Physician Engagement


            In a recently published interview[1] four health care executives were asked what they thought the term “physician engagement” meant  to them and their organizations. They replied that physician leadership was becoming more important, so engagement was a strategic necessity that had to be based on trust and transparency. When asked about barriers they had encountered, factors mentioned were time, the structural impediments of existing hospital medical staff arrangements, and poorly functioning information technology systems. The problem of compensating independent physicians for their time was also an issue being addressed in their respective systems.

            The moderator asked what the phrase “physician-led, professionally managed,” meant to them. The non-clinician CEO responded: “As we move forward, there will be less distinction between physician leadership and professional management.” The CEO who was an RN replied: “I would hope that new physicians coming out of medical school would have a better understanding about the expectations and the changing role related to their involvement and engagement.”  One CMO responded: “Some of the most successful organizations will be led by physicians who can professionally manage.” The other CMO added: “There’s going to be a recognition that a partnership is necessary for all of us to be successful. Neither party will be around 20 years from now if we go it alone.”

            I do not know anything about the four systems represented other than what is on their web pages, so I don’t know if these statements reflect reality or aspiration. I do know many hospitals assume their health care function is obvious, so “physician engagement” may serve as a code for “how do we make the doctors do what we want them to do?”

            I was recently asked about physician leadership and started by discussing the differences between formal and informal leadership. While formal leadership is important, I do not think physicians need to become either administrators or businessmen to provide clinical leadership, so I favor informal models. I was asked what I thought physicians should be doing to function as informal leaders. I think the most important thing to do is to talk to each other about clinical issues. Physicians have always practiced essentially isolated from other doctors, but when I was a neophyte, the older physicians would have conversations in the doctors lounge and in the lunch room and would ask each other’s opinion about handling a clinical problem—what we called a curbside consult. Somehow, we seem more isolated than ever, and perhaps less willing than ever to dispense free advice. (I know some colleagues fear they will be quoted in the record about a case they never saw and incur liability.) The demise of the doctor’s lounge has hurt the collegiality that essential to effective leadership, so the first step for someone who wants to be involved is to find ways to reach out. How you do it will depend on your local circumstances.

            The other thing I recommend is to start asking your nurses and other clinical workers for input as you make your decisions. While you are still responsible for the final decision, it never hurts to get the ideas of those who are also working on the patient’s issues. They may know key pieces of data about which you are unaware, and may save you from a significant mistake.

            These two simple ideas—talking to other doctors and to the nurses and other support staff—are the key to physician leadership, which is what I think the term “physician engagement” ought to mean. The challenge for the leaders interviewed in the article is not really to motivate the doctors to care, it is to find ways to craft their organizational structures to support that kind of activity. Now this sounds simple, but is quite difficult, as they acknowledged.  Hospitals are large, complex, highly regulated organizations, and with all of the silos and competing priorities, turning things around so that clinical microsystems are fostered and supported will be difficult. It is so difficult many formal leaders in hospitals will likely fall back on the old command and control model, in which case “physician engagement” really will be code for “how to we get the doctors to do what we want.” If you want your patients to get great care, though, it is imperative for you to do your part. Get your staff and your colleagues involved—talk to each other about your patients.

14 December 2014


[1] Combes J. Fiscal Fitness: The Role of Physician Engagement. Hospitals and Health Networks, November 2014, pp. 52-61. Available at

http://www.hhnmag.com/display/HHN-news-article.dhtml?dcrPath=/templatedata/HF_Common/NewsArticle/data/HHN/Magazine/2014/Nov/exdia-physician-engagement-hospitals-engaging-doctors-clinical-process-health-care-cost

Further Reading

Clinical Microsystems
Clinical microsystems are composed of front-line clinicians engaged in direct patient care.  Despite a lack of formal authority, they are the key to successful healthcare reform.

Nursing Staff Turnover
 If empowered teams of clinicians is the key to effective, efficient care, then staff turnover is Achilles' heel. Nationally, RN turnover exceeds the cap needed to maintain patient safety and quality of care. The problem and approaches to a solution are considered. 

Productivity in Healthcare Part 1
Many are focused on efficiency and productivity in healthcare without a clear understanding that the two are not interchangeable.  This article introduces the two concepts as they are commonly used. 

Productivity in Healthcare Part 2
The conflict between productivity and efficiency is examined from three perspectives using the care of dialysis patients as the case study.

Productivity in Healthcare Part 3
 The conflict between productivity and efficiency is contributing to widespread physician malaise, which has negative implications for health care improvement.
 
 Strategic Human Capital
Healthcare organizations need to realize the economic value of experienced teams of clinicians able to provide highly reliable care and to recognize the importance of maintaining team integrity in times of surges in patient volumes.