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For closer collaboration with local doctors, administrators need to demonstrate a sustained commitment, and recognize that any prior relationship history likely won’t be forgotten overnight, health care consultants say.

That trust gap, in some medical communities, might prove a significant one for hospital leaders to bridge. Twenty percent of doctors report a lack of trust in hospitals, according to a 2010 survey of 1,009 doctors commissioned by PwC Health Research Institute. An additional 57 percent said they only sometimes trust hospitals.

Given those numbers, physician courtship may have to unfold in phases. Administrators and doctors might start with a project that’s limited in scope, such as a quality improvement initiative, says Brett Hickman, national leader of health care merger and integration practice at PwC. "If you’ve had a very contentious relationship with your cardiologists for decades, and now, suddenly, the same administration wants to be a partner, that’s not going to happen overnight," he says.

Other recommended measures: air out grievances from both sides; hammer out strategies to avoid such pitfalls in the future; and cultivate and train natural physician leaders. Once identified, those leaders must be incorporated into the decision-making process to demonstrate that the clinical perspective is not being sidelined, says William Jessee, M.D., a senior vice president at Integrated Healthcare Strategies.

"I've been in a lot of meetings with hospital managers where they say, 'Well, I can’t talk about this with the physicians because they will spread it all over town,' " he says. "The flip side of that is, if you don't talk about it with the physicians, they are highly unlikely to be supportive, no matter how good the idea might be."

Building Trust

First, though, both sides "have to get the manure on the table," says Colorado Springs, Colo.-based consultant Susan Douglass Quirk, echoing a sentiment she recently heard from an administrator client. Some of those frustrations may reverberate back a decade or longer, she says. “We’re talking about things that come up like, 'Remember the co-management agreement that didn’t work in 1999?'"

Then, "you have to move into the next piece of it, which is developing joint goals so you can mutually survive," she notes.

Both sides should draft a list of items that they'll commit to stop doing as they move forward, Quirk says, citing the approach outlined by Good to Great author Jim Collins. For example, a doctor could commit to no longer showing up at meetings late.Administrators could agree to stop missing physical plant deadlines or if they can't meet one, explain why and provide a new timetable, she says.

Hospital leaders also should stop viewing their doctors as their customers rather than as their partners, and their input as whining instead of substantive, she says. A frequent physician complaint: doctors devote vital patient care time to meetings, "bearing their souls with the sheer hope that something will be done about it," and never hear anything further in response.

"What I've seen as most successful is when administration swallows hard and lets the physicians guide the innovation toward success," Quirk says.

The willingness of Florida’s Baptist Health Care administrators to provide some degree of ongoing autonomy was one of the primary reasons why Cardiology Consultants, also based in Pensacola, agreed to be acquired by the hospital system in 2010, says Ray Aycock, M.D., president of the 28-physician group at the time and until his term wrapped up in mid-2013.

Baptist leaders consented to the group’s desire to continue treating non-Baptist patients, Aycock says. Plus, he says, “Baptist, it was very clear through the process, was going to allow us to keep the majority of our internal governance structure.

"We've had an identity in this town for a long time," he adds. "We've worked very hard to build on our name recognition and we really wanted to keep that."

Mutual Collaboration

In the years since, as the group has worked with Baptist to expand the hospital system's cardiology market reach, both sides have strived to communicate on issues large and small, Aycock says.

Senior leaders have paired up with specific heart specialists in an effort to develop a closer working relationship, he says. Aycock also credits the administration with organizing regular and productive meetings.

If Baptist leaders have a particular problem or issue they want to better address, they bring it and any related data to the physician group, Aycock says. In turn, the cardiology group takes a portion of the meeting, usually 10 to 15 minutes, to update hospital leaders on any upcoming change in the cardiology field.

"Doctors hate meetings," Aycock says. "But these have worked because things happen because of them. Nobody minds having a meeting if you get a result out of it."

Incorporating data into meetings or discussions is vital to capturing physician attention, because that’s how they're trained, Quirk says. Also, hospitals should give physicians with leadership talent the training they require to reach that next level, skills that they may not have learned in medical school, she says.

Mid-career physicians, those in their mid-30s to mid-40s, are the sweet spot of talent that administrators should be working hard now to support and retain, she says. "They are on the cusp of the two worlds. They have the clinical acumen. They don’t necessarily have the business management and interpersonal acumen."

Hospital systems like Texas Health Resources already are making high-profile moves to signal that the clinical perspective will be given equal weight within a more aligned leadership structure.

Early this year, the Arlington, Texas-based system created a triad-style leadership arrangement at the 13 hospitals that it owns.The members of each hospital triad — comprising a chief medical officer, chief nursing officer and president — are considered peers, each with a defined set of responsibilities, says Daniel Varga, M.D., chief clinical officer at Texas Health Resources.

Varga, for his part, was hired in January to serve as the system’s clinical voice, working jointly with Barclay Berdan, Texas Health Resources’ chief operating officer. The integrated administrative-clinical design, both at the system and hospital level, reflects where medical care is headed, Berdan says.

"What we are really looking for is a less hierarchal leadership structure and one that’s more interdisciplinary and team-based," he says. "How care will be designed and delivered is by teams of interdisciplinary folks."

For more on building supportive relationships with physicians, read the September cover story, "Physician Alignment."

Charlotte Huff is a health and business writer in Fort Worth, Texas.