As hospitals work to navigate change, it is critical that they do so in a manner which reflects respect for the impact of change on the practice of their physicians in order to secure their support and commitment. We’ve seen rising interest in best practices for developing effective physician champions who can bring the voice of the physician into the change process and work to cultivate commitment among their medical staff peers. Their ability to do that stems from the concept of “referent power,” power rooted in trusted relationships. By selecting the right champions — individuals who have credibility with their peers — and giving them a meaningful role in shaping decisions, champions serve as a powerful source to overcome predictable resistance to change and foster broad support among physicians who were not directly involved in the process.
In our experience as healthcare leadership coaches, we’ve come to appreciate a few critical considerations in this process. We trust the following five practices will boost your chances of success in developing effective physician champions.
Step One: Careful Selection
In order to cultivate support from those not directly involved in designing a disruptive change, it is critical that those who are involved, the physician champions, enjoy a level of trust and credibility among those whose voice they represent in the process. They must also possess the ability to participate in a collaborative process in which they can work with other disciplines to shape solutions that advance the shared goal in a manner which respects the legitimate needs of other key players in the process.
The ideal candidates are those who have shown a capacity to embrace change if it is well designed and thoughtfully addresses their needs. You want to avoid the extremes. The naysayer who is consistently resistant to change or has no appreciation for interdependence with other disciplines can poison the process and impede progress. Likewise, the well liked but unassertive person who is known to “go along to get along” will not be effective as he or she will not be a trusted resource to represent the voice of his or her colleagues.
The ideal candidates will also have shown the capacity to engage in creative dialogue. They are able to look at options other than their preference in order to find solutions which meet their needs in a manner that is compatible with the other needs which are at stake. If they perceive their role as advocating solely for their needs with no regard for the need of other functions upon which success depends, the process becomes a power struggle with winners and losers instead of a creative endeavor or partnership.
Sometimes it is not possible to exclude individuals who do not meet these criteria because they sit in formal leadership roles or due to other political considerations. If that is the case, developing a set of clear expectations around the role of team members and a clear set of team ground rules and behavioral commitments becomes even more important (see below).
MEDI can support the selection process by defining the criteria, facilitating a process to vet candidates and assisting in developing supportive tools and messaging to reflect the intent of the selection process.
Step Two: Defining Role Expectations
It is important to establish from the outset clear expectations for the role of physician champions. Of particular importance is recognition that their role is to share in the process of designing the change as well as in deployment of the change. The opportunity to be co-architect of the change comes with the responsibility to be “co-owner” of the change as it moves forward.
Many times individuals agree to participate on teams or committees with the impression that they are merely there to express their personal opinion to the decision makers. In those cases, the individuals involved typically spend little time engaging with those whose voice they are supposed to represent. They do not establish themselves as the channel to bring the voice of their colleagues into the team process. And when the decision or change is rolled out and there is controversy, they take no ownership in the product which was produced.
True champions understand that they are being invited to participate in order to gather and represent the needs and interests of their discipline, to help fashion solutions that integrate their needs with the needs of other disciplines, and to assist in deployment of the change. In other words, they bring the voice of physicians into the room, work to find solutions that address physician needs (not necessarily in the way they would prefer) compatibly with other needs which are at stake, and then to communicate to their peers the manner in which their needs were addressed.
For some, that can be an uncomfortable role if the outcome isn’t the one physicians would have preferred. The credibility of the champions is key to getting others who were not in the room to understand and support the solution.
MEDI can assist team leaders in forging and framing team member expectations and assist in building the skills needed for them to participate effectively in a collaborative team process.
Step Three: Designing the Team Process
For physician champions to be owners of the output of a team they must have a legitimate role in the design process. This can be challenging with busy physicians who want to see their imprint on the team’s work but have limited time for participation in the detailed work of designing solutions.
One approach which can help address this tension is to engage the physician champions early in identifying the set of needs/requirements/interests they feel are essential elements of a good solution. This is different from asking them to propose a specific solution. It involves going a level deeper to understand the functional outcome that the solution is designed to advance. You want to know what their “design specifications” are for a satisfactory solution.
Think of it in the same way an architect designs a building. The architect gathers intelligence about all the functional elements which need to co-exist compatibly in the space before beginning the process of designing a proposed solution.
Armed with information about the physicians’ interests, the rest of the team can spend time in considering detailed alternatives provided that those alternatives speak to the direction provided by the physicians. It is also important to circle back periodically and “connect the dots,” demonstrating the manner in which the proposed solution speaks to the specifications provided by the physicians. And, of course, it is critical to provide a meaningful opportunity for the physician champions to offer suggestions to refine the proposed solution provided their refinements remain compatible with other interests which are also at stake.
MEDI can assist in the design and facilitation of the team process to help drive toward integrative solutions which promote shared ownership and commitment among the critical stakeholders.
Step Four: Team Formation
The foundation of a high performing team is trust in the competence and character of the team members. It is essential that they believe in the commitment of one another to the same shared goal and to finding a way to meet that goal in a way that addresses the legitimate needs of one another.
That sounds obvious and simple but the reality is that parties who have never worked together or, worse yet, have seen each other as adversaries, don’t naturally become a team or develop trust just by being in the same room. On the contrary, it is quite typical for people to come to the team with the idea that their interests are not aligned with the intent to vigilantly protect what they have at stake. And when there are differences of opinion, which is inevitable, that is often mistaken as proof that their interests aren’t aligned rather than seeing it as a different thought about how best to advance their shared goal. This is NOT the formula for an effective team process or for fostering trust.
MEDI has developed a team formation process which is aimed at accelerating the process of building trust.
It involves taking a bit of time, not much, to get the team members to open up to one another to get beyond their assumptions, and see each other as people with a similar sense of purpose and set of values. It also involves taking time to learn about the differences in one another’s behavioral patterns, motivators and underlying perspectives.
The fact is, we all come to situations with some pre-existing models we use to make sense of the world and in any group there can be significant differences in perspective. If team members can come to understand those differences as complementary perspectives, not different values or goals, then teams become far more effective at working through those differences and finding common ground.
Step Five: Building Team Skills
In order to sustain trust among the team it is essential that team members develop skills to help them engage in dialogue, manage through differences, and engage in a creative, collaborative process to define integrative solutions to which the team members can commit and take ownership. Trust can quickly recede if the team gets stuck and cannot define the way to move forward. Early assumptions about common values and goals can quickly be replaced as people divide into adversarial camps determined to hunker down to protect their interests.
MEDI has developed content for both team and individual coaching around these critical team skills and can help through general sessions, facilitation and individual consultation to assure the team becomes proficient in them.
Though no organization is the same, the pursuit of meaningful, lasting change is an inescapable demand of today’s healthcare leaders. Amidst so much uncertainty, developing effective physician champions is one reliable way to reach desired outcomes faster — and a resource healthcare leaders can’t afford to do without.
