Hospital Integration: Till Health Do Us Part

Wednesday, March 16, 2022 | Kevin Mair

As a new consultant to MedAxiom, Kevin Mair brings over 20 years of healthcare leadership experience across multiple specialties, most notably in cardiology and surgical practices. Known as a transformational leader with a proven record of accomplishments, Kevin is skilled in promoting positive and inclusive medical group cultures built on trust and high accountability that executes on system strategy.

As a cardiovascular administrator and longtime MedAxiom member, I am intimately familiar with how rapidly the cardiovascular landscape has changed over the last decade. In just a handful of years, the hospital integration wave disrupted the cardiovascular care delivery model that was in place for decades and drastically shifted the role of providers, for better or worse. It’s important to take a look back at pain points and opportunities to mend relationships so we can shape a successful “Alignment 2.0” model that enables true care transformation.

Addressing the Expectation Gap

The acceleration of cardiovascular physician group acquisitions, which began in 2011 ignited by Centers for Medicare and Medicaid Services reimbursement changes for diagnostic imaging, made business sense. However, the investment in cultivating the right culture and setting realistic expectations were undervalued. As with the analogy of a marriage, the failure to prioritize values and engage in conflict resolution are normal but can fracture the relationship between providers and hospitals if left unaddressed.

Once a hospital integration deal is completed and the honeymoon period is over, the proverbial marriage of physician employment sinks in, and both sides often feel like they did not get what they bargained for. Physicians become disengaged because they feel they have lost their autonomy with perceived excessive bureaucracy. Hospital leadership becomes disenfranchised because of discovered operational inefficiencies, failed cost reduction initiatives, perceived negative behaviors and growth projections that have fallen short. Additionally, the leadership team that was part of the courting phase and final acquisitions are likely no longer employed with the health system. Furthermore, a common one-size-fits-all methodology often means cardiovascular groups are embedded into a medical group organizational matrix. Although not always done maliciously, the environment changes and ultimately trust diminishes between both parties.

Culture Is King

The adage “culture trumps strategy every time” never gets old. An intentional focus on integrating and fostering the right culture ensures the Quadruple Aim is achieved. Successful partnerships with cardiovascular service lines realize this value and result in the growth and sustainability desired. To obtain and preserve the right culture, physician groups and hospital leadership should:

  1. Set a clear vision and strategic goals
  2. Share the vision amongst the team
  3. Encourage open communication for feedback on the vision and tactics for achieving goals

Set a Clear Vision and Strategic Goals

The book The Founders Mentality by Chris Zook and James Allen gives a great depiction with adequate research on cultivating an ownership culture. In physician practice management, these same tools apply to restore the speed, focus and connection to patients. A common mistake we as leaders can make is underestimating the value of culture and the value of the original practice owners. Discounting their knowledge or love for their group, patients and community can backfire because of the mindset that "we purchased" you but nothing should change. It takes a level of vulnerability, authenticity and humbleness to remain on the same page and keep agile for growth. We must invest in genuine partnerships and refrain from treating each other as commodities.

The book describes principal points to foster a “founders’ mentality” mission and purpose. Clear mission, vision and strategic goals should be formalized with physician involvement if not already defined. Once the senior leadership sets the strategic vision and purpose, the cardiovascular team should create aligned plans to support the overarching vision. At a minimum, retreats should be conducted before the beginning of the fiscal year and midway through.

Share the Vision Amongst the Team and Encourage Feedback

Next, create a communication plan to share with your team at each level. The investment in your frontline team members' understanding of their role in achieving your goals is often overlooked. Be sure to explain the “why” and encourage feedback on how they can contribute to achieving your objectives. It builds morale, and studies have shown it helps with retention when frontline team members feel valued and included in the process.

The Secret Sauce

Additionally, owner mindset at each level in the organization is imperative and the “secret sauce” in keeping the marriage healthy. How do physicians value partnerships?

  • Value is set on a clear and transparent vision and strategic plan
  • Access to capital and resources
  • Willingness to invest in technology
  • Swift movement in decision making
  • Admin and physician support
  • Alignment of incentives
  • Appreciation of each other
  • Effective governance and leadership

There is no one size fits all since culture and politics are local. However, there are numerous best practices any system can implement to garner the success they desire and transform their cardiovascular landscape to deliver exceptional care for the community they serve.

Learn more about the MedAxiom Consulting Team and how we can help you and your organization tackle operational, financial, strategic and clinical challenges.

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