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STUCK IN THE MIDDLEWITH YOU: NAVIGATING THE POLITICSOF HEALTHCARE.HCCA Compliance InstituteApril 18, 2016

Jay P. Anstine, JDCompliance OfficerAdvanced Medical Imaging Consultants, PC

NAVIGATING MY OWN POLITICS…

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OVERVIEW-NAVIGATION STRATEGIES Understanding The Political Landscape.

Building Strong Relationships with Leadership.

Using Diplomacy to Influence Behavior.

Using Diplomacy to Resolving Conflict.

Questions and Answers.

Is Healthcare Political?

Yes

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HEALTHCARE POLITICS & COMPLIANCE

POLITICAL POSITION OF COMPLIANCE?

Commerce with All Nations, alliances with none, should be our motto.

-Thomas Jefferson

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AND IF ALL ELSE FAILS?

UNDERSTANDING THE POLITICAL LANDSCAPE

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UNDERSTANDING THE LANDSCAPEOverview:

Identify “key stakeholders” in your organization.

Identify “the players” in your market.

Develop and maintain political-self-awareness.

IDENTIFY THE KEY STAKEHOLDERS Senior Management

Board of Directors

Physicians (including liaisons-CMO, Med. Dir, etc.)

Dept. Directors

HR Director

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IDENTIFY THE KEY STAKEHOLDERS

Get to know them…make sure they know you.

Set-up “Meet and Greets”.

Benefits? Understanding personalities, self-interests,

motivations, connecting history & relationships.

IDENTIFY THE PLAYERS IN YOUR MARKET

Who is a partner?

Who is a competitor?

Who are the key physicians groups?

Who are the contracted payers?

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IDENTIFYING PLAYERS IN YOUR MARKET Government Officials

Legislative, Executive, Judicial branches Federal, state, and local levels

Examples: DHHS, CMS, OIG, OCR, DOJ, Senate Finance

Committee, House Ways/Means, MEDPAC, etc. Governor, Legislators, Dept of Health, Medical Board Mayor, City Council, etc.

IDENTIFYING PLAYERS IN YOUR MARKETTips:

Ask around.

Study Up. Internet search Scan new stories, and periodicals, Email subscriptions

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POLITICAL SELF-AWARENESS

Be mindful of your surroundings.who likes who….who doesn’t like who…

Be mindful of key stakeholder pressures.

STAKEHOLDER PRESSURES-CEO Public: “High quality, lost cost services.” Board: “Improve the bottom line.” Board: “Do more with less.” Dept Leaders: “We need better equip/more staff.” Workforce: “Be a great leader & environment.” Civic Leaders: “Be a good community member.”

Compliance: “Follow those rules.”

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STAKEHOLDER PRESSURES-CFO Dept. Leaders: “Hey, we need more resources.” CEO/Board: “Stay within budget.” CEO/Board: “Fight reimbursement cuts.” CEO/Board: “Reduce those denials.” Government: “Billings are compliant.”

Compliance: “Follow those rules.”

STAKEHOLDER PRESSURES-DEPT. LEADERS C-Suite: “Meet your budget.” C-Suite: “Do more with less.” C-Suite: “Manage others effectively.” Staff: “Lead us effectively.” Staff: “Resolve our conflicts.” HR Dir: “Reduce staff turnover.”

Compliance: “Follow those rules.”

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STAKEHOLDER PRESSURES-HR C-Suite: “Reduce staff turnover.” C-Suite: “Hold down expenses.” C-Suite: “Positive work environment.” Staff: “Ensure our safety.” Mgmt/Staff: “Resolve our messy issues.”

Compliance: “Follow those rules.”

STAKEHOLDER PRESSURES-CMO C-Suite: “Keep the docs in line.” Physicians: “Keep the suits off our back.” Physicians: “Resolve our issues.” Physicians: “Fight for us.”

Compliance: “Follow those rules.”

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STAKEHOLDER PRESSURES-PHYSICIANS Hospital CEO: “Service & Quality Outcomes!” Group/Practice: “Be efficient and bring in $$$.” Group/Practice: “Don’t get sued.” Self: “Make $$ to justify schooling.” Regulators: “Do more with less.”

Compliance: “Follow those rules.”

STAKEHOLDER PRESSURES-NURSING C-Suite: “Quality and outcomes!” C-Suite: “Pass surveys and inspections.” Patients: “Keep us safe.” Physicians: “Be more efficient!”

Compliance: “Follow those rules.”

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STAKEHOLDER PRESSURES-COMPLIANCE CEO/C-Suite: “Keep us out of trouble.” CEO/Govt: “Resolve issues timely.” Dept Leaders: “We NEED to be able to do this.” Self: “Do the right thing.”

Govt: “Follow those rules.”

BUILDING STRONGRELATIONSHIPS

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TOP 5 COMMENTS AIMED AT COMPLIANCE.1. “Are you Crazy? You want us to do what?

2. “We’ve always done it this way…”

3. “You just don’t know operations…”

4. “You’re just an obstacle to me getting ___ done.”

5. “Do you know what the ___ I do for a living?”

BUILDING STRONG RELATIONSHIPSOverview:

Establishing Rapport.

Building and Maintaining Trust.

Supporting Your Leaders.

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ESTABLISHING RAPPORTRapport = mutual understanding.

Strategies:

Know the services provided and your market.

Take an active interest in your leaders.

ESTABLISHING RAPPORTTaking an active interest?

Initiate the “Meet & Greet”

Department “walk-thru”

Shadowing

Rounding

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ESTABLISHING RAPPORT

Tips:

Set time aside to “study up” on your market.

Find out their “story” in life & profession.

BUILDING AND MAINTAINING TRUST Trust = actions not words.

Strategies:

Be consistent with your work.

Be clear with communications and expectations.

