In Search of the Team Player

This article appears in the February 2012 issue of HealthLeaders magazine.

Often seen as self-styled Lone Rangers out to save healthcare with their clinical know-how, physicians must do a better job becoming involved in partnerships to overcome turf wars and ego-driven barriers to coordinate care and improve patient outcomes.

Improving relationships within hospital systems is critical, with the need clearly reflected in the HealthLeaders Media Industry Survey 2012, says Michael J. Dacey, MD, FACP, senior vice president for medical affairs and chief medical officer for the 359-bed Kent Hospital in Warwick, RI.

"Many hospitals now have millions of dollars each year at stake on quality and patient satisfaction measures," he says. "In many cases, a hospital's entire profit margin and then some will be accounted for by successful performance on these measures. In order to succeed with these, hospitals and doctors must work together."

It may not be easy.

The industry survey reveals that 10% of physicians blame themselves for the "healthcare industry mess," although three times that number—30%—see physicians as the ones who will save healthcare. And 13% say that physician disrespect and abuse of nurses is prevalent at their organization.

"It has become increasingly apparent that doctors have to work with other people and share the care of patients with other professions, whether they are nutritionists, pharmacists, or nurse practitioners," Dacey says. "You've got to be more collaborative, work as a team. There's a different mind-set."

Of physician leaders in healthcare organizations nationwide, 36% said the government was "most to blame for the healthcare industry mess." Another 23% blamed health plans, and 10% blamed physicians themselves.

Physicians should be blaming themselves for a big part of the healthcare morass, one physician leader suggests. "We order too much, [practice] too much defensive medicine, keep patients in hospitals too long," says Douglas Garland, MD, medical director of the MemorialCare Joint Replacement Center, part of 1,006-bed MemorialCare Health System in Long Beach, CA. "We truly care about people and good outcomes, but not in rationing care, which doctors must learn to do. We made our bed and now we must sleep in it."

Patients need to learn, too, Garland says. "They want their own doc, not a doc in the box; they want the latest and the best," says Garland, also cochair of the orthopedics, neuroscience, and rehabilitation program for the 420-licensed-bed Long Beach Memorial Medical Center.

And who's going to save the healthcare industry? Well, the doctors say the doctors, that's who. In the survey, 30% said that physicians would save healthcare, far outdistancing the other stakeholders, such as the government (13%) and hospitals (13%).

"So much for humility," Dacey comments.  "The real answer, of course, is all of the above working together," he says.

"Most doctors believe that very few administrators understand physicians and the problems they face," Dacey says. "And most administrators at both hospitals and insurance companies would say the same thing about doctors. And both groups are correct."

Relations between physicians and nurses are particularly important as systems move toward multidisciplinary approaches and use of nurse navigators with physicians for specialized care within service lines.

The survey results indicate mixed attitudes about physicians related to their nursing colleagues. While 48% said increasing scope of care for nurses would improve the quality of care, 26% said it would worsen.

When asked how pervasive physician abuse or disrespect of nurses is at individual organizations, 13% said it was common, while 88% said it was uncommon.

"I think it's an underreported thing, no question," says Dacey. "The truth is almost always the doc is not willing to listen to the nurse's input. The nurse may be right or wrong, but why won't [the doctor] listen? A lot of it is ego. I'm sure if you talked to the nurses, they would switch those percentages, and 88% would say it's common."

Dacey says, however, that more nurses are becoming assertive related to those issues, and physicians can "lose privileges and get sanctioned" by a medical board.

Physician and nurse relations are often dependent on where they work in the hospital, Dacey says. While ICUs or emergency departments may generate team concepts, a physician working on a medical floor "may feel that I'm going to be there for 20 minutes, and I don't have to take the heat" and start being abusive, Dacey says.

"Of course," he adds, "any disrespect should not be tolerated. Nurses are our partners."

Physicians say they believe that healthcare can't solve its own problems, with 60% saying there is too much self-interest among stakeholders.

"There is a lack of alignment amongst physicians, hospitals, insurance companies," Dacey says. "Each has traditionally had its own set of interests that were at odds with one another." Referring to job satisfaction, 24% of physicians said they were very satisfied and 49% satisfied, while 12% said they were dissatisfied and 1% very dissatisfied.

"Obviously, we would like more of our colleagues to be very satisfied," Dacey says. "I'm surprised that the numbers are not worse. It speaks to the real benefits of being able to make a difference in people's lives that even overcomes the paperwork, malpractice, and others from job satisfaction."

This article appears in the February 2012 issue of HealthLeaders magazine.