Too often, hospital and health system leaders turn to provider employment as an instant cure for symptoms like inconsistency of care, employee turnover, misaligned goals, and disconnected communication.
Getting a physician on your team doesn’t guarantee that the person will be immediately or easily invested in your mission and dedicated to your goals, however. Employed providers may not always equal aligned, engaged, or loyal providers.
But no matter what business relationship your hospital has with its providers, engaging them in performance improvement initiatives requires attitude and expectation shifts as well as strategic investments in culture and support systems. Use these ten ways to get providers aligned and performing optimally.
1. Cast the Vision
To stay productive, physicians need to see and understand a positive vision of what the future holds for the hospital or health system and their role in it. Research indicates that many have limited insight into how their day-to-day clinical decisions translate into efficient care delivery and its effect on their organization’s reimbursement. Not everyone will buy into the vision, of course, but hospital leaders can do their part by communicating coherent sense of direction.
The goal is to create an organizational climate where executives and physicians alike have a sense of shared purpose — so be decisive and chart a clear path for them to follow.
2. Redefine Productivity
Leadership should take a fresh look at physician "productivity," redefine what it means and set up incentives, initiatives, and information systems that support the new productivity goals and metrics.
3. Find Change Agent Role Models
Having committed physician leaders who actively participate in the change process is a critical component of provider productivity success. Physicians, like other people, are more likely to change if they see respected colleagues adopt the new behaviors.
Find physician leaders who can model the desired behavior and who play an active role in championing any change program. Then, celebrate their successes so others can appreciate the impact that those changes produce.
4. Remove Productivity Barriers
In a Healthcare Financial Management Association article on improving physician productivity, two SCP Health executives — Lisa Fry, Chief Growth Officer, and Stephen Nichols, MD, Chief Clinical Technology Officer — listed three common performance barriers that must be removed to increase productivity.
Documentation issues. Removing this barrier means having charts that accurately document patient care so that hospitals get paid for work being done.
Problems with the lab. Eliminating lab-related barriers requires data-driven assessments that identify issues and give staff the necessary insights to fix them.
EHR challenges. EHR systems are often the biggest clinical time wasters, according to Fry and Nichols. Updating the hardware on which the EHR is running is often one of the quickest ways to improve productivity.
5. Align the Culture
“Engagement is driven by group culture,” one physician leader said.
By that, he meant that attitudes won’t change unless culture does — and the culture must be right for hospitals and physicians to align regarding the clinical and business side of healthcare. Leadership must be invested in a sense of shared purpose with the organization for such alignment to occur.
This culture building is less about where the organization is headed and more about who the organization (and those within it) will be throughout the journey.
6. Recruit to Retain
The recruiting process can be the foundation on which provider productivity is built.
For that to happen, leadership must outline exact expectations, ideally during the candidate screening process, before the prospect comes for an in-person interview.
Careful preparation and vetting on the front-end can ensure only those doctors who buy into the culture and vision become part of the team.
Use this match-minded checklist as a basis when developing your recruitment process.
7. Provide Training and Resources
A survey of 1,400 physicians (PDF) by management consulting firm McKinsey found that training and resources ranked second only to compensation as a factor that influences change.
Hospitals and health systems should make strategic investments in capability-building programs to help physicians better understand the impact of their clinical decisions and give them the skills needed to ensure evidence-based clinical decision-making.
8. Make Room for Connection
In a New England Journal of Medicine article, Drs. David I. Rosenthal and Abraham Verghese remarked that "perhaps the greatest opportunity for improving our professional satisfaction (a productivity stimulus) in the short term lies in restoring our connections with one another."
That means hospital leadership must make room for providers to maintain collegial interaction and build relationships.
There are numerous ways to accomplish this goal: receptions to introduce new physicians, social events to celebrate holidays, small group gatherings, quality improvement projects, and HIPAA-compliant technology, such as secure texting, represent just a few of the many channels available.
9. Offer Clear, Competitive Compensation Formulas
Along with these other measures, hospitals and health systems must include compensation as a means to enhance performance and productivity. In that regard, clarity is the key characteristic. Whether based on volume (RVUs) or value (quality), such formulas are central to maintaining physician engagement.
They should be easy to understand and fair, accounting for differences in the patient mix of individual physicians. Compensation must also be competitive, which can be determined by referencing a variety of physician compensation surveys.
Cerner, a healthcare technology company, recommends that when onboarding new physicians, leadership should include an overview of the organization’s overall financial and revenue strategy.
“This should feel important from the moment they start working,” Cerner says.
10. Provide Focused Support to EM and HM Clinicians
EM – Brand Influence
The emergency department is where many people form long-lasting opinions about the hospital’s brand — its personnel, level of service, and overall quality of care.
For that reason, hospital leadership should prioritize measuring and tracking a range of operational and financial metrics to improve performance.
Healthcare technology company Change Healthcare lists four essential variables to include:
Average patient flow by hour. Tracking average arrivals and discharges by hour “helps emergency departments determine the most appropriate staffing levels for both physicians and physician extenders,” Change Healthcare says.
Average length of stay. This metric shows how long patients are within the department, from the initiation of care to discharge or hospital admission.
Time-to-RVU. Practices can use this provider efficiency metric to discover which clinicians are working most effectively and which may be struggling.
Provider report cards. Change Healthcare recommends combining different metrics to create additional insight into clinician performance. For example, along with time-to-RVU, a report card may include total patients seen, total RVUs produced, and total CPTs performed.
HM – Build an Ownership Culture
Most physicians, hospitalists in particular, want to improve the care they provide patients. They just aren’t quite sure about how to get it done.
They also likely don’t understand how hitting financial and operational goals is a piece of the care improvement puzzle, which is why it's essential to build an ownership culture.
According to the Advisory Board, an “ownership culture occurs in a hospitalist program when the hospitalists think of themselves as owners of their practice. They believe they have control of their outcomes and feel invested in their performance.”
There are a few prerequisites to building an ownership culture in hospitalist programs, the Advisory Board said.
“[H]ospitalist groups should use their structural elements, such as compensation, scheduling, and performance reporting, to promote a personal stake in program performance. Programs should also ensure strong program leadership with appealing leadership roles and an effective governance structure.”
When used correctly, the ten tactics listed here are a tried and true recipe for better physician alignment.
Aligned physicians are engaged, and engaged physicians approach their work with energy, enthusiasm, dedication, and a genuine commitment to improving their organizations both clinically and administratively (i.e., the business side of medicine).
So, show providers where they fit in, how their actions (or inactions) impact goals, equip them with the knowledge and skills they need to improve, and watch productivity increase markedly.
Learn how SCP Health can assist your hospital achieve future growth while improving provider performance and productivity.
Blog: Hiring the Right Healthcare Professionals
Case Study: Breaking the Cycle of Staffing and Operational Challenges
Resource: Happy Docs, Better Retention
Blog: Four Common Challenges of Hospital-Based Physician Services & Tips for Success