Ask Me MD: Medical School for the real world

BONUS - Britt Berrett, PhD - Improving Interactions with Hospital Administration

September 09, 2020 D.J. Verret, MD, FACS Season 1 Episode 6
Ask Me MD: Medical School for the real world
BONUS - Britt Berrett, PhD - Improving Interactions with Hospital Administration
Show Notes Transcript Chapter Markers

This week we have a bonus episode, one so good, it could not wait to be published. Before becoming a clinical professor at the University of Texas at Dallas, Dr. Britt Berrett served as a hospital administration in multiple hospitals and health systems. In this podcast, he gives a behind the scenes look at ways that physicians can improve their relations with hospital administrators. To learn more about Dr. Berrett, visit his academic webpage at https://jindal.utdallas.edu/faculty/britt-berrett or to get his book, Patients Come Second, visit https://amzn.to/2Gv0mgX.

If you have questions or ideas for a show, send us an email at [email protected]. Hear the latest podcast at http://askmemdpodcast.com or through your favorite podcast directory.

Announcer :

Ask Me MD, medical school for the real world with the MD Dr. D.J. Verret.

D.J. Verret, MD, FACS :

Greetings and welcome to another edition of Ask Me MD, medical school for the real world. I'm Dr. DJ Brennan. Today we get the pleasure of talking with Dr. Britt Berrett, currently a clinical professor at the University of Texas at Dallas. After spending a long careers to healthcare administrator Britt's going to give us the inside story on how doctors can better interact with healthcare administrators. We'll talk to Brett right after this. Welcome back to Ask Me MD, medical school for the real world. I'm Dr. D.J. Verret. And today I'm interviewing Dr. Britt Berrett, clinical professor at the University of Texas at Dallas with a long history in hospital administration before his professorship about hospital medicine and how physicians interact with hospitals. Britt, thanks for being on the show.

Britt Berrett, PhD :

I'm delighted and thank you for the invitation.

D.J. Verret, MD, FACS :

Can you give us a little bit of your background and where you come from?

Britt Berrett, PhD :

I've been in hospitals and healthcare for over 25 years 20 as a hospital president and CEO, most recently at Texas Health Presbyterian Hospital Dallas as the president and an executive Executive Vice President for Texas Health Resources. So prior to that medical city, it was the CEO. It's owned and operated by HCA and medical city Children's Hospital. my entire career has been in hospitals and six years ago, I felt a calling I had finished my PhD and at from the University of Texas, the School of Economics and public policy, felt a calling to prepare the next generation of healthcare leaders. So I came to UT Dallas, the judul School of Management. We started a health care management program. We've added a graduate program, we've created a Center for Healthcare leadership and management. We have a Master's of healthcare science for physicians that has interestingly as a two year waiting list, and I got involved with it years ago is running hospitals. A good friend John McCracken, Dr. McCracken called me up said hey, can you come teach our doctors about strategy? I'd love to. And so they have these cohort groups of about 60 physicians that sit around tables. And they have every six weeks they have a four day session. And they bring experts from all over and to talk. And it's a very participative and collaborative educational experience. And so I for me, this education space has been just a just a pleasure and an honor and a treat to be part of

D.J. Verret, MD, FACS :

Wth education in mind and all of your hospital administrator experience. What would you tell a physician about a hospital administrator that we wouldn't otherwise know that would help provide a framework for the administrators thought process?

