Sleepless in the C-suite: Workforce, Part 3

Intentionate’s Stu Schaff was interviewed on a recent episode of the Healthcare Financial Management Association (HFMA)’s Voices in Healthcare Finance podcast alongside Vicki Abelson of The Defined Leader and HFMA’s Todd Nelson.

In the interview, which comprises most of the episode, Stu discusses the issues that often arise between physicians and the employers of physicians when clear expectations are not set from the beginning. He also explains why physician compensation can be difficult to untangle and understand

You can listen to the podcast or read a transcript of the interview below. If you have any questions or would like to discuss how Intentionate can help your organization with provider compensation and setting clear work expectations, please contact us.

Interview Transcript

Erika Grotto, HFMA: 

The path to better communication among healthcare staff and leaders. Today on HFMA’s Voices in Healthcare Finance Podcast sponsored by Red Dot.

Hello and welcome to the podcast. I’m Erica Grotto. Today, we wrap up our three-episode series on the healthcare workforce. I’m getting over a cold, and you can probably hear my voice is a little off, which is unfortunate, but maybe just the right thing for an episode about obstacles to communication. Today, we’re discussing issues honey and lemon tea can’t solve, and finding ways for staff and leaders to work toward common goals. Stu Schaff is Founder and Principal of Intentionate Healthcare Advisors. His work is very physician focused. So, although there is some overlap with other types of work in healthcare, his comments are about physician work specifically. There’s actually one pretty stark difference between physicians and other types of healthcare workers; the expectations put forward by their employers.

Stu Schaff, Intentionate Healthcare Advisors:

This is a problem that goes both ways when you’re talking about physicians and the employers of physicians. It really starts all the way back at recruitment. What I mean is that the employer is generally not saying, “here’s what you need to do in your job”; like we, the average non-physician folks, would have a job description. We’d have SOPs, standard operating procedures; other things like that. We don’t really do that for physicians in the same way. What we do instead is we say,” you’re a doctor. You know how to doctor. I’m not going to tell you how to doctor”, right? And physicians for their part, are not really saying,” this is what I expect out of my job. This is what I need out of my job”. A lot of them have medical debt or other things that they’re worried about coming into a new position. They’re so worried that they’re going to lose the opportunity, that they’re afraid of speaking up. I’ve heard this from multiple physicians. What we have is a situation where each of the parties are speaking different languages in their own heads.

Ms. Grotto:

Another issue Schaff says is difficult to untangle is compensation. He says physician compensation can be hard to understand even for physicians.

Mr. Schaff:

There isn’t really education around the topics of business and finance for physicians in medical school or in training. Another thing is that, as an industry, we’ve found that the easiest way to address a problem is to try and build a better mousetrap. In this case, a “better compensation formula”. The reality is, we’re missing out on the more challenging but more meaningful ways to address an issue, which are typically not going to be about handing more money to that physician. It’s going to be about adding better infrastructure, adding another MA (medical assistant) to that clinic, finding more space for them to see patients; working with them to overcome whatever challenges that they’re facing. That’s more challenging. What we’ve done instead is said,” okay, well, I have this particular issue, how can I bolt something on to the compensation model to maybe address this particular issue?” All of these bolt-ons kind of stack up. There’re all these unintended consequences, and you have a situation, ultimately, for a lot of organizations where you have a complicated model. Most of the physicians, if you sat down and asked them, “how do you get paid?”, couldn’t give you a real, straight, correct answer about that. The ones maybe who could, there are very few, you just have a lot of confusion and a lot of dissatisfaction from that.

Ms. Grotto:

Todd Nelson, HFMA’s Chief Partnership Officer who we heard from in the first two parts of this series, agrees. He says understanding job duties, compensation, and how what a person does fits into the organization is all critical.

Todd Nelson, HFMA:

Having clarity of role, purpose, and the duties that you need to perform your job successfully is, you know; I can’t underestimate the importance of that. Whether you’re a physician, or a nurse, or an accountant, or a biller and revenue cycle, understanding your piece of the overall puzzle, and how you fit in there, is important. What are the duties that you need to perform to be successful? And then, when you perform them successfully, is there a reward for doing that? If so, what is the clearly articulated reward for that? I don’t know if many people understand the entire picture of that. They might understand, you know, the job duties and the job description. They get that piece, but they don’t know necessarily how they are going to be compensated by doing those specific things; or they may know very clearly what they get compensated for, but that might not align exactly with the duties they’ve been asked to do. I think that clarity of purpose and how it is tied to compensation, and how it fits in with the bigger picture of the organization, and what is needed, is very important.

