Q&A: Getting—and Keeping—Physicians On Board: Best Practices
When physicians understand that adjusting their behaviors results in better patient outcomes, they are willing and motivated to change. Here, three of Studer Group's medical directors—Stephen Beeson, MD; Jay Kaplan, MD; and Thom Mayer, MD—share tips and lessons learned.
1. How can we better engage our physicians in our organizational commitment to service and operational excellence?
JK: It's a matter of meticulous attention to processes and people. Physicians often do not understand what service and operational excellence is. They are trained as clinicians, not as management engineers.
So the first step is to help physicians to understand what's in it for them. That's how you engage them. Help them understand that by participating, their practice environment will become more efficient and their patients will receive better care. Once you have physician engagement, you can work on alignment…aligning their behaviors by asking them to do very prescriptive things to make your organization a better place for employees and patients as well as physicians.
TM: Ask physicians the questions: "Do we offer great service to patients in our facility?" The answer is likely "Sometimes" or "It depends on who's working." Explain that your goal is to create a practice environment that makes their job easier because the staff they work with are consistently skilled, positive, high performing, and strong communicators. Physicians also respect data. Use your physician satisfaction data from your patient survey to encourage their involvement.
2. How can we prove the data and get them to trust it?
SB: Individual feedback is one of the most important drivers of change. The number one medical group in the Press-Ganey database on physician satisfaction has complete transparency in their organization. They break out every physician satisfaction score by physician and post it. Physicians are highly motivated when they see that their colleagues are performing better than they are. However, I only recommend that very mature organizations attempt this. Otherwise, you risk alienating physicians at the beginning of the journey.
JK: Physicians often don't understand that "good" is not good enough when it comes to patient satisfaction. There are four competencies for clinicians: clinical knowledge and quality; productivity and efficiency; bedside manner, and being a team player. The last one is the most difficult for us, but it's critical. Also, I often explain to them that patients rate us on a 1 to 5 scale and that a physician who gets all "4's" will be lower than the 10th percentile when compared to physicians nationwide on patient satisfaction.
3. How would you go about transforming the physician experience at a hospital?
JK: Three things: First, make sure physician satisfaction is a standing agenda item on the medical executive committee and department or management meetings. Second, create a physician satisfaction team with at least one or two physicians who regularly attend. Third, survey your physicians. It doesn't have to be an annual survey. It can be as simple as three questions about what's working, barriers, and additional suggestions. (See sidebar to download a sample survey you can use.)
TM: It doesn't have to be a formal survey either. You can survey physicians every day. When a physician walks on a unit, nurses can ask, "How can I make your job easier?" If you want to know what the physician's experience is, ask about their expectation.
4. What wows physicians and transforms their experience at a hospital?
JK: C.A.R.E. Physicians want Care quality for our patients; Appreciation for what we do; Responsiveness to our issues; and Efficiency of our practice. One suggestion: Have the CEO and CNO round occasionally with key physicians. Physicians often complain that administrators don't understand. Tell them you want to get first-hand experience of how things go and what you can do to make it better.
SB: Here's one tool you can use to help even those physicians who spend little time in your hospital to understand your commitment to making their job easier. Have nurses ask patients to write down their questions for their doctor. The nurse then answers as many as she can. When the physician rounds, the nurse can say, "We are committed not only to providing exceptional care to your patients, but also to making rounding efficient for you. We've created a process so you can target the most important concerns of each patient."
5. What can we do about difficult physicians that set a negative tone or refuse to participate?
SB: There will be physicians who will prohibit you from achieving your organizational goals if you allow them. As a leader, you've got to be willing to articulate and reinforce the organization's non-negotiable behavior standards. Some of our biggest champions were our worst opponents originally. Adopt and enforce physician behavior standards that physicians sign as a condition of practicing at your organization. If all efforts fail, be willing to make bold moves, even if it means confrontation or losing them.
TM: What is it that is difficult about them? Find out from staff. There is a lack of courage and will at many organizations. Silence is not okay. Give them feedback and teach them what high-performing physicians are doing. Sometimes physicians seem like bullies because we believe we were trained to know everything. We are uncomfortable when we don't. Leaders must hold physicians accountable because it is the path to realignment.
6. How can we transform the patient's perception of time spent with the physician?
TM: Train physicians (and nurses) to sit down with every patient every time instead of standing up. The patient will estimate you were in the room three times longer. Ensure they ask: "Do you have other questions? Is there anything else I can do for you right now?" It's not really how much time they spend. It's the quality of time spent.
SB: When patients say, "My physician did not spend enough time with me," he really means his voice was not heard and his needs were not met. To address this, we recommend physicians proactively solicit the "patient agenda" during clinic visits and hospital rounds. Ask patients to list their specific concerns or explain what they would like to get from the clinical encounter. Since the agenda drives the encounter, physicians can efficiently address these issues and prevent the "door knob phenomenon," where patients ask a question just as the physician prepares to exit.
7. How can we select the right physicians?
SB: Typically, the physician selection process in health care has been very random. Since we know that in most industries prior behavior predicts future behaviors, we need to select physicians based on more than their clinical skills and professional reputation. Key attributes include: communication abilities, teamwork and collaborative abilities, caring, compassion, leadership, and clinical problem solving. We recommend behavioral-based peer interviewing to elicit competencies in these core physician attributes that will position an organization for success.