Are Your Physicians Ready for Reform? Why Change Management Matters

Nobody knows exactly how the Affordable Care Act will affect either the healthcare system as a whole or each individual player—but there is no doubt we are in an era of unprecedented change. Physicians now face the stress of planning for an ambiguous future in addition to the enormous stresses of practicing medicine today, which already include:

• Heavy patient loads and too little time with each patient
• Implementation of Electronic Medical Records
• Difficulty staying current with the latest medical research
• Flat revenue for the first time in many years
• Increase in malpractice litigation and pressure to practice defensive medicine
• Limited or restricted autonomy, and less independence
• Changing physician/patient dynamic, with increased questioning about treatment and care recommendations
• Increased stress and less work/life balance

Small wonder the Association of American Medical Colleges predicts a shortage of as many as 159,300 doctors by 2025—and that calculation does not include the 30 million uninsured people who may have access to the healthcare system once the Affordable Care Act goes into effect. All this is coming at a time when fewer people are entering the profession and many physicians are considering leaving.

“If you’re not engaging your physicians in discussions about how you’ll move forward together, they’re undoubtedly making decisions about their futures for themselves,” notes Dr. Alan Rosenstein, medical director for VITAL WorkLife.

The cost of replacing dissatisfied physicians who leave is high. Recruiting costs for a typical search are estimated at $30,000-$40,000, according to NAS Recruiting (2008) and a 2003 article in The New England Journal of Medicine. According to the same NEJM article, salary guarantees for the new physician can range from $150,000-$600,000. Then, NAS Recruiting estimates practice set-up costs at $150,000-$200,000. And, there are opportunity costs related to net lost revenue per day that, according to a study by Merritt Hawkins and Associates, can range from $4500 to $9000 per day, depending on specialty. With so much at stake, how much time have you invested in engaging your physicians in a discussion about their futures?

Embracing Change:
Addressing The Elephant In The Room

In a 2011 survey of healthcare leaders, 55% said their organizations will develop or be part of an Accountable Care Organization (ACO) within the next five years, 18% already had significant components in place and 27% were not planning to reorganize along those lines. The most successful healthcare organizations will be those that can effectively collaborate with their physicians to improve outcomes and patient satisfaction.

According to Liz Ferron, MSW, LICSW and a senior consultant with VITAL WorkLife, in terms of physician retention, the extent to which you’ve involved your physicians in charting the course of your organization will affect your ability to keep them on board. How do you keep physicians excelling at their current activities while engaging them in the process of transforming the theatre in which they literally and figuratively operate?

Ferron notes that best practices begin with providing an open forum for discussion about:

• The short- and long-term impacts of reform on individual physicians, your organization and the industry as a whole
• The benefits and trade-offs of proposed changes
• Behavioral and organizational dynamics that need to be addressed (identifying and communicating openly about barriers to change)

“Current medical training isn’t designed to produce physicians that excel in either open communication or multidisciplinary, collaborative work environments,” notes Rosenstein. “Building consensus around change is typically far more challenging with physicians than other employee groups.”

Diffusing Difficult Conversations:
Technical Versus Adaptive Change

In recent years, physicians have been pushed to be more efficient, more accountable and more business-minded—and the reward has not been monetary. Attempts to squeeze more from physicians will be less productive than finding ways to encourage better outcomes across the board.

It’s easier to build consensus around problems that are largely technical in nature, problems that are easy to identify, for which there are cut and dried solutions, that can be solved by an expert and require changes in just one area or department.

The more challenging issues are adaptive in nature, problems that are difficult to identify and for which there are no easy solutions—and the solutions that emerge require changes in values, beliefs, roles, relationships and approaches across departments and organizations.

Electronic Medical Records are a solution to a technical problem—how to document and share information in a timely, less costly and less paper-intensive manner. While there’s often some grumbling, particularly among older physicians, about changing their way of charting patients, it’s a problem with a clear solution.

Defining how to move from paying for procedures to paying for outcomes is an adaptive problem—defining and testing ways to work smarter, not harder, will require the active involvement of every healthcare stakeholder.

Effective Communication Tools:
One Size Doesn’t Fit All

In a 2009 article for Entrepreneur Magazine, Dr Richard Cohn, a surgeon and expert consultant on healthcare communication and collaboration, analyzed the way physicians’ practice arrangements affect they way they use and respond to common communication tools. He concluded that:

• Solo practitioners tend to wield and respond to power tools, such as command and control, threats and coercion, and setting an example.
• Physicians in a small group tend to respond to management tools, such as using measurement systems and conducting productivity analyses.
• Physicians who have a service contract with a hospital tend to prefer inspirational tools, such as charisma, clear vision, and salesmanship.
• Physicians in a multispecialty group tend to rely on cultural tools, such as mentoring new recruits, storytelling, and shared belief.

As you talk about change with your physicians, make sure you’re defining problems and solutions in ways that speak to their needs. If the process of opening this dialogue within your organizations seems overwhelming, VITAL WorkLife is here to help.

Change Management Support:
How VITAL WorkLife Can Help

VITAL WorkLife offers comprehensive support to healthcare organizations as they prepare for and implement change. We help leaders understand their role in the process and give them tools to promote consistent and effective engagement with physicians.

“Physician buy-in is essential to the success of every healthcare initiative,” notes Rosenstein. “By promoting respect at every level, we make it easier for organizations to communicate their needs and the voice of physicians to be heard.”

VITAL WorkLifes’ suite of change management tools includes:

Benchmarking surveys to assess current attitudes and measure morale

• Goal setting and program development
• Kick-off communications and programming
• Customizable onsite workshops and group trainings
• Physician Well Being Resources, an Employee Assistance Program designed specifically for physicians and their families, to help physicians cope with stress and frustration at early stages, and to meet with physician peer coaches who can guide and coach them through difficult times.
• Intensive coaching and counseling (through VITAL WorkLife’s Physician Intervention Services) to help those physicians identified as suffering from a higher level of stress or who are feeling overwhelmed, concurrent with the group training or on a stand-alone basis
• Follow-up surveys to measure outcomes
• Post-program sessions with leadership to review outcomes and determine follow-up actions

For more information on how VITAL WorkLife can help facilitate change within your organization contact us.