Give Physicians Support, Tools to Improve Working Environment

The best way to avoid friction with physicians is to involve them in the important decisions that affect the practice. With compensation, for example, Peters recommends creating a physician-led steering committee. "The administrator should provide the staff and support it and give them data but the ultimate decisions need to be made by the physicians," he says. "You can't just say 'be happy.' You have to create a model that allows them to constructively change how things are. Part of making them happy is to let them be responsible for things that they can control and drive."

In the case of EMR, Peters says it's imperative that operating processes are not changed before the EMR goes in. "You don't want to have an EMR and broken processes and no way to track what is going on in the practice with those broken processes," he says. "That is a good prescription for disaster."

Simplify as much as possible
Barbara Berry, senior director of planning and marketing at Northern Michigan Regional Hospital (NMRH), in Petoskey, MI, says the 243-bed, regional referral center for 22 counties has developed a management style that builds trust with physicians by clearing the hassles that distract physicians from their healing mission.

"You have to do what you say you're going to do, and you have to get the bureaucratic drag away from the physician. A practice manager or hospital administrator who can help dissolve and compress that decision-making cycle has the ability to win over physicians. Keep the noise away from them. They are here to practice medicine and take care of patients. Really, just make their life as simple as possible," says Berry.

Most recently, Berry and Peters helped nine NMRH-affiliated cardiologists change a practice business model that had been failing for two years. "A number of physicians had left the practice. They weren't able to recruit. Because the hospital depended on that practice as their largest service line, the market share was dropping," Peters says. "What the organization was able to do was acquire the practice, employ the physicians, and put in a new model for physician leadership, not just for the practice, but for the cardiology service line. And if you talked to each of the cardiologists, it has totally changed their lives."

Berry says the physicians' decision to change the business model was not pushed on them by hospital administrators, but was gently supported as the physicians realized their existing business model wasn't working. "It took 18 months, to where they had reached a point in their practice where they were pretty frustrated with their own inability to have a succession plan and then recruit," she says. "Knowing they were really the highest contributor to our revenue, it became an organizational strategic initiative to assist them."

Peters says the cardiologists went into the affiliation with NHRH assuming they would be hired into an employment model. "What was ultimately decided was we would create a cardiac institute where they would be a group but they would also have a role in co-managing the cardiovascular service line," he says. "They have really stepped up to the plate. The practice is doing better. They've made changes in how they cover their patients, how they interact with primary care physicians and with staff. There is a totally positive revamping."