3 Ways Leaders Can Help Physicians Manage Change

How healthcare leaders can succeed with value-based care, the Quadruple Aim, and more.

It's been said that the best way to eat an elephant is by taking one bite at a time. But if changes are elephants, today's physicians have herds of them on their proverbial plates.

For insights into managing the challenges of moving toward value-based care and more, I spoke with Gerald A. Maccioli, MD, FCCM, chief quality officer for  Sheridan Healthcare.

The following transcript has been lightly edited.

HealthLeaders Media: A common struggle among physicians and executives I've spoken with seems to be determining their pace of transition from fee-for-service (FFS) to value—deciding how much risk to take on and when. Is that consistent with your view?

Maccioli: Absolutely. Right now in clinical practice, whether you're a six-person group in Topeka, Kansas, or you have 5,600 physicians in multiple specialties like I have, you've got one foot in the traditional FFS world—and you have to do all of that reporting and revenue cycle and quality assurance work.

At the same time you have to gear up and create, in many cases, entirely new reporting structures for a value-based world.

It's part of why you see a lot of burnout and stress among physicians. It's the volume of change, the velocity of change, and the magnitude of change. MACRA is a prime example. The final rule is expected the first week of November, and in theory, go-live will be January 1, 2017.

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HLM: With so many demands on physicians and organizations, how can they begin to set priorities?

Maccioli: It comes down to three items. First is informed leadership. Large organizations need to appoint and empower either a chief quality officer or chief value officer who has an understanding of the legislative and regulatory landscape.

Next, it's got to be someone who has credibility with physicians. And the last thing is that it absolutely takes a commitment of resources.

You need all three. If you have leadership and vision, that's great but you won't accomplish much. If you have all the resources in the world but no leadership and vision, you're going to fail.

HLM: How can physicians and organizations get over the hump in which changes and "improvements" create more strain than noticeable benefit?

Maccioli: I made and hung a sign in my office that says, "Frame every decision with the Quadruple Aim in mind."

Everybody's heard of the Triple Aim—better patient experience, population health, and lower cost. And as a physician, as a patient, and as a citizen I absolutely believe in that. But the Quadruple Aim is when you include what I think is the preeminent variable of workplace satisfaction of the physicians.

That means setting up quality programs that are as seamless as possible for physicians and create as little friction as possible.

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You can't take unhappy, disenfranchised people who feel they're overburdened and put upon, and say, "Give us these wonderful results." You have to create an environment where those people who are going to facilitate the change feel empowered and engaged.

HLM: Amid all the talk about stress and struggle, what are the positives? What can physicians get excited about?

Maccioli: There are reams and reams of data of what happens with patients, and a lot of that information has been siloed and segregated.

One of the great things is that we're going to be able to show physicians that the results of the care they are giving and help them find ways to do a better job. I think it will be very empowering to get that kind of longitudinal feedback.