Physician-Hospital Relationships: Shifting Out of Passive Mode

The scenario is a common one these days. A hospital CEO hears about a group of surgeons planning to build an ambulatory surgery center, gastroenterologists developing a GI center, or radiologists opening a freestanding imaging center. Or hospital leadership hears a rumor about a group of physicians on the medical staff planning to build a surgical hospital with an outside developer. The typical reaction is, "I had no idea!"

Well, shame on the CEO. These events don’t occur in a vacuum. Physicians pursue entrepreneurial relationships with other physicians or with partners outside of the hospital for a reason. And the reason is that their relationship with the hospital is broken—trust has been lost, requests have gone unanswered, they feel undervalued and ready to toss in their lot with someone who appreciates them. The evidence is there—medical staff is apathetic, meeting attendance is spotty, interest in hospital programs and services is lacking. CEOs just find it easier to stay in a passive, reactive mode. Sure they might be responsive when physicians approach them with entrepreneurial ideas, but it is rare for CEOs to approach physicians in a proactive, collaborative manner.

So how can hospitals engage physicians as business and clinical partners in the delivery of healthcare services? Here are six suggestions.

1. Get out of the office. The CEO of a Mid-Atlantic health system spent the first four months on the job using his car as his office. He met with physicians in their offices and on their turf to rebuild relationships. He commented that it was easier to understand and empathize with their issues and concerns when he was out of his office and in theirs. An open door policy wasn’t enough. Another hospital CEO spends the first hour of the day in the physician lounge, near the computer terminals with patient records. Her goal is to visit with physicians on their turf to identify issues that are impeding the day-to-day practice of medicine.

2. Implement a comprehensive and systematic outreach program. Few approaches, if properly developed, result in stronger physician-hospital relationships than physician outreach. One of the best examples of an effective implementation of this approach is the Bon Secours Hampton Roads Health System in Virginia. Senior leadership, supplemented with outreach liaisons, meets regularly with physicians and identifies critical operational issues that are disrupting their practices. Examples include the availability of specialists, efficiency and quality of imaging services, care provided by the emergency department, and availability of operating room time. By listening to the physicians’ concerns and addressing these issues, the health system believes it can earn the referral relationships of physicians who have other choices for alignment—other hospitals, surgery centers, imaging centers, and diagnostic and treatment facilities. This outreach program is so vital to Bon Secours Hampton Roads Health System that the system CEO monitors the issue lists daily—tracks the resolution of issues and timely feedback to physicians—and shares information from the hospital or outpatient facility with other entities within the system.

3. Don’t rely only on economic models for physician alignment. Many hospital leaders are quick to conclude that physician relationships must involve formal economic relationships, such as employment, equity model joint ventures, or medical director stipends. However, the outreach program example illustrates that successful physician-hospital alignment and strong referral relationships don’t have to be driven by economics.

4. Include physician leaders in developing the strategic direction of the hospital and its programs and services. Many hospital leaders are fixated on return on investment, market share, and other concepts that are foreign to clinicians who focus on the delivery of patient care. Physician leaders are likely to be far more engaged if the strategic direction of the hospital includes the pursuit of high quality, efficient services, and the purposeful recruitment of clinicians who are complementary to the skills and expertise of the current medical staff.

5. Don’t rely on traditional committees, such as the medical executive committee, for physician input. Hoag Memorial Hospital Presbyterian in California formed a physician advisory council to deal with substantive medical staff issues in a forum that provides the appropriate amount of time and attention. The traditional medical executive committee was burdened with an agenda of standing committee reports, such as pharmacy and therapeutics committee, credentials committee, safety committee, and others. By the time physician leaders addressed critical issues facing the medical staff, meetings were often hours long. The physician advisory council meetings focus on service line development, measurement and demonstration of quality of care, achievement of pay-for-performance rewards from contractual payers, and other issues pertinent to medical practice. A committee like this can also include informal leaders, typically younger, future leaders of the medical staff, who are often overlooked by the elected membership of the medical executive committee.

6. Listen to the medical staff, don’t sell. Far too many hospital leaders try to sell programs and services rather than listen to physicians talk about the issues of the greatest interest to them. When hospital leaders use the jargon of financial return or poaching market share from competitors, this language represents a disconnect from patient care issues and the clinical practice of physicians. One hospital CEO uses an 80:20 rule, devoting the majority of time to listening to physicians (80%) and the minority of time (20%) to speaking.

CEOs who employ proactive communication and interactive approaches with their medical staff will discover that they are less likely to be blindsided by entrepreneurial, competitive physician initiatives. Instead, these initiatives won’t occur at all, or when they do, hospital leadership will be engaged enough to see the warning signs early on and take the appropriate, proactive measures needed to potentially salvage the relationships.