Create Physician Loyalty that Joint Venture Firms Can't Beat
By Brian C. Robinson, Studer Group executive vice president
Recently I was talking with a physician who was relaying his frustration with delays and inconsistencies at his local hospital. As he spoke, I couldn't help but think about my own experiences as a frequent flyer. While I'm not a physician, I tend to remember and recount the needless delays and frustrations I experience with airlines in the same kind of technicolor that he does when he speaks about the hospital.
Just as I would love an opportunity to share my suggestions with airlines on how they could make my travel more efficient and enjoyable, so too do physicians crave the opportunity to give meaningful input into how we can help them practice better medicine in most of our nation's hospitals.
They park at the hospital each day (instead of the airport), but experience similar avoidable delays. They wonder: Will I be able to find my patient or will they have been moved to another room? Will my surgery be canceled? Will the tests I ordered have been completed? Will the staff I encounter know about my patients?
These frustrations translate into delays that mean more hours rounding in the hospital and less time to see patients back at the office. From the physician's perspective, the hospital is essentially creating additional time and financial pressures on the physician and his or her practice.
In fact, physicians often feel that they work in four hospitals: the day hospital, the night hospital, the holiday hospital, and the weekend hospital. Operations can be that inconsistent. Their experience may depend upon who's working. Frequently though, they aren't offered a mechanism for true input.
And yet, we are often surprised when physicians get frustrated, angry, or leave us.
The Lure of the Joint Venture
While most leaders believe that physicians leave the hospital medical staff for a financially lucrative joint venture elsewhere, I don't believe— contrary to popular opinion—that the financial incentive is the main reason why they end up making the decision to leave. There's no question that the reimbursement environment has worn down physicians…or that they can generate income in some of these arrangements that is not available at your organization.
But the real reason they leave is for the opportunity to have a profound operational impact on decision making that they believe will impact the quality of care for their patients and their practice of medicine. As I've talked with many physicians across the country, they tell me they aren't leaving just for the money, but because of the meaningful dialogue, greater personal control, and input that results in improved outcomes for patients and their practice.
As leaders, we think we've offered this, but have we really? Typically we say, "Doctors, we need to get our costs down. We need your help and guidance. You can choose from one of these three devices." Or we come to them after the decision has been made. While we have lots of medical staff committees to help us meet Joint Commission and other regulatory requirements, we frequently come to physicians with a policy, process or procedure that we've decided upon and then ask them to bless our plans. Meanwhile, in the joint venture arrangement, partners are engaging physicians by leveraging their underlying bias and clinical expertise to help drive improved clinical, service, and operational outcomes.
If it were a true dialogue, wouldn't we give physician leaders the same input and decision-making ability we give to other leaders? Wouldn't we let them help create the agenda rather than facilitate our agenda? Physicians are scientists trained to make decisions based on evidence and data. They regularly abandon outdated medical protocols for new ones that demonstrate better outcomes. In the same way, they are proactive agents of change and will align their behaviors for more efficient operations when the benefits are clear. They thrive in a culture of high transparency where they can weigh the benefits, risks, and cost impacts of a decision.
What Physicians Really Want: A Seat at the Table
So what do physicians brag about when they leave the hospital for joint venture alternatives? While we may hear quite loudly about the income differential, what we find at Studer Group is that it's really about the input/ decision-making, efficiency, and quality these joint ventures will offer. And, while physicians won't tell you they're also leaving because they feel more appreciated in the new joint venture, appreciation—in addition to input, efficiency, and quality—is in fact the fourth driver for physician satisfaction. We need to find more meaningful ways to reward and recognize the many contributions physicians make.
By understanding their agenda, concerns, and priorities, we can create a shared agenda for true improvement. We can overlay clinical objectives on operational realties for shared decision-making. Whether our challenge is compromised clinical quality due to high staff turnover or poor financials due to decreasing net revenue, resource utilization or capacity issues, we can address barriers together.
