Engaging Physicians: Engaging Organizations

 

Note: As healthcare reform becomes reality, success for hospitals will largely be driven by engaged physician leaders who partner with administrative leaders to drive the strategic direction of the organization. In a 2011 study, the American College of Healthcare Executives found that among 514 CEO’s, the number one challenge when it came to improving patient safety and quality was “engaging physicians in improving the culture of quality.”  The challenge in engaging physicians is multifaceted. In many cases, physicians feel disengaged because of disagreements with administration over physician-related decisions, or feel that administration doesn’t accept constructive input from the physicians. Many feel they are not given the right information to help them understand decisions being made at the administrative level. Overall, there are barriers to physician engagement that must be tackled in order to succeed in a changing healthcare marketplace. A recent Gallup study spanning 94 hospitals and more than 130,000 employees finds hospitals with higher levels of employee engagement also register higher HCAHPS domain performance.

This is the first of several articles focused on helping senior healthcare leaders build more effective relationships with their employed and independent physician. We welcome your input.

 

What is most important to physicians? It is a question I’ve asked my Physician Leadership College students, most of whom are practicing physicians in their mid-forties and fifties, for the last ten years. Their responses have changed dramatically over the course of time. Ten years ago most were interested in implementing best practices and becoming more effective managers. Few felt they had an opportunity to impact their organizations in a meaningful way and acquiesced that this was simply the way things were.

Five years ago I noticed a seismic shift. The participants expressed an interest in learning how to work more collaboratively with diverse people to function as more effective teams. They were far more receptive to focus on the practice of medicine AND the business of medicine. They were hungry to learn the skills necessary to participate at the leadership table. Some realized that they had to augment their medical knowledge with the language and tools of business.

Changing expectations

This year I noticed yet another, though more subtle shift. Participants noted that they are interested in meaningful “relationships.” Relationships?!? The response took me by surprise. I then realized that the physicians expressed a desire for deeper, more meaningful relationships not only with their peers and patients, but also with the organizations they serve. At a time when there is great consolidation of business entities and uncertainty regarding the future of healthcare, there is the fundamental human need to belong to something greater of which we are proud and to create connectedness and meaning to get through the challenges ahead. Almost everyone in the class realized that business is no longer a dirty word…it is a fact of life. And they are open to embracing it as long as the needs of the patient are a significant part of that discussion. They understand that healthcare has moved to a far more competitive arena and those in my class are signed up to help their organizations adapt to the challenges at hand.

The essence of community

What I believe the physicians expressed is the desire to belong to and contribute to a community. A community is a group of people who:

  • Participate in common practices
  • Depend on one another
  • Identify themselves as part of something larger
  • Commit themselves for the long term to their own well-being as well as that of the organization.

Those organizations that are the most successful in building community effectively

  • Integrate individuals with diverse skills, interests, and values
  • Integrate diverse geographical locations
  • Increase the collective intelligence of the enterprise
  • Create extraordinary levels of trust
  • Develop creativity and innovation to resolve and anticipate problems
  • Create flexible organization boundaries

These are essential ingredients not only to community in the abstract, but more important, to move organizations to the delivery of new models of care, to achieve higher levels of productivity and profitability, and to realize the Triple Aim.

Some of the physicians, though clearly not all, want to tackle these issues. Many participants however characterize their organizations with similar language utilized by their predecessors: top-down decision making, overemphasis on financial performance that trumps patient satisfaction, and short term thinking. Many feel that they have become a commodity and are valued by their leadership only to the degree that they impact bottom line financial performance.

In too many instances administrative leaderships have not created the necessary “community” necessary to support those physicians who wish to participate in a meaningful way. A recent study by Physician Wellness Services and Cejka Search clearly shows areas of disconnect between what physicians look for and what they find and what organizations think they provide. Transparent communication, collaborative leadership style, and organizational adaption to change are attributes with the biggest gaps between what physicians consider to be important and what they perceive their organizations to be delivering. The gap between importance and organizations’ delivery is smaller on cultural attributes such as clear mission and values, and objective performance evaluations. But notably, these are attributes that physicians rank as having lower influence on their job satisfaction.

The transition to new and more effective models of care will occur when physicians are heavily invested in the process. This requires senior leaders to rethink, reshape, and rebuild their cultures and social infrastructures in a manner that builds greater inclusion, meaningful planning, higher levels of trust and participation, and effective action. The good news is that the there are several approaches designed to help physicians bridge this gap…if the administrative leaders actively commitment to participating in the process.

How to build a stronger physician community

Stronger organization community is a critical ingredient to achieve the strategic objectives and build the internal resilience necessary to quickly adapt during cycles of rapid change. Unfortunately it is now clear that most leadership development and employee engagement efforts undertaken by healthcare organizations have generally failed to create cultures where physicians feel they have a significant relationship with their organizations. Too much attention has focused on mission, vision, and values…too little in actively engaging physicians in the art of execution.

There are a number of approaches to community development within healthcare organizations that we would like to share with you in the future. We also want to hear from you around those practices that engage physicians to participate in more meaningful ways to improving the health of their patients and their organizations. Please E-mail thoughts to ralph@theleaderstoolbox.com

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