Ms. Grotto:

Vicki Abelson is an Executive Coach with The Defined Leader and was previously a revenue cycle leader in physician groups. She says departmental goals and how they fit in with the goals of the organization is another area that can be murky, especially in revenue cycle.

Vicki Abelson, The Defined Leader:

The organization might have, you know, one set of goals for the revenue cycle. Organizations oftentimes have different sets of goals. Revenue cycle employees don’t often know what it is that they’re working towards. It can be really hard to show up every day, and work really, really hard if you don’t know what your “Why” is. If you don’t know what the organization is moving towards; as nonclinical employees, it’s really, really important for them to know,” are we working towards a specific budget number? Are we working towards a specific number of cases coded?”; whatever it is, they need to understand what they’re working towards and why they are just like anybody else.

Ms. Grotto:

Schaff said untangling duties and compensation have to begin in the recruitment stage.

Mr. Schaff:

I heard a recruitment expert talk about this in a way recently that I think is really helpful to keep in mind. There are primarily four things that are going to draw a physician to a particular practice: whether it’s a hospital practice, and independent practice, or whatever. There’s the quality of the practice. There is the quality of life that that physician is going to have while they’re working in that job. There’s where the practice is located. There’s the financial aspect: compensation. You can’t change where you are. You can’t change your geography. You can’t change what life is going to be like living there. That’s just bigger than any practice manager or hospital CEO even, is going to be able to take on unfortunately. The ones you really can control are the quality of the practice and the financial aspects of it. So, it’s what it’s going to be like to work there and what they’re going to get out of it. What it’s going to be like to work there are those things I was talking about earlier. It’s the level of support that they’re going to get from other staff. It’s the IT systems that they’re going to have to work with and how much those are a roadblock versus a helpful tool. There’re things around throughput, whether it’s exam rooms, ORs, or tests, relationships with other providers, how that’s facilitated, reducing administrative burden, and so on.

Ms. Grotto:

As for physician compensation, Schaff said there are three words to keep in mind: clear, competitive, and fair.

Mr. Schaff:

I didn’t say sophisticated. I didn’t say complicated, and I didn’t say absolutely the highest paid in the market. That’s not always the most important thing to folks. It’s really again, that pay is clear, that it’s competitive, and then it’s fair.

Ms. Grotto:

Again, Schaff was talking about physicians specifically. According to Abelson, all of that can apply to other areas of healthcare.

Ms. Abelson:

When I talk to people in lots of different industries, oftentimes money is the last factor that they consider when evaluating jobs. They’re considering things like work life balance, advancement opportunity, education, PTO; other kinds of benefits. I really like to challenge employers to think about what are some of those other things? Is there an opportunity to be flexible with employees in terms of where and when they work? Are there opportunities to provide them with extra training? Whether it is in hard skills, systems, coding, processes, or perhaps soft skills in leadership in resilience, in communication and change management? That’s a really big one recently as well. Are there ways to provide advancement opportunities or special projects? Are there ways to offer more PTO or other kinds of incentives that will allow people to feel valued, heard, understood.

Ms. Grotto:

We’ll talk about how to make people feel valued, heard, and understood in a minute, after a brief sponsor break. Let’s take a minute now to get a word from our sponsor.

[Sponsor Break from 9:36 to 12:07]

Ms. Grotto:

FinThrive’s Vice President Jonathan Wiick mentioned in the first episode of the series, that stay interviews are important in addressing staff retention. With physicians in particular, Schaff recommends those stay interviews start right away.

Mr. Schaff:

The best thing that you can do is ask them what will help them. Ask them regularly. Show them that they’re being heard. You’re not making promises. You’re not saying we’re going to do exactly what you tell us to do. You’re listening to them; you’re showing them that they’re being heard, and you’re continually having this dialogue.  An open and honest dialogue, although it’s challenging for a lot of people, ends up creating a better work environment that physicians are going to want to be in. It needs to start again at the very beginning. Within say, 30 days of a physician starting, they should have a stay interview. There should be a structured way of continually checking in with them and making the time and space to sit down together and talk about what’s going well, and maybe what needs to be improved. That’s the best way to find out what they need. It’s the most direct.

Ms. Grotto:

Workload balance can be another important piece of the puzzle. Abelson said good leaders will be looking for imbalances and ways to correct them.

Ms. Abelson:

It’s so easy for our top employees to get all of the work and for our employees that are struggling, maybe, to not get as much work. It’s really easy in a group of people, to have some people that are not working quite as much while another person is completely drowning; and to think about how we better balance the work within our teams and within our organizations. Revenue cycle shops tend to be incredibly siloed. If you’re a surgical coder, if you’re a surgical pre-cert person, you’re only going to do this one thing, and it’s going to be really hard for you to go do oncology or to do primary care, whatever it is. So, how can we think about cross training? How can we think about workload balancing in such a way that allows everybody to be able to learn something new and also carry the weight.

