8 Steps for Spine Surgeon Leaders to Make Hospital Partnerships Work FeaturedWritten by Laura Miller | September 25, 2012
In today's healthcare environment, there are several opportunities for spine surgeons and groups to partner with hospitals. However, this relationship requires a special understanding between the two sides and strong leadership to really make it work.
"The spirit of the group as the hospital and surgeons come together mirrors the spirit of the leadership," says Scott Gibbs, MD, founder of Brain and NeuroSpine Clinic of Missouri and director of the Southeast Missouri Hospital's Brain and Spine Center, both in Cape Girardeau. "We have to keep that in mind as we create these relationships and as we promote the leadership of a new enterprise. Leadership means responsibility and we have to take a large amount of responsibility as we lead these enterprises."
Dr. Gibbs discusses eight steps for spine surgeons to build a mutually beneficial relationship with hospital executives.
1. Bridge the gap between surgeons and hospital executives with shared revenue opportunities. Hospital executives and independent spine surgeons have traditionally been on opposite sides of the spectrum when it comes to managing the spine hospital service line. However, more surgeons and hospitals are taking advantage of the opportunity to come together around a mutually beneficial goal — providing great patient care — while also sharing in savings and revenue generation.
"We have to recognize that one of the primary motivators for both hospitals and surgeons is revenue," says Dr. Gibbs. "I think revenue opportunities are very important and we have to inspire others to work toward a mutually common goal. Surgeons need to take the lead with hospitals and craft a vision that is mutually beneficial for the hospital and the surgeon."
These partnerships could come in the form of co-management arrangement of spine service lines, collaboration to construct a comprehensive spine "center of excellence" or a joint venture surgery center, among other arrangements. "The surgeons and the hospitals have to create a vision that is big enough to include both parties," he says. The future may bring additional challenges and opportunities for surgeons and hospitals to partner and share revenue gains, especially in accountable care organizations.
"What we need to do is create a comprehensive bundling of surgical procedures, postoperative care and pain management so there is one price for everything," says Dr. Gibbs. "Then we will have to negotiate with hospitals for our fee. The hospital has to understand that they must participate in developing the best treatment plan for their patients. Surgeons need to organize that for the hospitals because hospital executives don't practice spine surgery, so they sometimes under appreciate its nuances. We need to craft that vision for them and have the leadership to deliver it."
2. Appoint a strong central leader as the surgeon advocate. When partnering with a hospital, spine groups should appoint a strong leader as their central advocate who can work among the hospital executives and practice partners to broker a mutually beneficial relationship. This surgeon must be able to drive the project forward with an understanding of the challenges and opportunities on both sides.
"There are many people who aspire to leadership but few comprehend its true nature," says Dr. Gibbs. "In my opinion, leadership is intuition directed by common sense. Leadership isn't a minor element; it's a major element and I think hospitals need surgeon leaders to create a vision that is big enough to include many of the people in their hospital."
The most successful leaders exhibit several qualities respected by their partners within the practice and the outside community. "Part of leadership is giving service and remaining flexible, and having humility, self honesty and self confidence," says Dr. Gibbs. "You need to demonstrate loyalty to your hospital and your fellow surgeons."
3. Build mutual respect to overcome disagreements. Spine surgeons and hospital executives will have natural disagreements, as any parties in a relationship do. These disagreements could stem from different ideas about how the project should move forward, different priorities or a lack of understanding about the other party, but they can all be overcome if both groups are respectful of one another.
"The best way to overcome obstacles is to build mutual respect between the hospital administrators and spine surgeons, even when there is a disagreement," says Dr. Gibbs. "I've had it happen where I've disagreed with the leadership of our hospital but there was still respect between us. We don't always agree on everything but we do mutually respect each other. Flexibility is a very important part of leadership."
Participation from both sides will be crucial going forward, and you don't want one side to shut down because of a disagreement. Take time out of your schedule to meet with hospital executives and discuss your plans so everyone is on the same page.
"Walt Disney said if you can dream it you can do it," says Dr. Gibbs. "If you can dream it you can do it, but you have to engage other parties to participate in the vision and you have to remember that power belongs only to those who participate. Sit down with the president or CEO of the hospital and lay out a comprehensive vision for a neutrally rewarding partnership."
4. Keep the patient's best interests at the forefront of discussions. While there will be points of disagreement between surgeons and hospitals, both sides will agree that providing the best patient care possible — and doing what is in the patient's best interest — is most important. One of today's common partnership models in collaborating on a comprehensive spine care facility.
"If you offer all your services under one roof — neurosurgery, orthopedics, pain management and physiatry — you have a comprehensive program that will dwarf many of the competitors because so many times these specialists aren't under the same roof and patients are traveling all over town," says Dr. Gibbs. "You will see the disparities in their care."
