Friday, September 20, 2013

Module 4 assignment for my students

I am finding that using a blog as a way to create assignments for you, my students, is a bit challenging. The nature of most blog posts is to write reflectively, as if in one's own personal diary. Creating assignments is something else. :-) In one case, the issue is when an idea seems "ready" to be expressed. The other case is a matter of the calendar and the clock. I am a little behind in posting assignments right now, which suggests that this is still a blog, which is good.

I read a lot and our course is the theme of most of what I am currently reading. I have recently discovered Joseph S. Bujak as an author. He is a physician who has become an administrator. I am learning from the insights he has derived from his experiences. I often don't like what he has concluded, but the world is not necessarily what I would like it to be and I find his perspectives thought provoking. I am, perhaps, too much a idealist. As a physician who has become an administrator he, perhaps, has a "license" to say or suggest some things that those who are not physicians cannot say or suggest.

The gulf between hospital administrators and many physicians is frequently reported. Policy experts seem to be of the opinion that the only way Accountable Care Organizations may work is if they are led by administrators who are also physicians. I am sure that there are instances in which administrators and physicians have good and constructive relationships. But I question that administrators who are first physicians necessarily have a greater ability to work with other physicians. I read somewhere that the gulf is about the battle of the apostrophe. In other words, administrators by training and dispostion are primarily concerned about patients' interests; while physicians by training and disposition are concerned primarily about the interests of particular patients. In my idealism (a luxury of teachers) I want to believe that people can change and that it is possible for people of good will to learn from each other's perspectives. I want to believe that even as people age they can remain pliable. Yet in professional cultures (such as medicine and higher education) people cling tightly to the values acquired during training and years of practice. I believe that Bujak somewhere wrote, "Everyone is always 100% in agreement with his or her own perspective." That is especially true of professionals, including physicians and professional administrators. In the classroom I have the luxury of pretending to "see" everyone's perspective. In life, as a professional I see things from "where I sit" and who I am.

In the book Leading Transformational Change: The physician-executive partnership Bujak and Atchison include the following parable.

A scorpion wants to cross a pond and asks a frog for its help. The scorpion asks to ride across the pond on the back of the frog. The frog initially does not trust the scorpion not to bite him. But the scorpion explains that it would not be in his own interest to sting the frog because doing so would kill the scorpion. The frog agrees. Half way across the pone the scorpion stings the frog. Before dying the frog asks, "Why did you sting me? Now we will both die." The scorpion replies, "I am a scorpion. I have to sting you -- it's my nature!"

Ouch! The authors go on the write that effective leaders accept that they cannot change people; that effective leaders find ways to build upon what people already are and by helping others become more of what they already are. That parable haunts me because it challenges what I want to be true. And yet I expect that there is some truth or wisdom in it; otherwise it would not remain in my mind.

Okay, my students. What do you make of this? If it is true that one cannot easily modify professional cultures, then what are the implications for leadership in perilous times? Can we only trust others to be their essential selves? Are notions of personal and organizational learning just empty exercises in academic idealism? Please take whatever you can of this, reflect upon it, and share your journey as a comment to this blog post.

25 comments:

  1. I think that professional cultures can be changed but that is difficult to the point one would deem it impossible. I think that as people become older they become more stick in their ways and that extends to their professional life. A good example of this would be an organization that has been ran by pen and paper for, let’s say 30 years. Over time leadership changes and their decided the company needs an upgrade. This would be the perfect situation for the cliché “you can lead a horse to the water but you can’t make them drink”. An organization can implement change but the leadership has to take into consideration the average person will always fall back into their comfort zone. They may try the new direction for a short while but, if they are not strong-willed and willing to make that change then they will revert back to their normal ways. Much like the spider in your example, he tried to change because it would benefit both it and the frog. He began to struggle with the change then quickly reverted back to what he was “supposed” to do. In my opinion people react to non-forced change the exact same way.

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    1. Thank you. Please include a link to a relevant resource in each of your comments for full credit for class.

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  2. Well to first address the article in reference to physicians becoming administrators, and those assuming that they communicate better with administrators, which is something that I totally agree with because they are able to relate to physicians considering that they’re physicians. However, it doesn’t necessarily make them more effective administrators; it just helps them understand the professional culture. I honestly believe that anything can be learned and that specific skills can be acquired with not only education, but with experience. An effective administrative will gradually learn the professional culture of their organization. However, once this happens, one must ask if there are modifications that need to take place, or is everyone making personal and educational growth which is conducive for the organization? My theory of an effective administrator is not to necessarily adapt to the professional culture, but they should be able to relate, communicate, and deliver effective, constructive results. An administrator must realize that they can’t change people, but they can expand on their strengths and help channel their weaknesses to be more proficient.

