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Transparency, Communication, and Faculty Motivation
Rebecca M. Minter, MDVice Chair, Clinical Operations and FinanceAASA New Administrators WorkshopOctober 4, 2015
Department of Surgery
DisclosuresI am a faculty member
I am new to my role in Clinical
Operations
I am not new to managing teams
I believe effective communication is
critical and transparency is a
natural result
I have no financial disclosuresDepartment of Surgery
Goals for this talkDevelop an understanding for how to
effectively communicate with faculty
Explore the pros and cons of
transparency
Broaden one’s understanding of
what truly motivates high performing
individuals
Department of Surgery
Communication Basics
Department of Surgery
Miscommunication
Email is not a good medium for complicated or
unpopular communications!
Effective communicationis very time consuming!
Communication Basics
Department of Surgery
No communication
No Communication
Department of Surgery
Purposeful (not usually)
Path of least resistance
No time
“I emailed so and so and I never got a response.”
No communication
Department of Surgery
Finance Speak
Department of Surgery
/15%
Watch your crowd
Department of Surgery
Elements of Personal Communication• 7% spoken words• 38% voice, tone• 55% body language
Faculty PhenotypesBlissfully Ignorant
Department of Surgery
Just Want to Understand
Everyone is Trying to Screw Me
15% 80% 5%
Faculty PhenotypesBlissfully Ignorant
Happy
Department of Surgery
Just Want to Understand
Everyone is Trying to Screw Me
Faculty PhenotypesBlissfully Ignorant
Happy Goal Oriented
Department of Surgery
Just Want to Understand
Everyone is Trying to Screw Me
Faculty PhenotypesBlissfully Ignorant
Happy Goal Oriented Often Focused in a
Particular Area
Department of Surgery
Just Want to Understand
Everyone is Trying to Screw Me
Faculty PhenotypesBlissfully Ignorant
Happy Goal Oriented Often Focused in a
Particular Area Surprised when
they get a bonus
Department of Surgery
Just Want to Understand
Everyone is Trying to Screw Me
Faculty PhenotypesBlissfully Ignorant
Happy Goal Oriented Often Focused in a
Particular Area Surprised when
they get a “bonus”
Department of Surgery
Just Want to Understand
Curious – “Explain to me how…..”
Everyone is Trying to Screw Me
Faculty PhenotypesBlissfully Ignorant
Happy Goal Oriented Often Focused in a
Particular Area Surprised when
they get a “bonus”
Department of Surgery
Just Want to Understand
Curious – “Explain to me how…..”
Want to feel in charge of their own destiny
Everyone is Trying to Screw Me
Faculty PhenotypesBlissfully Ignorant
Happy Goal Oriented Often Focused in a
Particular Area Surprised when
they get a “bonus”
Department of Surgery
Just Want to Understand
Curious – “Explain to me how…..”
Want to feel in charge of their own destiny
Will respond to data
Everyone is Trying to Screw Me
Faculty PhenotypesBlissfully Ignorant
Happy Goal Oriented Often Focused in a
Particular Area Surprised when
they get a “bonus”
Department of Surgery
Just Want to Understand
Curious – “Explain to me how…..”
Want to feel in charge of their own destiny
Will respond to data May prefer a more
scripted incentive plan
Everyone is Trying to Screw Me
Faculty PhenotypesBlissfully Ignorant
Happy Goal Oriented Often Focused in a
Particular Area Surprised when
they get a “bonus”
Department of Surgery
Just Want to Understand
Curious – “Explain to me how…..”
Want to feel in charge of their own destiny
Will respond to data May prefer a more
scripted incentive plan
Everyone is Trying to Screw Me
Suspicious - think you are trying to hide things
Faculty PhenotypesBlissfully Ignorant
Happy Goal Oriented Often Focused in a
Particular Area Surprised when
they get a “bonus”
Department of Surgery
Just Want to Understand
Curious – “Explain to me how…..”
Want to feel in charge of their own destiny
Will respond to data May prefer a more
scripted incentive plan
Everyone is Trying to Screw Me
Suspicious – think you are trying to hide things
Often intimidating
Faculty PhenotypesBlissfully Ignorant
Happy Goal Oriented Often Focused in a
Particular Area Surprised when
they get a “bonus”
Department of Surgery
Just Want to Understand
Curious – “Explain to me how…..”
Want to feel in charge of their own destiny
Will respond to data May prefer a more
scripted incentive plan
Everyone is Trying to Screw Me
Suspicious - think you are trying to hide things
Often intimidating Generally glass half
empty type of folks
Faculty PhenotypesBlissfully Ignorant
Happy Goal Oriented Often Focused in a
Particular Area Surprised when
they get a “bonus”
Department of Surgery
Just Want to Understand
Curious – “Explain to me how…..”
Want to feel in charge of their own destiny
Will respond to data May prefer a more
scripted incentive plan
Everyone is Trying to Screw Me
Suspicious - think you are trying to hide things
Often intimidating Generally glass half
empty type of folks No incentive plan is
fair – others are getting more than they are
Communication strategiesBlissfully Ignorant
Happy Goal Oriented Often Focused in a
Particular Area Surprised when
they get a “bonus”
Department of Surgery
Just Want to Understand
Curious – “Explain to me how…..”
