The physician's role is changing drastically due to mergers of medical facilities into large health care conglomerates. According to research from the Advisory Board Co., a global researcher of the health care industry, the number of specialty physicians employed by hospitals increased from 5 to 25 percent, and employed primary care physicians doubled to about 40 percent between 2000 and 2012.

Physicians, who have been the leaders of their own practices for years or even decades, are being asked to change how they think about their work and how they perform daily tasks. Collaboration among physicians and the nurses and supporting staff members is critical to achieving the big-picture goals of the parent medical groups.

Lean process improvements are also an integral part of merging systems: They help to achieve the highest efficiencies and quality of patient care. One of the biggest challenges health care system leaders face when they're implementing a Lean transformation is participation from physicians. Gaining physician input and support early on leads to a more effective transformation that will be seen and felt both internally and externally. 

Creating a Better Organization

Physician engagement in Lean processes can help to create:

  • an equally engaged staff;
  • consistently high levels of quality care;
  • improved patient safety and satisfaction;
  • better staff morale.

Hospital leaders must work with physicians and supporting departments, as well as with experts in Lean processes, to better achieve physician buy-in for an optimal and sustainable Lean organization.

In many cases, a Lean consultant will work directly with the administrators and other front-line staff, receiving little to no physician participation. This approach is not unusual due to the busy nature of the physicians' work, but if the health system fails to obtain the physicians' point of view, the physicians will see little value in the transformation.

Instead, hospital leaders can use the Lean consultant as an objective mediator to represent all sides in the implementation of Lean processes. Leaders can increase direct contact between the Lean process leaders and the physicians by winning the support of just one to three physicians. Having an internal physician champion not only will provide great insight at the crucial beginning stages of Lean transformation, but will be a signal to other physicians to follow.

Learning the Language

Physicians are trained to make their own decisions and to work independently. Those coming from their own practices face an especially difficult transition to a new environment, one with more people to answer to. Providing quality care to their patients is the singular priority of physicians; whereas, facility leaders are likely to be more mindful of financial impact as well as delivery of care.

Members of the administrative and support staff are accustomed to working more collaboratively and might find it difficult to work with physicians who appear unengaged. All parties have a different language and think differently about the organization's goals.

Initial communications should stress that the Lean leaders are not here to punish; they're here to improve. Subsequent communications should appeal to the problems and solutions that benefit everyone. Show the physicians how incomplete charts, disorganized supply stations and poor access to instruments or other resources are reducing efficiency in a particular department; demonstrate how Lean can improve the department's performance.

For example, through a Lean project a surgical department in a hospital was able to improve surgical on-time starts by posting individual physician data in their lounge. The Lean improvement team provided the organizational goal; if a physician fell below it, his or her name appeared in red. The data garnered attention and helped to make each individual more aware of his or her performance compared with peers. As a result, the hospital was able to improve on-time starts (defined by five minutes before or after the scheduled start time) from 19 to 52 percent within a three-month period. This improvement let the organization perform three more surgeries a day, creating significant potential for more revenue.
Departmental inefficiency, as it applies to nursing staff, typically manifests itself in poor communication. Physicians become frustrated with obstacles to providing patient care and reprimand staff for bad processes. When things are more organized and efficient, communication improves, and the administrative staff feel more confident and engaged in their work.

For the organization overall, the data speak for themselves: More efficient processes mean employees are able to work smarter and stop wasting time and resources. Leaders can use a strengths, weaknesses, opportunities and threats, or SWOT, analysis to formalize the information captured from each professional team and map out the changes needed to move forward together. The goal is to create a mutually approved vision of the organization, as well as to capture the engagement from both the physicians and the administrative staff, with set roles, responsibilities, goals and objectives.

Ways to Achieve Engagement

Once leaders have established a good understanding of the language and perspectives of the physicians, the administrative staff and the organization's support staff, it is time to open the lines of communication among them in a safe, open forum. Leaders can apply the knowledge gained from their physician champion(s) to this step.

There are three important topics to address in group discussions: meeting long-term goals, improving patient care and building trust. The following are some simple methods for leading those discussions.

Set up a cross-team meeting. This initial meeting should be an introduction for everyone to learn and understand the Lean concepts, and to hear why it is critical for everyone to be involved for the long-term success of the organization. Set up mutual expectations at the beginning.

Continue with scheduled meetings on a quarterly basis. Attendance at these meetings should be mandatory to discuss improvements and maintain engagement.

Encourage participation by soliciting feedback from physicians and implementing their suggestions, whenever possible.

Consistently communicate current performance to the physicians. Status updates published in organizational newsletters and on posters in communal spaces will keep physicians in the loop and ignite their competitive spirit. Use a template for reports that is easy to recognize and understand. When necessary, follow up with physicians individually.

Use facts to reinforce shared expectations of success. Provide physicians with data that are relevant and up-to-date. For example, show them how a specific implementation is helping them and their patients.

Creating an engaged, high-performing organization and staff through Lean is important for facility leaders and employees transitioning to a value-based health care system. Following these methods will assist leaders in creating a more deeply rooted trust and acceptance of Lean transformation in all departments, contributing to a more efficient organization and an improved working environment that will last.

Don Spicer is a health care consultant with TechSolve, a Cincinnati-based process improvement consultancy.