Question: Recently, the Hospital’s CEO and the Emergency Department Nurse Management have been totally consumed by their disappointment with the ED’s key performance metrics. As Emergency Department Medical Director (EDMD) and President of the Emergency Medicine Practice, I want to help achieve the needed improvements and have some ideas about what needs to be done. But my partners and I are concerned that our group might become a scapegoat in the process. What do you advise?

Answer: If they’ve not already done so, administration is likely to begin searching for advice on achieving the desired performance improvement. That means searching online and calling fellow CEO’s to find a consultant to conduct an assessment and recommend organizational and operational changes.

Why CEO’s Use Consultants

Most administrators genuinely value an outside perspective. Even if they believe they know what the problems are, most feel that a new set of eyes is the best way to gain insight on the resolution of those difficulties. They may want a better understanding of the key contributors to those identified problems or believe they need the assistance of someone’s who has successfully resolved these issues elsewhere.

In some cases, a CEO just wants confirmation of their existing conclusions and intentions. They’re looking for reassurance or they need validation (some call it cover) for actions they’ve already planning.

Divining your CEO’s intentions is you next challenge. Doing so correctly is critical; it requires both very discreet intelligence gathering and an objective (and potentially painful) evaluation of your performance. Start with a careful review of your relationship with the hospital’s senior leadership team and the nurse management in the ED. Has anything changed in recent months—fewer contacts, less communication, etc.?

Evaluating Your Options

If you conclude that your situation is perilous, that the group is likely to be identified as the weak link, you may want to initiate an all out effort to salvage the contract. That usually means calling in all the favors with key medical staff and board members, hoping that will be enough to force administration to back down. Be advised, however, that such a strategy is rarely long-term. If administration is determined to get you, they usually do!

Take Initiative

If you’d rather not go to war or if you conclude you don’t need to but would rather not just wait for the scenario to unfold, there is another alternative. You and your colleagues can seize the initiative. Surprise administration by being the one to suggest the retention of a consultant to conduct an assessment. Do your own research and have a firm you can recommend to do the job. And here’s the real surprise…offer to pay for part of it!

Doing the unexpected creates cognitive dissonance. If things are really bad, such a disruption in administration’s presumptions could be enough to change their entire perspective. In either event, by taking the lead, you’ll signal to administration that you have the insight and initiative to play an active role in finding a solution.

If you’re concerned that administration might not go for it or has already retained a firm, hire your own consultant. If you have to put a fight, having committed the time and expense to conduct an objective assessment of the ED’s performance could be very effective in securing support of key medical staff and board members.

Finish What You Start

But like other endeavors, don’t start this process unless you’re prepared to finish it. Be diligent in your research. Make sure your suggestions and recommendations are sound. Be certain that the consultant you chose is as well respected by other hospital executives, as they are by fellow physicians. When you’re investigating different firms, be sure to ask for both physician and CEO references.

And be prepared to make a major investment—consultants with a proven track record don’t come cheap. Daily rates can exceed three, four, even five thousand dollars per consultant! A typical assessment project can run into the mid five figures and the implementation of recommended changes can be two or three times that amount.

For many single campus emergency groups, that kind of money can be a real issue. So you’ve got to decide what keeping the contract is worth and evaluate the cost of losing it.