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Foster Ownership Culture


In my June column (“Follow the Money,” p. 61), I wrote about my concern that SHM’s “2007-2008 SHM Survey: State of the Hospital Medicine Movement” showed that more than one-third of hospitalist group leaders reported they did not know their groups’ annual professional fee revenues or expenses.

This is consistent with my experience working as a consultant with many other practices, and is one of many common findings in a struggling practice.

What about the opposite side of the coin? What are the common attributes of a healthy, successful practice? I talk about this all the time with my consulting colleague, Leslie Flores (director of practice management for SHM). We’ve become convinced that while the attributes to ensure success vary a little from one practice to the next, they can be rolled into the global heading of a “culture of ownership.” That is, the practices in which hospitalists think of themselves as owners of the practice (even if they are, in fact, employees of the hospital or some other organization) are most likely to be successful.

It is possible to maintain an ownership culture even if the hospitalists are employees of a larger organization like a hospital (and not owners of their practice in the contractual sense).

What is it?

Ownership culture is a mind-set, not a legal description of who has contractual ownership of the practice. I learned the hard way that not everyone knows what I mean when I talk about an ownership culture.

During the course of a conference a few years ago, I had several conversations with a sharp hospitalist practice leader about the problems his group faced. Apparently, many other doctors at the hospital treated them like residents. As I learned more it sounded as though this largely was the fault of the hospitalists themselves. It seemed clear to me the underlying theme was each doctor in the practice felt little connection to his/her hospitalist colleagues and the hospital in which they worked.

I began talking with the practice leader about how things could be different if the hospitalists would think of themselves as business owners and act accordingly. Yet, he couldn’t make sense of what I was saying since he thought I was suggesting that all the hospitalists resign from employment by the hospital (and presumably give up the financial support it provided) and form their own corporation. That isn’t necessary. It is possible to maintain an ownership culture even if the hospitalists are employees of a larger organization like a hospital (and not owners of their practice in the contractual sense).

Recognize it

A Web search on “ownership culture” returns a number of interesting sites. In fact, there is a National Center for Employee Ownership, which has an interesting Web site geared toward employees who own a significant portion of their company’s stock.

You also might want to look at their article titled “What Is an Ownership Culture?” ( and think about how your practice fits into that description.

Leslie and I have developed an informal quiz to help hospitalist practices think about whether they are supporting an ownership mindset. While we haven’t done research to validate these measures, we have considerable anecdotal experience supporting the idea that a high score on the questionnaire (i.e., lots of answers in the “pretty much” or “100%” columns) correlates well with an ownership mentality on the part of the doctors in the practice.

We’ve found such practices usually function more effectively and have happier hospitalists and customers (e.g., hospital personnel, other doctors, and patients). If you have an idea for valuable additions, deletions, or modifications to the questionnaire I’d love to hear from you.

Does it Matter?

While there are lots of other components to a good practice, I believe an ownership culture is one of the most important features leading to a successful and thriving practice. It is difficult to maintain a successful practice for very long without it.

You don’t have to take my word for it. Writing in The Baptist Health Care Journey to Excellence, Al Stubblefield says:

“Because it is so rare, an organization that is able to create this culture of ownership within its workforce has a high probability of creating a sustainable competitive advantage … The second advantage, which came as an unexpected bonus for us, is that creating a strong, attractive culture results in incredible recruiting power.” TH

Dr. Nelson has been a practicing hospitalist since 1988 and is co-founder and past president of SHM. He is a principal in Nelson/Flores Associates, a national hospitalist practice management consulting firm. He is also part of the faculty for SHM’s “Best Practices in Managing a Hospital Medicine Program” course. This column represents his views and is not intended to reflect an official position of SHM.

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