Britt Berrett, PhD :

There actually is a lot of good literature out there. That speaks to the differences between hospital and healthcare executives, and physicians. And some will sell bread that's too general, I'm not so sure. Here at the university, I can tell students that are going to go into marketing versus accounting. It's just, they're just wired different and in there, they're attracted to move in a specific direction. Hospital presidents and healthcare executives, by and large, absolutely care about this profession, the finances, what they get paid, you would be a little discouraged. The pay is not not attractive. People don't get to hospital administration, because of economics. That's, that's not a driver. I think in my experience has been, it's a pursuit of meaning and being part of something bigger. They like to solve problems and they like to work with people. That's that's been than the majority of my experience. And so understanding as you work with a healthcare executive that they they want collaboration, they want cohesion, they want, they don't want to call people out, they don't want to be punitive. They they didn't go through an educational process where you know, your tippy toes every single day, they went through an educational process where a group team have to solve solve a problem together. I've pointed it out to some of my physician colleagues, and their response is, well, that's what you do in medical school. You know, you solve a problem, you diagnose it, and I'll say yeah, but, you know, hospital presidents don't write orders, right. Hospital presidents Don't be called you know, you didn't call me This is CEO Barrett, you know it, you know, there's a professional sovereignty That's different, that might be helpful as you navigate the relationship. I will say the great ones love great Doc's, there's some that are just caustic and rude. And, you know, they're not the kind of healthcare executive want to work with. But by and large, there's a tremendous honor and respect for the medical field and physicians and what they're able to what they're able to do. Those. So those are some some thoughts that I'd have.

D.J. Verret, MD, FACS :

And those are great, great insight, actually, in that difference in education. I think, for me, when I when I've been coming through working with hospital administrators in various capacities, that difference in education was actually key to finally understanding some of their thought process, it really is a different thought process than what physicians have.

Britt Berrett, PhD :

Yeah, when you're when you're navigating through education, there's not a lot of education, you know, it's four years of undergraduate, two years of graduate, very few have doctorates. You compare that to a physician who has a very rigid structured and overwhelming curriculum. Okay. In the hospital administration, a lot of what you look, what you do is what you've learned. So you see a lot of healthcare administrators talking and collaborating and, and coordinating graduate work is all team based on group projects. So that that required in recognition of different specialties, but on rare occasions, will you see someone demand to be in charge? I remember one time I was interviewing for a job, and to two comments from two physicians, one of them says, I want to be the captain of the ship, I'm tired of being told what to do with Medicare and with electronic medical records. And the list goes on. And I said, Hey, listen, I didn't create those restrictions. I am not in charge of Medicare. I you know, I didn't insist upon electronic health record record that that wasn't my doing. But that's something we need to deal with. Well, I'm the captain of the ship of about. So that was one dynamic. The other is one of them, came to me in the interview process. He said, we just had an incident in the art this morning, where a surgeon threw an instrument at a staff member and it wasn't he wasn't like, you know, it wasn't like Chuck Norris throwing it. But you know, he threw in that general direction out of frustration, because things weren't as they had, had to be and should be. And the the the panel said, Well, what would you do about that? And I said, well, we'll I'm not an MD. These are your professional brothers and sisters. What did you do about it? What's your responsibility? And there's just a reluctance that I have seen, to to hold one another accountable. And so sometimes the hospital president has to be that. That principle, and that's, that's an exhaust, if you want to know what exhaust hospital executives and healthcare executives, always having to be the heavy having to be the heavy hand to say, you know, your quality measures don't line up, we have done the analytics. And the response is, oh, that's garbage data, blah, blah, blah. No, it's not garbage data here the comparative.Are you with me on it?

D.J. Verret, MD, FACS :

Yes. Yes, I am on the MEC's and credentialing committees and board of directors for ACO's. And, oh, yes, I see it all the time.

Britt Berrett, PhD :

And it's exhausting. And you and you would, I've been blessed that I've worked with some phenomenal physicians who I just Anna saying is one of those. Gary White's another, I mean, just phenomenal physicians that are honorable and are willing to step up and be heard. If I was going to give advice to healthcare executives, I said, find those great doctors and work with them and cherish those relationships. And I you know, they're the ones that help us move and execute change in health care.

D.J. Verret, MD, FACS :

When I look at physicians groups, broad physician groups that may interact with hospital administrators, I would look at employed physicians versus independent practice physicians, and I think the interactions are a little bit different. What is one piece of advice that you would give to each one of those groups about dealing with hospital administration?

