Building Trust with Physicians During Times of Disruption

A physician CEO at an academic health system discusses how implementing a new funds-flow model requires leading with integrity.

UW Health, a Madison, Wis.-based integrated academic health system with 1,500 employed physicians and $3 billion in annual revenues, is in its first year of transitioning to a new funds-flow model. The process is disruptive process and requires trust and collaboration between physicians and administrative leaders.

Historically, clinical, academic, and research funds flowed directly to the clinical department chairs. But now the health system, which is affiliated with the UW School of Medicine and Public Health, will have greater oversight of the funds, and departments will be required to build budgets—some for the first time.

“We had to work very closely with our department chairs to get to a funds-flow model that was modernized to help us meet the challenges for today and tomorrow,” says Alan Kaplan, MD (pictured at right), CEO of UW Health. Ultimately, a key goal is to incorporate departmental incentives in the funds-flow decision-making to encourage departments to provide more coordinated, integrated care. With the new model, an integrated budget allows the organization to set strategies and adequately fund them through a global budgeting process, Kaplan says.

However, changing the funds flow is a disruptive process for many physician leaders. “It is a big cultural change and a shift in the perception of control,” Kaplan says. During this first year, leaders are standardizing accounting processes across departments. Kaplan says the transition to the new model will likely take two more years.

Lessons Learned

As these new processes are put into place, Kaplan and his team have been aligning physicians by building trust. He offers some guidance for physician leaders on how to engage the medical staff and create trust during times of disruption.

Lead with integrity. “It sounds so easy in practice, but it’s not,” Kaplan says. Demonstrating consistent behavior and keeping others informed of decisions and changes that affect them is critical to leading with integrity. It is best to obtain input prior to making decisions that affect patient care or clinical work. However, when a decision has been made, don’t attempt to sell physicians on the idea.“If you think physicians are not going to like what you have to say or a decision has already been made, just say that up front,” Kaplan says. “They’ll respect you more than if you try to falsely get their input.”

Make sure the organization acts on physician feedback. UW Health is taking steps to ensure every physician committee is chartered so members know which administrative leaders are responsible for acting on their recommendations. This approach helps ensure better administrative follow-through on the committees’ ideas. “Physicians need to know that their voices are being heard and their decisions are being respected,” Kaplan says. 

Map the informal network. To understand the key decision makers and influencers in his academic environment, Kaplan often asks department chairs and other physician leaders which two or three other physicians he should speak with on a particular topic. “You start learning who talks to whom and who is influential,” he says. “Often, you’ll find that the most influential physicians are not the loudest.”

Be transparent. Kaplan and his team broadly share the organization’s financials with physicians to ensure they understand what is driving the health system’s strategies, including an $80 million margin improvement initiative. Physicians participate on the steering committee overseeing the margin improvement initiative as well as on specific work groups on clinical documentation, pharmaceuticals, and supplies.

Address burnout. This issue, which is becoming more pervasive in health care, affects physicians’ quality of life and makes them less amenable to cultural change. As Kaplan notes, “Leading necessary change requires a healthy and engaged professional workforce.” Leaders at UW Health have begun to use a physician wellness survey created by Stanford Medicine to gauge burnout across the organization. Based on the results, they will look for sustainable solutions to reduce physician stress. 

Be an active listener. Prior to joining UW Health as CEO in 2016, Kaplan was executive vice president and chief clinical transformation officer for UnityPoint Health, a 21-hospital system based in West Des Moines, Iowa. He also served as president and CEO of UnityPoint Clinic, a 1,300-provider medical group that he created from groups in nine different regions.

When Kaplan founded the new medical group, he went on the road with UnityPoint Health’s marketing team to learn more about each of the 120 clinics involved. “This helped to build our credibility,” he says. The team also captured stories for a blog so that physicians could become more familiar with their new colleagues, who might be separated by hundreds of miles. “What happened was this huge system with more than 1,000 providers across three states got to know each other,” he says. “They also began to share innovations across the system.”

Let physicians find their own solutions. When creating the new medical group for UnityPoint Health, Kaplan convened an advisory group that included physicians from the various regions and constituencies. During four six-hour sessions, the physicians created a new entity with a new governance and management structure. Later on, they collaborated on a standardized compensation model. Having the physicians craft their own future was vital to bringing them together in a unified medical group, Kaplan says.

Focus on soft skills. When organizations are experiencing significant cultural changes, Kaplan recommends that physician leaders make sure their soft skills are fully developed. “No matter how bad you are at any of these soft skills, there is a way to improve if you put in the time and effort,” Kaplan says. For one year, he spent three hours a week in improv classes to become a better public speaker. “I learned how to read an audience and engage with them,” he says. 

Kaplan also credits an executive coach for helping him build his leadership acumen during the past 10 years. As he says, “It really helps to have a confidant who understands you and can help you hone in on those behaviors that get in the way of your success or help ramp up your behaviors that are good but need to be even better.”  

Laura Ramos Hegwer is a freelance writer and editor based in Lake Bluff, Ill. 

Quoted in this article:

Alan Kaplan, MD, CEO, UW Health, Madison, Wis.

This article is based in part on a presentation at the 2018 ACHE Congress in Chicago.