Create Physician Loyalty that Joint Venture Firms Can’t Beat
By Brian C. Robinson, Studer Group executive vice president |
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ecently 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. |
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| 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. |
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| 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? |
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| 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. |
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| 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. |
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| And yet, we are often surprised when physicians get frustrated, angry, or leave us. |
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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. |
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| 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. |
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| 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. |
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Physicians and Hospitals Work in a Parallel Universe |
| We think we understand each other (hospital leaders and physicians) because we work side by side in the same building every day, but actually our approaches are very different. |
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| Characteristics of Hospital Leaders |
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| Characteristics of Physicians |
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| Work with medium and long timeframes |
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| Work with short and medium timeframes |
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| Like a track team or a golf team |
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| 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. |
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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. |
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| 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. |
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| 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. |
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| 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. |
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| 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. |
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| 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. |
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| 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. |
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| I find that physicians truly understand
the need for a strong, vibrant hospital where
they can practice and their patients can receive
quality care. |
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| 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. |
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| 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), for specifics on how to
roll out more than a dozen tools that respond to
each of these drivers. |
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| 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. |
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| 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. |
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| 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. |
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| 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.) |
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| 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. |
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As a former CEO who ran small rural hospitals, large academic medical centers and multi-facility hospital systems, Brian C. Robinson is a 25 year healthcare veteran. He is frequently asked to serve on Boards in Washington, DC and has been appointed by the U.S. Secretary of Health and Human Services to serve as technical advisor to CMS. |
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Hospital Check-Up Report 2007, Press Ganey |
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