Britt Berrett, PhD :

Well, independent physicians need to recognize and understand themselves. Why have they stayed independent? What what has been the driving force? from an economic perspective, it really makes no sense whatsoever in this day and age. I mean, a single practitioner, a, a small group, but true economically, it is really tough to to experience the economies of scale, so I think you need to understand yourself, and why you are where you are. And then why you would even enter into those kind of relationships with an integrated delivery system health care system. And so you got to be willing to give up, there are things that you are going to have to get give up to benefit from being part of a bigger hole, autonomy, your ability to choose in some specific areas that I think independence needs to understand that now, those that are employed, and are part of an integrated delivery system, a recognition that it's all for one, One for all, that the the, the lone wolf approach this, this sense of individuality, it becomes very complicated health care delivery, we have a patient that comes in as seen by primary care and needs an ortho consult, referring to the same orthopedic physician allows us to aggregate information and make determinations on long term care because we are moving, make no mistake, we are moving into more integrated delivery systems. The the days of the solo practitioner and the solo hospital are coming to an end, there's a new, you've seen this in this pandemic, we've got to collaborate, we've got to coordinate, we have got to talk. And so the solo practitioner, you've seen some migrate to come share medicine and in some other models, okay, there'll be there'll be a small niche for that. But the majority will become part of integrated delivery system. So understand the organization understanding the importance of collaboration, understanding what you're going to have to give up to be part of that bigger hole. Thanks. I think that's the first step.

D.J. Verret, MD, FACS :

In your in your career, is there anything you would change with how you worked with your doctors, something you may have learned later in your career that you would have changed early or just overall? Some way you may have changed?

Britt Berrett, PhD :

Yeah, that's really good question. Um, I've thought a lot about that. And the question that I should have asked is, what do the physicians want? What do they value? what's important to them as it relates to running a hospital? A too often I'm like, Okay, I got to make sure all the nurses clock in at eight o'clock. So I got to get a clock system and, and I got to make sure I aggregate information. So I got to give an electronic medical record and I like is so very business oriented. I didn't pause and ask him, what's important to you? What do you value what what do you cherish in this relationship as you use our facilities of cartilage and bones and orthopedic surgeon who has been a dear friend, he's since retired, think he lives in Palm Springs. Carl told me, I just want great nurses. I just want I just want an O r were great people function. And I thought you know what, the let me let me focus on building the talent. And so we pursued magnet certification and nursing Sheila, Emily's the chief nursing officer at the time, and we we had to let go a large number of very poor have let go of marginal players and only accept exceptional players. We paid for education, we created ladders, we create shared councils, the dots wanted a nominal talent around them. And what I wanted was loyalty to the organization. To that there was me support and, and, and coordination that that that issues that were of quality nature that the physicians would embrace. And they would recognize the importance of the reputation of the whole organization to the point where they're willing to, to engage in very hard decision making. Presbyterian Hospital Dallas, I think you may or may not recall, went through a horrible period, when one of the physicians accused the medical staff of collusion. And the the, it was eventually dismissed. But it pushed that medical staff to the edge because physicians give a lot and they're willing to commit to assess the quality of their colleagues. Those that back away from that. Yeah. My example of the throwing the scalpel in the art Well, there's a great podcast out there called Dr. Death, and the orthopedic neurosurgeon in DFW, wherever the physicians there are plenty of anesthesiologists and other neurosurgeons and surgeons that were aware of what was going on. But you know, only a few stood up and said not okay not on my watch not in this in this community and kudos to them. And some of them. I, I know them by name, I remember them coming talk to me in the, the, the waiting rooms or the doctor's dining rooms as things were evolving, so I kind of wandered on that one. But those are some of my thoughts.

D.J. Verret, MD, FACS :

When you made the commitments to improving and getting the doctors what they want, in the example, you gave the excellent nursing staff, the magnet status. Did you see that loyalty from the physicians as well?