Want to feel in charge of their own destiny
Will respond to data May prefer a more
scripted incentive plan
Everyone is Trying to Screw Me
Suspicious - think you are trying to hide things
Often intimidating Generally glass half
empty type of folks No incentive plan is
fair – others are getting more than they are
Communication Landmines
The compensation
plan
The incentive plan
Department of Surgery
A Tale of Two Comp Plans
Department of Surgery
Operating Margin by Division and DepartmentCollections Model
CT CRS GS TrB SO Vas TX Ped Pla Dept
Oper Margin +++ ++ + + +++ +++ + ++
A Tale of Two Comp Plans
Cardiac & Thoracic Surgery (blended)
$61.43
Colorectal Surgery
$47.83
General Surgery
$57.47
Trauma Surgery
$55.39
Surgical Oncology
$48.79
Vascular Surgery
$50.66
Transplant Surgery
$59.13
Plastic Surgery
$65.40
Pediatric Surgery
$81.18
Department of Surgery
Median AMGA Compensation to Work RVU Ratio 2011-2014
A Tale of Two Comp Plans
Department of Surgery
Operating Margin with Specialty Specific AMGA wRVU Payments
CT CRS GS TrB SO Vas TX Ped Pla Dept
Oper Mar - Col +++ ++ + + +++ +++ + ++Oper Mar - wRVU ++++ ++ -- - +++ ++++ ++ ++
A Tale of Two Comp Plans
Cardiac & Thoracic Surgery (blended)
$61.43
Colorectal Surgery
$47.83
General Surgery
$57.47
Trauma Surgery
$55.39
Surgical Oncology
$48.79
Vascular Surgery
$50.66
Transplant Surgery
$59.13
Plastic Surgery
$65.40
Pediatric Surgery
$81.18
Department of Surgery
Median AMGA Compensation to Work RVU Ratio 2011-2014
Blended wRVU
payment of $65.00
A Tale of Two Comp Plans
Department of Surgery
Operating Margin with Specialty Specific AMGA wRVU Payments
CT CRS GS TrB SO Vas TX Ped Pla Dept
Oper Mar - Col +++ ++ + + +++ +++ + ++Oper Mar - wRVU +++ ++½ + + ++ ½ ++ ½ ++ ++
So What Happened?Three years later……..
Annual Faculty Satisfaction Survey
Department of Surgery
Excerpted Questions 2012 2014
14. I am compensated fairly for my work 76% agree 54% agree
15. I am compensated fairly as compared to my peers at other institutions
65% agree 40% agree
In Debriefing…..Failure to adequately communicate
the process, logic, and modeling that
supported the decision for a blended
model
Failure to engage all stakeholders in
the planning and decision-making
What steps were undertaken to
address the problem?Department of Surgery
The second landmine
The incentive plan
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The incentive planAssure understanding of the source
for incentive payments, and the
criteria for earning an incentive
Differentiate a bonus plan from an
incentive plan – which is it?
You must understand what motivates
an individual
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What is the source of incentive payments?
Clinical revenue
–But at what level?
–Department?
–Division?
–Section?
“The department”
Department of Surgery
Criteria for earning an incentiveIs it an incentive or a bonus?
Prescriptive versus flexible
Are criteria pre-defined?
–At the level of the individual or the
group?
How was it communicated to the
faculty?Department of Surgery
Incentive plans
Department of Surgery
What motivates an individualfaculty member?
What are you trying to incent?
The surprising truth about what motivates us………
Department of Surgery
https://youtu.be/u6XAPnuFjJc
Motivation – Take-home pointsIf/then rewards work for simple tasks
–Do more cases, get an incentive payment
Principle of “Pay people enough to
take the issue of money off of the
table” is important
–Opens the door to set the bar high for an
incentive to be earned Department of Surgery
MotivationImportant to remember – “When the
profit motive becomes unmoored from
the purpose motive bad things
happen.”
–Unnecessary procedures
–Internal competition
–Failure to properly supervise
Department of Surgery
MotivationMake the task more complex and
empower the faculty to find a solution–Autonomy
–Mastery
–Purpose
Individuals are internally motivated – and
their motivation is hard-wired and unique –What makes them tick?
Department of Surgery
Downside to Transparency?Recognize there are pros and cons to
transparency–It can be a burden to young faculty
members and the “blissfully ignorant”
–It takes time and may create less
“flexibility”
Department of Surgery
The positive effects far outweigh the downsides which can be managed.
SummaryCommunication and Transparency–Tailor your message to the faculty
phenotype–Always respond – even if only to say you
need more time–Engage the faculty in decision-making
(autonomy)–Ensure there is understanding – explain
the reason why!–Try to predict the communication
landmines and be proactive!Department of Surgery
Summary - Motivation
Motivation is individual and unique
Carrots and sticks only work for
simple tasks
Try to pay individuals enough to take
the issue of money off the table
Set a high bar for the incentive –
motivate them to achieve the BHAG
Department of Surgery
Department of Surgery
Thank you