Doctors on Board? Nine Steps to Practicing Excellence

Published Date: 10/24/2006

Doctors on Board? Nine Steps to Practicing Excellence
Excerpted from Practicing Excellence: A Physician’s Manual to Exceptional Health Care (Fire Starter Publishing, 2006, ISBN-10: 0-9749986-3-X,
ISBN-13: 978-09749986-3-3, $28.00), by Stephen C. Beeson, M.D.

         No doubt about it: the process of implementing service and operational excellence among physicians can be challenging. How does an organization get physicians “on board” and aligned with the group mission? Dr. Stephen C. Beeson has the answer. In his new book, Practicing Excellence, he takes you through a stepwise sequence of performance implementation for physicians with the overarching mission of physician and organizational success by providing exceptional care to patients in a purposeful and collaborative work environment.

 Step 1: Physician Leadership Commits to Excellence. In the medical group environment, physician leadership must be willing to lead constituent physicians hand in hand with your administrative leadership as a unified effort. Physicians are the perceived leaders of your organization for those doing the work of patient care, and their visibility and support in this effort is a necessity. Individual physician behavioral change does not occur in a vacuum. Behavioral change begins to occur when a medical group communicates a vision for group and individual success through the consistent execution of service and clinical excellence. Individual physician engagement and change are more probable when the strategic priorities and mission are communicated to physicians by respected physician leaders, and they understand that their role is central to success.

Step 2: Select a Physician Champion. Who communicates and coordinates the change effort and how it is done is critical for effective engagement of your physicians. Instilling and creating physician behavioral change is a challenging proposition, and to whom physicians listen is highly selective. It is very impactful when a respected colleague, who does the same things, sees the same patients, and works as hard as anyone else, stands up and says:
         “This is the right thing to do for our patients, the right thing to do
         for our staff, and the right thing for us to do. We will succeed by
         providing exceptional care to patients in the kind of collaborative,
         purposeful work environment that will make us the best...”

Your physician champion should meet the following criteria: high peer review, high patient satisfaction, strong collaborative abilities, strong communication skills, and, most importantly, commitment to the organizational mission.

Step 3: Define the Role of Your Physician Champion. Responsibilities include:

• Communicate the vision of service and operational excellence as foundational to medical organization success.
  
• Communicate with physician leadership the strategy and progress regarding physician performance improvement.
  
• Maintain service excellence as a principal strategic priority for physicians.
  
• Coordinate and conduct physician service excellence training.
  
• Develop patient satisfaction feedback that provides physicians their comparative performance and identifies opportunities for improvement.
  
• Coach low-performing physicians as measured by patient satisfaction.
  
• Collaborate with administrative leadership to assist with staff training.
  
• Create reward and recognition tools for high-performing physicians.
  
• Collaborate with physician leadership to create and implement behavioral standards for staff physicians.
  
• Monitor physician satisfaction to assure physicians’ concerns are heard and addressed.

Step 4: Train Your Physician Champion. In order for your physician champion to be effective, not only do you have to select the right leader and provide vigorous organizational support, but, most importantly, you must train him or her to lead. Even high-performing physicians will not necessarily have the skill set to lead this effort effectively. High-performing physicians know how to take excellent care of patients and to get the best from their staff, but receive little training in physician leadership. When selected to lead this effort, one must assume the role of a student, learning all he or she can about drivers of patient satisfaction and physician satisfaction and predictors of physician behavioral change.

Step 5: Launch the Commitment to Excellence and Train Your Physicians.
The “launch” of your commitment to excellence should be a dedicated event with mandatory or “incentivized” attendance.  The objective of this launch will be to define the physicians’ role in the organizational mission and to provide tactical training to create results. Follow these six steps to effective physician training:

1. Profile the positive things about your medical group. Remember, physicians are more inclined to “get on board” when vision and accomplishment are evident.


2. Create the “burning platform.” In order for physicians to become receptive to change, they need to understand why change is necessary. Physicians must understand the data that is driving this effort.


