY RATHER |
| about engagement, they are speaking in code for | | | | THAN ABDICATE. |
| what they already give that is not appreciated, | | | | Are we willing to face what we have not been |
| valued or supported by the administration. Both | | | | willing to face-our own part in creating the |
| sides stake out viewpoints, positions and | | | | problems? No matter how small a role he plays, |
| interactions that make real progress, change or | | | | each participant in an issue is 100 percent |
| collaboration impossible. | | | | responsible for the part over which they have |
| Common issues involve in-house clinical services | | | | control and can take action. The vice president of |
| coverage, emergency department specialist | | | | medical affairs referenced earlier took 100 |
| coverage, staffing for clinical service areas, and | | | | percent responsibility for her part in the ongoing |
| marketing and educational programs. The chief of | | | | ER coverage dilemma. |
| the medical staff, the vice president for medical | | | | After coaching more than 1,000 top executives, |
| affairs, clinical department head, CEO and the | | | | we've found the Rule of Three particularly useful |
| hospital board, hospital staff, community and | | | | when monitoring a person's commitment to |
| patients are frequently locked in an endless and | | | | responsibility. For example, if the internal medicine |
| exhausting game of villain, victim and hero. The | | | | department chairman refuses to discuss sharing |
| formula for change seems elusive, yet the steps | | | | resources with family practice after the vice |
| are simple-stop blaming and only hold others | | | | president has carefully worked out the plan and |
| accountable after you first own your part of the | | | | beneficial results, the vice president is not |
| problem; notice the gap between what's wanted | | | | responsible. However, after the third sound |
| and what's actually created (the commitments | | | | collaborative initiative is dismissed without open |
| and the deliverables); and take 100 percent | | | | dialogue, the vice president might ask, "How am I |
| responsibility, rather than abdicate. The result will | | | | creating this outcome?" Instead of loudly |
| equal engagement for both physicians and health | | | | complaining about the chairman's lack of |
| care leaders. | | | | engagement when he's not around, an |
| STOP BLAMING AND HOLD OTHERS | | | | accountable leader might approach the chairman |
| ACCOUNTABLE ONLY AFTER YOU FIRST OWN | | | | directly, owning a full role and inviting a shift to |
| YOUR PART OF THE PROBLEM. | | | | create a different outcome. |
| In learning to take a medical history, caregivers | | | | An enlightened chief of staff we work with |
| are taught to begin with the "chief complaint." | | | | recently set the agenda for a medical executive |
| Somehow the chief complaint has become the | | | | committee meeting by facilitating a discussion of |
| mantra of our health care interactions and | | | | the current issues with the following model: |
| discussions. When you complain and explain, you | | | | • What is the issue as you see it? |
| pretend you're not responsible for your failure and | | | | • How have you contributed to the issue? |
| this does nothing to change the reality. In fact, | | | | • Are you willing to resolve this issue? |
| you contribute to an increasing trend of poor | | | | • What changes are you willing to make and |
| results. Explanations (no matter how good) mean | | | | lead others to make? |
| you're dead in the health care water. Conversely, | | | | The meeting stayed within the prescribed time |
| telling ourselves and others the impeccable truth | | | | limits for the first time in anyone's memory. The |
| about how we get in our own way and then | | | | outcomes were impressive. Old issues no longer |
| clearing the path, is the only route to success. | | | | appeared on the agenda, so there was room for |
| This happened recently at a meeting to hash out | | | | solving the new issues. Most in attendance said |
| issues with neurosurgeons at a major | | | | that although it was hard, it was fun and they felt |
| metropolitan health center that took a hard line | | | | more connected than ever before. They'd |
| about ER coverage for trauma, demanding large | | | | become engaged. |
| subsidies from the already contracted hospital. | | | | As you live and work with the new accountability, |
| The vice president of medical affairs made a bold | | | | you'll no longer make excuses or blame others. |
| move toward engagement when she candidly | | | | Instead, you'll ask how you can be more, better, |
| admitted that she had contributed to this problem | | | | faster, smarter-and then you'll make it happen. As |
| by gossiping with colleagues about physician greed | | | | we seek a better health care system, the |
| and arrogance. The head of neurosurgery then | | | | prescription of accountability is the best drug |
| sheepishly admitted he had taken an arrogant and | | | | around and comes from the internal pharmacy |
| selfish stand and had encouraged his colleague in | | | | without concerns for side effects of drug |
| orthopedics to join him. At that moment, the | | | | interactions.We suggest that you try this |
| group began to move towards a solution. | | | | engagement formula for a week or even a day |
| Notice the gap between what's wanted and | | | | to confirm the experience of many creative |
| what's actually created-the commitments and the | | | | leaders and organizations, creating health and |
| deliverables. | | | | longevity along the way. |
| In the care of our patients, we urge personal | | | | |