This is an excerpt from the HealthLeaders’ book The Complete Guide to Physician Relationships: Strategies for the Accountable Care Era.
There are many references about the relationship between organizational leaders and physicians in healthcare publications, in webcasts, and on the speaking circuit. There is a need for healthcare organizations and their leadership to be in sync with the medical staff. Leaders are acutely aware of the need to balance cost containment and care delivery.
In the 2011 HealthLeaders Media Industry Survey,cost reduction was the highest priority for leaders, with 35% selecting it as one of their top three priorities—quality/patient safety ran a close second, at 33%. Care delivery is at the center of our discussions, but collaboration to manage cost effectiveness is the driver. And although models and methods abound, at the heart of change is the ability to talk with each other—the need to appreciate the business and personal challenges of each party.
Physicians still have room for improvement with their ability to listen to other perspectives and give leaders who are trying a chance. But building that trust is tough to do in the healthcare market. This survey is not about acknowledging trust issues or calling out what the physicians should do differently; rather, it is about providing leaders insight into what the physicians want to hear.
The data highlights priorities for the future success of leaders and the physicians they work with and also provides perceptions about organizational cultures and perspectives. As we anticipate closer working relationships between physicians and healthcare organizations, it is key to understand where doctors believe the organization does an excellent job and where healthcare organizations do not perform as well.
The survey was designed to understand how well physicians believe their organization does in several key areas. Other survey questions centered on physicians’ views of where leaders need to focus their attention for the medical staff and, more specifically, what aspect of the new hospital–physician relationship is most important to them. Not surprisingly, the desire for involvement—control—of one’s own destiny is apparent in the survey results.
Remember that the survey was implemented to expose communications, so as we discuss operational challenges or business structures, the intent is not to build out the method, only to define and then detail what they want to hear—with a little bit of when and how.
Where the medical staff wants support from hospital leaders
The survey respondents can be grouped almost equally into two categories:
- Those who want healthcare leaders focused on care delivery
- Those who desire attention on the business relationships
Twenty-five percent of respondents say quality is the most important obligation of leadership over the next three years. This would indicate that doctors are listening to health reform messages on the topic of quality and collaboration, as well as having a strong desire to provide good care to their patients.
An additional 13% felt that the leaders’ most important role was to improve physician involvement and collaboration. Another category that emerged as a priority under the umbrella of hospital operations was the need to make it easier to practice at the facility, which scored 10%. In total, 48% responded that the focus should be on the care delivery side of the equation.
None of the collaborative business/practice strategies scored very high as a standalone, but when grouped together, 36% of the respondents say these strategies are their single choice for hospital leadership’s support of the medical staff. It included a small number (6%) who want increased employment, almost 18% of physicians who want practice support, 8% who desire partnerships without employment, and 4% who cited more aggressive business development.
In the “other” category, respondents most frequently mentioned physician recruitment.
For most of the survey questions, there was more unity around the answers than for this one. The differences may be due to the level of in-hospital involvement, so we evaluated the data by primary care physicians (PCP) vs. specialists:
- Improving quality is the most important element to both PCPs and specialists; however, is it emphasized more by specialists
- PCPs are more likely to identify practice management/support than specialists
When survey respondents were asked to select one answer, 5% chose multiple answers—which may say something about their perception that one priority is not enough.
Today’s leaders have a lot going on. As they evaluate medical staff relationships with clinical, business, and peer groups, multiple obligations are in play. The physicians responding in this survey are almost equally divided on their perceptions of the leader’s priority to support the medical staff. At face value, it leaves strong leadership teams challenged to determine what to tackle first. And this is only the medical staff’s agenda—there are others, of course.
Creating future leadership
There are national trends and then local realities. With regard to the priorities and expectations of your local medical staff, it’s imperative to dig deeper into their needs, the pulse of the local market, and the priorities.
Starting with data, the decision support team can assist the leadership in understanding which physicians fall into that “can’t afford to lose” category.
Use the data to first project their three-year practice plan. You can use data like age, admissions patterns, and tenure with the organization, as well as qualitative details like recent discussions regarding employment or group merger to get a sense of their ability to remain in this category.
Next, carve out those physicians that you perceive to be future leaders. You may find some in the “can’t afford to lose” category, whereas others may be active in practice building and may be splitting current referrals. Focus on these two categories first. Leaders should meet personally with these doctors—there will be a time for group discussion (primarily for action and implementation) later. If your organization has leaders who have been engaging with medical staff on a regular basis, use that group. If the physician relations team has a strong relationship with the doctors who have been selected, then ask them to facilitate the discussion with leadership.
The personal meeting has value at several levels. First, you are able to clearly discern the priorities of your vital medical staff members. Second, it sets the stage for shared development. And third, it is a proactive method of reaching in and framing a model for ongoing communication.
Even though some CEOs may say it is too time-consuming, if it is staged and well coordinated, it can actually be a time saver. Instead of fighting the rumor mill, create the message.
Quality
As it does in many conversations with physicians about priorities in today’s healthcare environment, quality bubbled at the top in this study as well.
The physicians’ responses to having leaders focus on quality improvement likely leaves some leaders saying, “They have no idea about all the quality work we are doing.” Physicians clearly want the hospital to exceed expectations in quality and to create a safer and better experience for themselves and their patients.
Whereas leaders recognize all of the efforts internally to enhance quality within the hospital, physicians recognize only those elements that impact them on a personal level. The gap between these two areas may fall to directors and managers to regularly remind the doctors of the strides that have been made to work on quality and to share the information in a way that is patient care– centric. Data can be shared that graphically shows the impact of quality initiatives. Physicians can be asked to weigh in on quality initiatives that will impact them. Rather than creating a committee, consider a meeting or a task force that includes two sessions with very actionable agendas and outcomes. The beauty of their desire for quality is that everyone wants the same end result, and the language of data speaks for both parties.
Support at the practice level
Second to quality, getting the hospital’s support in practice operations and management is on the minds of physicians, with almost 18% of survey respondents indicating so. This is great news for hospital leaders in that physician practices view the hospital as a resource for more support and are willing to ask for it. For those physicians who want more support, there is the challenge of practice management in a tough economic climate with more change to come. Organizations should define where are the opportunities to help physicians—for example, by evaluating the type of tools that could be offered and the fit of those tools with what the doctors in your market desire.
Best practice in this area would be to make sure that you only offer what you know you can deliver. And let doctors’ needs be the driver of your actions. Resist the temptation to create practice support strategies that are more focused on what you need them to do to help you grow your business. If you stay focused on their practice development needs, you’ll gain in the long run. Careful messaging for your team around what can be done legally and what should be done politically will of course make for an appreciated value-add.