Want Change? Physician Empowerment = Physician Engagement

We’ve said it before and we will say it again:

over 70% of change initiatives fail.

In 1995, John Kotter published research that revealed only 30 percent of change programs are successful. In 2008, a McKinsey & Company survey of business executives indicates that the percent of change programs that are a success today was still…30%. The numbers today aren’t much better. A survey conducted by AHA shows that barriers to change are most disconcerting in the areas of physician engagement and buy-in and organizational barriers to collaboration.

hhn aha

Obstacles hospitals leader identify as barriers to achieving strategic priorities http://bit.ly/1ItPM2i

With all of these barriers, how can positive change happen in healthcare? How can we beat these odds together on Integrated Teams?

With Physicians who are empowered through leadership education, and as a result, engaged in making change happen as a collaborative process at every level of the organization!

Let’s shift the paradigm of Clinician as Individual Contributor to Clinician as Change Agent.

Change Agents aren’t token “champions” acting as lone wranglers of a herd:

  1. They are trained and utilized as leaders engaging staff at every level.
  2. They are agile strategists empowered to identify and make simple, iterative improvements that lead to lasting results.
  3. They are encouraged to have a growth mindset of progress over perfection
  4. They are well-supported by executive leadership sponsors and administrators


We urge senior leadership to invest in developing their physician leaders to be agents of change. In return, physicians must also accept themselves as change leaders, regardless of their actual job title!

The Physician Leadership Institute provides education and tools for Physician Leaders to not only make transformation happen, but to make it stick. We offer concise but comprehensive strategy maps and other essential education for change agents, including the PLI Change Framework. Note the upfront emphasis on terrain mapping and stakeholder analysis and the iterative design that is inherent to a circular process:


Physician Empowerment = Engagement

Physicians truly hold the key that opens the door to transformation in healthcare delivery. How will you empower them through leadership development, and engage them to lead change in your organization?

If you want to build a ship, don’t drum up the men to gather wood, divide the work and give orders. Instead, teach them to yearn for the vast and endless sea.

     — Antoine de Saint-Exupéry


We look forward to hearing from you!

3 Steps to Go from Dependency-based to Leadership-based Communication

Physician leaders, how are you showing up at work?

To your senior leadership? To your leadership partners? To your staff?

show up

This classic article by Harvard thought leader Nancy Koehn perfectly illustrates how your presence affects your effectiveness. How you “show up” matters as much as any decision you make throughout the day and must be examined. It will manifest itself in how well you can manage up, down, and sideways in all of your daily operations.

Think about the words you use to approach (or avoid) interactions with others.

Do you use dependency-based language, or the language of leadership?

You can evolve your communication style from one of dependency, that results in low-quality, reactive relationships, to one of leadership that results in high-quality, proactive relationships.

Flip the script from dependency to leadership language in your interactions with others, whether you are managing up, sideways, or down!

3 Steps to Go from Dependency-based to Leadership-based

PLI provides emerging leaders with courses and coaching in developing an executive presence, using leadership-based language, and courageous conversations! 

To learn more about how you most effectively can show up as a physician leader, please see our customized services and solutions in Leading with Purpose, Leading Self, Leading Others, Leading with Strategy, and Leading for Results.

leadership skills

“We are what we repeatedly do.” ~ Aristotle

How will you show up differently today?



Physician Leadership Institute at the AHA Leadership Summit!

Rewriting the Health Care Playbook:
Leading Transformation and Innovation


The AHA Solutions 23rd Annual Leadership Summit took place July 23 – 25, 2015 in San Francisco, CA and we were there!

We joined senior executives from the nation’s leading hospitals and health systems at this unique forum where health care leaders discuss the critical issues facing their organizations and network to find the solutions they need to be more successful. The Leadership Summit offered strategies and tools to help organizations better serve their patients and communities while improving financial and operational goals.

Physician Leadership Institute CEO, Mo Kasti, shared methods for innovation and solution generation with retail healthcare partners, connecting to the long-term strategic goals, and advice for what to do when the going gets tough.



