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Leaders go first: Clinicians as a powerful catalyst for change

More than 130 rural hospitals have closed in the past decade and at least 600 more are at risk, which threatens 60 million people across the country. Many rural hospitals are fighting for survival, almost entirely caused by burdensome regulations, decreasing reimbursements, increasing costs, and workforce challenges. This poses a threat to population health and can have negative downstream effects on rural economies. Although this crisis is complex, each hospital’s destiny is directly linked to the quality of its leadership.

While it is important to pursue solutions at the state and federal level, there is an incredible opportunity for leaders to create the momentum to change the direction of rural health care. More pointedly, administrative leaders and clinical leaders can help bridge the “opportunity gap” between clinicians and their personal development towards becoming transformational leaders. This article examines the unique perspectives of administrators and clinicians and aims to equip each with proven strategies to help understand the relationship, improve collaboration, close the opportunity gap, and create a crisis-proof leadership culture.

Clinicians are the catalyst

Clinicians can be a powerful catalyst for change that administrators can utilize in times of need to benefit the hospital and community. However, several distinct barriers prevent this from becoming reality.

First, administrators should accept that any efforts to reach goals, meet targets, or achieve metrics are futile without buy-in from front-line clinicians. Therefore, priority must be placed on achieving their active participation. Because they work in the trenches, clinicians have the keen ability to provide unique insight with accuracy and precision that could save the organization from making preventable mistakes, identify bottlenecks in the system, identify key opportunities for clinical expansion, and strategize ways to achieve a common goal.

Hallway meeting

Clinicians could carry the message from administrators more effectively to other providers, nurses, and staff due to their position, their working relationships, and their trust capital. They have the potential to drive excellence on the clinical side, which theoretically should translate to quality, metrics, patient experience, hospital ratings, and communication scores.

Start with what you already have

Some clinicians are overlooked and underestimated but are diamonds in the rough. Clinicians have been exposed to the high pressures of academia, the health care system, patient reviews, and patient mortality. They are capable of handling problems that arise and finding a way to solve them. When expectations are communicated clearly and directly, clinicians will often meet or exceed expectations. If this is not the case, the message may need to be reframed or delivered differently.

In other cases, clinicians are overlooked or deemed unfit to be leaders based on their reputation or past response to directives handed down by administrators. Many misunderstood clinicians can become incredible leaders if given the opportunity and rooted in a well-nurtured hospital environment. They can be easily identified – just ask them directly whether or not they are interested in spearheading a project or exploring leadership opportunities. Don’t be surprised if they are startled by this inquiry, as they may never have thought an administrator would ask for their input. If they are interested, give them a chance, and you will see a good return on that investment.

Meet clinicians where they are

As an administrator or hospital leader, when planning to implement a new protocol or strategic initiative that affects clinicians and patient care, involve them early in the process. Taking just a few minutes to explain the initiative’s goals and seeking their input will gain their respect and buy-in immediately.

Rural clinicians

Be sure to meet clinicians where they are by providing the necessary background, data, and details for buy-in to take place. Seeking their input on how to achieve the goal will pique their interest, create ownership, and transform their “work” into “purpose,” which fuels motivation as opposed to uninspired work from a directive they never quite understood to begin with. Seek to create a professional culture that is relational, not transactional.

Explain the ‘why’

Oftentimes hospital leaders fail to explain the “why” behind certain initiatives. Without understanding the reasons for a particular directive, clinicians often feel confused, detached, undervalued, or overworked, which leads to burnout and poor compliance. Most clinicians are reasonable people and will go the extra mile if it helps the hospital, administration, or patient.

Consider this example of approaching a clinician with a new hospital initiative to improve documentation. The dietary team identifies a patient has severe protein calorie malnutrition and wants the clinician to support that in their progress note. If simply told to document it, a clinician may view that diagnosis as insignificant, chronic in nature (patient’s baseline), and not the reason for the patient’s hospitalization. They may be reluctant to take the extra time and effort to identify the diagnosis, add it to the problem list in the EMR, and document it in the notes with a proper assessment and plan.

