Physician executive experts answer your medical management questions - Ask the Coach

Physician Executive, Sept-Oct, 2002 by Howard Kirz

Flummoxed in Florida

Dear Flummoxed,

Barbara Linney, ACPE's communications and career expert, says the key to your situation is to be willing to Count beans some of the time.

"If you want to influence a person like this, you have to use their style occasionally. People who dislike bean counters often view themselves as the only ones in an organization able to see the big picture, in this case quality and service. You have to get in the other guy's shoes some of the time."

Like Barbara, I think it's highly unlikely you'll ever persuade your CFO that his values are wrong. It's very common, particularly in a health plan, to be teamed up with other executives of different skills and values. A better strategy might be to spend some personal time together trying to understand each other's points of view, learning to work together respectfully despite your differing areas of emphasis.

Another excellent strategy I've used myself and recommended to several coaching clients is to produce a "quarterly qualities" report right alongside the quarterly financials. Use specific numbers and YTD figures to display your key health care indicators in a format similar to the monthly financials and with similar "bean-counting" precision. Distribute the report in exactly the same manner as the financials and you'll be pleasantly surprised at the reception.

Overall, I'd suggest just backing off a little, not on your own values but on your need to influence your colleague's. You'll both be much happier and more effective for it.

I'm thinking about looking for a new job, hopefully as a VPMA or CMO. I have 6 years of good experience as a medical director, a new MBA and a flexible family situation. What are the three most important things I should consider as I start my search?

Clueless in Carolina

Dear Clueless,

1. Location.

It's the one thing you can't change (just like real estate). Location is critical to the non-working hours of your week, to your family and to your soul. Figure out where you want to live first.

2. Organizational kind and culture.

What kind of health care organization do you feel best in? Hospitals? Health plans? Large groups? Small groups? Academic medical centers? Tech firms? And in what organizational culture? Profit? Not for Profit? Dynamic and changing? Relaxed and stable?

To a large degree, organization type and culture will determine your long-term sense of fit and comfort in your new job. These characteristics are generally quite robust, changing rarely or only over prolonged periods of time.

3. Boss.

While factors 1 and 2 are critical to your long-term happiness and professional well-being, "boss fit" is critical in the short run. You will surely experience boss changes or perhaps even replace your boss over time, but only if you survive. Do you like him/her? Is he/she supportive of you and of your new position? Do you feel that you will grow and thrive under his/her supervision?

After maximizing these three most critical characteristics, look at the job description and compensation package. Such things may seem of great importance at first and perhaps be emphasized by certain recruiters, but these factors always change over time and can often be significantly negotiated in advance.

On the other hand, since your friends and coworkers will immediately ask about the title and the money, you might as well know the answer. Job change is a time of great opportunity and personal growth. Use these three clues wisely and enjoy the journey.

I'm a third-year board member I'm getting progressively disgusted with our board meetings and beginning to feel like we're just another dysfunctional family Our evening agendas drag on forever, our members fight about insignificant things, personal politics prevail over performance (in fact what is board performance anyway?) and self-interest runs rife. What can a physician board member do about these things? Or should I just apply my talents elsewhere?

Bored Member

Dear Bored Member,

Board performance is one of my favorite topics. Your board's certainly a mess and I bet some of our readers can relate to your problem. The short answer is that board performance is almost always fixable.

The long answer is that it's tough to do from the seat you're in and would be a lot easier if your board improvement ideas are supported by your chair or at least some other senior board members.

Start there. Privately voice your concerns about board effectiveness to your chair or to other senior members with whom you have a good relationship. If you get some interest and at least a little support, suggest an evaluation as the first step toward identifying the areas that might be mutually interesting for the board to pursue.

Good board evaluations are not easy to do and it sounds like you're in no position to just dream one up by yourself. There is some excellent literature on this topic, including:

* Improving Board Effectiveness by Holland, Ritvo and Kovner. Published by American Hospital Publishing, 1997.

* Board Work by Pointer and Orlikoff. Published by Jossey-Bass Publishers in 1999.