The rapid pace of reform is requiring health care leaders to accelerate progress on physician engagement initiatives. To that end, physicians and hospital administrators may find a road map useful for improving the level of engagement. Such a road map can be enhanced by specific measures designed to show whether the engagement initiative is achieving meaningful results.
This article proposes one such road map in the form of 12 positive actions — six actions for administrators and six for physicians. Each action is quantifiable in specific measures that are meaningful to all parties.
A Shared Responsibility
Administrative discussions about physician engagement tend to presuppose a limited aim to get physicians more engaged with certain activities within health care facilities. Unfortunately, the engagement issue has been framed in such a way that the onus for making changes and demonstrating flexibility rests largely with the physicians. Viewed in these terms, it is little wonder that physicians have been less responsive to calls for more engagement than administrators had hoped.
This is no less the case when the facilities directly employ the physicians they aim to influence. But, all too often, the reality for hospital leaders is that employment does not create engagement. Demand for physicians is so acute that they can safely treat C-suite exhortations with benign neglect. Physicians simply have too many employment options to be pressed into engagement on unwelcome terms.
This is a timely moment to reframe the conversation toward achieving shared goals. It is a moment to ensure that more symmetry and reciprocity is built into the engagement process. The challenge for hospital administrators and physicians is to engage each other in ways that are focused on shared long-term goals, while delivering short-term measurable outcomes. The following is a list of positive actions — each of which can be tracked with specific measures — highlighting what administrators and physicians can do to improve engagement.
What Administrators Can Do for Physicians
Work closely with physician leaders to help keep the practice groups stable, improve physician satisfaction and reduce turnover. Attend physician meetings when possible as a positive presence so the physicians recognize that they are being heard and acknowledged, while allowing them to drive the agenda. Demonstrate a willingness to engage equally with independent physicians and hospital-employed physicians.
Create career paths for physicians to prepare them for leadership roles with increasing responsibility. For example, provide rotating committee memberships, task forces, research opportunities and other activities through which they can develop leadership and administrative skills. Invite physicians to attend meetings on topics that range beyond a clinical scope.
In a spirit of transparency, share with the physicians the financial and operational goals of the hospital. Help them view the hospital's objectives through an administrator's eyes and understand how administrators plan to engage the physicians in meeting those goals.
Make regular visits into the community to meet with the hospital's constituents on their turf. Visit local post-acute facilities and review programs to avoid readmissions. Make joint calls on the hospital's referral sources, such as post-acute care facilities and community primary care physicians, and thank them for their confidence in the hospital's capabilities.
Openly share information about physician turnover and retention rates. Connect this effort with physician and patient satisfaction scores to set up a formal program for improvement.
Provide the physicians with more protected nonclinical time for engagement-related activities. Offer physicians the training and educational resources to increase their knowledge in such fields as health care economics and to improve skills such as team-building dynamics and interpersonal communications.
What Physicians Can Do for Administrators
Take the time to learn about the big picture: how the hospital aims to achieve its goals for each of its stakeholders. (Bear in mind, however, that each facility has its own unique set of circumstances.) This knowledge will help physicians to determine the best way to serve the hospital's goals in conjunction with their personal and professional goals.
Learn the basics of hospital accounting and finance. This is necessary to truly grasp the perspective of the hospitals' administrative leaders. Even an eight-hour online course would be a great way to start, and it can be done with continuing medical education credits.
During your patient encounters, seek opportunities to characterize your facility and the medical staff in a way that communicates confidence. This is a simple but often-overlooked step for physicians. Patients may take this into account in their post-discharge evaluations of a hospital.
Balance the need for autonomy in treating patients with the responsibility to make systems-oriented decisions that benefit the facility as a whole. Contribute to the systems-related issues that are important to the hospital over the long term.
Concentrate work time at one facility and minimize part-time work at other facilities. Engaging at one facility is challenging enough; physicians who work with systems and staffs at two or more facilities often prove less able to engage in a meaningful way.
Recognize that the hospital's physician leaders carry significant responsibility in ensuring that engagement is successful and yields the intended results. Leaders of each practice group active in the hospital, whether employed or independent, should have a specific engagement plan developed in concert with hospital administrators and should play an active role in peer-to-peer accountability.
The Rewards of Meaningful Engagement
A paucity of positive engagement between physicians and hospital administrators frequently lies beneath a surface of a formal calm. Uneasy relationships between physicians and administrators can, indeed, directly impact patient care, a condition that may not go unnoticed by the patients.
The new era of health care reform necessitates and rewards close integration and strong team-building between all stakeholders in the inpatient delivery system. Health systems with a demonstrated ability to create engaged physicians and administrators will possess a sustainable competitive advantage in the marketplace. More important, facilities and medical groups that successfully negotiate obstacles to achieve a fuller and more complete engagement with one another will create superior outcomes for their patients.
Todd J. Kislak is the chief development officer for Hospitalists Now Inc., a physician services company based in Austin, Texas.