Rural Physician Leadership Curriculum

1
Rural Physician Leadership Curriculum

• West Virginia University
• Rural Family Medicine Residency Program

2
Rural Physician Leadership Curriculum

• Module 8
• Physician Advocacy

3
Description
Rural Physician Leadership Curriculum

• Funded by HRSA Grant D22HP00306
• Objective 1
• Develop a competency based longitudinal
  curriculum in Rural Physician Leadership

Konrad C. Nau, MD
Principle Investigator Chair, Dept of Family
Medicine-Eastern Division WVU Rural Family
Medicine Residency Program
4
Learning Objectives Module 8
Rural Physician Leadership Curriculum

• Understand the principles of influence and
  advocacy
• Review the legislative process
• Understand how to communicate effectively with
  legislators
• Review the types of ineffective communications
  with legislators

WVU Rural Family Medicine Residency Program
5
Influence

• Influence Activities all
• Involve an individual
• Engaged in some behavior
• Designed to effect the behavior
• Of another individual
• Ultimately, your behavior forms the perception
  others make of you

WVU Rural Family Medicine Residency Program
6
Influence

• What people use to get what they want from others
• Knowledge
• Experience
• Authority
• Position/status
• Question Are these behaviors ?

WVU Rural Family Medicine Residency Program
7
Influence Knowledge

• Beware of the Power of a Good Idea
• Right does not make Might
• Scientific Method Medical World
• Political Method Legislative World

8
Scientific Method
apply Scientific Method
What is the best choice ?
Scientific Truth
Evidence-based decision
WVU Rural Family Medicine Residency Program
9
Political Method
sample data/opinion poll
What is the best choice ?
Perceptions of Options
Perception-based consensus
WVU Rural Family Medicine Residency Program
10
Influence

• What people use to get what they want from others
• What we say
• How,when, where we say it
• Our gestures, timing, tone
• Using various modes of communication
• Question Are these behaviors ?

11
Influence Language

• Words ,the fragile vessels of our meanings,
  easily lose their way in the channels of others
  minds

Charles Dwyer, PhD
Increasing Your Influence , 2002, Tampa, Florida
ACPE, Interact Physician in Management Seminar.
12
Influence Language

• Keep it simple no medical jargon
• Package your message in the words of the person
  you are trying to influence
• In their Pet phrases
• Insider/key words

13
Influence Language

• Paraphrase what you want to say
• Several times
• Several ways
• Tell a personal story
• Flood kills 1,000 vs flood killed my neighbor
• Stimulates the warmth of a personal relationship

14
Influence Negative Language

• Danger negativism causes you to limit your
  behavior repertoire in attempting to influence
• Avoid He doesnt get it
• Maybe he does indeed get your message and he
  doesnt like it !
• Consider
• Accepting responsibility for your influence
• Try another behavior technique

15
Advocacy

• ADVOCATE

- to plead in favor of urge support (v)
- one who pleads the cause of another (n)
- a lawyer practicing before certain courts (n)
16
Advocacy

• ADVOCATE

Great leaders are historically PROACTIVE
Legislative process creates REACTIVE legislators
If constituents dont weight in on a bill ,
they - dont care - dont matter
17
Civics 101 A Bill Becomes Law

• Bill introduced by a member

House of Delegates example 100 in WV one per
district
State Senate example 34 in WV one per
county
18
Civics 101 A Bill Becomes Law

• Chamber leadership assigns bill to a Committee

House of Delegates Speaker of House
State Senate Senate President
19
Civics 101 A Bill Becomes Law

• Committee considers the Bill

Discusses,Amends and Passes Bill
OR
Bill discussed but never reported to chamber
members
20
Civics 101 A Bill Becomes Law

• Bill has three readings to the entire Chamber

Discuss,Amend and Pass Bill

21
Civics 101 A Bill Becomes Law

• Bill sent to the other Chamberwhere

22
Civics 101 A Bill Becomes Law

• The Process is Repeated

23
Civics 101 A Bill Becomes Law

• Conference Committee sometimes needed if Bills
  have differences

House
Senate

24
Civics 101 A Bill Becomes Law

• Unified Bill Passes both Chambers and goes to
  Governor

Signs Bill Into Law

25
Civics 101 A Bill Becomes Law

• If Governor Vetoes Bill Legislature can.
• Override the Veto and Bill becomes law without
  Governors signature

26
Leadership Where ?
Doctor
Employee
Organization
Patient
Michael S. Woods, MD
Applying Personal Leadership Principles to Health
Care The DEPO Principle , 2001, Tampa, Florida
ACPE, page 18.
27
Advocacy Rules of Effective Organizations

• Norman Schwarzkopf Rule
• Make your friends your heroes and they will fight
  for you like heroes

• Ronald Regan Rule
• Why a good story always beats the facts

Joe Gagen
Legislative Grassroots Training January 13, 2002
WVSMA Presentation, Charleston, WV
28
Advocacy Rules of Effective Organizations

• Animal Farm Rule
• All legislators are equal its just that some
  are more equal than others.