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    1. Sorry, here's my link:
      http://hbr.org/product/skills-of-an-effective-administrator-harvard-busin/an/74509-PDF-ENG

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    2. Sorry, here's my link:
      http://hbr.org/product/skills-of-an-effective-administrator-harvard-busin/an/74509-PDF-ENG

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    3. Thank you. I see the link you added.

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  3. Being a physician doesn’t make you a better communicator with administrators. For a health professional culture I believe it takes a variety of people from different areas. Not everyone thinks the exact same way about every situation or issue. An effective administrator should be able to view, identify, adapt, clarify, and correct among other duties. No one is a perfect being and you can always learn something you didn’t. We are not living in a perfect world, but small changes can make a big difference.

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    1. Thank you. Please include a link with each comment and post.

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  4. The healthcare system has become very complex. Physician's becoming administrators is seemly being the new role of physicians especially for the new generation of doctors. Physicians are like the solid foundation of an organization as it seeks to improve care, staff performance and patient experiences. Although I don't think it makes them more effective. Within an organization administrators will learn along the way to figure out what will work to make the organization successful. Within any organization there will be a need for improvement. So therefore people must adapt to change. Any time change takes place administrator must be able to collaborate with people, listen well, and be comfortable making some people unhappy. For example, the organization that I work for; preparation for electronic medical records has not been easy for physicians as well as employee's they just need a paper chart for security I guess:-) it's more like the younger employee's are ready to fully implement medical records but unlike the older employee's are having a hard time adapting. I guess relating to the scorpion "paper charts are just in their nature." With that being said you can't change people but you develop a system for them to adapt to change. Organization administrators must get everyone on board with adapting to "meanful use" as the new healthcare law unfolds.

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    1. Thank you. I see the link you added. It is possible to edit one's own post or comment, I think.

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  5. Forgot to add Link http://www.amednews.com/article/20110404/business/304049965/4/

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  6. This comment has been removed by the author.

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  7. This reminds me of a story my Uncle George used to tell me all of the time. I found it online and it is below:

    An old woman was walking down the road when she saw a gang of thugs beating a poisonous snake. She screamed at the thugs and rescued the snake, taking it back to her home where she nursed it back to health.

    One day on their way into town, the woman picked up the snake and he bit her repeatedly. “Oh God,” she screamed, “I am dying. I am dying!” She turned to the snake and looked it in the eyes. “I saved your life. I was your friend. I trusted you. Why did you bite me?”

    The snake turned to face her as she drew he final breath and hissed, “What did you expect? You knew I was a snake when you took me home.”

    Now you see why I immediately thought of this story. It basically has the same principles. The morale of the story is simple…you can only trust a person to be him or herself. Had the frog or the old woman in both of these stories kept this principle in mind, they would not have opened themselves up attack. Like the TV doctor house always says, “People lie.” With this in mind, how does one protect him or herself in a dangerous environment? The best thing an administrator can do it being proactive. As we discussed in class, there are multiple steps that healthcare administrators can take. They can identify locations and times that are likely to risky. Another couple of good steps that can be done are to screen applicants carefully and install electronic surveillance devices. I don’t think that the culture cannot be changed, however. I believe that the notions of personal and organizational learning may beneficial to physicians. That’s right; I believe some of the theoretical methods discussed in a class will help the practicing physicians. I think that there are certain actions a physician can take to put the patient in a comfortable environment. In my opinion, this would help the doctor or nurse maintain control by having a patient in a serene location. Placed in an aesthetically pleasant atmosphere can bring the truth out of a patient, or at least allow for the physician to drill down to the myriad of symptom to get to a proper diagnosis. I just feel that if both the patient and the staff were all in more comfortable environments, it would lead to safer working conditions.