Moderator:  Anthony Burke, President and CEO, AHA Solutions, Chicago, IL

Panelists included:

Chris Lloyd, FACHE, CEO, MHMD Memorial Hermann Physician Network and CEO, Memorial Hermann Accountable Care Organization, Houston, TX

Harry Leider, MD, Chief Medical Officer, Walgreens, Deerfield, IL

Mohamad S. Kasti, MS, MBB, MCA, CEO, The Physician Leadership Institute, Center for Transformation and Innovation, Tampa, FL

Aric Sharp, VP of Accountable Care, UnityPoint Health, West Des Moines, IA.

The conversation included these esteemed healthcare experts weighing in on questions such as:

  1. How has the shift toward value-based medicine impacted the way you work with partners?
  2. How have your organizations changed since moving to do business this way?
  3. What are the signposts of a culture where partnership is honored and employed?
  4. What are the signposts that a partnership is going to be successful?

Tony Burke, Senior Vice President of the American Hospital Association and President and CEO of AHA Solutions, Harry Leider, MD, MBA, Chief Medical Officer and Group Vice President Walgreens and Physician Leadership Institute CEO, Mo Kasti, present at the recent AHA Health Forum Leadership Summit in San Francisco, CA.

Couldn’t make it this year? Check out #HFSummit on Twitter to review the action!

5 Steps to Accelerate Change in Value-Based Physician Compensation

Policy meeting

The transition from volume to value is here.

Have you ever attempted to change your physician compensation formula before? Odds are, it was not an easy task.

How about trying to change your physician compensation from volume to value?

We have 5 steps to help you be successful!


To begin, The Healthcare Financial Management Association provides useful benchmarks and great scorecard examples for senior leadership in the initial creation of a value-based physician compensation model. These guideposts, along with our suggestions below, will help you assess and navigate the terrain of your organization’s upcoming transition.HFAG scorecard examples

But beyond these recommended guideposts for physician scorecards and the logistical systems to support them, there are important psychological elements you must consider. 

A deep systemic change (such as value-based compensation) must be designed for and by the humans using it, or it will fail.


Between 60 percent and 90 percent of change initiatives flounder because leaders tend to focus primarily on “technical” solutions while paying no attention to developing a strategy for engagement of the proposed compensation plan. At PLI, we have adopted a simple, yet powerful equation that shows that the Transformative Results (T) of an implementation depends on the quality of Proposed Solutions (S) and the Engagement by the stakeholders:

transformation equation


So how do you engage your physicians effectively to move forward with value-based compensation?
Through a deliberate plan for physician engagement!



5 Steps to Accelerate Change (and Engage Physicians!) in Value-Based Compensation


Step 1:
Map your terrain. Different terrain requires different strategy.

As leaders, it is not only incumbent upon us to plan for logistical elements of a systemic change, but also the human elements. Start by examining all stakeholders.

Whose support, commitment, and engagement do you need in order for the change to be successful? The board, the executive team, the MEC, Department chairs, and physician leaders. Depending on your bylaws, it will determine how extensive your stakeholders list is. Who will be impacted by this change? When working on compensation, should you change everyone or start with a smaller segment. The authors of HFMA article recommend, and we agree, to

focus initially on compensation of primary care physicians. Most physicians paid under some form of value-oriented arrangements are primary care physicians. Changing the compensation of specialists is more difficult, and therefore is less common, because measures to effectively link payment incentives for specialists to performance are limited and require more substantial data resources than are required to track the performance of primary care physicians”

The tendency is to go after 100% consensus and try to engage and convince everyone about the new plan. You don’t need to engage all at the same time!, Decide where you should first spend your time using the 80/20 rule.

