SNAPSHOT

Physicians are frustrated and overwhelmed by the changes in care delivery. To support them and build engagement, boards and executives need to provide guidance and support at all levels of a physician’s career.


As health care organizations take on accountable care and fixed-dollar reimbursements, boards are realizing the importance of physician engagement and alignment. Achieving performance goals, improving quality, safety and resource utilization in care, and increasing patient satisfaction all affect financial viability. Physicians are crucial to each of these efforts.

To foster physician alignment, hospitals and systems have implemented a variety of strategies, including adopting best-practice guidelines and protocols, and standardized orders; providing aggressive case management intervention; implementing computer-assisted alerts and reminders; and, in some cases, employing or contracting only with preferred providers. All these strategies contribute to success, but barriers to physician engagement and alignment still exist. Are hospitals going about this in the wrong way?

Most of these efforts focus on telling physicians what to do, how to do it, the metrics they need to meet, and the penalties for not achieving the desired goals. Some physicians may go with the flow, but others may express concerns about what they perceive as a shift in attention from quality of care to finance and productivity. They resist being told what to do. To change this situation, a multistep solution is required. Boards and executives need to develop a better understanding of what’s important to physicians; allow them to have input, involvement and leadership roles in achieving mutually agreed-upon goals; and provide support, encouragement and recognition to help them adjust to the pressures of the transforming delivery system.

Culture Takes the Lead

Developing a positive organizational culture and a strong administrative and clinical leadership commitment to patient-centered care is the foundation for physician support. Setting the tone, culture, commitment and direction must start with the board. The growing focus on consumer satisfaction and accountability for performance outcomes means that health care organizations must recognize that they have multiple customers: patients and their families, administration, clinical and supporting staff, and physicians — all of whom share responsibility for patient care. But, physicians take ultimate responsibility for patient management.

The first step in engaging physicians is to involve them early in the care redesign process. Set the stage by educating them about the new dynamics of the health care environment. For instance, physicians need a better understanding of how payment models have changed, the growing emphasis on performance monitoring and accountability for services rendered, and how this impacts their role in patient care. Once they understand, they will become more responsive to change.

Physicians then should be given an opportunity to share their concerns and weigh in on decisions. Boards and executives can use departmental or one-on-one meetings or town hall forums to solicit their input.

Physicians who are new to the organization will need a comprehensive onboarding process to familiarize them with the nuances of the work environment, expectations and responsibilities, and avenues for support. Many organizations have begun using a more extensive interview process to assess a prospective applicant’s cultural fit with the organization’s direction.

The next step is care redesign. Although hospitals and systems can implement best-practice guidelines and protocols, and develop electronic health record-supported algorithms and standards to reduce unnecessary variations in care, these guidelines, protocols, electronic exchanges and data analysis don’t get at the core of providing high-quality health care. It takes more than knowledge and clinical expertise.

As care responsibilities extend beyond traditional walls and disciplines, caregivers need to work together to communicate and coordinate effective care plans, and provide the personal touch that leads to high-quality outcomes. To foster this behavior, many health care organizations offer training courses to enhance communication and team collaboration skills. Some organizations also offer education on emotional intelligence, diversity management, cultural competency, customer service, conflict management, stress management, anger management and other domains to improve the physician-staff-patient relationship, and boost patient and staff satisfaction. These programs can enhance physician understanding, responsiveness and engagement. And in cases where physicians exhibit more disruptive behavior, individual coaching or counseling or other more formal interventions may be a necessary step to improve behavioral compliance.

Caring for Caregivers

Knowing why physicians disengage is essential to understanding the physician world and resulting attitudes and behaviors. Numerous articles and reports have pointed to the frequency and impact of stress and burnout on physicians, which affects more than 50 percent of the physician population, according to a 2012 Archives of Internal Medicine article.

As we know, physicians make the worst patients. They are so driven that they either don’t recognize that they are working under stress, they ignore the fatigue or physical or emotional consequences or, if they do realize that they are stressed, they feel as though they can handle it themselves. Even when physicians recognize that they need help, many are reluctant to ask for it because of their egos and stoicism, a concern about perceptions of their competency or worries about confidentiality.

To address these situations, trustees and executives need to be more proactive in providing administrative and emotional support. This will help to keep physicians energized, satisfied and more engaged in the care delivery process. Many of these services can be provided internally through human resources, wellness committees and employee assistance programs or outsourced to vendors that specialize in these areas.

Finally, trustees should take the time to acknowledge physicians’ efforts and recognize the time, effort and contributions they make. Simply ask them how they are, show them respect and thank them for the services they provide.

Everyone Benefits

Physicians are at the heart of a hospital’s success. To enhance their engagement and alignment, trustees and executives need to provide a supportive environment and understand the perceptions, attitudes, skills sets and motivating factors that influence physician behaviors. Additionally, the board should involve them in discussions about achieving mutually beneficial goals, respond to their concerns, and provide the leadership, structural, operational, clinical and emotional support to help them adjust to the changing health care environment.

These actions have the best chance of improving physician satisfaction, and they will enhance their morale and engagement, and strengthen the hospital-physician-staff-patient relationship. Finally, remember that the pivotal role of physicians, nurses and support staff in care delivery deserves respect, starting with the board and carried through the organization by all members of the health care team. The result will be improved efficiency and better outcomes. 

Alan H. Rosenstein, M.D., M.B.A. (ahrosensteinmd@aol.com), is a practicing internist and an educator and consultant in health care management, San Francisco.


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More on Physician Engagement

“The Importance of Physician Leadership” by John Morrissey, April 2015

“Physician-Hospital Alignment: Meeting on What Matters” by Mary K. Totten, April 2014


How to Boost Physician Engagement

• Enhance board recognition and cultural commitment to the importance of physician involvement and engagement

• Provide physician education on the changing structure of health care delivery

• Develop programs that enhance physician skill sets to support relationship-building, communication and collaboration

• Involve physicians in care redesign strategies

• Provide appropriate administrative, clinical and behavioral support for physicians in need

• Recognize and thank physicians for what they do

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