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On April 28, 2019, Siona commented on Physician Compensation; Is complexity the enemy of good? :

I like your description of the Venn diagram where reality, equity and ego intersect šŸ™‚
This is spot on.

I certainly do not have all the answers, but we do not have overly complex KPI metrics attached to physician compensation. Physicians are either paid on a fixed salary + overtime and on-call rates (public sector) or via fee-for-service prices (private sector). Doctors can charge whatever private fees they feel like the market warrants, but the private health insurance rebate is fixed per DRG and patients pay a variable ‘gap’.

In an effort to reduce the variability of Physician related operating expenses (mostly salary) in the pubic sector, our organisation has very recently introduced a very tight clock on/clock off arrangement, where overtime must be pre-arranged and pre-approved. This went down like a lead balloon the other month when it was introduced, but on the flip side, overtime costs have significantly decreased in the medical groups.

Let me know when you work it out šŸ™‚

On April 28, 2019, Siona commented on Public/Private Competition :

Just to clarify, is your hospital a public or private organisation?
How do the police provide the services? (do they subcontract their own health professionals?)
Can you come up with a win-win and the police cub-contract your organisation? (I am thinking of our last few lectures in March where we discussed that sometimes the struggles of a negotiation become that focus, when we should be focussing on value creation).

On April 28, 2019, Siona commented on PA/NP Engagement :

We do not have PAs, and there are only a very few NPs. Having said that, I think we have all experienced a situation where a team/individuals do not appear committed nor engaged.
Like the above comments, culture is really important, but rather than just focussing on the PA/NP team, I think it is worth investigating the behaviours of the ‘line managers’ for the NP/PA team. The times I have seen this kind of blatant lack of engagement, the line managers asking for volunteers to work the extra shifts have been renowned for their poor communication, lack of tact, grumpiness and general poor leadership skills. Thus, when a fvaour is asked, people are less likely to respond positively.

With growth comes growing pains.
Amalgamating organisational cultures, visions and missions is never going to be an easy scenario, nor do you ever hear such acquisitions going swimmingly well in the short term. I believe that strong leadership, a shared combined vision and change champions combined with patience, understanding and perseverance will get your team there in the long run.
Good luck!

I too struggle with this RS and at times have found my shift from ‘Leading a Team’ to ‘Leading Leaders’ to be a challenging one. Delegation takes significant time and sometimes we do not have that luxury. But, as Ghandi says, “A sign of a good leader is not how many followers you have, but how many leaders you create”….so I am convinced that we must continue to develop šŸ™‚

I have found some leadership development theory to be helpful in my thought process: i.e. discussions around a leadership pipeline state that ‘as a person progresses in levels of leadership a MINDSHIFT HAS TO TAKE PLACE. When you move from being an individual contributor, to a leader, to a leader of leaders, to a leader of an entire business, these transformations and considerations must shift in:
– How do you value time?
– How you spend resources?
– What you prioritise?, etc.

In an effort to be a better ‘Leader of Leaders’ I have in the recent past made a conscious effort regarding this and have focussed on one leader/team at a time. I am having moderate success and look forward to the next few months.

I’m also eager to hear other peoples’ ideas.

On April 2, 2019, Siona commented on Advanced Scope Clinics :

Thank you East Coast Connection šŸ™‚
Can I clarify what a Physician’s Assistant is? Are they not medical practitioners? What training do PA’s have?

On April 2, 2019, Siona commented on Physician Engagement in this value Based Environment :

Great question.
Although this conversation is about physicians, I believe the same can be said about most professions working in the healthcare industry.

A previous organisation that I worked for really excelled at team engagement. The following are noteworthy ways that engagement was fostered, perpetuated and maintained that may add to the ones you are already using to assist with Problem 1 and 2:
1. Use incentives that have meaning. As a rule, money incentives were never used, but incentives were matched with what that particular team/individual really valued. Most of the time, they did not have a significant cost profile, but they included a prime car parking space for a month, a voucher to their habitual lunch time restaurants (which means that they had to find out where you really liked to go), opportunity to present at a popular forum etc etc. The response to these incentives was powerful
2. Recruit with care. Some people are not suited to that balanced culture of innovation and accountability. If compliance is a real problem, then it would be discussed in interviews, at the time of sign on and then again at orientation. People were let go in their probation period if they exhibited behaviours of ‘not-caring’. This was tough for the team in the short-term as it increased everyone’s clinical load, but beneficial in the long-run.
3. Rigorous non-negotiable maintenance: Standards were set upon the commencement of employment and they were never allowed to slip. There was generally 1-2 people assigned to follow up and maintain a certain standard of care and they were particularly ‘tough’ on the leadership group to ensure that the correct example was set.
4. Celebrate and commiserate together. It sounds silly, but they really made simple efforts to support the team during great and not-so-great circumstances i.e flowers delivered to a doctors’ rooms when a loved ones dies, a bottle of wine with a card when they aced a conference presentation etc.

Sound easy…but as we know the reality is always more complex. But I still believe that unless the simple team engagement activities are performed, the larger change management will never occur.

Good luck!