• Bebe Rebozo Rule
• Always make your friends before you need
• them

Joe Gagen
Legislative Grassroots Training January 13, 2002
WVSMA Presentation, Charleston, WV
29
Advocacy Rules of Effective Organizations

• LBJ Rule
• When you have them by the b----, their hearts and
  minds soon follow.

• Prince Machiavelli Rule
• Dont burn a bridge that you may need to
• cross again.

Joe Gagen
Adapted from Legislative Grassroots Training
January 13, 2002 WVSMA Presentation, Charleston,
WV
30
Advocacy Rules of Effective Organizations

• Its Their Game Rule
• Legislators get to choose who they listen to.
• They can interrupt you, but you cannot interrupt
  them.

Joe Gagen
Adapted from Legislative Grassroots Training
January 13, 2002 WVSMA Presentation, Charleston,
WV
31
Advocacy Rules of Effective Organizations

• The Long Memory Rule
• Legislators often have long memories for rudeness
  ,arrogance, and ignoring their rules of decorum.
• Lack of respect will hurt your cause more than a
  bad testimony.

Joe Gagen
Adapted from Legislative Grassroots Training
January 13, 2002 WVSMA Presentation, Charleston,
WV
32
Most Effective Methods of Legislative Contact

• Face to Face Individual visit
• Poll of the District
• Face to Face Group Visit
• Telephone Call
• Personal Letter

Dr. Charles U. Larson
Professor of Communication Studies Northern
Illinois University, 1983
33
Most Effective Methods of Legislative Contact

• Resolution Passed by an Organization
• Petition
• News Report of Group/Individual Position
• Form Letter

Dr. Charles U. Larson
Professor of Communication Studies Northern
Illinois University, 1983
34
Legislators Order of Returning Letters

• Campaign volunteers who recruited other
  volunteers
• Donor who recruited other donors
• Volunteer
• Donor

Joe Gagen
Adapted from Legislative Grassroots Training
January 13, 2002 WVSMA Presentation, Charleston,
WV
35
Advocacy Rules

• Note
• All of these tried and true advocacy rules deal
  with your BEHAVIOR
• Not your KNOWLEDGE or IDEAS

36
Advocacy Avoidance Rules

• Avoid forcing legislator to make a hard vote.
• Avoid surprises.
• Avoid making assumptions.
• Avoiding hard votes is done by legislators use
  of calenders and committees

37
West Virginia PhysiciansApply Advocacy Rules

• Avoid forcing legislator to make a hard vote.
• Care Coalition created
• Avoided confusing legislators with each health
  care group offering their own/competing medical
  liability insurance bills

38
West Virginia PhysiciansApply Advocacy Rules

• Ronald Regan Rule
• White Coat Day
• Physicians and patients meet with legislators to
  tell their story of how the medico-legal climate
  was effecting them

39
West Virginia PhysiciansApply Advocacy Rules

• Prince Machiavelli Rule
• State medical association avoided insulting and
  focusing on legislators unfriendly to physician
  view of liability reform

40
West Virginia PhysiciansApply Advocacy Rules

• Its Their Game Rule
• State medical association leaders told that tort
  reform was a multiple year process
• First bills wont get out of committee
• First bills voted on by entire chamber wont have
  everything physicians want
• Legislative leadership would have to change to
  remove traditional road blocks
• Physicians need a broader voice

41
West Virginia PhysiciansApply Advocacy Rules

• Norman Schwarzkopf Rule
• WESPAC increased contributions available for
  nearly every House of Delegate and State Senate
  race

42
West Virginia Rural Physician Advocacy

• 2001-2002 Legislature
• Teacher 26
• Trial Lawyer 21
• Defense
• Lawyer 4
• Physician 0

• 2002-2003
• Legislature
• Teacher 24
• Trial Lawyer 10
• Defense
• Lawyer 11
• Physician 2

43
Finances Advocacy
2001-2002 2002-2003 W.Va. Legislature
PAC Contributions 2002 Election Cycle

• Teacher 26/24
• Trial Lawyer 21/10
• Defense
• Lawyer 4/11
• Physician 0/2

44
Physician Advocacy SUMMARY

• INFLUENCE What people use to get what they want
  from others
• INFLUENCE your behavior
• What you say
• How,when, where you say it
• Your gestures, timing, tone
• Your use of various modes of communication
• ADVOCACY applying your influence in the
  political process

WVU Rural Family Medicine Residency Program
45
Physician Advocacy SUMMARY

• Scientific Method
• Seeks a central scientific truth
• Valid in Medicine
• Not usually applicable to Political Processes
• Political Method
• Seeks perception-based consensus
• Scientific right does not make political might
• Review Lessons of Civics 101 when physicians must
  enter advocacy arena

WVU Rural Family Medicine Residency Program
46
Physician Advocacy SUMMARY

• Legislative Advocacy
• Has rules of engagement and decorum
• Personal communication is the most powerful
  advocacy tool
• Financial contributions are required to gain
  access for physician issues
• Build as broad a base of coalition members as
  possible for your cause.

WVU Rural Family Medicine Residency Program
47
Physician Advocacy SUMMARY

• Legislative Advocacy
• You may feel like a drug rep at times in the
  process
• But
• If physicians dont enter the political process,
  we surrender the outcomes to the influence of
  those that do.

WVU Rural Family Medicine Residency Program