Case Studies

Client
A large primary care group practice.

Problem
Many physicians new to the practice were dissatisfied with the financial terms that were negotiated when the practice was formed (a year prior to their joining it). The conflict threatened to force the dissolution of this otherwise successful group practice.

HCNA Interventions
Interviewed practice members and performed a financial analysis of the company.

Helped members distinguish between short- and long-term rewards and how different members within the practice would benefit from their individual investments at different times.

Assisted in restructuring the practice’s organizational and financial agreements.

Built consensus within the practice to achieve real buy-in to the new organizational structure and financial terms.

Results
The group practice has continued to expand the size of the group and to accumulate capital to fund future growth.

Because of the process, the newer members gained an appreciation of the value of the older member’s investment in building the practice.

Client
A newly integrated health system.

Problem
A state university medical school teaching hospital merged with a large community teaching hospital. HCNA was contacted to assist in the integration of some of the clinical departments.

HCNA Interventions
Worked with the leadership of the medical school, the Board of the new organization, and the CEO of the newly formed corporate organization.

Defined the major differences in the corporate cultures and developed the parameters for integration of some of the major clinical departments.

Collaborated with the Chiefs of Service from both institutions to conduct financial analyses.

Negotiated the departmental specifics about the leadership, structure, unification of professional compensation and benefits.

Built consensus within the departments moving forward with consolidation of departments.

Results
By identifying the significant differences in the corporate cultures of the merged organizations, HCNA helped some of the groups move forward with integration.

The integration of these departments had a positive impact on the overall organization and encouraged other groups to begin discussions.

Client
A community hospital.

Problem
The hospital needed assistance in assessing whether its financially troubled Behavioral Health program should be maintained, closed, or negotiated for outside management.

HCNA Interventions
Conducted a comprehensive on-site assessment of the Behavioral Health program.

Prepared a comprehensive report detailing the alternatives and their consequences for the hospital to consider.

After considering all the options, the client requested that HCNA provide interim management of the program.

While the hospital recruited for a new program manager, HCNA implemented changes to enable the program to function more efficiently and cost effectively.

HCNA identified the need to improve communications between fiscal services and the program providers, to improve employee morale and build team functioning.

Results
Administration has made a demonstrable commitment to maintain the program with significant management changes.

A new manager has been hired and the clinical providers are more informed about the financial issues that imperiled the program and the hospital.

Physicians are working more collaboratively to solve some of the problems.

HCNA is facilitating meetings between the administration and the physicians to help identify new options for physician compensation.

Client
A large health system.

Problem
Several members of a high volume, clinical division within this large health system made a financial investment in a for-profit specialty hospital. The hospital responded in an effort to maintain its competitive position which the physicians viewed as overly aggressive. After about a year of actions and reactions, the dispute escalated into a climate of distrust and conflict.

HCNA was asked by medical staff leadership to mediate between the clinicians and the hospital administration.

HCNA Interventions
Conducted a series of telephone interviews with several of the clinicians involved. The physicians felt a need to tell their stories to put current problems into a historical perspective.

Organized a process through which the clinical division was able to comply with a directive from the Medical Executive Committee.

Facilitated meetings to help the division and the administration work through the episodic conflicts to re-establish a more effective model of working together.

HCNA continues to provide on-going coaching to senior administration and divisional leadership.

Results
There is now increased hospital support for the clinical division and an improved understanding of each party’s needs and expectations.

Both parties are now making a concerted effort to work collaboratively to implement strategic initiatives.

Client
A community hospital

Problem
The Chairman of the Board and the CEO were unable to work together effectively in the best interests of the organization. Board counsel requested HCNA assistance to mediate the issue on their behalf.

HCNA Interventions
Interviewed the CEO and the Board Chair, as well as other members of the Board and the medical staff leadership, to assess and define the issues.

Facilitated a series of weekly two-hour meetings with the CEO and Board Chair and gave them assignments to work towards consensus between the meetings.

Results
After the series of meetings, the Board Chair completed his term of office, chose not to stand for election again, and resigned his seat on the Board.

The CEO remained in his role and asked HCNA to return to the hospital to help resolve another issue.

Client
A community hospital.

Problem
The Vice President Medical Affairs asked HCNA to work with a physician to provide “coaching” to modify the disruptive behavior of a high-volume surgical sub-specialist who was creating problems in the operating room and throughout the hospital.

HCNA Interventions
Conducted interviews with the department chief, the surgeon, and other key members of the organization.

Held a number of coaching and training sessions with the sub-specialist.

Results
The sub-specialist gained a better understanding of the role of administration and began to try to work with them rather than at cross-purposes.

The operating room staff and others throughout the hospital perceived a significant change in the sub-specialist’s behavior.

Client
A small community hospital in the midst of organizational change.

Problem
The hospital recently converted from a municipal organization to a private not-for-profit organization. Several issues needed to be addressed: Board restructuring, redesign of the CEO role, and a search for a new CEO.

HCNA Interventions
Conducted a series of structured interviews with the board leadership as well as community leaders and members of administration to identify the strength, weaknesses, and organizational priorities.

Facilitated a Board retreat during which consensus was reached on a plan for restructuring the Board as well as the role of the CEO.

Collaborated with the executive search firm to recruit the new CEO.

Results
With HCNA assistance, the Board recognized its need to become better educated about the fiduciary duties of a not-for-profit Board and created a new Board development plan.

A new CEO has been hired and HCNA subsequently facilitated a retreat with the new CEO, the restructured Board, and the medical staff leadership.

Health Care Negotiation Associates, Copyright (C).