Alignment, all working together to achieve the same vision, is a term that has been fully integrated into the culture of healthcare.

Yet alignment is hard to achieve between physicians leaders and administration. Let’s examine how each group defines alignment.

Administrators tend to think of alignment in terms of cascading goals for their team so that everyone can see the larger vision in black and white. The support of goals and understanding how each personal goal “rolls up” into that larger vision is paramount for an effective team.

While physicians may not disagree with this definition of alignment, they think of alignment in a different, somewhat more practical way. Alignment occurs when administrative partners support their desire to have an impact and take the best possible care of patients.

In my experience as a healthcare consultant and administrator, I have found that physicians’ define support by the position they hold in the organization. Some physicians feel supported (and therefore aligned) with administration when they have the resources they need to take care of patients in the most cutting edge way. Some feel aligned when their input is not only gathered, but carries some weight on decisions that impact them, their colleagues and their patients. And some physicians feel aligned simply by feeling understood. (This last example applies when there is inherent trust that already exists between physicians and administration.)

The different definitions of alignment and paths to achievement are not surprising. Physicians and administrators have vastly different education and training. Continuing education is completely separate and siloed. The inherent motivation to choose these separate paths likely stems from different life stories. The result is differing perspectives on how best to achieve results. It is no wonder that potential for tension and frustration between physicians and administration exists.

Why Alignment Is Critical

Logically, it is easy to understand why alignment is so important. When we are all rowing the boat in the same direction, we reach our shared destination efficiently with equal amount of effort on behalf of the crew.

But we all know, as humans, logic often takes a back seat to emotions when the stakes are high for us personally and for patients.

Often, the reality in many health systems, is that each member of the “rowing crew” is trying to reach a different island. Each member knows which destination is the absolute right destination. Island 1 is the best for patient care, Island 2 offers access to more patients, and Island 3 is where the value equation is optimized.

The crew then starts to row in opposite directions to their ideal destination. Frustration mounts, progress slows to a halt and finger pointing does nothing to solve the situation.

Without alignment, judgment often replaces curiosity.

A terminally curious team might discover that Island 4, that had not been on anyone’s radar, is the best option.

Why True Alignment is Difficult to Achieve

The primary reason why alignment is so complex is that

Alignment requires transparency.

Transparency is one of those factors that many healthcare administrators think they provide, yet most physician team members want more of. This discretion in transparency is what drives a wedge in trust and wreaks havoc on a culture of well-meaning, motivated physician and administrative leaders.

The amount of transparency in a culture is typically driven by the amount of fear and uncertainty held by its leaders. Because this fear and uncertainty drives unconscious messages of self doubt it impacts the ability and/or willingness to be transparent.

Examples of unconscious self-doubt messages that impact transparency:

“If I am 100% transparent. then I may have to change course and I KNOW this is the right direction.”

“If I talk to them about XYZ challenges, they may realize I don’t have all the answers and don’t deserve to be in this position” (imposter syndrome at play).

“If I tell them no, it may dampen motivation and put a negative spin on our culture” (this is when the “slow-no” is implemented as defined by an initial yes without action).

“They don’t need to know. I want to protect them from this.”

None of these thoughts are productive, yet we all have them. It is important to acknowledge what holds us back from alignment through transparency.

5 Steps to Achieve Alignment through Transparency

  1. Get honest with yourself.  Seek opportunities to be more transparent

 It is often in self-reflection where the most progress is made. In other words, be transparent with yourself so that you can enhance transparency with others.

Be honest and clear with yourself. Take time to reflect .
Write down your answers to the following two questions:

Where are you an open book?

Where have you withheld information?

Note, when answering these questions refrain from judging yourself. Just stick to the facts.

  1. Reach inside. Question Why:

Now that you have identified where you have been transparent and where there are more opportunities to do so, question why transparency has been limited in certain areas.

Ask yourself these guiding questions to gain clarity on your reasons for being less than transparent: (Hint: if your answer involves blaming someone else, go back to the drawing board and ask yourself this question again.)

  1. What is the risk of being transparent?
  2. What is the risk of not being transparent ?
  3. Think of a time when someone was not transparent with you.
  • How did that make you feel?
  • How were your thoughts about that person impacted?
  • What was your resulting behavior?
  • Was the behavior aligned with your desired results?
  • How has your own style of transparency been enlightened by that example?
  1. What is the ONE thing that everyone is aware of but no one is talking about?

 No matter the situation, there always seems to be at least one elephant in the room that holds up progress in a certain area.

Perhaps it is inherent market competition that requires a shroud of secrecy which unfortunately extends to our internal partners.

Perhaps it is that there are competing incentives (not uncommon with physician and administrative partners).

Perhaps when priorities are examined, they are in direct conflict with one another.

Whatever the elephant in the room is in your organization and partnership, identify it. Talk about it.

  1. Take action.

 Reflection and awareness without action is a wasted opportunity for progress.

Identify the action that you can take immediately (or at least this week ) to enhance your transparency and therefore, initiate alignment.

It just takes one person to begin a new conversation from a place of curiosity that changes everything.
Find the courage to be that one person.

Carrie Koh is a consultant and Interpersonal Efficiency coach with a passion to change the way we connect to one another in healthcare to ensure efficient results for patients and greater fulfillment for each other.










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