Find a Successor

Almost no one starts a new job by trying to find a successor. Most people start by organizing their files and defending against any potential successors. However, the practice will clarify your role, define desirable characteristics for this role, highlight ideas for your personal development and that of your successor, and provide ample time to recruit and mentor protégés who may be successors. Your protégé can assist with activities, and you will enjoy mutual encouragement.

What prevents you from developing a successor right now?

Finding a Physician Champion

As you consider possible medical staff members, look for important characteristics. Your candidates should demonstrate personal integrity. Confirm your impression of their personal integrity with other physicians, partners, nurses, patients and sometimes the grapevine. Physicians who are medical staff leaders would seem to be a good choice and often are. Remember that medical staff leaders have generally been politically active. Leaders may compromise to make deals and put “spin” on reports. This is not to say that politically active physicians are unacceptable, but be circumspect. Ask yourself, do they have the respect of the medical staff? Have they alienated segments of the medical staff during political battles? Can they build respect and trust? Are they empathetic with the members of the medical staff? Can they meet the expectations and needs of their sponsors and supervisors?

Where to Start

Start your project with the goal in mind. The hospital has a mission that is theoretically its overriding goal. Keep in mind that the institution may not be doing what it says it’s supposed to do. Among the reasons for this non-alignment are that the mission statement may not match the thinking of principle leaders. The mission statement may have been designed by a committee years before and relegated to an unused box of documents. There may be a disparity between the stated mission and the way the institution is functioning. The stated mission may be on target while the institution is off course. The stated mission may never have been properly designed or both the action and mission could be inappropriate. All too often the mission has drifted from the enlivening purposes of the founders.

What goal are you trying to achieve?

Forum's Purpose

I hope that this Forum provides a starting point on this battleground and an approach for attending to the medical staff, aligning physicians on the institutional mission and fostering a spiritually nourishing environment. I shall try to write to that physician in the hospital who will lead the work; I will call that person a physician champion. However, I also want to write for hospital administrators, nursing staff, hospital chaplains, and health policy planners. I shall try to keep the concepts consistent with Christian theology. Nevertheless, I want to honor people from all faith traditions. As I worked for ten years with physicians at St. Vincent Hospital in Indianapolis, I tested these concepts repeatedly. They are generally well received. Finally, these ideas are not doctrine, a cookbook or the only possibility. It is simply one place to start. I know that there are many other directions to take and I hope that readers will share those with an interested and concerned community.

Do you have any suggestions about the format?

Barriers to Collaboration

Physician Formation emphasizes the good news. Every physician resistance is a teaching opportunity. Opportunities abound. Physicians are passionate people. They do amazing work, and most physicians entered the profession with high idealism and compassion. Physicians who choose to work in faith-based hospitals often do so precisely because they possess very admirable personal qualities. These are powerful qualities and more than adequate to counter the daunting barriers.

Have you noticed any differences between physicians working in a faith-based hospital compared to those in a non-faith based hospital?

Barriers to Collaboration

Ironically, issues of faith are often the greatest barriers to physician formation. The prevailing attitude in the United States is that faith and its expressions have no role in the work place. Perhaps this attitude derives from a mistaken interpretation of the constitutional separation of church and state. Others feel that expressions of faith are imperative, but may not express themselves appropriately. Some physicians, like other hospital workers, have preconceptions about spirituality that arise from their faith traditions. Others have no faith tradition or possibly exhibit antagonism toward God, faith or a particular faith tradition.

Where does faith get in the way for you?

Barriers to Collaboration

Physicians themselves create barriers to a healing collaboration with the hospital. Foremost they are incredibly busy. The demands of practice administrators, the electronic medical record, and the growing detail of required documentation insures that physicians will be busier yet. Physician lives are not generally very well balanced. Rest, recreation, and family relationships fall victim to the demands of the practice.

What is the state of "life-balance" for the physicians you know personally? If their lives are out of balance, why is it so? What should be done?

Physician Practice Environment

Other features of the medical practice landscape thwart the goal of real healing. Physicians are under intense scrutiny by peer review, bed utilization review, and practice guideline compliance monitors. Patients have increased access to medical information and misinformation from the internet. Physician incomes have been falling for several years. The collective message physicians hear is: “Non-physicians do not trust you, do not believe that you know as much as you should and that you are not worth what you are paid.” The collective message is not very positive. It is difficult for a physician to bring healing to the bedside when they experience this level of devaluation.

Is this message true?

Hospital - Physician Relationships

The relationship between hospitals and their physicians is critical to the goal of real healing. Many features of modern practice strain those relationships. Some physicians are employed by their hospitals and have the strains of employee-employer relationships. Others are employed by independent practices which often compete for business against the very hospitals that court their cooperation.

What do you think is the role of business competition between hospitals and physicians as both seek to heal patients, body, mind and soul?

Mission

Having physicians want to be within the mission of the hospital is critically important. Physicians make virtually all of the major decisions regarding the health care of individual patients. Those are decisions that alter treatment outcomes and institutional bottom lines. Physicians carry real authority to the hospital staff, the patients and their families. Because of the power of their authority they have the potential to deliver real healing. Physicians are trained to deliver cure and palliation but not particularly trained to deliver real healing.Patients want to be cured, but they long for real healing whether they can articulate that longing or not.

What do you see as the authority of physicians?