10 Ways to Boost Physician Engagement

Strategies to improve physician engagement include giving clinicians a voice in decision-making and addressing toxic work environments.

Physicians are the least engaged members of the healthcare workforce, according to a new report published by South Bend, Indiana-based Press Ganey Associates.

In healthcare, the impact of workforce engagement has commonalities with other industries such as productivity, turnover, and financial performance. However, healthcare workforce engagement also impacts the health, safety, and wellbeing of patients.

"High workforce engagement is associated with improved or maintained patient experience scores from one year to the next, while no such improvement or maintenance is seen in the presence of low workforce engagement," the Press Ganey report says.

Physician engagement data

Data in the report was drawn from engagement surveys conducted in 2018 of more than 1.8 million physicians, nurses, and other healthcare workers.

The report features several key findings about physician engagement:

• Physicians posted the lowest mean engagement score by job category on a scale of 1 to 5: 4.02. Senior management posted the highest mean engagement score at 4.60. The data shows that the closer a healthcare worker is to providing patient care, the lower the engagement score.
   
• Length of service had a significant impact on physician mean engagement scores. Physicians with less than six months of service posted a 4.29 score. Physicians with three to five years of service posted a 4.06 score. Physicians with 21 to 25 years of service posted a 4.16 score. The engagement data shows a honeymoon period, followed by a steep decline, then recovery toward the end of physicians' careers.
   
• Physicians scored lowest for resilience, which Press Ganey measures with two primary components: decompression, which is the ability to disconnect from work; and activation, which is the ability to connect with the meaning of work. Physicians scored lowest for overall resilience at 3.96.
   
• Physicians scored lowest for ability to decompress at 3.34. "This finding helps explain physicians' increased vulnerability to burnout and the growing number of physicians who are experiencing it," the report says.

Boosting physician engagement

There are 10 ways to improve physician engagement, Martin Wright, a partner in strategic consulting at Press Ganey, told HealthLeaders.

1. Consistent measurement and understanding of physician needs is crucial, he says. "Organizations are not asking physicians what gets them engaged or about the challenges to be engaged on a consistent basis. So, leveraging a scientifically based, psychometrically sound survey measurement tool is the first step."

2. It is important to connect physicians with their meaning in work. "Storytelling can be effective in daily experience or safety huddles. Meetings can start with great stories of patient experiences, which can reconnect physicians with the importance of their work," Wright says.

3. Physician voices should be heard in the executive suite. "Year over year, we see that one of the drivers for physician engagement is the ability to influence decision-making. Having a pathway for physicians to share their voice and influence decisions is absolutely critical," he says.

4. Systemic factors can create a great culture in which to practice. "These factors are universal—they are not limited to one set of caregivers. For example, there can be an organizational commitment to zero harm. Systemic factors give caregivers something to rally around and build engagement," Wright says.

5. "It helps to truly put the patient at the center of everything a healthcare provider organization does, including work processes, vacation schedules, and parking garages to help caregivers to center themselves on what is most important and reconnect on why they decided to work in healthcare," he says.

6. Physicians should understand the interconnectivity of multiple work streams. "Many times, there are initiatives for safety, for quality care, for patient experience, and for engagement. Those initiatives are interconnected. If we can bring those initiatives together and streamline them so we are not asking physicians to do 20 things on top of their patient care routine, then we can create a more effective and efficient work environment," Wright says.

7. Data in healthcare should be used effectively and not simply collected. "An effective way to drive physician engagement is to build a comprehensive data strategy that improves transparency and helps everybody understand the objectives to which the organization is driving. For example, there can be a balanced scorecard that helps physicians understand what is expected of them in a transparent way. Those scorecards help promote a natural competitive spirit that is common among physicians," he says.

8. The presence of toxicity in an organization's culture should be curbed. "In some organizations, bullying and incivility reigns. It's hard to build engagement in that type of an environment. You need to create a just culture and allow space for collegiality," Wright says.

9. Organizations that are accelerating improvement on engagement have focused on building leadership abilities among physicians, he says. "Leadership skills are not always taught in medical school, but we call on physicians to be leaders every day. So, organizations can adopt intentional physician leadership development programs for physicians who are not only formal leaders but also informal leaders in places like the operating room."

10. Accountability structures for what is expected are important. "In a traditional leadership structure, we ask a group of physicians to do something, we train them on it, we expect them do it, then whoever leads the department checks back to see whether the physicians did what they were asked to do. But that type of accountability alone is not enough to drive engagement. For example, we need create space for peer-to-peer accountability such as the ability to have meaningful dialogue with peers," Wright says.