Aligning Physicians and Healthcare Organizations
Healthcare organizations continue to struggle with true alignment between the organization and the doctors they employ. I have been on both ends of this alignment as a practicing physician, medical group leader, hospital president and system CEO. The lack of full engagement and alignment with the physicians should surprise no one, yet it needs to be addressed and bridged intentionally to optimize both the success of the system and the personal satisfaction of the physicians.
Organizations who believe they can approach their doctors as interchangeable production units are sorely mistaken, and physicians who think everything would be solved if they were just left alone to practice are equally in error. The presence of different priorities should not dictate cultural conflict and lack of alignment. Instead, it should be a priority to create healthy cultures around shared goals and benefits.
Physicians are often working in their own world, heads down, attempting to get through a day of complex and stressful work emotionally intact and with a sense of doing the best they could for their patients. This is a natural consequence of the geographic spread of practices, the uniqueness of the culture in each microsystem that is a clinical practice, the needs and workflows of different specialties, the electronic health record, and many other factors.
Change is often perceived as “one more thing” creating a barrier to care, an outside mandate interfering with the patient-physician relationship. Indeed, this concern often manifests as a rejection of the “business of medicine” and a sense of disconnect from the overall economics of the organization in which they work.
Likewise, today’s ever larger and increasingly complex healthcare systems care deeply about the communities they serve. However, as the pressure on reimbursement and cost escalates and competition intensifies, these organizations also need to stay focused on the system economics in order to execute their mission. In a rapidly changing environment, priorities around survival and change become magnified. Doing more with less, making the right strategic investments, and growing your aligned patient base become paramount.
Today’s ever larger and increasingly complex healthcare systems care deeply about the communities they serve.
Aligning Priorities With Physicians
Consider how disconnected these priorities can become. Why, for example, is patient satisfaction important? For the system, it might be a mix of published rankings of systems, patient capture, marketing by word-of-mouth, and avoidance of reimbursement penalties. For the doctor who is incredibly busy managing her day and seeing all her patients, it may be meaningless or simply a reflection of whether she is doing a good job caring for them. Likewise, aggressive goals for growth as a system are meaningless to the physician practice that’s so busy they have a three-week wait time for an appointment.
Thankfully, there are clear areas where organizations and their doctors can create clear win-win situations. In my career, the easiest one was the operating room. Creating efficiency in the operating rooms reduced friction in the surgeon’s day, made him/her more productive in revenue generation, benefited the patient by creating access and care without delays, and improved the hospital’s bottom line.
In my experience, the most overlooked area to align priorities with physicians is in the area of malpractice risk reduction. A well-designed program to address and mitigate medical liability risk directly benefits the organization through cost reduction (particularly if self-insured), lost physician productivity through the legal process, as well as supporting other organizational goals such as improved quality and patient satisfaction. If done well, it signals support to your physicians and other members of the clinical team.
The physician benefits primarily by reducing her chance of being sued, which is well established as a career threatening, emotionally draining experience with a long recovery time. Again, if done well, and with an emphasis of efficiency, focus, and respect for the physician’s time, physician satisfaction can be improved by engaging them in a process grounded in their own well-being and protection.