3. Review the compelling evidence for service excellence. The case for service is strong in the literature and has demonstrated that it will improve patient satisfaction and patient loyalty and reduce malpractice exposure. It will improve economic returns, patient care, clinical outcomes, and will ultimately drive physician satisfaction.


4. Provide practical tools. These prescriptive behaviors are best formatted into how physicians treat staff, patients, and each other within a new Culture of Excellence.


1. How Physicians Treat Staff—Physicians will need guidance and training to understand how their treatment of staff will predict staff performance, loyalty, and retention, and will significantly affect the bottom line of the organization.
   
2. How Physicians Treat Patients—Physicians must implement simple prescriptive tools that work to drive service excellence and clinical effectiveness.
   
3. How Physicians Treat Each Other—Physician satisfaction and professional fulfillment is tightly correlated to the relationships a physician has with colleagues.  Collaboration, cooperation, support, respect, friendship, and positioning each other well in the eyes of patients should be core values that are trained and expected of your staff physicians.
   
5. Provide physician testimony. An effective way to close training is to find a respected physician within your group to stand up and provide a personal testimony as to why this effort must be done.


6. Provide physicians their personal patient satisfaction data. Following physician training, provide individualized patient satisfaction data to each of your physicians, including national comparative data as a starting point for your efforts.

Step 6: Measure Performance and Provide Feedback. Once your commitment to service excellence has been clearly and repeatedly disseminated to your physicians, and tools and training are provided, the time comes to track and use patient satisfaction to drive performance. Patient satisfaction data is most effective in creating physician behavioral change when it is fully transparent within your organization, and this should be the ultimate goal of patient satisfaction measurement. The process of providing physicians with progressively visible patient satisfaction results must proceed in a stepwise fashion, depending on the maturation of the culture of your group. When individual performance is visible to everyone, physicians become receptive to implementation of training that improves the patient experience.

Step 7: Use Measurement to Drive Results. Tools and training for your physicians will be a continual process led by your physician champion. Measurement of patient satisfaction with progressive transparency of data will proceed as your organization matures. Next, data and tools must be used to drive results. Patient satisfaction percentile goals must be formally established and communicated within your organization. To truly impact physician behavior, individual physician compensation must, in some way, be impacted by patient satisfaction performance. The amount and distribution of income based upon performance will need to be a medical group leadership decision.

Step 8: Celebrate Success. High-performing physicians must be recognized as you roll out visibility and accountability for performance. Recognition for the individual physician is more important than many realize and ranks consistently as a principal predictor of physician satisfaction. Strategies for recognition are numerous, and the methods selected are relegated to the medical group leadership. Options may include:

Individual quarterly certificates, handed out and profiled at medical staff meetings for all those finishing the quarter in the 90th percentile and above, as measured by patient satisfaction.

A physician award system, where several physicians who represent exemplary performance are selected per quarter and are profiled amongst their colleagues.

Personalized letters written by the medical director, sent to physicians’ homes, simply thanking physicians for the extraordinary work that they do.

A bi-annual physician excellence dinner, hosted by the medical leadership, where the top performing physicians are invited, dined, and thanked for the great work they have done.

Step 9: Deal with Perpetual Low Performance. As you measure patient satisfaction performance, you will find the same group of physicians will cluster at the bottom. As an organization committed to excellence, you must implement a strategic plan for these physicians. Three options exist. First, you do nothing and ignore them. This option will eventually impact your group’s progress and is not a good option for the physicians, the group, or your patients. Second, you can fire them. Though this option unfortunately can become a necessity, it is expensive, it damages your reputation in the physician community, and it can negatively impact physician morale. Third, you can engage your physicians in individual coaching and mentoring and make them accountable for their own improvement.

# # #

For more information, please contact Dottie DeHart, Rocks-DeHart
Public Relations, at (828) 459-9637 or DSDeHart@aol.com,

 

Use the Related Tools:
Beeson Nine Steps Tip sheet