1. Offer yourself as a CEO that will place the patient (and the patient alone) at the center of the organization. If you can convince your physician peers that the patient is your North Star, you will get enough of them to support you that you will have a mandate to make some difficult decisions.
2. Hire a really good CFO/COO team to clean up the organization and provide you with the resources needed to create the patient centered medical center your citizens deserve.
Go to their staff meetings where the rank and file are likely to attend. Then offer information on only the most relevant projects/initiatives to that department.
First one must establish a good working relationship between the hospital administration and the union. Reduce any adversarial posturing. Have open and honest negotiations. Then work with the union and its membership to understand the health impact on the patients from absenteeism. It adds tremendously to overtime costs and increased FTEs. This means less base income for the employees that actually show up to work, and less money available to improve the health of the patients though hospital capital improvement. Work with the union to paper trail and release the worst offenders and the message will be sent.
Hold up the mirror to their performance (hopefully their lack of excellence has been documented). Then explore why they are underperforming in a way that demonstrates you care for them (“surely this isn’t the type of doctor you wanted to be when you where 25, what is motivating this behavior?”) In my experience most physicians who are disruptive or underperforming are struggling with personal issues. Find out what they are. If someone is just pathological, do everything in your power to get rid of them.
Physicians want authentic peer leadership that places no priority above the best interest of the patient, and emphasizes the primacy of the physician-patient relationship (and the time this requires). If you lead from this place, the physicians will follow.