Scenario: The Chief Executive Officer (CEO) of a large hospital comes into the Chief Medical Officer’s (CMO) office after a hospital board retreat meeting on strategy for faster physician integration. His marching orders include allowing daytime coverage but restricting after-hours house staff coverage only for patients of physicians who are fully employed by the health system. The CEO knows this will create an uproar but wants the CMO to get “buy-in” from all physicians on the medical staff. He shares the 5-year financial projections and insists that viability of the institution is at stake. The relatively new CMO not only realizes the challenge represented but also recognizes a great personal opportunity. From her efforts in the past 2 years, she has garnered a reputation for honesty and integrity. Relying on her education in leadership, communications, and negotiations, she formulates a strategy to achieve the CEO’s directive.
Problem: “Getting buy-in” has become an unwelcome phrase for many physicians. The general implication is that hospital administration wants salaried physicians or other leaders to persuade the “troops” to agree to something for which a decision has already been made. Persuading others is often an art and not a show of strength, and furthermore, not always rational. The art involves putting yourself in the other person’s shoes and asking yourself: “Would I buy this if the idea was offered to me?” If not, leaders first need to convince themselves of the benefits of the intended proposal. If it is always about you and your victories, you will acquire a reputation of being a self-serving leader and lose followers when you need them. Once a leader has convinced himself/herself, pushing hard against a timeline does not always work. Sometimes, being too aggressive can have the opposite reaction.
Solution: Physicians are scientists and, therefore, are influenced by data and empiric arguments. Most proposals advanced by hospitals involve finances to some degree. The problem is that most physicians do not have expertise in analyzing financial data. Thus, physician leaders must make the facts easily understandable and not use book-based accounting terms in attempts to impress physician groups. This may result in a reinforcement of the bias that everyone in administration is concerned only with money. Leaders must make the financial application easy to understand, possibly with charts or graphs, and seek to educate in the process.
Even though the proposal may be factual and well reasoned, the medical staff sometimes has not had time to process the pros and cons or separate their own parochial interests from those of the institution. Persuasion does indeed involve emotion at times but must be used wisely and at the right time when reason and rational arguments have hit home first. That is not to say that everyone in the audience will be convinced of the brilliance of your argument but it may persuade enough people to come over to your side. When emotion is used and timed correctly, it creates excitement and tends to spread through the audience so it completes the “sale.”
If there is not enough support, it is best to let things rest and work on those who are opposed to the proposal as a knee-jerk response or based upon misperception. The leader needs to have established a reputation for honesty, integrity, and listening. A physician leader speaking on behalf of the institution may have already been deemed as having gone over to the “dark side” of administration and thus, sacrificed integrity. A successful physician leader will discuss the downsides of a proposal as well as inherent risks of the endeavor. If this is done, the opposition tends to then start looking at the positives you have presented.
Conclusion: Although presenting data to physicians is vital to getting their “buy-in” for an idea or proposal, the physician leader must build a reputation of honesty, integrity, and being a good listener. Convincing physician audiences almost always takes more time than hospital administrators think it should. Facts help to put the idea on a sound footing as well as a clear and rational explanation brings attention to the proposal. But genuine emotion displayed at the right time creates excitement and can lead to closing the deal.