OAKWOOD HEALTHCARE SUCCESS STORY - HOW THE 7 HABITS® TRAINING HELPED CONTROL COSTS, IMPROVE CARE, AND BUILD TRUST BETWEEN PHYSICIANS AND ADMINISTRATORS

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Executive Summary
How healthcare organizations respond to industry reform is critical to their success. With third-party payers restricting the money healthcare providers can spend on patient care, doctors and administrators at Oakwood Healthcare System in Dearborn, Michigan, were placed in adversarial roles. This case study examines how Oakwood:

• Responded to the lack of trust, cooperation, and communication between physicians and administrators to meet future healthcare needs
• Implemented a four-phase leadership training approach-including FranklinCovey training-that helped physicians assess challenges, recommend solutions, and lead the process for implementing those recommendations
• Increased teamwork, reduced medical supply inventories, controlled costs, and improved patient care through principle-centered behavior

Healthcare Reform Demands Trust and Teamwork
In 1996, Oakwood Healthcare System launched a two-year reengineering process to reconfigure its expansive healthcare delivery organization to meet the needs of the new millennium. Oakwood consists of six hospitals and 30 clinics and employs a staff of 8,000 along with 1,100 affiliated physicians.

But according to Dr. Ron Larson, a physician and Executive Vice President of Medical Affairs, the reengineering process offered no real solution for developing personal leadership skills. Then members of the reengineering steering committee experienced The 7 Habits of Highly Effective People® public workshop. They recognized how bringing the training in house could foster trust and teamwork at all levels of the organization, particularly between physicians and administrators.

Turning the Expertise Inward
Oakwood's reengineering effort encompassed four specific areas: leadership, managed care, integrated systems, and healthcare finance. Senior management mandated that the organization identify and prepare 70 physicians to assume key leadership roles within the Oakwood system. They knew that without the involvement and representation of physicians, Oakwood would not be able to maintain its competitive position and create future growth.

"Thriving within the turbulence of healthcare reform is all predicated on developing trust," said Larson. "In the past, relationships between physicians and Oakwood administrators were nonexistent." Internist and steering committee member Dr. Elaine Atallah added, "Restricted third-party payments placed physicians and administrators in adversarial roles. We were experiencing vulnerability, uncertainty, loss of control, and a lack of shared vision and strategy."

Dr. Tim Love of Oakwood's Critical Care Medicine Service echoed these concerns: "We worried about low trust levels. You have administration and you have the medical staff. While administration owns the resources, the medical staff is responsible for 80 percent of expenses. The need to form a partnership between administrators and physicians was paramount in order to control costs and improve quality at the same time."

With the help of FranklinCovey, Oakwood structured a Physician Education and Leadership Program (PELP) to help prepare physicians for leadership roles. FranklinCovey coordinated the teaching of the managed care, integrated systems, and healthcare finance modules with university-level consultant specialists in these respective areas. The leadership component, based on The 7 Habits of Highly Effective People® workshop and elements of First Things First® (now FOCUS: Achieving Your Highest Priorities) and Principle-Centered Leadership® (now The 4 Roles of Leadership®) workshops, served as the foundation for training in the other three areas.

A Four-Phase Approach to Partnership
The plan to build a partnership between administrators and physicians was implemented through a four-phase approach: 1. Kickoff Meeting; 2. The 7 Habits of Highly Effective People® workshop; 3. The 7 Habits Renewal and First Things First® workshops; and 4. Principle-Centered Leadership workshop.

Phase 1: Kickoff Meeting
Seventy selected physicians, along with nursing leaders and Oakwood administrators and top executives, attended the kickoff-a celebration of Oakwood's commitment to physicians and the physicians' commitment to Oakwood. FranklinCovey facilitators explained the structure of PELP, how it would relate to the physicians personally and professionally, and committed them to make a serious effort to apply what they would learn so that change could occur.

Importantly, facilitators explained the 7 Habits Effectiveness Benchmark, a preworkshop peer profile the physicians would use to seek the insight and feedback of close associates in order to design a personal improvement plan. The profile served as a benchmarking tool to measure the effectiveness of the 7 Habits training. Physicians also received a copy of The 7 Habits of Highly Effective People book by Stephen R. Covey and The 7 HabitsTM audio learning system. This opportunity for participants to become familiar with the 7 Habits materials instilled a basic understanding of the 7 Habits concepts and prepared participants for a meaningful, hands-on workshop experience.