It is important to know when it comes to the transition to value –based payments, where your physicians fall on the Stakeholder Support Spectrum versus where you need them to be.

silent majority

The Spectrum includes:

  •  Early Adopters (MOJO)
  • Silent majority (JO)
  • Resistors- Late Adopters (NOJO)

Map the terrain by assessing your stakeholders’ current stance regarding the change. Who is strongly supportive of the proposal? Who is reluctant or even actively resistant? And who appears to be neutral or hasn’t indicated their level of support? By assessing the terrain in this way you will be better able to develop a sound influence strategy and identify where (toward whom) to direct your time and effort.

A typical terrain has the following distribution:

  • Early Adopters 20%
  • Silent majority 60%
  • Resistors- Late Adopters 20%

Remember – The Silent Majority Counts!

The natural tendency of physician leaders is to spend 80% of their time on dealing with the 20% of the resistors/late adopters and that is typical because the resistors may be the most vocal and/or most influential.

  • Focus 80% or more of your early influence efforts on energizing the early adopters and gaining the support of the silent majority, rather than on convincing resistors.
  • Capitalize on the energy of the early adopters by enlisting their support in your efforts to influence others.
  • Develop a strategy to influence the late adopters – those whose support you need but do not yet have.
Step 2:
Create Aligned Purpose

“People don’t care how much you know until they know how much you care.”

Too often, leaders begin their influence efforts by selling what they believe to be the benefits of the proposed new compensation model rather than showing how the proposal connects to the interests, concerns, and needs of the person they are seeking to influence. In order to capture another’s interest, and ultimately gain his or her support, change agents must start by seeking to understand what that person values.

Effective influence starts with understanding others’ concerns and needs so that you can speak to how the change connects with what they care about. When others can see the intersection between what you are asking of them, and their own concerns, they are more willing to engage in conversation about the change. It is through these conversations that you gain their commitment and willingness to take action to achieve the desired result.

So, what will you do to win the hearts and minds of the 60% Silent Majority? What about your change-averse Resistors and Late Adopters?



Step 3:
Engage Others – Develop and Groom Physician Change Agents

Leading change is not an individual sport. It is a team sport.

Reaching out to your Innovators and Early Adopters first can create the groundswell needed to engage others in the movement toward value-based compensation! Their ideas and positive energy will pay off quickly:

  • It will naturally skew your core physician team to those who are most willing to grow and rise with the inevitable tides of modern healthcare, AND
  • The silent majority will take note of where and with whom, you as a leader, spending your time- with the early adopters versus the resistors? They will engage and listen to their peers – The early adopters, AND
  • Overcoming the early hurdles will build both confidence and robust logistical systems ahead of the pack and could potentially become a draw for physician engagement.


  1. Who is most respected among the physicians in your group?
  2. Would s/he be an authentic spokesperson for your physicians, even if s/he is often more of a “Late Adopter” or “Resistor”?
  3. Would s/he courageously reflect back to you any issues as you progress toward a scorecard for value-based compensation?
  4. Can you ensure the transition is made with an interactive feedback loop in place?

A word of caution: Being a change agent is not a natural competency for physicians. They need to be developed and mentored in skills that allow courageous conversations to take place, so barriers can be addressed AHEAD of the design and implementation of the new physician scorecard and payment model.

Step 4:
Have an Influence Strategy

Physicians are motivated differently. Some play to win or play not to lose!

Based on a Harvard Business Review article Do You Play to Win—or to Not Lose? Heidi Grant Halvorson and E. Tory Higgins raise issues that physician leaders must pay close attention to.

The authors tell us there are two types of people: promotion-focused and prevention-focused:

Promotion-focused people see their goals as creating a path to gain or advancement and concentrate on the rewards that will accrue when they achieve them. They are eager and they play to win. You’ll recognize promotion-focused people as those who are comfortable taking chances, who like to work quickly, who dream big and think creatively.  

Prevention-focused people, in contrast, see their goals as responsibilities, and they concentrate on staying safe. They worry about what might go wrong if they don’t work hard enough or aren’t careful enough. They are vigilant and play to not lose, to hang on to what they have, to maintain the status quo. They are often more risk-averse, but their work is also more thorough, accurate, and carefully considered. To succeed, they work slowly and meticulously. They aren’t usually the most creative thinkers, but they may have excellent analytical and problem-solving skills.

