by Dr. Kenneth H. Cohn

Two weeks ago, I was asked to visit a Midwestern hospital where physicians had voted to have the CEO's contract terminated. During several years of fighting, battle lines had developed over what was the physicians' responsibility for caring for patients vs. hospital administrators' rights to manage hospital operations. Hot-button words like "disruptive" and "abusive" added flames to the fire.

As I described in a previous Hospital Impact post, I've learned that each medical staff has its own culture based on beliefs, attitudes, habits, and stories that one ignores at one's own peril. Resolving a medical staff crisis requires a facilitator--a guide from the side, rather than a sage on the stage.

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We devised a questionnaire that could provide insight into what was going on rather than assume that we already knew the answers. Questions included:

• How would you rate your experience here?
• What is going well for you?
• How likely are you to recommend this hospital to a friend, colleague, or a family member?
• On what do you base your rating?
• What is the future of this hospital?
• What role do you see yourself playing?
• Which obstacles need to be addressed now for the hospital to thrive?
• Whom else should we interview?

The physicians, administrators, and board members found the discussions therapeutic, an indication that someone valued their input and validated why they were angry and apprehensive.
Momentum began to build. Physicians who were initially too busy to participate began asking why they weren't interviewed; so we filled the time until we collected 25 interviews in our database.

The purpose of this admittedly early post is to share with readers insights that I have learned through experience in hospitals where physicians of Asian background felt humiliated in front of their colleagues. Displaying cultural sensitivity is an important key to success in many hospitals around the United States.

Although the following points may seem like common sense, in our hurried lives, we forget them sometimes. Ways to help colleagues save face include:

• Calling a physician by his/her formal appellation (i.e., Dr.) rather than by first name
• Trying to begin a conversation with the 1 percent of areas of agreement rather than the 99 percent of areas of disagreement
• Praising a physician publicly and discussing concerns privately face-to-face, rather than via email
• Coming to know other aspects of a physician's life, such as volunteer interests and hobbies
• Reaching out to a physician's spouse and children to make them feel welcome in the community
• Expecting surprises
• Demonstrating flexibility
• Understanding that for those who grew up in poverty, fear of losing affluence may drive their outlook

Have you faced similar situations? What worked at your organization? Please contribute your insights to our learning community.

Ken is a practicing general surgeon/MBA and CEO of HealthcareCollaboration.com, who works with organizations that need to engage physicians to improve clinical and financial performance in this era of healthcare reform. His upcoming book, Getting It Done: Experienced Healthcare Leaders Reveal Field-Tested Strategies for Clinical and Financial Success, will be published June 30, 2011. Please learn more by visiting http://gettingitdonebook.com.