Phase 2: The 7 Habits of Highly Effective People® Workshop

Three FranklinCovey facilitators presented simultaneous workshops of the 7 Habits, consisting of 20 to 25 participants each. The focus was on physicians' personal and professional leadership. Participants engaged in the mission statement process received a physician-customized Franklin PlannerTM, and were given Oakwood-specific case studies on organizational issues, such as manpower planning and clinical pathways (treatment modalities or best practices).

In the past, administrators had sought physician input on issues affecting Oakwood, but many doctors were either too busy to respond or felt their ideas wouldn't be valued. However, through the 7 Habits workshop experience, physicians were asked to work on solutions to challenges, communicate those recommendations, and lead the process for implementing their recommendations. The heightened trust and improved communication and synergy between physicians, nursing, and administration as a result of this process were remarkable. The work on treatment modalities alone helped Oakwood dramatically reduce medical supply inventories because of more uniform methods of treatment among physicians.

Each participant left the 7 Habits workshop with a copy of the First Things First book and the associated audiotape series as postwork for Phase 2 and prework for Phase 3.

Phase 3: 7 Habits Renewal and First Things First
One of the hallmarks of FranklinCovey workshops is the Empowered Learning ModelTM (ELM) process, which is designed to improve performance. In a nutshell, ELM is not a quick-fix, one-time training event, but rather a process of preparation, participation, and performance measurement. Phase 1, with its peer profile and preworkshop preparation, and the Phase 2 hands-on 7 Habits workshop, were devoted to the first two ELM steps. The third step, performance, is about putting learned principles into action, which impacts the return on training investment.

Phase 3 served as a renewal of the 7 Habits, with emphasis on mission statement and the time-management principle, Habit 3: Put First Things First® (What Matters Most® workshop). The bulk of this phase was performed outside the classroom setting. Participants focused on performance, working through First Things First principles and completing assignments-looking for all the ways they can apply these principles within the Oakwood system. The self-paced video and homework helped them prepare for Phase 4.

Phase 4: Principle-Centered Leadership
In this phase, participants focused on the Organizational Effectiveness CycleTM process. This process helped empower them to effect change in their personal lives, their teams, and, finally, within the larger Oakwood system. The objective was to have participants exit this phase with the knowledge and skills to solve their challenges more effectively by becoming organizational practitioners.

Dr. Larson explained that by incorporating the 7 Habits, First Things First, and Principle-Centered Leadership into the larger PELP program, Oakwood was able to bring physicians, management, and staff closer together in a quick, concentrated fashion.

He said, "Identifying case scenarios and commissioning physicians and other training participants to help us resolve these issues has resulted in improvements beyond what we imagined. The whole 7 Habits process began at a very personal level that reached beyond the workplace to family life. Living the 7 Habits on and off the job brought about such a positive change that we were collaborating and providing solutions together instead of being confrontational."

Dr. Larson added, "As an outgrowth of principle-centered behavior and stronger relationships, we're better positioned to control costs, improve patient care, and succeed in the turbulent managed-care environment."

Real Results and the Road Ahead

As a result of the 7 Habits training, issues that Oakwood had been struggling with for years are being resolved. The organization has since trained 15 in-house facilitators to share these principles of effectiveness with hundreds more physicians, nurses, and administrators. According to Dr. Larson, Oakwood has seen the following benefits:

• Increased physician involvement with management concerning quality care issues in the managed care environment
• Heightened trust between physicians, administrators, hospital and clinic staff, and third-party payer organizations
• Improved personal leadership, empathic listening skills, and other core competencies among physicians
• A new Oakwood culture based on shared values that enhances the ability of physicians and staff to meet the challenges of the new business of medicine

Dr. Larson concluded, "With healthcare reform, we must have an attitude of teamwork in every situation. At Oakwood, we've taken ownership of our problems by making changes. The outcome is collaboration instead of confrontation, deeper understanding, shared values, stronger relationships, synergy, and higher trust. And, ultimately, vastly improved patient care through applying the 7 Habits."