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Dear Director,
I’ve been a chairman for several years and had a great relationship with our former hospital president who left last year. I’ve had a hard time getting to know and communicating with his replacement, and I think this has hurt the progress our department has made. What recommendations do you have for getting my message heard?

One of the most important jobs of any ED chairman is maintaining relationships with hospital administrators. Keeping these lines of communication open is critical when it comes to contract retention and making improvements in the department, particularly when there has been a leadership change. I’ve worked in a variety of institutions and it’s been the same story everywhere, regardless of the varied reporting structures in place.

Where to begin? If you haven’t already done so, it’s critically important that you schedule a meeting with your current hospital president. You need to establish how often, how much detail, and in what format he wants to hear from you. And every conversation with someone from the C-suite needs to include the words, “What can I do for you?” When I first met with my latest hospital CEO, I wasn’t sure how he would respond to that question. Turns out, he was under a lot of pressure to increase pay to on-call specialists (like many CEOs). He asked me how often the on-call specialists were being called. One survey and one week later, I had a pretty good answer for him. Bottom line, if all we’re ever doing is bringing up problems or requesting money, no one will want to talk to us.

Chain of Command
Every hospital has a reporting structure, and while your previous president may have liked meeting with you, it’s possible your current president would prefer that you interact with the member of their executive team who is responsible for the ED. I’m sure you know who your nursing leadership reports to and this is where I see chairmen make mistakes. Typically, the ED falls under the chief nursing officer (who we inherently don’t like to report to) or the chief operating officer. As physicians, we need to divorce ourselves from the notion that reporting to the CNO is bad. At the end of the day, the hospital has an executive who is responsible for the ED and we need to work with them to insure our business line is successful.  I remember a meeting with my CMO who also happened to be a department chairman. He responded to an ED issue as a chairperson would and I had to remind him to put on his CMO hat and look at the situation from a hospital perspective. When we report to a CNO or COO, I hope and I usually find that they wear the hat of being in charge of the ED business line and hear our message, not just as a request from a physician wanting something, but wanting what’s best for the hospital’s success.

Personalities
I’ve had hospital presidents who had open door policies and happily let me drop in to chat every week (one colleague referred to these as a drive by) and others who religiously scheduled me for the 4th Friday of the month at 8am. This really highlighted the differences in their personalities and how I had to deliver my message—literally from free flowing discussions and updates to regimented reported formats. You need to take the personality type of your executive into consideration before any meeting. Are they the type who likes data and graphs or do they like to talk at you and show how powerful they are? Can I make a joke with them or is it better that I call them Sir or Ma’am? Whatever limited understanding I have of personality types goes into play when I get time with these leaders as I want to deliver my message in the way most clear to them.

Regular meeting
I like to meet with my C-suite liaison every 4-8 weeks. It’s important to share our successes and failures and to discuss the ED’s agenda and how it fits into the hospital’s agenda. Sometimes I’ve scheduled these meetings with no real agenda and expected to be done in 15 minutes only to sit and get updates on other events throughout the hospital that may or may not impact me. You may go into a meeting expecting it to be quick because there were no ED issues only to spend an hour giving your thoughts on issues outside of the ED (budget, overall admission rates, construction, contracts with other groups) or learning the real story behind a senior executive’s departure. This relationship and history of communication will be invaluable when the crap hits the fan and we’re digging ourselves out of a hole. As an added resource, you can consider inviting your hospital president or VP to one of your regular physician department meetings.  This can be for a quick introduction or to let them hear the entire meeting so they can see how involved and committed your department is. 

Messaging and Presentations
If you work in a bizarre meeting-free hospital, it’s still important to get your message across to administration. There’s a variety of ways to do this. Friends of mine have had great success by putting out a weekly or biweekly email to their staff and CC’ing the CEO. The email can discuss volume, good and bad events, tips on reducing length of stay or whatever project you’re working on that quarter, as well as include core measure reminders, or highlights from complimentary letters that you’ve received about docs or people who were highlighted by name in patient sat surveys. It’s not unusual for CEOs to think that ED chairman aren’t “around enough” because we keep irregular hours and don’t conform to the 8a-5p hospital culture, and this kind of regular “newsletter” has the added bonus of letting the CEO know that you’re steering the ship in the right direction. One caveat: be sure to let everyone in your group know that you’re CC’ing the CEO so that they don’t “reply all” with a smart alec comment. 

Since sending a biweekly newsletter can be time consuming, sending a direct email to your CEO as a quarterly, semi-annual, or (at a minimum) annual report can also be useful. Consider using a SWOT analysis template for strengths, weaknesses, opportunities, and threats. This can encompass volume, recruiting, patient sat, core measures, turn-around time issues with other departments, etc…I’ve also come to realize that most CEOs don’t want to read the 20 page annual reports that I used to write, so sending them something in a power point presentation format that is heavy on graphs with a few key messages in text that is easy and quick to flip through is probably a better use of everyone’s time.

Finally, most of us are asked by some oversight committee to give quarterly or at least annual reports. If your CEO doesn’t attend these meetings, this should be your trigger to get your slides in front of them. Whether it’s a scheduled meeting or an email, make sure you have action plans to improve upon weaknesses and be sure to share your successes and what you intend to do to maintain the success.

Conclusion
As chairman, you are the liaison between hospital administration and your department. Contract retention is based on performance but also on the C-suites perception of your leadership. Establishing regular contact with them is critical for delivering your message and understanding how the ED fits into the hospital’s mission. Best case is that you meet regularly with the CEO or one of the hospital executive VPs, but if you’re in an environment that isn’t conducive to that, be sure to communicate by at least doing an annual report – and always make sure you’re offering to help the CEO in any way that you can.

Secrets to C-Suite Success

  • Regular contact is critical
  • Establish how your C-suite liaison wants to get updates (regular meetings, drive by’s, emails, etc...)
  • Maintain regular meetings – you never know what will come up in conversation
  • Invite them to your monthly staff meeting
  • Ask “what can I do for?”
  • Adapt to their personality for style and content
  • Regular emails or a department newsletter can keep everyone focused on the mission and let the CEO know you’re eyes are on the road ahead
  • Take advantage of opportunities to state your case. Presentations allow you to craft your message – even if the C-suite isn’t there, be sure to email them a copy
  • Annual reports or presentations should be a minimum goal




Michael Silverman, MD, is a partner at Emergency Medicine Associates and is chairman of emergency medicine at the Virginia Hospital Center.

 

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