Here’s where explaining the “why” to the clinician can help. Take the time to show how the cost of health care related to patients with malnutrition is significant and cited as high as $49 billion, because they typically have a longer hospital stay, higher occurrence of surgical site infections, and higher in-hospital mortality. If it were appropriately diagnosed and documented, it could have an impact on DRG assignment, and therefore higher reimbursements. This provides the necessary education to the clinician, explains “the reason” behind the request for the extra documentation, establishes relevance, and initiates a degree of ownership and responsibility. This will essentially guarantee buy-in and compliance from the clinician – not just in the short-term, but from that point forward.

Invest in their leadership pathway

Consider sending clinical leaders to conferences that teach them how to adapt to the ever-evolving rural health care landscape. Equip clinicians with the necessary tools and resources to operate at the highest degree of effectiveness. Be transparent with financials and other issues so they can fully understand the situation. Create leadership roles for clinicians and trust their leadership. Open and frequent communication with clinicians goes a long way. These are the elements of investment that develop ordinary clinicians into transformational leaders, which is one of the most essential ingredients to sustainable success.

The time is now for administrators to be intentional and reach out to providers to identify, grow, and develop them into transformational leaders, not only at the patient’s bedside but also in the board room or around the conference table where decisions are made. Transformational leaders surrender their immediate self-interests and work with teams to identify areas that need change, shape the company culture, and inspire others. This creates an ownership mentality, where self-sacrifice is innate and loyalty to the administration or organization is born.

Rural leaders

With proper mentorship and guidance, ordinary clinicians have the potential to drive change and inspire others in a way that administrators may not be able to do.

Reciprocally, the time is now for clinicians in rural hospitals to step outside their comfort zone and answer the call to leadership excellence. To lead effectively, clinicians need to be equipped with a deeper understanding of the health care system from a CEO’s perspective so they can take part in fiscal responsibility and work from the inside out on ways to lower costs and improve reimbursements.

Leading from the front

During periods of success within a hospital, great leaders may choose to lead from the back of the room, humbly deferring the credit and recognition to employees and staff. However, during challenging times, these same leaders reflexively shift to a different posture – leading from the front. When facing turmoil, great leaders fully understand the need to initiate a strategical pivot, which innately transfers the heavy burden of responsibility and risk onto their shoulders.

As leaders, it is critically important for administrators and clinicians to “go first” – to make the first move, one towards the other, administrator to clinician and vice versa. Clinicians should not wait passively on the sidelines for a hospital leader to come seek their guidance or insight. Instead, they should take the initiative to proceed with self-directed leadership opportunities. This means clinicians should make the effort to meet with administrative leaders at the hospital and find out what they can do to help, learn, and grow.

In the same way, administrators should avoid overlooking the value clinicians may bring to the strategic side of hospital initiatives and instead seek out providers, invite them to meetings, or simply stop by their office for a few minutes. An overwhelmingly large percentage of clinicians will not be seeking out leadership roles but have the necessary insight and skillset to play a significant role in creating meaningful impact. Because clinicians do not generally search for opportunities outside of patient care, they need to be brought in by administration. Most of the time, clinicians will feel empowered and valued when they have been told their insights are appreciated and trusted. This is the way of transformational leaders who lead from the front and “go first.”

NRHA adapted the above piece from Rural Physicians Group, a trusted NRHA partner, for publication within the Association’s Rural Health Voices blog.

Matt Pappy, M.D.
About the author: Matt Pappy, M.D., a board certified Family Medicine physician, has been with RPG for over 6 years and has worked with client hospitals in hospitalist, chief hospitalist, and regional medical director roles. Dr. Pappy oversees regional medical directors, works closely with all client hospitals, and continues to fill some hospitalist shifts to maintain the perspective of what it takes to serve in a rural hospital.

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