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    An Insider's Guide to Physician Engagement
    An Insider's Guide to Physician Engagement
    An Insider's Guide to Physician Engagement
    Ebook146 pages3 hours

    An Insider's Guide to Physician Engagement

    By Andrew Agwunobi

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    About this ebook

    Physician engagement in a hospital or health system can be powerful. It can drive culture change; it can knock down operational, financial, and strategic challenges; and it can lead to better outcomes. But in many organizations, physicians are demoralized and disengaged. Why do physicians in one hospital demonstrate ownership in improving their organization's performance while those in another hospital show no personal commitment to organizational success?

    This book guides leaders in creating environments where executives and physicians jointly work toward shared goals. Concise, accessible, and packed with real-world examples, An Insider's Guide to Physician Engagement presents a practical plan of action for healthcare executives and clinical leaders at all levels of the organization. Each chapter offers pearls of practical wisdom and shares inside tips to help leaders move from understanding to action.

    The author, drawing on more than two decades as a physician, health system CEO, and consultant, takes a seen-it-from-all-sides approach to topics that include the following:

    Busting the myths to change the culturePresenting data effectivelyLaunching costquality campaignsArticulating a clear visionLearning how physicians thinkEmpowering physician leadersMeasuring successPhysician engagement is both an art and a science. By uniquely addressing the challenge from the perspective of both executives and physicians, this book provides an inspiring, achievable plan for physician engagement that has been sorely lacking until now.
    LanguageEnglish
    PublisherHealth Administration Press
    Release dateJul 18, 2017
    ISBN9781567939224
    An Insider's Guide to Physician Engagement

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      Book preview

      An Insider's Guide to Physician Engagement - Andrew Agwunobi

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      CHAPTER 1

      Recognize Disengagement

      PHYSICIAN DISENGAGEMENT HAS been growing inexorably for decades. What's really unfortunate is that physicians have stopped struggling against it; disengagement has become the new normal for physicians just when health system executives need their help the most. The premise of this book is that the solution to most challenges health systems face in today's era of decreasing reimbursement, value-based care changes, and brutal market competition is for executives to engage physicians as coleaders.

      COLEADERSHIP

      Coleadership goes beyond asking physicians to be partners on specific initiatives, such as reducing length of stay. It means a radical culture change where executives and physicians jointly guide the organization. The premise behind the premise is that health systems, as healing organizations, are best run by both healthcare executives and healthcare providers.

      Case in Point: Many years ago, physicians were deeply involved in the leadership of hospitals. In the early 1900s, the American College of Surgeons (ACS) was responsible for identifying minimal standards for organized medical staffs, accurate medical records, and adequate treatment and diagnostic facilities. ACS later became a founder of the organization that evolved into today's main hospital accrediting body, The Joint Commission.

      Fast forward to the present, and such promising beginnings are lost in history. Physicians have relinquished aspirations to be involved in the leadership of health systems, and instead they have withdrawn almost completely to the sphere of treating patients. I would argue that as physicians left the leadership stage, the executive task of optimizing the performance of health systems became impossible.

      When I refer to physician coleaders, I don't just mean medical directors or department chairs; I also include rank-and-file doctors. A culture of physician empowerment is impossible unless all physicians feel ownership, because regardless of whether physicians are formal leaders, they lead the care for their patients. Coleadership, therefore, refers to shared leadership between executives and the medical staff.

      True, the pendulum of attitudes about physicians as leaders has started to correct. More doctors are being hired as health system CEOs, and in some systems, a dyad model pairs executives with physician leaders to promote a balanced management approach. These are good trends, but they don't go far enough. For example, only 5 percent of health systems have a physician CEO, and in most systems using the dyad model, the culture doesn't change to support true coleadership: The dyads exist, but the executive half of the dyad still leads the physician half (Robeznieks 2014).

      I hear less about dyads today. Instead, there is movement toward physician leadership development programs. This evolution is fine, but executives are often confused about what to teach physicians and what to do with them once they are taught. This confusion results from a lack of a clear premise or goal for the leadership development programs and causes many of them to fall short and fizzle out over time.

      Coleadership is a difficult concept for many executives, and even some physicians, to embrace. Therefore, it is hard for health systems to achieve. It's difficult for executives to embrace because not only must they share power, they also must share power with a group that is indifferent (at best) or antagonistic (at worst). For physicians, coleadership is difficult because they feel so marginalized and disengaged that the concept of leading anything outside of direct patient care is inconceivable.

      For both sides, the challenge is compounded by a lack of trust. In fact, trust between executives and physicians has eroded so completely that what I once described as abutting silos are now distinct workforces separated by a demilitarized zone.

      Although hard to accomplish, the concept of coleadership is simple to describe: Executives must share decision making with physicians, while physicians must take responsibility for the success of the whole health system.

      Shining examples of physician authority and accountability still exist. One such example is Mayo Clinic. As John H. Herrell, chief administrative officer of Mayo Clinic from 1993 to 2001, observes in Management Lessons from Mayo Clinic (Berry and Seltman 2008, 102):

      What differentiates Mayo Clinic is the structure that makes the physician accountable for what happens throughout the institution. If the institution fails, the physicians have only themselves to blame. This fact affects physician behavior at Mayo Clinic in a positive way. They must keep the institution's interests in mind because those interests are aligned with their own.

      Creating such a structure and culture isn't easy; Mayo Clinic has the advantage of having been founded by physicians more than 100 years ago and it still isn't perfect. The good news, however, is that just as fallow land can eventually produce bountiful crops, even health systems that have never engaged their physicians have the potential to achieve unimagined levels of success with physician coleadership. Full coleadership will be impossible for most, but health systems that reach even partial coleadership will gain immense competitive and financial advantage. Like Mayo Clinic, they will rise to the top.

      THE PHYSICIAN ENGAGEMENT CONTINUUM

      It's helpful to start a book about physician engagement with a definition. Put simply, physician engagement exists when physicians care about the well-being of their health system and want to work with executives to solve the system's problems.

      This simple definition will likely fit most executives’ understanding of physician engagement, but it is too narrow for this guide. It lacks the necessary tautness of physician engagement, analogous to prongs plugged into a socket. It also misses physician accountability and decision-making authority, which are essential. We can address these shortfalls by recognizing that physician engagement exists on a continuum (exhibit 1.1):

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