Physicians vs. Administrators…An Odd Couple With Potential

A big factor in the reason why physicians and administrators seem to have very adversarial relationships is because they were trained to think differently.

Being in the middle of change at an organization is exhausting.  Especially if you are one of the agents of the change, such as a trainer.  As the trainer, you are always “on”…not only are you never permitted to say or do anything that might reflect poorly on yourself/your company, but you also cannot say or do anything that would sabotage your goals of increasing employee understanding of, acceptance of and comfort with the changes that are coming.  You have to comfort those who are upset by the coming change, whether they are scared for the security of their positions in the future or whether they have turned their fear into anger and begin lashing out.  You have to let them vent their anger and frustrations, and then not only talk them down to a more calmed state but then seek to make sure that they are actively participating in the learning process, so that they will be able to function once you are no longer there to hold their hand.  And if there were politics or other organizational conflicts going on before you arrived, don’t expect them to go away just because there is a stranger in the building.  These are just the basics.  You also spend the day answering questions, formatting your information and delivery to be the most effective, and thinking on your feet.  You spend a good portion of the day talking and your brain rarely gets a break. Often when I am onsite for training, I finish the day too exhausted to do much more than grab a quick dinner in the hotel and go back to my room to spend the rest of the night vegging out.

So whenever you have to deal with a group of people who seem to want to take out every ounce of anger and frustration they have out on you, it gets old very quickly.  If you work in a particular sector long enough, you learn to identify these people and groups early on, so that you can respond to them appropriately and hopefully get them on your side.  I spoke about some strategies for doing this in this post on dealing with change management in organizations.

The healthcare industry is currently going through drastic changes, and it seems that physicians are often the group who get singled out for being the biggest barrier to those changes.  The nurses and health care workers in my family have often complained loudly at family gatherings about how “One of the last courses in medical school must be God Complex 101”, and each of them has horror stories about working with physicians who have a particularly acute case of this condition.  Not all of them are that way of course, but it does seem like every hospital or clinic has their version of Dr. Perry Cox from Scrubs.

The Burden of BrillianceSo it was with great interest that I saw a webcast from the Association for Talent Development titled The Zen of Physician Engagement presented by Dr. Kenneth Cohn, a qualified doctor and CEO of, which seeks to improve physician engagement in the changes that are occurring within the healthcare industry.  He works as a consultant and retreat facilitator to help hospitals and physicians repair broken relationships and strengthen them for the challenges ahead.

The webinar itself was a bit shallow, and suffered from something that I often see in professional public speakers and consultants; an over-abundance on platitudes but very little in the way of substance.  Think of it as if Barney Stinson from How I Met Your Mother was given an hour to speak about improving your business, and spent the time instead with quotes like this…

How to Succeed by Barney Stinson

Not exactly the most helpful information.

But there were some things out of the webinar that were useful.  One of those things was the reminder that a big factor in the reason why physicians and administrators seem to have very adversarial relationships is because they were trained to think differently.  Dr. Cohn referred to this in physicians as a V-Model of Thinking; a physician is taking in large amounts of information, and then drilling down to arrive at one diagnosis.  This is an approach that tends to favor including factors which are relevant to the diagnosis, and disregarding everything else.  It produces a very narrow field of vision.  Administrators, on the other hand, have what Dr. Cohn referred to as a W-Model of Thinking because they are focused more on taking information given to them and coming up with a range of responses, after which one selection is made upon consensus with others.  This is bigger-picture thinking, which necessitates including all of the possible factors, whether they are relevant or not.

Narrow-thinking and Big-Picture Thinking don’t play well together; they tend to clash pretty terrifically when they are forced to work together.  But how can you solve this problem?  By reminding them of why they got into the healthcare field in the first place.  Both the physicians and the administrators are doing what they are doing because they want to help their patients, and both of them are engaged in that process, just in different ways.  By getting people to focus on what they have in common, instead of the process which may be wildly different, you can help each side see the point of view of the other, and strengthen the relationship.

This is where the shift towards patient centered care is helpful not only in delivering better patient care, but also in building stronger health care facilities.  If you can put the patient at the center, and get all of the players involved to focus on that patient, you can build a less territorial and adversarial culture, as the groups work together to achieve their goal of helping the patient.  Those of us who are trainers or involved in the change process know this to be true; get the group focused on one goal, and it’s amazing how fast things can turn around.  You might even leave the institution stronger than when you found it, and that’s not a bad legacy to leave.

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