However, identifying and advancing the shared agenda requires hospital leaders to ask for meaningful input and guidance from physicians. Studer Group recommends a Diagnose—Engage—Communicate model for maximum impact.
Diagnose—After surveying the experience of 21,000 physicians practicing at 224 hospitals in 2007, one study1 offered a national priority index of what is most important to physicians. The top three issues? Response of hospital administration, making patient care easier, and how administration deals with changes.
Before you can determine what to fix for your physicians, you need to diagnose their top concerns. A common mistake: In our effort to standardize, we miss the opportunity to address key issues for physician specialties and individual physicians. In some organizations, aggregate physician satisfaction may be very high, while it is low in key specialties or with key physicians. In the same way leaders drill down by unit to analyze nursing satisfaction, they need a plan to address pockets of opportunity with key physicians.
Also, while many organizations are identifying and correcting daily frustrations, fewer are asking physicians to dream big. Removing daily barriers for physicians is key, but it's also just the foundation for building an active, inspired partnership for creating and sustaining a worldclass organization.
Have you ever asked a physician whom you would like to retain to provide input on ways that your organization can fundamentally change the way it delivers care? What is good for the physician is almost always good for the patient. In this way, we can use the physician agenda to address our organizational agenda.
I find that physicians truly understand the need for a strong, vibrant hospital where they can practice and their patients can receive quality care.
Engage—Talk with your doctors. Find ways to step into their world before you ask them to step into yours. In other words, demonstrate interest in their agenda and their concerns and follow up to let them know when you will deliver or why you can't. As you demonstrate increasing interest in their needs, they will become increasingly interested in the hospital's success. The result will be stronger collaboration.
Once you know physician priorities, ask yourself, "Is this an efficiency, input, appreciation, or quality issue?" That will guide your response. I encourage you to download a copy of Studer Group's Physician Collaboration Toolkit (free to Studer Group partners) at www.studergroup.com, for specifics on how to roll out more than a dozen tools that respond to each of these drivers.
Communicate—As noted above, physicians respond well to objective evidence. A few quick tips: Know your data. Track and report on the metrics that matter most to your physicians. If you ask for physician input on which metrics they would like to track, they will be more willing to be held accountable for their performance on them.
If the hospital needs to track specific metrics that don't seem of ready interest to the physician, connect the dots on why they are important rather than blaming the Joint Commission. While physicians might perceive length of stay, for example, as a hospital finance issue, you can explain that in busy hospitals, reducing length of stay improves patient throughput and quality of care. You can tell them that by measuring LOS, you are committed to getting the physician's patients out of the emergency department faster so they are easy to find in a patient room for efficient physician rounding. This creates an aligned agenda for a common set of priorities.
Also, the CEO can communicate commitment and transparency to physicians by sharing his or her own leadership evaluation goals with the medical staff. I have found that by sharing this information and dialoguing on goals, physicians will offer excellent suggestions for improvements that will drive results and become engaged in achieving them.
If physicians see that clinical quality or safety metrics are heavily weighted, they understand your commitment to patient safety. This creates an aligned agenda. Remember too to share patient compliments with physicians as this builds a shared emotional bank account. (A hint: One of the best ways to harvest these is through the use of discharge phone calls to patients.)
When we are transparent and reach out to physicians—our subject matter experts on clinical care—with this kind of two-way engagement, we align our needs with their needs for a powerful shared agenda that increases physician loyalty. Therein lies the return on investment of our time. We create a better environment for employees to work, physicians to practice, and patients to receive care.
Physicians and Hospitals Work in a Parallel Universe
Characteristics of Hospital Leaders |
Characteristics of Physicians |
Hierarchical |
Collegial |
Strategic |
Tactical |
Work with medium and long timeframes |
Work with short and medium timeframes |
Operational orientation |
Custom orientation |
Economic accountability |
Clinical accountability |
Like a football team |
Like a track team or a golf team |
1 Hospital Check-Up Report 2007, Press Ganey
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