Leading Community Urology Practices Through Change: Hospital Administrator Outlines a Series of Key Strategies

Bryan N. Becker, MD, MMM

Bryan N. Becker, MD, MMM, put the magnitude of the change in perspective with a question: “Why are we the only industry that has not changed its delivery model in more than 75 years? We’re trying to take care of more people…and sicker people in the exact same way we did it in 1930.”

Changing that model will be difficult and disruptive, he said, but recognizing the size of the change and developing a plan for managing it will be keys to success in large urology group practices.

Becker, associate vice president for Hospital Operations at the University of Illinois Hospital and Health Sciences System, outlined strategies in a talk during the LUPGA 2013 annual meeting in Chicago:

Communicate each point multiple times: Becker cited a “rule of 8,” meaning that information should be communicated eight times, whether written, spoken, tweeted, posted, or via combinations of those modes. The repetition increases the chances that information will be heard and retained.

Get on the balcony: Stepping back and taking a different vantage point allows practice leaders to see patterns and sequences, putting events in context. In looking at the big picture, Becker added, leaders must recognize challenges related to the way support staff perceive changes in workplace values and power. This can involve responsibilities as mundane as who controls the telephone, he noted.

Identify the adaptive challenge: Physicians should clarify challenges in their own minds so they can convey them clearly to staff members. At the same time, practice leaders should better define challenges by seeking additional perspectives. They must consider potential conflicts such challenges will bring up, potential winners and losers in the organization, and “festering issues” within their practices that could get in the way of desired outcomes.

Regulate distress: Instituting change means asking people to do things they don’t want to do. Physicians and practice coordinators, as leaders, should aid staff members by making their environment a safe and non-judgmental place in which to ask questions and raise issues.

Give people more responsibility: “Some people will fly; some people will fail,” Becker said. “But you need people who will get you where you want to be.”

Protect your successors: They are the future leaders, and should not be bogged down with minutiae.

Raise the heat and then back it off: Staff will burn out under unrelenting pressure, and there will be rebellion. Staff will feel comforted when they see that their leaders have periodically lowered the heat and are willing to take on some of the change.

Watch for work avoidance: Some staff members will see that practice leaders are willing to take on some of the work, and will be happy to let them do so. Leaders can gently point this out, and then determine whether these staff members are incapable of doing the work, or are avoiding it.

Give work back to people: As leaders of change, physicians must be comfortable laying out a vision and then delegating work to those capable of doing it; looking to others for creativity; and encouraging staff members to solve problems on their own.