Relationship Building Blocks and the New Era of Healthcare

The main message is that approaching relationships in a structured manner, keeping these key concepts in mind, will lead to a stronger, more secure future in this highly complex healthcare world we find ourselves in today.

If civilization is to survive, we must cultivate the science of human relationships—the ability of all peoples, of all kinds, to live together, in the same world at peace. —Franklin D. Roosevelt

We keep hearing about how complex the current and future healthcare system is in the United States. Technology is driving us crazy. We have to look at changing everything that we have. We have to know how much it costs to see a patient. We will lose fee-for-service income. One thing hasn’t changed and actually needs to become a major focus of the future: our relationship with our fellow human beings!

Every day we talk with our patients, staff members, other providers, vendors, and so many more individuals. In some way, all of these are “customers”; but more to the point, we relate to them in some way all the time. The technical aspect of the world, with the Internet, blogs, e-mail, social media, etc., takes away some of the personal, face-to-face time that existed in the past. However, there is still a relationship between the one who sends a message and the one who receives it.

These relationships, personal and technological, require “work” to develop, maintain, and enhance. Several years ago, an article was published suggesting that there are keys in building relationships. 1

These keys will ensure success in personal as well as in business. Figure 1 reflects the basic concept noted in the article but modified here to ensure focus on the long-term relationships that you have.

Figure 1. Relationship building blocks.

• Social Bonds

• Mutual Goals

• Power/Dependence

• Structural Bond

• Communication

• Consistency

• Compare Alternatives

All of these bullets above flow into TRUSTTRUST flows into Commitment, Compliance, Communication

Essentially, a strong relationship is built on trust. If you can’t trust someone, how can you have a long-term relationship? How you build that trust is key to achieving commitment, compliance, and cooperation. These three “C’s” represent the desired outcome.

SOCIAL BONDS

The icebreaker in building a relationship is getting to know each other socially. This means to ask questions about the other person’s family, interests, hobbies, etc.— “How many children do you have?” “Where did you go to school?” “Do you like sports?” and so on. It is also necessary to observe the type of clothing worn, and if in an office, to look at pictures and paraphernalia on the wall or desk that will further the conversation. This social bonding can then help with the next encounter. The provider can ask a lot of questions, but so can the front desk staff and triage team. Note these social items on the patient’s chart to help everyone in the office get to know the patient better. As a provider, if you are visiting the hospital CEO in his or her office, pay attention to what is on the desk or the wall, which will help with the next conversation.

The message here is to gain an understanding of who the individual is so you can personalize things as much as possible to set a positive tone for the relationship.

MUTUAL GOALS

Why have a relationship with someone if you don’t know what is important to that person, what he or she expects from the relationship, or his or her own personal goals? There is a purpose in all relationships based upon the expectation or goals that are part and parcel of why the relationship exists in the first place. In a provider-patient relationship, the mutual goal might be for the patient to get well or at the very least have an improved quality of life. In a sales relationship (for example, when a patient needs surgery and there is a sell required!), the mutual goal would be to reach agreement on the price, service, etc. of a particular item.

The message here is to understand what the other person has in mind but also to know what you expect from the relationship, and that the two sides are complementary and consistent with each other.

POWER/DEPENDENCE

Like it or not, there is not only a “mutual” aspect but there is a power position as well in any relationship. One of the individuals involved is in control most of the time. In the provider-patient relationship, who has the power? Often it is the provider who is leading the Q & A portion of the visit and instructing the patient what needs to be done to achieve the mutual goal of the patient getting well. However, the patient may be in the power position when it comes time to talking about his or her needs initially or in complying with the proposed care plan. The power position does suggest there is one dependent on the other. The new employee is dependent upon his or her mentor to learn, but later the mentor/supervisor is dependent upon the employee to perform his or her assigned duties. This is not a negative context; instead, it is acceptance of reality. However, if the power or dependence becomes too dominant, the context turns negative, and the relationship is destined for failure.

**There is structure in the very nature of the provider- patient relationship.

**The message here is to be aware of the dynamic of power and dependence. In many instances, it is beneficial, but it can also be detrimental if taken to extremes.

