Hardwired Results: Issue 22

with Bobby Rodwig, MD, MPH, medical director, Transfusion Services and medical director, Professional Staff Services, Ochsner Health System, New Orleans, LA

In the aftermath of Hurricane Katrina, New Orleans-based Ochsner Health System underwent a transformation. What started as a multi-specialty group practice with 250 physicians in a partnership model eventually developed into a larger integrated delivery system with more than 1,100 employed physicians and 2,500 community physicians in multiple hospitals spread across southeastern Louisiana.

“Engagement became more challenging because suddenly everyone’s span of control was much larger,” explains Bobby Rodwig, MD, MPH, medical director of Professional Staff Services at Ochsner. “Instead of huddling with a few physician partners someone had always worked with, they needed to drive 30 miles to meet with a large group of unfamiliar physicians who worked at multiple clinics and hospitals.”

When Ochsner recognized that survey scores were on the decline, it began with a deep dive to understand the results of its most recent physician engagement survey. What was at the top of physician barriers? Lack of information. “Physicians said we weren’t doing a good job of keeping them informed…that nobody talked to them,” notes Dr. Rodwig. “There were too many emails on organizational priorities, so people just weren’t reading them. Meetings weren’t conveniently located, so they didn’t attend.”

As a result, leaders consolidated emails to once a week, moved important meetings to convenient campuses, and invited physicians to half-day bi-annual updates by Ochsner CEO Warner Thomas. At these meetings, he shared the strategic plan, financials, key actions, and organizational successes. Attendance is mandatory for employed physicians.

Because physicians are inherently competitive, no one likes to hear that their department sits in the bottom fifth percentile for physician engagement. Ochsner began by being transparent about how departments ranked in physician engagement and then actively coaching physician leaders in the bottom 20 percent.

Frequently, low performing departments were symptomatic of a low-performing leader with an “us against them” attitude or a recent leader change. Individual coaching sessions focus on leadership training and communicating the evidence (i.e., research studies) to connect specific leadership behaviors to higher physician engagement and better clinical outcomes.

The best way to build trust and buy-in? Rounding on physicians. After sharing an instructional video and role playing how physician rounding works, Ochsner required all physician leaders to round on every staff physician quarterly and follow up through the use of stoplight reports that showed progress.

“By far, the issues that came up were little daily annoyances that weren’t that hard for us to address,” says Rodwig. “One physician said the lock on the door didn’t work and he’d been asking for it to be fixed for two months, but couldn’t get approval to buy a new lock. Another explained that he had to walk to the other side of the building every time he needed to print out a patient instruction sheet for a patient because he can’t get a new printer. So we eliminated many of the barriers for management to make such decisions. There were lots of quick wins leaders could communicate quickly in their rounds.”

In Ochsner’s first 12 months of using the tactics above, physician alignment ratings for employed physicians jumped 31 percentile points to the 90th percentile. This reflects physicians’ increased confidence in leadership and their agreement that administration offers opportunity for input, is responsive to feedback, and treats physicians with respect. Engagement— which measures an even higher order—such as likelihood to recommend and to remain with the organization—is on the rise too with an increase of 10 percentile points.

“Building trust and partnership with physicians isn’t about the newest technologies and innovations,” explains Studer Group Medical Director Dan Smith, MD, FACEP and lead physician coach for Ochsner. “It’s about responding to physicians’ fundamental needs as partners: garnering input and responsiveness, promoting quality and efficiency of practice, improving communication, and appreciating the efforts of colleagues. Ochsner’s commitment is clear.”