Bringing all the specialists together allows everyone to expect consistent, high quality care for their patients. This type of facility is also more convenient for patients because they can see several specialists in one visit if necessary and can coordinate care more easily.
"This is a creative collaboration and it's in the patient's best interest," says Dr. Gibbs. "We have to craft an incredibly positive experience for our patients and make them loyal fans. It's not just about satisfaction, it's about loyalty! You want the patients to say they won't go anywhere else but to your practice and if they say that with their hands on their hips, they are showing conviction about their loyalty, and that's really important."
Without loyal patients, you will see people in your community traveling long distances to receive better care instead of going to your clinic.
5. Stay on the cutting edge of spine care: outpatient surgery and pain management. True leadership requires room for innovation, and right now the field is moving rapidly toward outpatient surgery centers and interventional pain management. Hospitals see this as an opportunity to provide better care for their patients and partnering with surgeons ensures clinical quality and efficiency.
"If you look at the Sg2 data, the trend is toward outpatient surgery," says Dr. Gibbs. "The leading and cutting-edge aspects of spine surgery lie in outpatient procedures. These are minimally invasive surgeries that also include pain management techniques. Pain management is a big part of our practice and we use pain management specialists before we offer surgery. If they still have pain after surgery, our specialists can work with them postoperatively so we don't cast them off."
In some cases, the relationship between spine surgeons and pain management physicians has been strained, but Dr. Gibbs sees both specialists becoming an important part of patients' treatment pathway in the future.
"There are some surgeons who perform surgery and afterwards they say there is nothing else they can do for their patients," says Dr. Gibbs. "We keep these patients in our practice and refer them to our pain management specialists, who can help them reduce their discomfort. We create a treatment plan for the best patient care — and that means not sending our patients away from our practice until they are better."
6. Form the foundation of your relationship around value created. Spine surgeons must demonstrate the value they bring to the table as partners with hospital executives. This value can come in the form of clinical expertise, operational efficiency or positive reputation, and should become the foundation of your relationship.
"We as men and women need to become men and women of value to our patients and create relationships with the hospital that drives value," says Dr. Gibbs. "I think value is created through creative collaboration with the hospital. As the Irish playwright George Bernard Shaw said, 'Life isn't about finding yourself; it's about creating yourself.' We have to continue to create ourselves as spine surgeons."
Heightening your value as a surgeon often means continuing your education, learning new surgical techniques and participating in research to advance the field. It also means using new technology and adapting to changes in spine care delivery.
"We have to grow and learn new procedures and stay abreast of new technologies," says Dr. Gibbs. "There are a lot of surgeons who don't seem to make as much effort as they need to in staying abreast of new technologies and techniques. If they do that, they will be at the head of the pack. Leadership is about leading, not working from behind."
7. Go the extra mile to treat colleagues and patients respectfully. Hospital executives aren't the only people surgeons must form a positive relationship with for this partnership to work; they must also take care to treat their office staff, hospital staff and patients respectfully.
"We have to remember that the people we work with at the hospital and our practice are our greatest assets," says Dr. Gibbs. "We have to choose people who are service-oriented and kind; our services can't be draped on Cindy Crawford and made to look good. Patients don't see what we did inside them; they only see the outcome and they remember the experience they had with us. We want to make sure that the experience was extraordinary positive."
The most sought-after surgeons will go the extra mile for their patients. Dr. Gibbs and the other neurosurgeons in his practice do this by sending each patient undergoing surgery flowers and a card, thanking them for entrusting them with their care.
"I've done that for 15 years with ever surgical patient," says Dr. Gibbs. "I cannot tell you how many patients told me postoperatively they never received flowers from a surgeon before. It doesn't cost a lot of money — about $15 per patient — and I think it has a huge marketing value."
8. Take action on your ideas and promote creativity. Leaders on both sides of the partnership must be action-oriented to see any partnership through. Everyone involved in the partnership should feel comfortable expressing creative solutions to problems as they arise and the organization needs to be flexible enough to act on those ideas quickly.
"As we engage the hospital and generate action — and action generates creativity — people become more creative about how to enhance the patient experience," says Dr. Gibbs. "I see the opportunity of leadership as a way to change healthcare. Once you create that process, people become engaged and they want to participate in something of high value."
For example, if the hospital has patients traveling from long distances, make sure they are able to see several different specialists in your comprehensive programs and have all their services, including imaging, done on the same day so they don't have to travel back the next week.
"Your team will become creative and present ideas to you to make an even better patient experience," says Dr. Gibbs. "Action is something that generates creative collaboration towards the very best patient care."
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