One of the most difficult challenges for leaders is provider compensation concerns. In fact, when it comes to money, even outside of work, you think you know someone but the true person is often revealed when it comes to money that pertains to them personally. I have seen it turn what I thought was the nicest person ever into a mean-spirited individual who would stop at nothing to achieve a financial advantage. When it comes to financial discussions, be ready and not surprised by actions and behaviors.

Leaders have a great responsibility in being accountable for everything and everyone. It is hard to describe unless you have been in such a position yourself. You then throw in the natural operational challenges which come with the position and you have the pressures and challenges that come with the job. And then you throw in provider compensation issues on top of it all. These issues can take it to a whole new level of complexity which can seriously threaten system success and sustainability if not addressed effectively.

One of the key factors of successful health care leaders is the ability to work with medical providers. How you manage clinic operations and provider compensation has a direct impact on the success of the organization. Providers are key to an organization’s success and issues with provider compensation can be a serious distraction from patient safety and system growth.

Recall from previous posts that structure is one of the key components of a healing ecosystem. Structure comprises the physical, digital, and regulatory environment in which we do our work. Often, individuals, teams and even units or departments feel apathy or despair as soon as we embark on conversations about structural elements and wellbeing at work. We tend to view these elements as difficult or impossible to change and mostly as sources of annoyance, frustration, and depletion. Despite our tendency to view structures as immovable sources of burnout, they are important components of the ecosystem and they deserve attention. Changing structures can take considerable time and effort, and yet these changes tend to create significant impact on the nature of human interactions and the range of human emotions experienced in daily work. Any leader or organization seeking to create a healing ecosystem therefore must consider how changes in structures can enhance thriving. A great example is the structure a healthcare organization has with providers; which is a key element that comes into play when addressing compensation.

So, here is my story. When I started in my rural organization 40+ years ago, the providers were their own separate corporation and there was limited trust with hospital administration. They shared with me they that they really had no vested interest in the success of the hospital as their revenue primarily came from clinic revenue; and the hospital was just a vehicle for some additional income. Over time, we developed a trusting relationship; which played a crucial role when the providers decided to sell their practice and agree to merge with the hospital. The merger helped address the previous concerns about where income was earned, for example the clinic lab or the hospital lab. Now it did not matter and the focus changed to where was the best service for the patient. Also, now the success of the merged clinic and hospital, or system as we called it, was extremely important to the providers as their compensation and benefits were directly tied to the success of the system. Another key component of the new compensation structure was it was a compensation model based on production and not salary unless they were in a position that required a salary.  It rewarded effort and covered compensation risks that were beyond their control like working at a satellite clinic. Yet even with a vested interest in the success of the system and a fair compensation model, how much they got paid and negotiating annual adjustments was always a very challenging endeavor.

When we first merged, we developed a medical services agreement which spelled out how compensation would work. However, market changes and organizational growth quickly made the initial compensation model obsolete. Each annual negotiation became more challenging, often stalling and going into the next fiscal year requiring retroactive pay when everything was settled. It was not a sustainable model and created undue significant stress for everyone. It was starting to undermine our excellent working relationship and something had to change!

The first change we made was to form a system compensation committee consisting of four vice presidents and myself as CEO. We asked the providers to form three compensation committees; one for family practice, one for specialists and one for allied health providers. We then worked with each group to develop a compensation philosophy and mutually agreed upon the sources for comparative market compensation data. We agreed to focus on total compensation which would include salary and benefits. We then agreed that all compensation arrangements be in compliance with fair market value and all IRS and Medicare regulations. To ensure compliance, it was agreed to annually have an outside agency conduct a compliance assessment.

We mutually agreed on an out of state firm recommended by the providers’ attorney to complete our first assessment. The assessment was a disaster! The firm did not understand rural healthcare and the initial report indicated our compensation agreements were not in compliance. The report was filled with numerous incorrect assumptions and the firm was unwilling to address the errors, claiming their report was correct. This created significant consternation by the medical staff to have even an initial document inferring noncompliance. The providers were so upset that both the medical director and chief of staff stated they knew nothing about the report being completed and blamed the system. Well I had kept track of the minutes of all the meetings involving the assessment which showed all the physicians had been made aware of what was being done. Once I shared this information and took full responsibility for this action being pursued for the protection of all the providers, the energy switched from blame to resolution. We worked together to not accept the report and issued to the firm explanations of the incorrect assumptions and errors in the report. We had our attorneys send a letter to the firm sharing our disagreement with their decision and that we had not and would not accept any final report from the firm. We then mutually interviewed other firms and since then, have been working with an excellent firm which has guided us well with all our compensation negotiations and assessments.

A key learning from our initial assessment is that medical directors are in a very difficult position to represent both the system and the providers. They cannot serve two masters; and we clarified that with any compensation negotiations, the medical directors will serve on the provider compensation committees and not the system committee. This protected the medical directors and enhanced the trust and working relationship with the system.

Each fall, the benefit renewal costs are submitted to the compliance firm who then takes market data and submits a total compensation market comparison which is used to begin annual negotiations; and we can finalize the next year’s contract on schedule for both contractual and budgeting purposes.

This does not mean that challenges and questions don’t arise in regards to the negotiations but that is where trust in our relationship, the process to allow voices to be heard, and the use of a mutual agreed upon resource allow these challenges and questions to be addressed in a timely manner. It does not mean everyone is happy when these are done but we all know it is fair. And best of all we can offer competitive compensation arrangements which help recruit and retain medical providers. The fact that as a rural facility, we have more providers interested in joining our organization than we have work reflects on the healing ecosystem that has been created.