You need to align your discussion about the newly proposed compensation model around what motivates the Silent Majority, Late Adopters, and even your active Resistors will yield tremendous insight into your physician culture and ultimately make your payment model far more effective if you reach out to them and address their concerns. We know from research that physicians are greatly motivated by:

  1. Taking care of patients/healing others
  2. Solving complex problems
  3. Income/Status/Identity
  4. Avoiding Risk and Liability, and of course,
  5. Quality of Life

Examining the motivations and underlying belief systems about value-based physician compensation in your organization is a critical part of the shift to make it a reality. The HFMA article authors support this by stating there is The Role of Nonfinancial and Intrinsic Motivation that cannot be ignored:

“The effects of physician compensation on clinical and cost outcomes are complex and involve many psychological and economic factors. We found strong support in the literature for the idea that many factors motivate behavior and that people react differently to the same set of incentives…we also found differing levels of support for using compensation as the primary lever for motivating higher-value care.

Many organizations acknowledge that extrinsic motivation (i.e., external reward), such as that created by compensation models, is not what drives most primary care physicians to practice medicine or to deliver high-quality, efficient care. Rather, many physicians are driven by intrinsic motivation, such as an internal drive and belief system to provide the highest-quality care for patients

Step 5:
Anchor Change in the Culture

Anchoring change requires Transformational Leadership that is visible, courageous and serves a great role model.

  • Step up – Know when to lead from the front and from behind.
  • “It is better to lead from behind and to put others in front especially when you celebrate victory when nice things occur. You take the front line when there is danger.  Then people will appreciate your leadership.” – Nelson Mandela
  • Walk the talk – People are watching you. Being visible in a time of change like compensation is critical.
  • Over-communicate the opportunities (not just the threats)
  • Optimize yourself – Take care of yourself when under stress. Remember that you set the tone and mood for the rest of the team.


This human side of the change will be the difference between a successful transition where everyone feels heard and respected, and a painful one where hard feelings result in low engagement and turnover. 

Only by understanding your stakeholders can you get to know the terrain!



Have questions?

The Physician Leadership Institute is here to help you make a successful transition to Value-Based Physician Compensation. Our Readiness for Change Assessment allows you to plan your change initiative effectively. Our Physician Change Agent Certification helps you develop a strong coalition for success.

Our customized services and solutions range from on-site Strategy and Innovation offerings for Executive Teams, to healthcare leadership development programs in becoming a Certified Change Agent, to providing individual courses in Resilient Leadership and Courageous Conversations. We even offer C-Suite coaching for individuals and groups! Contact us.

5 Integrated Leadership Lessons from the 2015 Women’s World Cup Champions

2015 World Cup Champions

The excitement of the recent win of the 2015 Women’s World Cup by the US team has stirred the international community. We watched, riveted, as time and time again the team demonstrated true a balance of focus, complementary strength, and intensity. Much is being written about this team’s success and how that translates to effective leadership.


But let’s go beyond what’s already been said, and ask:

What can we learn about Integrated Leadership from the 2015 Women’s World Cup championship team?

Lead with PurposeLead SelfLead OthersLead with StrategyLead for Results

While there is even more wisdom to share after this epic win, ultimately, we agree the most with simple advice recently given to healthcare leaders by Phil Dalton, Senior Vice President, Physician Strategies at VHA Inc:

“Get in the game”!


2015 World Cup winners

For how to create the foundation for Integrated Leadership, visit our prior post on Transforming Healthcare through Trust: A Model of Integrated Leadership

For commentary on what skills aspiring healthcare leaders should aspire to gain, see The Traits of Today’s Ideal Health Care CEO by Howard Larkin, which along with the outstanding U.S. Women’s Soccer Team, served as a great inspiration for this post.

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