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Support network depends on position.

A physician executive moving into a now management position will need to consider at an early point the psychological and emotional support systems that will be available or that can be constructed. Because most career moves are upward, where there are fewer peers and fewer steps to the top of the hiaorarchical adder, these support systems must be created f rom a decreasing pool of people. Ronald P. Kaufman, MD, FACPE, Vice President for Health Sciences, University of South Florida Medical Center, Tampa, has made two career moves in which support systems played key roles. Physician Executive interviewed Dr. Kaufman on his experiences with support networking.

A move to a new position in a new organization is exciting and fraught with promise. If the decision has been made on the basis of sound judgment and good information, the job itself is an opportunity to extend knowledge and skills and take on new challenges. Whether the move is lateral or upward, if the decision is solidly based, there will be professional growth. Even when the move is made from a position that has soured, these positive elements should be in place. Regardless of the old position, the new one should represent renewal and extension in a career. But career moves are also fraught with peril. In most cases, a network of professional friends and colleagues are being left behind. The value of these networks cannot be overestimated. One's peers and colleagues are sources of psychological and emotional support. Ideas can be tested with them well before implementation or even public presentation. The result can be more successful implementation and fewer mistakes. Networks are also places to vent anger and frustration and to gain encouragement in the resolution of personal or professional crises. When issues of vulnerability and threat are absent, networks can be immensely positive mechanisms for any manager.

Obviously, a new network has to be found in a new position. And it will have to be constructed from scratch. The departed manager's network cannot be merely assumed. Critical parts of it will not even be available to the new manager. Networks, because they are built on trust and confidentiality, are very personal. They cannot be handled as if they were commodities. Dr. Kaufman remembers his move from Hartford (Conn.) Hospital, where he was director of medical education, to George Washington University Medical Center, where he was medical director. Building a network in his new position was very natural, he says. "I became collegial with people on the medical staff, the faculty, and adminstration because I wasn't threatening to them. I wasn't the boss. They could talk to me. They got to know me as a physician and as a human being."

A move to a top-level position is very different, in Dr. Kaufman's view. In his current position, he says, there was almost zero network. But he suspects that other physician executives who have moved to top-level positions in organizations may feel the same networking loss that he has experienced. "I realm at some point in my new position that, as the top medical professional, I had no network," Dr. Kaufman says. "But it has dawned on me that others like me-medical directors, vice presidents of medical affairs, and other top medical management positions-who have moved to their positions from the outside probably face the same loss. How does one establish networks? How can they succeed? Do they lock themselves in their offices? Whom do they talk to and how do they establish credibility?"

Dr, Kaufman had risen to vice president of medical affairs and executive dean at George Washington University Medical Center, after serving in a number of increasingly responsible roles over the 17 years he was with the organization. "The networking was almost unconscious. I learned a lot about management, because there were a lot of people who were willing to help me. I think that a majority of the members of the medical staff there believed that their best interests and mine coincided. We were trying to build a high-class hospital together. Part of my credibility was that I had been one of them."

Part of his success at George Washington University Medical Center is owed to the organization chart, Dr. Kaufman admits. Because he came in at the bottom of the medical management chart for the institution, each of his steps to higher responsibility and authority were cushioned by the networks that he brought with him. It made it easier for him to test new initiatives, and it gave him credibility when controversial moves had to be made. In one promotion, his predecessor had implemented a highly controversial faculty practice plan. "It was fought bitterly, and vestiges of the bitterness remained when I moved up. The practice plan still was anathema to some medical staff members, but they believed they could work with me. And we did work together."

The difference between his career at George Washington University Medical Center and his position at the University of South Florida Medical Center is just that, Dr. Kaufman says. "I grew into the top position at GWU. I was appointed to my position at USF. Over time, I recruited a number of the physicians at GWU. Even in hard times, there was a nucleus of people who, even if they didn't agree with me, would come and counsel me and share their points of view. They would pledge to support me even if they disagreed or would warn me that they would oppose me. In short, I had a network of work colleagues that worked to my and the organization's advantage."

Dr. Kaufman admits that he didn't realize the value of the network at George Washington University Medical Center until he found himself without one at the University of South Florida. "It was amazing how much information I received in very casual conversations with members of the GWU medical staff. Just as important, the arrangement allowed me to send messages to the network. It was a good working relationship."

Dr. Kaufman says that it is important to understand that the University of South Florida and its medical school are very young, the latter just 19 years old. Many of the faculty and administration were present at or near the founding. He also says that he was hired at a time when the medical center had decided that it needed to move from a very decentralized management to a highly centralized system. "I moved to the top when the need for change had been acknowledged by the university administration. The decent" approach simply wouldn't work in a time of increasingly scarce resources. There was too much duplication under it."

So," Dr. Kaufman says, "I joined the organization at the top at a time when control had to be centralized and faced a network of which I just wasn't a part. And I was charged with asking these people to accommodate some substantial changes. We have made many of the necessary changes, and there are more that will have to be accomplished, but it has been a bruising battle for the most part. I'm sure that there are reasons for this beyond my inability to establish rapport with key people and develop a supportive network, but I believe the absence of a network has been the major cause."

Formal meetings just aren't suited to the development of the atmosphere that he believes is essential, Dr. Kaufman says. "You can chew up an hour or two in a meeting just doing bureaucratic work the agenda, voting, etc. Most of the work has already been done in committees. You discuss a package, vote on it, move to the next item, and continue to adjournment. Then everybody disappears."

Dr. Kaufman laughs about "loneliness at the top." But that is an apt term for what he describes. The question, he says, is "How can that loneliness be eased by someone coming into the top from the outside? How can an effective support network be developed effectively in a new environment for the top-level executive?" One of the answers that he has developed in response to the difficulties in his present position is a return to past experiences. He says that he took previous networking too much for granted. Because he grew into positions, he wasn't consciously aware of the networking and its value to him and the institution. "Reaching out and finding contacts and developing the rapport and trust that are essential to successful networking must be done consciously and overtly," he says. He quickly adds that he doesn't suggest that the effort be reduced to "glad-handing." It needs to be sincere, he says.

Of course, good relationships have been forged with key members of the University of South Florida Medical Center administrative staff and with the top administration of the university. Many of the working rules were effective at George Washington University Medical Center have proved to be just as useful at the University of South Florida. The hitch, he says, has been with the medical staff.

Dr. Kaufman believes that more and more physicians are going to face this problem as they move to higher and more responsible positions in health care organizations and as the system becomes more competitive and resource conscious. "There is no way for the physician executive or the organization to succeed in the absence of a cooperative relationship among the major players. The executive and the medical staff have to work together if progress of any kind is to be made. So they have to be able to talk to one another. That means networking to me. I think that networking has to start with family and friends. They can give you the strength to deal with work situations. Then you have to keep adding to the network as the need arises. Building trust and solving problems. It won't be easy. I've found that out here at USF. But it will be necessary. If anyone has guidelines on how to get it started, I'll be part of their network." 13
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Title Annotation:interview of Ronald P. Kaufman of University of South Florida Medical Center
Author:Curry, Wesley
Publication:Physician Executive
Article Type:Cover Story
Date:Nov 1, 1990
Previous Article:Dear Boss.
Next Article:A tale of two systems: a personal account of a successful consolidation.

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