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4 keys to developing positive working relationships with physicians

Relationships between healthcare organizations and physicians are a growing trend within the industry as more doctors become employees of hospitals. Building healthy working relationships between the two factions is important, says David Ebel, who retired from the Mayo Clinic in 2006 after having spent 19 years in finance and 10 as CFO. "In the past it was easy: Doctors knew how to practice medicine, admins knew how to run a hospital. But they aren't two separate things. The two groups need to come together to work towards making changes for ACO, Medicare, readmissions and reducing cost from the system," said Ebel. "Besides, I'd rather have a physician decide where we can economize in the care that we receive more than an admin!"

A doctor's input and ability to speak on the implications of the changes being made is imperative, Ebel said. Explaining the financial side of the business to providers is also key. An admin's role, Ebel stressed, is to explain to physicians that certain things can't be done in certain ways.

"We'll have better organizations if we can learn to work together ... if we can understand both financial and personnel realities," Ebel added.

He outlined the four ways a hospital's financial administrative staff can work with physicians to develop positive working relationships.

1. Take the initiative
Doctors are a group of knowledge-driven people. The way to approach them regarding financial matters and issues is to take the initiative to inform and educate them. Be available to them. Be transparent with them. "Recognize that as you work with these people within an organization, there will be hard messages. Messages they don't believe and changes they may not want to make. You're going to need to get them to understand so those changes can be made," Ebel said. One way to do this is to present your financial results and plans to physicians regularly in either forum or session-type settings. "Don't worry if not many show up," Ebel said. "The effort on your part to show that you're willing to have these open discussions is the critical component. If just a few physicians show up to listen, because of (the) collegial relationships doctors have, the message will be received." Expect to be challenged by those in attendance though, and recognize that it's an indication of interest as well as an opportunity to build credibility. Be sure to respond positively and openly with facts, with logic, with basics.

2. Explain where the money comes from
It's important that doctors know where the money your organization receives is coming from. "If you borrow to service your debt, physicians need to know that there are debt covenants that have financial requirements," Ebel said. There are things organizations have to maintain, and measures that have to be maintained. If they aren't, for example, bond holders have the right to bring in consultants to tell the hospital what to do in order to restore financial measures. "The hospital doesn't get to hire someone. Bond holders get to choose to protect their interest, not the organization's culture or morale," Ebel said. "Doctors won't necessarily like what they have to do if it comes to that, so it's imperative to keep them [the physicians] informed on these things."

3. Inclusion
Invite physicians to join institutional oversight and governance committees so they have a firsthand knowledge base about what's being done, why decisions are being made, what the processes are, etc. "Choose doctors that are interested, willing to learn and willing to spend time on this," Ebel suggested. "The return is that you'll get informed input from physicians. And other physicians will end up respecting the results more when they know their colleagues have been involved. This builds credibility, respect, a feeling of solidarity and that the right decisions are being made."

4. Leverage physician-to-physician relationships
Use physicians to communicate particularly difficult, practice-related messages to other physicians. "If you're seeing one physician deliver higher-cost care than his colleagues and perhaps needs to change his approach or treatment, it's more effective if another physician talks to him about those cost considerations. Being spoken to by an admin is just not the same," said Ebel.

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