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On April 27, 2019, Lisa commented on Opening up to enjoy the big picture :

It would be important to create a sense of urgency among the surgeons and radiologists in both institutes. They already lost the acute stroke care to another hospital, what will be lost next? In addition, it would be important to understand what really is the “stone in their shoes”, why are they so strongly against collaboration. Is it fear for losing their autonomy, losing their roles as professionals, losing their power, losing their jobs or what? If you could figure that out it might help you to tackle it by openly discussing the matter with them.

Can you make them accept that their hospitals are to merge and now they have a change to make the best out of it? Could you bring them together to discuss, what would the ideal future look like. If they could agree about that, then they could maybe start working towards that.

Maybe you could get them to do some joint project together to improve the care of some patient group. Start from the patient: what the patient need, what is valuable to him, how would he like his care to proceed, and are we now able to provide them with that. Could we do it better if we worked together?

Can you align the KPIs and incentives of the different groups of doctors to support collaboration?

Sounds like a very familiar challenge to me, too! One important thing in my mind is to set joint goals and KPIs for different silos. Patients’ processes tend to cross may silos in the organization. Making people see that is important. Taking a few patient processes and working together to describe them, look at them from the patient’s point of view, aiming at improving them in a patient-oriented fashion, and then setting joint goals and KPIs sometimes help. It is also important that the incentives of leaders and the staff are aligned with creating collaboration, not supporting silo thinking.

I think it is highly important that you manage to change how things are now working in our organization, It requires – in my opinion – both you to change and your people/your organisation’s leadership to change.

To train and coach you staff to be able to take responsilibily, I would start with systematic discussions about the values, vision, mission, strategy and annual goals of your organization. I would then continue discussing what those mean in the every day life at each level of your organization. If you hospital had for example a goal to improve productivity, what does that mean in each department, each ward etc, what should they aim for in order to help the hospital to yield its goal. Unless people know what they should be aiming at, it is difficult for them to work towards that. Then you should empower them to make changes, suggest ideas and make decisions to reach their goals, within boundaries that you have set, of course. You should meet with them regularly (one a week at least) and go thorough their KPIs, ideas, challenges, and coach them to take actively responsibility. Ask questions, don’t give them answers. This all takes a lot of time and effort and required that the mindset of you and your staff changes. When making your staff take responsibility, it often helps if you can create some kind of sense of urgency.

Your own way of working and seeing your role has to also change. You have to be systematic is delegating things that are not really your job, but learn how to follow that things move then ahead. Follow and coach, but do not criticize or do the job yourself. Sometimes your staff will choose to do the things differently from what you would have done, but if the outcome is ok, let it be. Learning to delegate is not easy. There is a wonderful old HBR article on delegating by Oncken et al. “Managing time – Who’s got the monkey”. I highly recommend that.

I think it is highly important to push decision making to service lines as much as possible. They are the ones who (should) know best what the patients’ need are, how the processes are working and how to improve them. However, making them capable of making the decision requires that you train them to do that. You have to engage them so that they understand what the values, vision, strategy, and goals of you organization are and how those impact on what their goals at the service line level are. This takes quite a bit of work and time. Once you have agreed with them on their goals and KPIs, you should start allowing them some freedom to try things and take decisions in order to achieve their goals. However, you should also set them clear boundaries within which their decisions must be and limits when they must reach for their superiors. You should follow their progress closely and coach and guide them in their process. Empowering the service line level and making them capable and accountable for decision making takes time.

On April 27, 2019, Lisa commented on Dyad Leadership :

Dyad leaderhip is challenging according to my experience. It only works if the individuals work well together and complement each other. I would advice you to consider changing the organizational structures so that you have only one leader – either physician or admistrator – and the other reporting to him. If you create a matrix, it must be very clearly clarified and agreed how has the final say when final decisions must be taken. In hospitals it is always practical to have a person with medical background in that role if you just have to skilled physicians to do that.

I must have clear description of the roles and responsibilities documented and agreed. It’s important to set joint goals and KPIs for the medical leaders and administrators. It is also important to create joint leadership forums to increase and facilitate the interactions between the two groups. When setting the goals and KPIs, keep the patient in focus, and start from considering what creates value from them.