So here we all are. Standing on the pier of history ready to embark on the most extensive transformation in the health care delivery system in our professional careers.

A transformation that will require the closest working relationship between administrators and physicians since the first hospital doors swung open. One that will make all of us mutually dependent on each other for financial viability and outcomes. One that will change both business models simultaneously. And as we run to board the boat to sail bravely into the future, what are we carrying? Could it be we're toting the same old baggage?

We're poring over the accountable care organization concept with a proverbial fine-tooth comb, searching out details, caveats and conundrums, trying to fill in as many technical fine lines to the big picture as we possibly can. Obviously we can't get from here to there without physicians. Other than where physicians generally fit in the overall new delivery system schematic, what do you know about these folks with whom you're supposed to go skipping hand-in-hand into the future? No, not just the basic fact sheet, I mean really know—as in knowing individual people.

Not everyone falls into neat little categories but, broadly speaking, real differences exist as to how physicians and administrative execs view the known world. For example, physicians encounter patients one at a time. Execs see multiple patient types, community needs, gaps and opportunities in patient services. For physicians, reimbursement is personal income. Execs see organizational financial stability, access to capital, and growth. Physicians quickly make individual decisions based on personal judgment and scientific evidence. Execs work collaboratively with many others with an eye toward long-term strategic goals and enterprisewide success. Physicians are accountable for contributions to their group or individual practice. Execs are accountable to a board of trustees charged with fiduciary and ethical responsibility for an institution that is viewed as a community asset.

You've seen a similar list. Trouble is, it's viewed as an interesting exercise rather than a practical and useful indicator to help understand physician behavior on a day-to-day basis. But there's a bigger hill to hike.

In many parts of the land, physician alignment is absolutely top-of-mind and is Strategy Numero Uno. Some are sounding the bell that we'll never get to a transformed delivery system without a seismic shift in corporate culture on the part of both physicians and hospital leaders—no matter how flawless the technical and strategic plan may be.

Before you devise a grand management strategy, I'd review the basics. A recent PricewaterhouseCoopers physician survey found that the majority of doctors just don't trust hospitals. Why? Lack of transparency and lack of communication. Many a good old-fashioned face-to-face conversation is in order before we can move on to the brave new world.