When an organizational unit isn’t working well it’s usually because leaders are not addressing small problems before they become big.

Large organizations don’t suddenly become dysfunctional—they drift there slowly over time. Almost always someone has tried to address the situation on multiple occasions and failed, causing the physicians and staff to become resigned that further attempts at fixing the situation will be useless.

“We’ve tried that, it’s no use” is a frequent refrain. In this circumstance people rarely decide to entertain serious further efforts at change until the problems are big ones or a crisis appears on the horizon. Half-measures at this point are almost certain to fail. The only answer is to start over, laying a new foundation upon which to build a new organizational culture.

Since most of the people will be the same, however, we run a significant risk of recreating the same problems we had before unless the people involved, or at the very least their leaders, change first. We therefore recommend starting with the physician group, providing them some new relationship management and communication tools, and making sure that they are aligned as to where they want to lead the department. Physician unity and the discipline to maintain ranks are extremely important when a new culture is being created.

Largely because physicians were never trained in business management techniques most medical groups have never taken the time to discuss what kind of an organization they want to have or to set detailed goals for it. The ‘We’ll all just work hard and success will come’ approach might work for a while in a stable business environment but in today’s medical practice world things change too fast to stick with one set of goals or strategies for very long. Setting goals is essential to strategic planning because strategy is about how you are going to achieve the goals you set for yourself. Tactics in turn are the individual steps the practice will take to execute its strategy. To realize the organization’s goals they must be clear to everyone on the team. The Second of Stephen Covey’s 7 Habits of Highly Successful People is “Begin with the end in mind.”

HPC’s consultants are skilled in facilitating medical group strategic plan development. They stay abreast of all health care system developments that may impact hospital-based medical practice in the near or intermediate term and can speak authoritatively about both threats and opportunities. The involvement of an outside facilitator is also helpful in that it helps draw out minority opinions in the medical group so that these get expressed and not withheld because they feel they may be at odds with the group’s leadership.

Using the SWOT Analysis approach (Strengths, Weaknesses, Opportunities, Threats) the facilitator helps the group identify and prioritize the top 3–5 strategic opportunities or priorities for the coming year. With these identified the facilitator then leads the group in the selection of Project Team Leaders and Members, and in the preparation of Project Records to bring some structure to the process of going about achieving the group’s goals.

There are inevitably knowledge deficits in regard to strategic planning, strategies, tactics and project management, which the HPC facilitator can fill as the process unfolds, typically over a two-day retreat format the first time it is done.

It’s not uncommon that a practice isn’t really sure about how its performance compares to that of its peers and where the opportunities for improvement lie. For both medical groups and service line department, HPC often conducts either or both an operational or financial benchmarking assessment to develop this knowledge before beginning the strategic planning process. HPC has associates in nursing, service line management, billing and collection, and many other areas of medical practice assessment that it can call upon for assistance as needed.

Nothing gets accomplished in the world without a pre-existing relationship and clear, mutually supportive communication. Our training provides the physician group members with a simple system for building and maintaining key relationships before they are needed. Waiting to establish a relationship until you need something is always a more difficult situation and much less likely to provide you what you need.

Communication, especially that which addresses upset or conflict, is typically difficult for relatively poorly socialized physicians – they just weren’t trained in this and had little time to pick it up by “hanging out” and socializing in college since they were in the library. HPC’s communication training provides the physician with a framework for communication that offers a step-by-step approach to clear communication and an easy way to hold the other person accountable while simultaneously working to insure their success.

The basic unit of accomplishment in all organizations is a project. HPC’s project management training is based on the approach used by the American College of Emergency Physician’s (ACEP’s) Emergency Department Director’s Academy in training ED Medical Directors. Robert and Ron are both EDDA Faculty members and teach this same material there.

With the new set of relationship, communication, and project management skills we are ready to craft a Vision Statement for the practice and through strategic planning identify the first set of project topics to be addressed.

An organization’s culture must be designed from the bottom up to be effective. It is hard to hold people accountable for supporting an organizational vision into which they had little or no input. And while it may seem to be a lot of personnel time and energy to achieve what appears on the surface to be a relatively small accomplishment (the Vision Statement) there is no substitute for taking the time to define why you are working together, what you want to become, and the role of the individual in that journey. HPC facilitates Vision Statement development in a two-day retreat format along with interspersed didactic sessions about the business realities of the practice and relationship, communication, and project management material reinforcement. The end result is a written Vision Statement, the identification of the group’s highest priority issues, Project Team Leaders for each issue, the initial draft of a Project Team Record, and a simple communication convention that can be used to maintain accountability as projects are completed and recommendations implemented.

Keeping the Vision alive in the organization is a significant leadership challenge. HPC recommends and teaches a variety of ways to do this but paramount in importance is the communication technology we teach. Not only does it serve to keep the Project Team Leaders and Members engaged but the same communication approach also holds people accountable for their actions and can be used across the organization. HPC frequently recommends its continued involvement in the implementation phase of change management. HPC consultants mentor the Project Teams and the leadership in how to get the most out of a project in the shortest time. By the end of 6-12 months the project approach to practice management issues is typically well ingrained into the way the organization thinks about problem issues and can go forward on its own without consultant involvement.

“A cardinal principle of Total Quality (management) escapes most leaders. You can’t continuously improve interdependent systems and processes until you can progressively perfect interpersonal relationships.” —Stephen Covey

Jim Mugan"Through your expertise Agnesian Healthcare was able to make dramatic improvements in our Emergency Department. Ron was the lead consultant for our project and he brought much experience and credibility with the physicians and administration. He guided our new group of emergency physician toward becoming a cohesive team. Our door-to-provider times are now averaging 15 minutes and we have seen 5–10% growth of ED visits for each of the past three years."

—Mr. Jim Mugan, Senior VP, Clinical Services

Agnesian Healthcare, Fond du Lac, Wisconsin