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Rural Physician Leadership Curriculum

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					Rural Physician Leadership Curriculum

     West Virginia University
     Rural Family Medicine Residency Program
Rural Physician Leadership Curriculum

       Module 8
       Physician Advocacy
Rural Physician Leadership Curriculum
Description
 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
Rural Physician Leadership Curriculum
Learning Objectives : Module 8
 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
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
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
Influence & Knowledge
   Beware of the Power of a Good Idea

   “Right does not make Might”

   Scientific Method = Medical World

   Political Method = Legislative World
 Scientific Method
                                               “apply Scientific Method”




   What is the best                           Scientific
     choice ?                                  Truth


                      “Evidence-based decision”


WVU Rural Family Medicine Residency Program
Political Method
                                               “sample data/opinion poll”




   What is the best                           Perceptions
     choice ?                                  of Options


                      “Perception-based consensus”

WVU Rural Family Medicine Residency Program
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 ?
Influence & Language

   “Words ,the fragile vessels of our
    meanings, easily lose their way in the
    channels of other’s minds”


Charles Dwyer, PhD
Increasing Your Influence , 2002, Tampa, Florida : ACPE,
Interact Physician in Management Seminar.
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
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
Influence & Negative Language
 Danger : negativism causes you to
  limit your behavior repertoire in
  attempting to influence
 Avoid “He doesn’t get it “
    – Maybe he does indeed get your
      message and he doesn’t like it !
    – Consider
      • Accepting responsibility for your influence
      • Try another behavior technique
 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)
 Advocacy
    “ADVOCATE”

Great leaders are historically PROACTIVE

 Legislative process creates REACTIVE
 legislators
 If constituents don’t weight in on a bill , they
      - don’t care
      - don’t matter
   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
   Civics 101 : A Bill Becomes Law
Chamber leadership assigns bill to a Committee

                      House of Delegates
                           Speaker of House

                      State Senate
                             Senate President
   Civics 101 : A Bill Becomes Law
Committee considers the Bill

                      Discusses,Amends and Passes Bill

                                  OR

                      Bill discussed but never
                      reported to chamber members
   Civics 101 : A Bill Becomes Law
Bill has three readings to the entire Chamber

                       Discuss,Amend and Pass Bill
   Civics 101 : A Bill Becomes Law
Bill sent to the other Chamber……where
   Civics 101 : A Bill Becomes Law
The Process is Repeated……
   Civics 101 : A Bill Becomes Law
Conference Committee sometimes needed if Bills
have differences



    House                           Senate
   Civics 101 : A Bill Becomes Law
Unified Bill Passes both Chambers and goes to
Governor


                  Signs Bill
                  Into Law
   Civics 101 : A Bill Becomes Law
If Governor Vetoes Bill – Legislature can….
Override the Veto and Bill becomes law without
Governor’s signature
   Leadership : Where ?
                          Doctor


Organization                                      Employee



 Michael S. Woods, MD      Patient
        Applying Personal Leadership Principles to Health Care:
        The DEPO Principle , 2001, Tampa, Florida : ACPE, page 18.
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
Advocacy Rules of Effective
Organizations
   Animal Farm Rule
    – All legislators are equal ; it’s 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
Advocacy Rules of Effective
Organizations
   LBJ Rule
    – When you have them by the b----, their
      hearts and minds soon follow.

   Prince Machiavelli Rule
    -Don’tburn a bridge that you may need to
    cross again.
        Joe Gagen
Adapted from Legislative Grassroots Training January 13,
2002 WVSMA Presentation, Charleston, WV
Advocacy Rules of Effective
Organizations
   It’s 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
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
 Most Effective Methods of
 Legislative Contact
 1.   Face to Face Individual visit
 2.   Poll of the District
 3.   Face to Face Group Visit
 4.   Telephone Call
 5.   Personal Letter

Dr. Charles U. Larson
 Professor of Communication Studies
 Northern Illinois University, 1983
 Most Effective Methods of
 Legislative Contact
 6.   Resolution Passed by an
      Organization
 7.   Petition
 8.   News Report of Group/Individual
      Position
 9.   Form Letter
Dr. Charles U. Larson
 Professor of Communication Studies
 Northern Illinois University, 1983
Legislator’s Order of Returning
Letters
1.   Campaign volunteers who recruited
     other volunteers
2.   Donor who recruited other donors
3.   Volunteer
4.   Donor

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

    – All of these tried and true
      advocacy rules deal with your
      BEHAVIOR

    – Not your KNOWLEDGE or IDEAS
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
West Virginia Physicians
Apply 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
West Virginia Physicians
Apply 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
West Virginia Physicians
Apply Advocacy Rules
   Prince Machiavelli Rule
    -   State medical association avoided
        insulting and focusing on legislators
        unfriendly to physician view of liability
        reform
West Virginia Physicians
Apply Advocacy Rules
   It’s Their Game Rule
    – State medical association leaders told
      that tort reform was a multiple year
      process
      • First bills won’t get out of committee
      • First bills voted on by entire chamber won’t
        have everything physicians want
      • Legislative leadership would have to
        change to remove traditional road blocks
      • Physicians need a broader voice
West Virginia Physicians
Apply Advocacy Rules
   Norman Schwarzkopf Rule
    – WESPAC increased contributions
      available for nearly every House of
      Delegate and State Senate race
West Virginia &
Rural Physician Advocacy
2001-2002           2002-2003
  Legislature         Legislature
 Teacher      26    Teacher      24
 Trial Lawyer 21    Trial Lawyer 10
 Defense            Defense
  Lawyer        4     Lawyer       11
 Physician     0    Physician     2
    Finances & Advocacy
2001-2002 2002-2003       PAC Contributions
  W.Va. Legislature       2002 Election Cycle

 Teacher      26/24
 Trial Lawyer 21/10
 Defense
  Lawyer        4/11
 Physician      0/2
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
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
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
Physician Advocacy: SUMMARY
    Legislative Advocacy

    You may feel like a drug rep at times in the
     process

    But

    If physicians don’t enter the political
     process, we surrender the outcomes to
     the influence of those that do.
WVU Rural Family Medicine Residency Program

				
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