Britt Berrett, PhD :

I did. I did. When I first got there, the surgeon comes into my office and says, You got to be kidding me. One pair of scrubs a day. I'm like, What are you talking about? He says, I am authorized for one pair of scrubs a day. I suppose that's me. That makes no sense to me whatsoever. So I walked out in the to the or, and bumped into one of the housekeepers. I said, What's the deal with scrubs? He says, Oh, yeah, yeah, we're very limited on those when you talking about so wouldn't talk to the director, environmental services, he goes, Oh, we're losing so much money on lost scrubs, that you know, we have to restrict one set of scrubs per surgeon per day and, and I've got this idea that we're going to have like a vending machine for scrubs, I went, you know, the scrubs cost me like you know, a buck. And I have a surgeon whose economic activity could create 10s of thousands if not hundreds of thousands of dollars. And we're spitting on a pair of scrubs. And so I immediately eliminate that restriction. But then, of course, I branded all my scrubs with the hospital name on it. So if you stole them, you're a walking billboard for me, but nonetheless, but I share that story because sometimes we get very myopic, in our day to day with the physicians realize that I was all about quality, and I was all about building a team around them. There was tremendous buy in and that's why you saw loyalty, and engagement and participation. And it's almost like this, this, this wave of collaboration. When I left medical city, we were one of the top 20 most profitable hospitals in the United States. Forbes magazine did an analysis and based on number parameters when the most profitable, hostile United States, we were the best place to work multiple years, we had received the state award for Malcolm Baldrige for quality. physician, recruitment is going through the roof we we invested $300 million in the campus. Look, the first thing we built on the campus actually was a child care center. And after that a parking garage and I told the staff, those are your two big pinch points, aren't they? Yeah, then we moved on to the critical care tower and the gentleman's tower. So I guess the point of sharing all those stories is, you need to understand what the medical staff needs, and then they respond. And so some of the great Doc's I got a chance to work with and very grateful for that experience. And I think a lot of people miss that whole integration idea where it's not just about the bottom line, but if you take care of all of the other pinch points that people have, the bottom line will flow through without much of an issue. True, so true. And in and also, you know, I watch great Doc's on, know how to say thank you. express appreciation, true appreciation. And sometimes it's as small as you know, I get a box of doughnuts, and I'm bringing them up to the floor to just say thank you, or, you know, participation in scholarships for nurses that we individually want to go to nursing school. It's the small, seemingly insignificant stuff that builds a culture and the great physicians get it and then when they retire, there is all not only sadness, to see them retire, but great joy for the time that they've been together and great organizations are able to do that. I think as we create integrated delivery systems, that will be demanded much more than it is right now. Right now we're we're pretty fragmented. But as we build these integrated delivery systems, the cherishing relationships and cherishing long term relationships will become very important.

D.J. Verret, MD, FACS :

When you look at I know you, you are viewing the integration, but right now, especially in the DFW area, we have a lot of independent physicians. Was there something that that seemed to be most difficult when dealing with the independent doctors?

Britt Berrett, PhD :

That's a tough question because my initial responses, when you deal with one physician, you deal with one physician. And then you say, Well, there are some commonalities among different specialties, right? We saw that in med school, right? I went to Wash U and St. Louis. And, you know, when you went through the ortho, you could see, you know that behavior and neuro that behavior. Pediatricians are, you know, you there's, there's that element to it every time you say that you're proven wrong, but one thing that I learned with working with doctors is extremely bright. And I found great joy when they were respectful of my expertise, as opposed to a suspicious, suspicious or, or uninteresting. So I found it was imperative to build trust to understand where we're coming from. The relationship is with an independent practitioner is being created because of this. And it gets back to the original conversation. Don't look on the wall for the, you know, there's one organization, their, their, their mission statement is, above all else, we're committed to care and improvement of human life in recognition of this commitment, we strive to provide high quality cost effective health care, sir, I like that. That's pretty fast.