Provider compensation issues can be one of the biggest challenges for health care leaders. However, it also provides the opportunity to develop relationships based on trust. For example, early on in our merged relationship, the annual compensation agreement forgot to include matching FICA. Even though the agreement stated the system would not have to reimburse the providers, we knew it was the right thing to do and we made the doctors whole. It was the start of the journey to develop trust by being fair and doing what is right regardless of what is on a piece of paper. This trusting relationship has seen us grow from two providers to 55 and we continue to grow. The organization has recouped the investment many times over but the most important thing has not been financial. The trusting relationship has allowed us to focus on the needs of our patients and we have improved access and quality of care to this region. That is what we are most proud of; and it is our patients who have won.

It began with an invitation—not just to a place, but to a possibility.  It happened because my wife persisted in desiring to pull together a gathering for fellow residents at our 55+ apartment complex.  It occurred because she convinced me it was a chance to build community and further new relationships.  It succeeded because it connected with many at an emotional and personal level.

Twenty-two neighbors, all over the age of 55, arrived one Sunday afternoon at our lakeside townhome.  There was no agenda, no formal program. Just a warm welcome, a table full of potluck dishes, chairs facing the water, and time carved out of ordinary life.

Leadership, here, looked different. It wasn’t about directing; it was about holding space. The hosts, my wife and I, demonstrated adaptive leadership—creating a container for others to bring their stories, questions, and wisdom. We honored both the seen and unseen experiences of aging, of living through change, of carrying personal histories that often go unspoken. The leadership made room for vulnerability.

The structure was simple and intentional. An outdoor conversation area formed naturally as the sun shone brightly, the temperature eased by a soft breeze off the lake. People drifted between conversations—some about grandchildren and gardening, others about sports and leisure activities.  There were pauses, laughter, even moments of silence. This flexible, light-touch structure allowed the group to regulate itself. It invited both spontaneity and safety, accommodating introverts and extroverts alike.  Surprisingly to me, when offered the chance to participate in charades, giant Jenga, and a game of cornhole, everyone in their own way stepped up, and the laughter, and shared vulnerability of potentially embarrassing themselves was shared by all. 

The climate was unmistakably healing. It wasn’t just the lake breeze or the gentle rustle of trees. It was the unforced kindness in every interaction, the way people listened to one another, how they noticed who was quiet and gently drew them in. A sense of psychological safety emerged—not because it was mandated, but because it was modeled. People felt seen. Valued. Whole.

And of course, the individuals brought it to life. Each resident came with their own lived experience—some navigating loss, some rebuilding after change, others perhaps seeking a sense of purpose in this next chapter. Together, they created what no one person could alone: a temporary community where healing wasn’t something to fix but something to feel. The group was not solving problems; they were sharing presence with each other.

This was not a one-time event. It was a living expression of an infinite mindset—an acknowledgment that relationships are never complete, that wellbeing is a shared, ongoing pursuit, and that community doesn’t need to be built perfectly to be deeply meaningful.

This lakeside gathering showed that a healing ecosystem does not require a formal program or institutional resources. It begins with intention. With creating space. With listening deeply. And with trusting that, given the opportunity, people will bring their full selves to the circle.

In our last post, we introduced the second component of a workplace healing ecosystem: climate. As we noted, thinking about what climate means and how to work on it may seem more ambiguous than working on organizational structure, which might then discourage anyone from tackling climate as a means to improve well-being at work. In addition, it’s natural to wonder whether focusing on something as diffuse as climate can have an impact.

In our last post, we introduced the second component of a workplace healing ecosystem: climate. As we noted, thinking about what climate means and how to work on it may seem more ambiguous than working on organizational structure, which might then discourage anyone from tackling climate as a means to improve well-being at work. In addition, it’s natural to wonder whether focusing on something as diffuse as climate can have an impact.

As we continue to explore the concept of organizations as healing ecosystems, we now move beyond the first component of the model – structures and evidence that working on structures can enhance well-being – to an equally important component: organizational climate.

Completing my third and fourth year at Tulane during a pandemic in the combined public health and medicine program gave me the opportunity to witness crisis leadership first-hand, albeit from a medical student’s perspective. Feeling that intentional leadership training in medicine is lacking, and with guidance from some mentors, I sought to expand my expertise in this area. This led me to the Crisis Leadership Canvas for COVID-19.

Most of us think of structures as physical buildings or organizational hierarchy – but structures show up as policies, systems, programs, schedules, or any other decision, rule, constraint, or tool that impacts how work is organized and executed. Even an agenda for a meeting is a form of structure.

The Marvel Cinematic Universe. The Justice League. Superpowers abound – so cool, so fun, so unbelievable. Fantasy. Real people don’t have superpowers. Superpowers are beyond our grasp. Or are they?

Despite our tendency to view structures as immovable sources of burnout, they are important components of the ecosystem and therefore deserve attention.

Discovery creates interest, curiosity, and potential excitement among those directly involved. Fingerprinting the goal drives engagement in making it happen.

What would a healing ecosystem look like, at work? Defined, an ecosystem is a a community of organisms and agents that interact with and within their physical environment.

New Orleans is a city of jazz, crawfish boils and many other forms of togetherness. The collective city was very lonely. Krewe of House Floats gave us the opportunity for an aesthetic reset—a phrase sometimes used in Organizational Aesthetics (OA).