According to a January 2014 poll of C-suite healthcare executives conducted by MedAssets1, cost reduction and operational efficiency transformational strategies were cited as their top priorities:
- 55% reported a decline in year-over-year operating margins in fiscal year 2013—as opposed to just 26% in fiscal year 2012
- More than 75% indicated their organizations are engaged in transformational initiatives in the face of healthcare reform-related economic pressures
- 59% indicated that physician groups were the most important partner in the success of those initiatives
- Given how essential physicians are in the eyes of C-suite executives, it’s disturbing when those same executives are viewed with little trust by clinical physicians.
In a 2011 survey by PWC2, when physicians were asked whether they trust hospitals 20% said “no” and 57% said “sometimes.” Given that lack of trust, how realistic is it to expect 100% buy-in when physicians are asked to make major changes in the way they practice or are compensated for their work?
C-suite executives in turn are often frustrated by having the need to persuade and incent physicians—particularly employee physicians—to participate in transformational initiatives vital to organizational success. “Isn’t being on board part of what they’re paid to do?” “Can’t they see that without these changes, this organization won’t be financially viable?”
The reality is that engagement can’t be mandated. There has to be mutual alignment between leadership and physicians to ensure that each group’s needs are satisfied.
“If you’re asking physicians to change their practice patterns, they’ll want assurances that patient care won’t be compromised and that there’s something in it for them besides more work,” says Liz Ferron, vice president of clinical services for VITAL WorkLife.
A respondent to the 2013 Physician Engagement Survey3 conducted by VITAL WorkLife and Cejka Search noted:
“Many hospital administrators seem to think they can demand engagement. In my experience it is a function of mutual respect, good communication and a mission that at its heart supports good patient care. No substitutes exist.”
There’s no easy to solution to bridging this trust chasm—but organizations that are willing to be transparent in their intent and communications have proven their ability to engage physicians.
Measurement Lends Credibility
Most failed attempts to bridge the communication divide are based on mistaken assumptions about the level of engagement or trust an organizations’ physicians are experiencing.
“Our research demonstrates an across-the-board disconnect between physician and executive perceptions of physician engagement and career satisfaction,” notes Ferron.
Whether administrators use an internal tool or a customized version of the engagement survey VITAL WorkLife deployed nationwide, administrators need to collect baseline data not just to understand the size and scope of any issues, but to be able to measure progress against stated goals.
The Dual Benefit of Physician Wellness Committees
The Joint Commission requires medical staffs to have a process in place to identify and manage individual health issues for licensed independent practitioners that is separate from disciplinary processes.
“While Physician Wellness Committees aren’t required per se, we’ve found that healthcare organizations who implement them effectively not only enhance physician work/life balance, but also build trust with physicians that can be invaluable when trying to engage them in strategic initiatives,” notes Ferron.
Ferron recommends that the make-up of Physician Wellness Committees include both executive and multi-disciplinary physician leaders as well as representatives from social work and spiritual care.
It can also help to have a third-party facilitator, such as VITAL WorkLife, consult on committee structure and dynamics, communication strategies and program initiatives. “Where trust is lacking, inviting a independent mediator often speaks louder than words,” says Ferron.
Physician Wellness Committees also provide an ideal forum for educating executives and physicians alike about how improvements in work/life balance, stress management, sleep hygiene, setting appropriate boundaries and employing effective conflict management strategies can impact not just career and life satisfaction, but also patient safety and health.
“We know that doctors with healthy lifestyles are more likely to recommend lifestyle changes to their patients,” says Jennifer Rooke, MD, MPH, FACOEM, FACPM and consulting physician for VITAL WorkLife.
In a 2012 survey4 of 1,000 physicians about their lifestyles, doctors who exercised at least once a week or didn't smoke were about twice as likely to recommend that patients eat a healthy diet, reduce salt intake, attain or maintain a healthy weight, limit alcohol use and exercise regularly.
“As Physician Wellness Committee members work to understand and address the specific factors affecting the mental, physical, and emotional well-being of the physicians in that specific organization, they begin to see issues from a more global perspective,” notes Ferron. “They often become less territorial and guarded as they see the benefits of collaboration.”
Instituting an Ongoing Dialogue
At organizations where communications between physicians and leaders are already strained, scheduling monthly dialogues may be the last thing anyone wants to do—but according to Ferron, it’s often the first intervention that makes a meaningful difference.
“When physicians have no vehicle for bringing complaints, voicing frustrations, making suggestions or getting feedback, that’s fertile ground for misinformation and dissatisfaction,” says Ferron.
In many cases, VITAL WorkLife helps design the format for and facilitates initial monthly dialogues in order to lay the ground rules for respectful communication and ensure that all voices are heard. VITAL WorkLife consultants also provide feedback and coaching to leaders about how issues were handled and suggestions regarding how to approach similar situations in the future.
Follow-Up is Key
Having convened physicians and asked them for their input, it’s essential that leaders respond in a timely and proactive manner. Even if a recommendation can’t be implemented, leaders should be accountable for explaining why and offering alternatives—or opening the subject up for further discussion.
“If you’ve given your physicians an expectation that you’ve heard their concerns and are going to take action, you need to follow through,” says Ferron. “You can’t necessarily work miracles, but you do need to demonstrate a good faith effort.”
Leaders should also be aware that policies effective for long-term strategy may pose particular hardship for individual physicians—who may change jobs rather than adapt to call or clinic schedules that prevent them from participating in work they feel vital to their careers or lives.
Developing a transparent over-ride mechanism that allows for flexibility without favoritism has proven helpful for some organizations.
Provide Necessary Resources
Physicians are great problem-solvers and subject matter experts—but few have the leadership skills or industry perspective of an administrator with an MBA or doctorate in health administration. Physicians who are interested in leadership roles should be encouraged and provided resources to develop those competencies.
The American College of Physician Executives offers distance education options for physicians who want to pursue a career track in leadership. VITAL WorkLife offers coaching and counseling for physicians who want to improve their executive communication and relationship skills.
“Physicians are great students and quick learners,” notes Ferron. “For most, it’s simply that ‘people skills’ aren’t something that was taught or evaluated in medical school.”
Contact us to learn more.
1 MedAssets, Feb. 11, 2014, http://ir.medassets.com/releasedetail.cfm?ReleaseID=824866
2 From courtship to marriage, a two-part series on physician-hospital alignments, April, 2011, retrieved March 20, 2014 http://pwchealth.com/cgi-local/hregister.cgi/reg/from-courtship-to-marriage-series.pdf
3 Physcian Wellness Services/Cjeka Search, “Physician Engagement Survey,” https://www.vitalworklife.com/resources/research-and-articles, January, 2014
4 Hung, Olivia Y, et al, “Doctors practicing healthy lifestyles more likely to preach it to patients,” American Heart Association, March 2012 http://newsroom.heart.org/news/doctors-practicing-healthy-lifestyles-230084, retrieved March 23, 2014