D.J. Verret, MD, FACS :

Yeah, that was very fast.

Britt Berrett, PhD :

Yeah. Well, I could I, you know, more succinct is profit maximization.

D.J. Verret, MD, FACS :

It didn't sound heartfelt.

Britt Berrett, PhD :

It wasn't heartfelt. So understanding where people are coming from, but independent physicians have been independent for a reason. They like the autonomy, and to make their own decisions when you become part of their whole. You, you have to compromise on that. And sometimes it's very disturbing. I don't think you need to compromise on the quality of care, but you have to compromise on how you do things in a integrated delivery system. And that will be very difficult for the future. I think that's probably one of the biggest stumbling blocks is the loss of autonomy or perceived autonomy.

D.J. Verret, MD, FACS :

You mentioned a lot of things which actually could apply to this next question, but I'd like to throw it out there anyway. What advice would you give a CEO about dealing with doctors?

Britt Berrett, PhD :

My advice to hospital healthcare executives, CEOs cherish the relationship and recognize all the sacrifices that the physician is made to get to that point in time. Recognize, I think, I think the physicians, as we talk about hospitals, and nurses, and skilled nursing and assisted living, all the different elements and all the obligations and regulations. I think there's a wholesale assault on the medical profession. I think physicians are being demanded to change moreso than they have ever been in the history of the delivery of health care. They matriculate through education, they're led to believe that their healthcare experience professional experience is going to be x. And when they get there, it's not that way. Especially for those that are mid career where we're in the middle of a pandemic. And if you don't think healthcare is going to change, you're wrong. I mean, how many didn't want to do digital telehealth, and now they're required to, I mean, think about it, you you get your energy from interacting with people and you love the curative process. And, and all of a sudden, you're on zoom all day. This, this is a very difficult time. And so as hospital CEOs recognize and embrace that, respect that I think also the the I was sitting in a meeting once and we were talking about putting together a project and the CFO says, you know how you herd cats? We're talking about the disparate personalities and you know, your herd cats. And I said, Well, how do you herd cats? He goes, you move the food bowl. You know, he was jokingly say, doctors are all about money. And I looked at as a You're an idiot, that's not true. Is there that? Yes, no question. But I think for the great doctors, health care, funding the money is not is not the motivator. There are other things that you need to understand before you engage in a relationship with a physician. I think there's great value in exploring that.

D.J. Verret, MD, FACS :

We're talking with Dr. Britt Berrett, a clinical professor at the University of Texas at Dallas, about interactions between physicians and hospital administrators. We're going to take a quick break and after the break, I'm gonna ask Britt his top three pieces of advice. Welcome back to Ask Me MD, medical school for the real world. I'm Dr. D.J. Verret. And as we do with most of the end of our segment with our interviewees, I'm going to ask Dr. Britt Berrett about his top three things he would tell a doctor, but couldn't when you are on the job as a hospital administrator, I'm going to kind of put you on the spot there. But

Britt Berrett, PhD :

You know, my initial reaction is, the first thing I tell them is shut up.

D.J. Verret, MD, FACS :

And very fair, very, very often, I would even tell them that a lot of times,

Britt Berrett, PhD :

