Giving PEARLS

BIG MEDICINE is having a problem getting their doctors engaged and realigned and being learning organizations. BIG DEVICE, BIG DIGITAL HEALTH and BIG PHARMA are have the same problems given recent changes in how they have to do business because of regulatory and market forces.

In short, both need a new way to give PEARLS-Physician Engagement and Realignment Learning Systems, and I don't mean clinical pearls during rounds.

Here are some ways to engage employed doctors:

1. Create a culture of trust and caring, not rules

2. Give doers the tools they need to improve

3. Coach them daily

4. Give doers the internal and external incentives they need to improve

5. Recognize that it's not all about you. Most doctors feel ignored when it comes to innovation and change strategies.

6. Use expectancy theory to reward i.e. a proximate relationship between success and reward shortly afterwards with something the doctor values

7. Stress self-performance and measurement against a standard

8. Be fair

9. Be transparent

10. Fix the system that creates errors, not people.

11. Put us both out of our misery and help me find another place to work 

12. Clarify expectations. Do you want me to innovate or not?

13. Lead by example

14. Stop wasting time on the 77% who are disengaged. Focus on the 13% instead

15. Create a product I can believe in instead of sell and deliver using dysfunctional systems.

16. Stop subjecting them to needless administrivia and IT mandates

17. Create care teams so everyone can practice at the top their license and add maximum value.

18. Recruit for innovation

19. Focus on user/customer/patient/payer defined value instead of engaging in turf wars with advance practice professionals

20. Practice Othercare

We need to recognize that biomedical innovation and entrepreneurship is a separate academic and practical discipline that intersects with all parts of research, development and care delivery. Consequently, practicing the discipline takes discipline.

Saying, though, is one thing. Doing is another. In order to execute on these ideas, organizations need a structure, process and systems to make it happen. PEARLS can fill the gaps in physician knowledge, skills and abilities, create alignment between the values of the organization and that of the employees and systematize organizational learning.

The Five Disciplines of organizational learning as published in The Dance of Change The challenges to sustaining momentum in a learning organization are presented below. Each of the following five disciplines represents a lifelong body of study and practice for individuals and teams in organizations.

1. Personal Mastery

This discipline of aspiration involves formulating a coherent picture of the results people most desire to gain as individuals (the personal vision), alongside a realistic assessment of the current state of their lives today (the current reality). 

Learning to cultivate the tension between vision and reality, represented in this icon by the rubber band, can expand people's capacity to make better choices, and to achieve more of the results that they have chosen.

2. Mental Models

This discipline of reflection and inquiry skills is focused around developing awareness of the attitudes and perceptions that influence thought and interaction. By continually reflecting upon, talking about, and reconsidering these internal pictures of the world, people can gain more capability in governing their actions and decisions. Here is the difference between the clinical and entrepreneurial mindset.

The icon here portrays one of the more powerful principles of this discipline, the ladder of inference depicting how people leap instantly to counterproductive conclusions and assumptions.

3. Shared Vision

This collective discipline establishes a focus on mutual purpose. People learn to nourish a sense of commitment in a group or organization by developing shared images of the future they seek to create (symbolized by the eye), and the principles and guiding practices by which they hope to get there. 

4. Team Learning

This is a discipline of group interaction. Through techniques like dialogue and skillful discussion, teams transform their collective thinking, learning to mobilize their energies and ability greater than the sum of individual members' talents. The icon symbolizes the natural alignment of a learning-oriented team as the flight of a flock of birds.

5. Systems Thinking

In this discipline, people learn to better understand interdependency and change, and thereby to deal more effectively with the forces that shape the consequences of our actions. Systems thinking is based upon a growing body of theory about the behavior of feedback and complexity-the innate tendencies of a system that lead to growth or stability over time. Tools and techniques such as systems archetypes and various types of learning labs and simulations help people see how to change systems more effectively, and how to act more in tune with the larger processes of the natural and economic world. The circle in this icon represents the fundamental building block of all systems: the circular feedback loop underlying all growing and limiting processes in nature.

PEARLS are platforms that can be automated, personalized and developed based on organizational and individual needs. Now that's a great pearl that I'm sure will be a board question.

Arlen Meyers, MD is the President and CEO of the Society of Physician Entrepreneurs