Being Indispensable

Is being indispensable important to you?

Moving from a clinical career into management can result in culture shock. The shock can be lessened by moving gradually. You start as a medical director. You increase your management hours while gradually reducing your clinical hours.

But whether you make the move gradually, or simply move into a full-time executive position overnight, there can be a loss of job security. When you're practicing your specialty, and have a following of grateful patients (especially when you own your practice), it seems that nothing can jeopardize your career.

But as an executive, you have a single boss. If your rapport with him or her suffers, your job can slip away .

Easy Come, Easy Go

Our new medical group VP came highly recommended. He had run a large territory for a regional multi-specialty group. He had good communication skills. He was likable and had a good sense of humor.

Special efforts were made to integrate him into the executive team. His orientation went well. Our team spent several of our meetings specifically getting to know him. We tried to help him understand the culture of the organization and of our team.

In less than a year, he left the organization. Similar events occurred in other divisions. New VPs came up through the ranks or were hired from outside. The resumes looked good. They seemed to have great potential. But within a year or two, they were gone.

It was a little unnerving at times. It made me think “how secure is my position?” “How can I prevent that from happening to me?” The issue of job security for an executive in this situation appears to boil down to one factor.

Indispensability

It became obvious to me. There was one factor common to those who left. They were dispensable. And the “long-termers” all seemed to have skills or knowledge that made them indispensable.

When the medical group VP left, it was relatively easy to find someone else to step in and keep things rolling. However, those who remained had unique skills that were difficult to replicate.

So, if you want “career insurance”, become indispensable to the CEO! Even if you report to another person, such as the COO, meeting a need that is vital to the CEO (as long as he or she stays in that role) is the best way to ensure your longevity.

Practical Implications

For the executive physician, that means bringing your unique talents to bear to become indispensable. Skills that you may have that set you apart from the other members of the team might include the following:

• Ability to understand and communicate well with other clinicians
• Special relationship with the organization's patients (consumers)
• Ability to translate complex clinical concepts into layman's terms for the CEO and board
• Mastery of quality improvement, including measurement tools and systems, and statistical concepts
• Communicating physicians' experiences in a way that allows the CEO to understand their perspective

You should meet one-on-one with the CEO regularly (at least bi-weekly). Be proactive when meeting with your CEO. And prepare an agenda for each meeting that lists all of your current projects, goals and departmental updates. Then focus on the most pressing issues. In so doing, the CEO feels informed and is not caught off-guard by looming issues. And unscheduled “urgent” meetings become unnecessary. So you won't be known as  the high-maintenance CMO!

Avoid These

The other truth for any administrator is this: Things are going well when we are NOT hearing complaints. The worst case is when your CEO is pulled into a problem regarding an issue you should have taken care of.

Here are some fairly common  examples:

• Members of the medical staff are unhappy because of a decision that was made without their input
• Another VP asks the CEO to resolve an issue affecting both of your divisions
• One of your staff fails to deliver a report or contract review that results in a delay in another department's project

You should strive to pro-actively identify problems early and resolve them without involving the CEO whenever possible.

Other Ways to Become Indispensable

Become an expert. Develop a deep understanding of complex issues. The Harvard Business Review published an article in 2011 (Making Yourself Indispensable) admonishing managers to strengthen their core strengths, but to also strengthen complimentary skills.

For the physician executive, examples of enhanced expertise might include:

• HealthGrades Methodology for Measuring and Reporting Quality
• Truven's Methodology for awarding Top 100 Status
• CMS quality measurement and reporting initiatives
• Coding and documentation and how it affects quality and safety reporting

Based on such expertise, you should consider volunteering to provide regular updates  to the board on:

• Annual published HealthGrades Ratings
• Annual summary of sentinel events and root cause analyses
• CMS Hospital Compare reports
• Annual quality monitoring reports

It might also be of benefit to provide board education concerning broader issues, like:

• Understanding quality and patient safety.
• How do we perform a root cause analysis?
• What is LEAN process improvement?
• How do we prevent medication errors?

Bottom Line

By implementing some of these ideas, you will become an indispensable asset to the  CEO, the board, and the organization, while enhancing your own job security.

What other ideas should I add to the above list? What skills does the CMO uniquely demonstrate in your organization?