I would, I would admit, there are days when you just kind of go, Oh, come on, are you kidding me. Um, and then I take a big deep breath and all and I'd say, um, help me understand where you're coming from. Help me understand where you're coming from, I think it's imperative and my counsel to physicians and health care, understand yourself and understand where the individuals coming from. Once you do that, it becomes illuminating I, as I mentioned, previously, I worked with a health care system and the medical staff was in complete uproar. And the healthcare executives had really made some some poor choices and decisions. And so I brought in some health care coaches for physicians. And what that did was it was an executive who could help facilitate a conversation between key physician leaders and administration. And I gotta tell you today, it was invaluable, it was probably the best money I've ever spent on building rapport, because you sometimes need to be coached through these relationships. These are all new things. People say, Well, I don't meet, you know, coaching, I don't meet Well, I'm not so sure, I think we are in turbulent times. And the the ground keeps on shifting. So things that we assumed worked in the past, aren't going to work into the future, demanding that you're the captain of the ship. That's just not going to work anymore. Collaboration is too intense and too imperative. So understanding yourself understanding where you're coming, where others are coming from, and then looking for support and assistance, a coach, a group of individuals, these podcasts, I, I can't help but think that if you're driving along, listen to this podcast, some ideas are coming to mind going, Yeah, I need to think about that. And I would engage in a conversation with colleagues and friends and say, you know, this is where I'm coming from, this is what I'm thinking, what are your thoughts? Um, I like the idea of coaching. I had a friend, he, he called the guy office executive, and he said, I want you to be my coach. And the guy said, I'm very expensive. And says, Well, I need a I need a coach, to give me advice. Now, the individual was the guy who was asking for the help was young and an entrepreneur and the guy he was asking was a fluent and successful, he goes, Okay, what's going to cost you 10 grand? And there's like this pause. And my friend, the entrepreneur said, Ah, what can we do about this as well, it's 10 grand, every time you visit with me, you have to pay me 10 grand. And he's a, okay, he valued that much. So he would call them up, and they would actually have a series of conversations for that 10 grand, and the coach would take the 10 grand, and he would donate it to a charity in the name of the individual he needed. He didn't need the money. But he wanted to make sure that this entrepreneur was serious that this is Yeah, valued. It wasn't as casual who What do you think he was, he was actually paying money to get counsel advice. And so he was taking copious notes. And he was returning and reporting. He laughs about it. Now he says, you know, after about the, you know, after what I was into is about 50 grand. He said, Yeah, I can see you're serious. All that money's been donated to X, Y, and Z. And, you know, in the future, we'll, you know, we'll continue to have this relationship. There's a you know, you've got to value that Council. So not only reach out to your friends, your colleagues, but commit resources, value, that kind of input. And that's interesting story.

D.J. Verret, MD, FACS :

Yeah, that is a very interesting story. Well, Britt is always a really appreciate the time. Lots I would hope as you mentioned, that people came away with a lot of good things to think about. I know I actually learned some some tidbits along the way today as well. Thanks again for coming.

Britt Berrett, PhD :

I'm grateful to be here today. And thank you for your work on this. I think this podcast is an opportunity to open up the conversation now here's an offer to those that Listen, I'm at the University of Texas at Dallas. And, and I welcome a call. If you'd like to visit I'm there is a demand and the need for great minds to start collaborating and coordinating. I know your your podcast is local, national and international. When we wrote this book patients come second. It's gone. I mean, it's not as I mentioned, a new New York Times bestseller. I'm being given the opportunity to talk with people across the world, now worked in Saudi Arabia, worked in Korea, went to the Korean Hospital Association and spoke there. There are a lot of great people that embrace what you've described and the the tenants of what you believe. We just need to make sure that our voices are heard and we collaborate to support one another. So I offer that I'm at the Jindal School of Management Center healthcare leadership management at the University of Texas at Dallas. So I welcome that connection.

D.J. Verret, MD, FACS :

Thanks again, Britt. You're listening to Ask MD, medical school for the real world. I'm Dr. D.J. Verret. And until next week, make it an awesome week.

Announcer :

Thank you for joining us for another episode of Ask Me MD, medical school for the real world with Dr. D.J. Verret. If you have a question or an idea for a show, send us an email at questions at ask me Md podcast.com.

Introduction
Interview
Britt Berrett, PhD Background
What would you tell a physician about a hospital administrator that we wouldn't know?
What advice would you give independent physicians and employed physicians about working with hospital administrators?
If you could do over, what would you have changed in how you dealt with physicians?
What was most difficult in dealing with independent physicians?
What advice would you give a hospital administrator about dealing with doctors?
What are the top three things you wanted to tell a doctor but couldn't as a hospital administrator?
Britt's invitation