STRUCTURAL BOND

Any organization has a structure. Whether or not it is written as an organizational chart, it does exist. This formal approach to a relationship is necessary to ensure that everyone knows where they fit in and how they work with others, and to continuously fulfill the organization’s mission. There is also structure in the very nature of the provider-patient relationship, with the provider the presumed leader.

However, keep in mind that there are informal relationships that may not be structured in a technical sense but can be just as powerful and impactful as a formal structured one, such as when there is a non-appointed leader who has followers in an organization. These individuals may lead to negative issues as well as positive, especially as they relate to the relationships you have with others. Awareness of these informal relationships is key in establishing and maintaining your pathway.

The message here is to recognize the importance of the formal structure and that there is another aspect of a relationship that involves an informal component.

COMMUNICATION

Enough said! Well, not really. None of the aspects of the relationship are possible without effective communication. There is a sender of the message and a receiver, a talker and a listener! Listening is an art that is not always done well and requires focus. Beyond the obvious verbal communication is the nonverbal or body language message. Asking questions of a patient but looking at the computer screen may send a message of disinterest or not caring about what is being said. Crossing your arms during a conversation may also be telling. In the electronic world, using capital letters is said to be screaming. It is difficult to really understand what someone is saying or his or her intent in an electronic communication. Many times, the nonverbal, facial expression or the direct opportunity to ask for clarification is missing, which makes the communication process incomplete or ineffective.

The message here is to ensure that there is effective sharing of ideas and communication of who you really are to the other party in the relationship.

CONSISTENCY

Without a party of a relationship being consistent, how do you know what will happen next or what to expect? Sending a message that shows how you really feel or act and doing it regularly will help build the relationship with the other party.

The message here is to be yourself, always.

COMPARE ALTERNATIVES

With more than 7 billion people on earth, there are alternatives. In some cases, it is better to choose the alternative. In other cases, it is better to recognize that there are alternatives and that what you have is the right one. This concept becomes very important to remember for the provider and the entire staff of the practice. The patient has a choice; and if the relationship is not built on all the points above, the alternative will be chosen. There is always another applicant for a position. The concept of alternatives should be in the forefront of your mind in developing a relationship, especially with those who you serve.

The message here is that there are other choices. If you want the relationship to continue, it is important to make the other person feel welcomed and respected.

TRUST

There are many other terms that could be used, but I believe these are the basic building blocks leading to a level of trust. Merriam Webster defines “trust” as “assured reliance on the character, ability, strength, or truth of someone or something.” The basis of any relationship then is built on the idea that we “trust” the other party. If you cannot trust someone, how can you have a positive relationship? You may not trust someone and still have a relationship, but it will not lead to any of the three C’s.

Today’s healthcare world is built on one relationship at a time.

The far right side of the figure suggests that the outcome of all of the above is a commitment to the relationship. The business and the individual expect and desire the long-term commitment. After all, it is easier (and cheaper) to maintain a relationship than it is to build one. A com- mitted relationship will also include a compliant one. And what better way is there for the provider to achieve mutual goals than patient compliance with the agreed upon care plan? This also means there is full cooperation on the part of everyone to ensure health is achieved. And for the provider side, in today’s world of care coordination based on evidence-based medicine, the key may be in following through with the patient on his or her commitment to comply with an agreed upon care plan. There must be mutual trust established between provider and patient, which hopefully leads to satisfactory outcomes. It may not be a valid “C” in the perspective of most relationships, but is still worthwhile to think about.

Today’s healthcare world is built on one relationship at a time. It is obvious when you think about the provider- patient or the employer-employee relationship. It is fairly obvious when you consider the provider-referral or the vendor-customer relationship. But as time moves forward, there will be an increased need to build better relationships with payers, hospital staff, other providers who may be competitors, employers, government officials—regulators or elected—and others in your local community.

The main message is that approaching relationships in a structured manner, keeping these key concepts in mind, will lead to a stronger, more secure future in this highly complex healthcare world we find ourselves in today.

REFERENCE

1. Wilson DT. An integrated model of buyer-seller relationships. Journal of the Academy of Marketing Science. 1995;23:335-345.

Owen Dahl is a practice management consultant, author, and speaker.odahl@owendahlconsulting.com

This article first appeared in The Journal of Medical Practice Management

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