Ms. Grotto:

Another thing to remember is that nothing we’re discussing happens in a vacuum. Leaders too are experiencing stress and burnout. Trying to balance a growing workload with a shrinking staff can be difficult. So, finding time for real conversations can be a big challenge. But the alternative isn’t always the best path, according to Schaff.

Mr. Schaff:

It’s not easy to have an open conversation with someone when you’re not used to doing it. What I’ve found in talking with hundreds of hospitals and medical group administrators, and hundreds of physicians in the last several years, is that everybody has the things that they’re worried about. Those weigh on them whether it’s in the work that they’re doing on a day-to-day basis, the things that are happening outside of work with their families or their friends, or whatever it may be, everybody has a lot on their shoulders. They’re trying to do the best work that they possibly can, with the resources they have, in the time that they have available. That’s a lot for anybody to take on. Now add on the complexity of the healthcare industry in general.  It just creates a situation where it becomes extremely difficult to imagine reaching deeper, finding more time and more space for these important conversations. As a result of that, we just go for what’s easy, or what feels easy. That’s the thing. Let’s give another bonus for doing X. Let’s give a retention check of X dollars. Instead of going in and solving the underlying problem, I think that’s why it’s just human nature to look for the path of least resistance, even if that path isn’t going to drive the most meaningful, long-term change. There’s nothing wrong with a quick win, but you can’t stop there.

Ms. Grotto:

For Abelson, it kind of comes down to the old adage about eating an elephant one bite at a time.

Ms. Abelson:

It becomes incumbent upon our leaders to really understand that it’s a domino that needs to fall first, in order for the employees to feel supported and in order for their employees to feel like they’re understood, and they’re appreciated. So, if it’s unclear expectations, what can we do today to help them clear up their expectations; help them clearly understand where it is they’re going. The first thing I would recommend is to understand what is your team members. Overall, obviously, every might everybody might have slightly different things. But overall, what is their primary driver? What is the thing that makes them the most frustrated on Monday morning, when they wake up, in order to go to work? Start chipping away at that answer. The other thing too is, we put a lot of focus on the leader to solve the problem, but I would really encourage us to think about this as a co-creation. So, the leader, the team members, employees, and the organizational leadership, come together and come up with a solution together. None of us are perfect. None of us are going to have the one perfect idea that’s going to solve all the problems. I can guarantee you that when those three groups of people come together, they’re going to be able to come up with a solution that’s going to be better than what they have today.

Ms. Grotto:

Stu Schaff recommends that leaders become more deliberate in their communication strategies.

Mr. Schaff:

I have a challenge for every healthcare finance leader and every healthcare operations leader. That’s to carve some time, a half an hour, 45 minutes, maybe an hour, if you can afford it out of every day, and say, this is the time that I get out, and I talk with my people. I figure out what is going well, what could be improved, not making any particular promises, but I’m going to be accountable to them because I’m asking them to be accountable to me as well.  I would be willing to bet that organizations that take me up on that challenge will find that they’ll find their short-term wins when something’s pointed out to them that somebody was too afraid to say, for one reason or another. They didn’t feel like it was appropriate, or they didn’t think to because nobody asked. They’re also going to find opportunities for meaningful long-term change. And yes, sometimes it involves an investment of money. Sometimes that can be significant, but I find that there is an ROI. We’re dealing with this at a time where the labor market is really just in a crazy place. I don’t have a better way to put it than that. I’ve been told by healthcare leaders that they don’t know what to do. They just don’t know what other solutions they have. The most valuable asset that you have is your time. So, why don’t we use that asset to protect our organization’s ability to recruit and retain great people, which ultimately, are really the lifeblood of our organizations.

Ms. Abelson:

Don’t be afraid to be wrong. If you try one thing. If you try, perhaps a daily huddle that tells people what their daily goals are; then people might say,” I don’t know if this is not really working for me”, then, you know to throw it out and try something new. Communicate proactively that this is what we’re doing to try and solve this problem. If it works great, we’re going to keep doing it. If it’s not working, we’re going to try something else and we’re going to try doing something else. At the same time, we need to stay accountable to what our organizational goals are and to what our deliverables are so that we can keep moving in the right direction.

Ms. Grotto:

Voices in Healthcare Finance is a production of the Healthcare Financial Management Association and written and hosted by me, Erika Grotto. Audio editing is by Linda Chandler. Brad Dennison is Chief Content Executive. Our president and CEO is Joe Pfeiffer. Thanks to our sponsor Red Dot. Learn more about them at reddotmgmt.com.