ADVISORY e-ALERT     November 30, 2010
Advisory Law Group, a Professional Corporation



In the physician-hospital administration dynamic, it's commonly thought that the relationship of referral maker/referral receiver dictates power. It's time to challenge that assumption. Or, even though that assumption might be true, it's time to change the dynamic anyway.

If you're one of my clients, or even a member of my larger reader community, you know that I work with both hospital based groups and with very entrepreneurial physicians, often surgeons.  One thing that's become clear over the decades is that some groups which, by virtue of their practice and specialty, are devoid of the ability to refer, actually have a superior position in the power structure with hospital administration. At the same time, it's become clear that some large referrers, which one would think would have the ability to dictate terms, have far less power in the relationship than commonly thought to exist.

I've written in other issues of the Advisory E-Alert and in articles for other publications on elements of the global process required for achieving a power position, the process that I refer to as The Strategic Group Process™. I'd like to expand on one of the Process's concepts, that of Framing the Issues™, which deals with the power of controlling context.
Stated generally, the relationship between hospitals and physicians and the negotiations that take place in the course of that relationship, do not occur in a vacuum.
Instead, they take place within a context, one that can be manufactured and controlled.

In my article on context published for the anesthesia market as To Control The Contract, Control The Context and for the radiology market as Increase Negotiating Power, I touch on two of the controllable elements of context: (i) the hospital's perception of the group, and (ii) the context of the particular negotiation.  This article presents a third element: Changing your perception, the hospital community's perception, and the hospital's own perception of the function of hospital administration.

Let's use as our example a hospital based group. In my experience, when they first consult with me, most, if not all, hospital based group leaders believe that the hospital,
personified by its CEO, holds the power. They see their group as providing a service for the hospital - a service that the hospital administrator can choose to terminate by way of ending their exclusive contract.

It's true that for these groups, prior to embarking on the course of the Strategic Group Process™, the hospital administration holds the power position. But what if, at the same time that the group begins to deliver an experience monopoly, a standard of service and interaction that no one else can duplicate (see Are You Headed To The Anesthesia Factory? or Creating An Experience Monopoly) and at the same time that it works to establish a frame for the next subject matter negotiation (for example, the renewal of its exclusive contract), the group also works to reframe the relationship between it and the hospital CEO such that the CEO's job is no longer a variant of "running the hospital," but, rather, "assisting physicians in the delivery of medical care to their patients at the hospital?"

Of course, there are several notions at play here. One is internal to the group leadership itself, a type of mental imaging to boost its own conception of its power. The second is the creation of a different than usual power dynamic though tactics implemented by the group to influence the medical staff's perception of the role of hospital administration. The third is the changed self-perception of the hospital's CEO.

There's a parallel to a story told by George Leonard in his wonderful book, Mastery. Leonard relates the story of teaching his aikido students a wrist lock that might, with significant force, work to subdue an attacker, but which when combined by the student with the mental image of her fingers extending from the attacker's wrist through his face to the base of his skull, which imagined finger extensions are then "swept" downward along his spine, brings about a startlingly more powerful result.

These concepts are not easy to implement. In some cases, it may be harder to change your own perceptions than those of others. The work required to morph the conceptual framework of the larger medical staff requires both strategy and devotion to carrying out tactics. Impacting the CEO's own vision of himself is accomplished through both direct and indirect actions. None can be implemented quickly, which is why, again in parallel to Mastery, significant effort devoted over significant time is required.

One thing is certain:  The present perception of power as flowing from the hospital will not change on its own. 

To begin the process of transforming your power position, contact Mark F. Weiss now. 





Mark F. Weiss was quoted at length by Rachel Fields in her article, 4 Ways Physician Groups Can Increase Their Earning Potential, published on October 28, 2010, at



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