A Familiar Resolution: Improve Physician Relations

Carrie Vaughan, for HealthLeaders Media, January 2, 2009

The goal of improving physician relations is healthcare's equivalent of New Year's resolutions like spending more time with family and friends, quitting smoking, or losing weight. They're all worthy endeavors, but they're often doomed to fail because they lack sufficient planning, accountability, and support.

Still, improving physician relations will likely remain a top priority for hospital CEOs in 2009. So how can administrators show doctors that they are really listening to their concerns? "By actually listening," jokes Bill Donatelli, a regional vice president with QHR, a hospital management and consulting company. And even if your organization can't afford that new MRI machine or da Vinci Robot Surgical System, Donatelli says, CEOs should "provide straightforward answers in a timely manner and look to see if there is some alternative that can be provided."

That seems simple enough: Be honest, time sensitive, and really listen. Unfortunately, nothing in healthcare is ever simple—especially physician relations. During the past year of talking with industry experts and hospital executives, I've heard plenty of thoughts on how to build a better hospital-physician relationship. Here's a snapshot of some of those ideas.

Give physicians a voice. Asking physicians their opinions on improving patient care or crafting the strategic direction of the hospital is one way to garner a mutual respect. For example, Delnor-Community Health System in Geneva, IL, has several physicians on the hospital's board of trustees and quality committee. The physicians are out there on the frontlines and know what can improve quality, says board member Melissa Coleman. "If you are initiating or implementing a quality initiative, get doctors involved and let them drive it," she says.

Scripps Health in San Diego, CA, created a physician leadership cabinet to help guide the strategic direction of the organization. When Chris Van Gorder stepped into the CEO role in 2001, the health system had lost $21 million and his predecessor had been forced to resign after receiving five votes of no confidence by the medical staff. In 2006, the system posted an operating margin of $129 million, and the percentage of physicians who are satisfied with Scripps hospitals rose from 78% in 2003 to 86% in 2007. This advisory group of physician leaders has been a key component to regaining the medical staff's support and turning around the hospital's operations, says Van Gorder.

When it comes to quality and patient safety, James A. Rice, PhD, vice chairman of The Governance Institute, says physician leaders should inform the hospital board and administration what processes they are establishing to guard against medical errors, enforce hand washing, and handle credentialing and privileging issues. He also advises administrators to include physicians in strategic planning discussions on technology trends that may impact clinical outcomes or quality. Board members, senior executives, and medical staff leaders should all come together to look at the efficacy of the technology, as well as the capital consequences for the hospital, Rice says. "That is another partnership or culture of respect that is important to build between the board, management, and physician leaders."

Align goals. Physicians aren't motivated by HCAHPS scores or improving the hospital's ranking on the Centers for Medicare & Medicaid Services' core quality measures. Doctors are focused on patient outcomes and eliminating waste. They want more time with their patients—not more time filling out paperwork for various quality ranking organizations. But this doesn't mean that the goals of docs and administrators are mutually exclusive.

If the hospital's goal is to look good on CMS' Hospital Compare Web site, that probably won't engage physicians, says James L. Reinertsen, MD, president of the Reinertsen Group and a senior fellow at the Institute for Healthcare Improvement. But if the hospital's goals are to improve patient outcomes for specific disease by using clinical indicators to monitor the organization's progress on evidence-based medicine and CMS guidelines, that is more likely to garner physician support, he says.

Full hospital-physician integration. Some hospitals are finding that integrated delivery models are the best way to speed decision-making and align the goals of the physicians and hospital. Kelby Krabbenhoft led Sioux Falls, SD-based Sanford Health to an integrated clinic model 12 years ago. And even though the restructuring was met with some resistance from both administrators and doctors who were opposed to the concept, Krabbenhoft credits their new clinic model as one of the key reasons Sanford Health is a $1.5 billion organization today.

Similarly, Lakewood Health System in Staples, MN, also integrated the local physician group into the hospital in 1997. That alignment has enabled Lakewood to quickly adapt to constantly shifting market dynamics, which will be even more important for the healthcare organization's survival in the years ahead. "Everything is moving faster," says CEO Tim Rice. "Opportunities, when they do arise, all require a careful review and assessment, but if it takes a considerable amount of time today, some of these opportunities are lost."

Carrie Vaughan is leadership editor with HealthLeaders magazine. She can be reached at cvaughan@healthleadersmedia.com.
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