Be thorough in your approach.

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BUILDING TRUST Tips:

Under-promise and over-deliver on deadlines.

“Own” your faults and mistakes.

Don’t be afraid to say “I don’t know.”

SUPPORT YOUR LEADERS Support = being engaged to their work.

Strategies:

Be a resource for them (treat em like a client).

Advocate on their behalf when appropriate.

Recognize them when appropriate.

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SUPPORT YOUR LEADERS Tips:

Be on time for their mtgs/actively participate.

Make it easy for them to find information.

Send thank you notes & manage up.

USING DIPLOMACY TOINFLUENCE BEHAVIOR

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WHAT IS DIPLOMACY?

Diplomacy is the art of letting someone have your way.-Daniele Vare

A diplomat is a man who always remembers a woman’s birthday, but never remembers her age.

-Robert Frost

THE COMPLIANCE DIPLOMAT?

Commerce with All Nations, alliances with none, should be our motto.

-Thomas Jefferson

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DIPLOMACY TRAITS Rapport Empathy Active Listening Assertiveness Self-Control Confidence Planning Conflict Resolution

COMMUNICATING DIPLOMATICALLY Strategies:

Actively listen.

“Know” your audience.

Exercise self-control.

Balance politeness and honesty.

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COMMUNICATING DIPLOMATICALLYExercising self-control…ask yourself:

Does this need to be said?

Does this need to be said by me?

Does this need to be said now?

COMMUNICATING DIPLOMATICALLY

Honesty Politeness

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COMMUNICATING DIPLOMATICALLY Tips-Verbal Communication:

Develop a communication plan…adjust as needed.

Keep the focus on the issue…not the person.

Avoid aggressive words (always, never, etc.).

COMMUNICATING DIPLOMATICALLYWhen do you discover writing an

emotional email?

As you type it.

After you've sent it.

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WRITTEN COMMUNICATIONS? Tips-Written Communication:

Emotional? Hold off on hitting send.

Proofreed, proofreed….and proofreed proofread.

Use a 2nd set of eyes.

Write to assume it will be read by others.

COMMUNICATING WITH LEADERS Mindset of Healthcare Leader?

Highly educated.

Fast pace/address constant uncertainty each day.

Strategic planning/decision-makers.

Act by “group think” model (e.g. committees).

Expected to excel at managing relationships.

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COMMUNICATING WITH LEADERS Strategy: Communicating with Leaders.

Identify then mirror their communication style. (e.g., email, phone, in-person, etc.)

Make information easy for them to locate.

Be prepared when you meet with them.

COMMUNICATING WITH LEADERS Tips: Communicating with Leaders

Know how decisions are made in the organization.

Always keep their pressures in mind.

If consulting…follow I.R.A.C. or S.B.A.R.

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COMMUNICATING WITH PHYSICIANS Mindset of a Physician: High achiever/competitive by nature.

Expected to be efficient/quick with decisions.

Autonomous decision makers.

Trained to be precise.

COMMUNICATING WITH PHYSICIANS Strategies: Communicating with Physicians

Communicate efficiently…less is better.

Engage them in the process if you’re seeking buy-in.

Use situational examples they can relate to.

Don’t just bring problems, bring solutions.

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COMMUNICATING WITH PHYSICIANS Tips: Communicating with Physicians

Be able to answer…. “what do you need from me?”

Leverage your physician champions when necessary.

Avoid corporate jargon.

Build rapport whenever possible.

DIPLOMACY SKILLS: STRATEGIESFOR RESOLVING CONFLICT

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CONFLICT RESOLUTION-OVERVIEW Step 1: Identify parties & negotiation styles.

Step 2: Understand all points-of-view (“POV”).

Step 3: Identify negotiables, nons, & walk-aways.

Step 4: Find common ground.

CONFLICT RESOLUTION: STEP ONEIdentify Parties &Negotiation Styles

1. Competitive (“I win, you lose”).

2. Accommodating (“You win, I lose”).

3. Avoiding (“I lose, you lose”).

4. Compromising (“We win some/lose some”).

5. Collaborating (“I win, you win”).

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CONFLICT RESOLUTION: STEP TWO Strategy: Negotiation Styles.

Key questions:

Identify each party’s style and positioning.

What are the leverage points for each side?

CONFLICT RESOLUTION: STEP TWOStrategy: Understanding POV.

Key questions:

What are each sides motivations/interests?

What specifically do they object to and why?

What are their political pressures?

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CONFLICT RESOLUTION: STEP TWO More Strategies-Understanding POV.

Ask questions…and regurgitate understanding.

“Walk-a-mile” (observe, shadow, walk-thru, etc.)

Role-Play (e.g., try advocating both sides).

CONFLICT RESOLUTION: STEP THREE Strategy: Identifying Negotiables & Nons.

Key Questions: What would you like to see happen…and why?

What are you willing to give up?

If we can’t resolve-what does that look like?

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CONFLICT RESOLUTION: STEP FOUR Strategy: Finding Common Ground.

Seek to have each side to demonstrate empathy.

If struggling: ask each side to present a solution benefitting the other.

Make sure each side gets value for concessions.

CONFLICT RESOLUTION Overall Tips for Conflict Resolution:

Do your homework on all sides to the issue.

Don’t let emotions drive decisions…regroup.

Pick your battles/keep lurking pressures in mind.

Keep the focus the issue…not the person.

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FINAL COMMENTS

Be mindful of your surroundings & pressures.

We have to have issues to be employed.

Periodically step aside to gain “perspective”.

Find a support system.

AND AGAIN, IF ALL ELSE FAILS?

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QUESTIONS?

Jay P. Anstine, JDCompliance OfficerAdvanced Medical Imaging Consultants, PCj.anstine@advmedimaging.com970-267-2678