    Work Cited:
    Richard, R. (2010). Retrieved from http://www.olyblog.net/story-old-woman-and-snake

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  8. I feel that this is not true because people are dynamic and people themselves have the ability to change and evolve depending on the necessity. Yet the nature of man seems consistent in what is expected from human beings. On the other hand, professional cultures themselves represent flexibility and room for growth. For example, the time of the Great Depression signified a cultural milestone through the ability for individuals to become leaders and implement different operations for growth. Therefore, I believe that in the time of need, man will rise to the challenge and overcome any obstacle because life is the most important aspect in any culture. Even in my life I have modified certain aspects, regardless if one expected me to remain stagnant. For instance, I never been much of an athlete and when ask to participate, I woefully rejected. Yet one day, I began to change, I began to practice very hard at the sport that I hated so much. The only thing is I didn’t understand why because my nature was refraining from doing sports. I adapted to change and I stood up to the challenge of the sport. Further, I feel that the parable represents different races and the ultimate struggle of human beings to work together without the animosity of the fact that they are different and there culture isn’t the same.

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  9. Vontresa Stephens
    Effective leaders always accept the things that they cannot change and have the courage and wisdom to know the difference. Effective leaders takes the time to know whom and what they are dealing as well as working with and looks for ways to add on not to tear or take away. Mama always says, “Nothing ever stays the same and that is true”. Not even ones profession. There will always be some add on and some take away but not all at once. We can see that with doctors that are use to writing everything down with pen and paper and now slowly but surely it haves come upon many that electronic records are coming into play. There has been one doctor that I know for certain retired because he refused to transform into this new technology. They could have brought the computers into the office but they could not make the doctor use the computer. It takes times with anything especially if it has been done a certain way over a period of time.
    One may put a doctor in administrator position but that does not mean that is the best thing to do. If those doctors do not have good communicating skills it is already a done deal. Most doctors do not communicate well because they are always on a time schedule and very busy trying to meet that quota for the day. In the story concerning the spider, it changed for a moment but not long enough to make it across the water. I’m not saying that all doctors are alike because there may be that one that would make the best administrator that one could hope for. I do say good luck. http://www.kevinmd.com/blog/2011/01/void-physicians-administrators-hospitals.html

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  10. A professional culture refers to patterns and traits expressed by a particular group that belongs to a certain profession. An example is the medical profession. Here, medics and doctors are meant to conduct themselves bound by the culture of the Hippocratic Oath. http://www.ask.com/question/what-is-professional-culture I don’t think because a person is a physician doesn’t make him or her capable of been an administrator or been more qualified to address administrator. Even thou they do play an important role in helping one to decide to make clear choices when it comes to their health. Because an administrator is one who basically run a business or an organization. I personally don’t see my doctor as a business owner and she isn’t in an organization; just like I go to work I see her as doing her job. Any one can be consider an administrator as long as he or she is aware of what they are talking about and is stating facts. I feel like I’m an administrator when it comes to my husband health because I have read and taken notes at the hospital and at the doctor office to what they are doing or plan on doing to make him better. Sometime I have to advice them on the next step to take sometime to make sure he has the best medical help

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  11. "Hope for the best, but prepare for the worst," is a maxim that I live by. I feel as though it tells us exactly what we should do when faced with moments of uncertainty. When a Physician becomes an administrator, it does not necessarily mean that he or she will be the greatest communicator because he or she was already a physician, and will relate to other physicians well. Nor does it mean that he or she will implement some breakthrough policy to eradicate years of futility and bureaucracy. If this is not the person they had shown themselves to be prior to being appointed to this position, then its doubtful that they will become this person, as it is indeed difficult to teach an old dog new tricks. Im not saying that it is impossible, only that it is unlikely for a cheetah to change its spots. If a Physician was an effective leader before becoming an administrator, chances are that he or she will retain this skill and it will carry over to the new position as well.

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  12. http://www.star-telegram.com/2013/10/12/5239841/more-doctors-nurses-becoming-hospital.html

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  13. Health systems are encouraging physicians to be on various boards and committees at every level of their organization. Physicians are stepping up to do so. Some health systems have dedicated physician organizations to provide direction to the institution, while others have physician leadership training programs to ensure they have doctors with the skills to fill key roles.
    Not all physicians have the qualities required to become hospital administrators. Potential physician leaders must be cultivated; they must be provided developmental opportunities to become effective leaders. People who work on alignment issues say having physician governance is particularly important. Some insurers say they don’t want to work with ACOs or other alignment structures that do not have this in place.
    Many of the ACOs chosen to participate in programs run by the Centers for Medicare & Medicaid Services have physicians in charge. The experts say physician leadership makes it more likely that an alignment structure will achieve the desired ends and that physician will go along. Arredondo said, “When physicians are aligned, physicians will participate in programs to improve hospital effectiveness,”
    Elliott, V. S. (2012). 4 essentials to physician-hospital alignment (mgma-acmpe meeting). American Medical News,

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