This post is the last of a three-part series entitled Setting New Providers Up for Success. Part one approached the topic from the standpoint of the resident and provided advice on how to transition from residency into a career as an attending physician. Part two shifted the focus to the hospital and addresses hiring the right prospects.
In this post, we discuss aligning providers with facility goals.
Healthcare provider and hospital goals must align to improve patient experience and clinical outcomes. But facilities can’t expect providers to get on board if they don’t understand the goals and aren’t given a voice.
This is especially true in a time when hospitals and health systems are being pressured to cut costs, reduce medical errors, and adopt standardized processes and new ways of doing business that challenge providers' established habits.
An article in the Harvard Business Review (HBR) — Engaging Doctors in the Health Care Revolution — puts it pointedly:
"[M]any physicians are deeply anxious about the changes underway and are mourning real or anticipated losses of autonomy, respect, and income. They are being told that they must accept new organizational structures, ways of working, payment models, and performance goals. They struggle to care for the endless stream of patients who want to be seen, but they constantly hear that much of what they do is waste."
When providers view changes as clashing with longstanding patient care values, they are less likely to adopt new behaviors and practices, the article said. Yet, without doctor's buy-in, excellence in patient care is put in jeopardy.
What can hospitals do to achieve such buy-in, and how should providers respond? Consider these six strategies when approaching change across your healthcare organization:
No one likes to change, particularly if they don't understand the rationale. Physicians are highly unlikely to modify their behavior unless they know how the changes will improve the quality or cost efficiency of care.
What goals are typical? A Press Ganey strategic insights report lists patient safety, clinical quality, workforce engagement, and patient experience as customary.
Achieving long-term success requires more than "discrete changes within different areas of operation," the report said. Instead, real healthcare transformation can only be achieved when hospital leadership and caregivers converge around shared goals and an integrated plan.
So, the first step is to ensure everyone is on a level playing field and clearly understands the goals.
Engage in Shared Purpose
"Most discussions about health care these days dwell on its problems — spiraling costs, lack of access, uneven quality — and give short shrift to the possibility of a better future," the HBR article said. "To help physicians move beyond grief and anger about what they might be losing as the health care system remodels, leaders must shift the conversation to something different — something positive, noble, and important."
The article challenges hospital leadership to articulate a vision of what improved healthcare for patients can become.
Creating a shared purpose begins by listening and showing respect for diverse views and co-creating processes that help turn the vision into reality, it said. Transparency, two-way communication, respect, and empowerment are imperatives.
Appeal to Self-Interest
Physicians, like everyone else, are motivated by financial incentives and job security.
"Even if their organization’s noble shared purpose resonates deeply with them, they also care intensely about what measures are being used to gauge their performance and how the data are collected and analyzed,” the article said.
However, organizations can over-weigh the importance of compensation to influence physician behaviors, says a report from Mckinsey, based on a survey of more than 1,400 providers.
"Although most physicians do rank compensation first among the factors that would influence their behavior, they do not believe it outweighs everything else," the report states.
The survey asked respondents to list factors that might convince them to change their practice or collaborate with others. While compensation ranked highly, physicians also deemed nonfinancial rewards such as training and capability building, constructive feedback, effective communication, and strong role modeling by physician leaders important.
When physicians value membership in an organization — out of pride, a need for security, or some other reason — they are motivated to adhere to that organization’s standards and traditions, the HRB article said. Case in point, the “Mayo way of doing things” referring to the strict, but respected, formal dress code at the Mayo Clinic. The historical and cultural significance of the dress code has been passed down since its start in the 19th century.
Tailor Levers to Different Types of Physicians
No two doctors are alike, so it stands to reason that what factor influences one to change won't another. That's why having a variety of levers to engage physicians is crucial.
Mckinsey advises health systems take steps to understand the differences among the physicians they work with, target the groups they want to address first, and then tailor the levers they use with each group to increase the probability of achieving goal alignment.
Don't Underrate the Power of Leadership
Another element comes into play when creating an environment conducive to goal alignment: leadership.
In his blog post, The Power of You: Commitment to Leadership, David Schillinger, MD, FACEP, Chief Medical Officer, SCP Health, said: "Building a successful emergency medicine or hospital medicine program requires leadership — someone who can steer the ship in a predetermined, goal-oriented path."
He outlined four areas where leadership can influence behavior.
Invest in Leadership Success
“If we do not invest in the success of our leaders, we should not expect to have success as a company," he said.
Build a Foundation on Organizational Values
Without a solid core, no organization can excel, Dr. Schillinger said. He advised building a foundation on truth, which leads to trust.
Create a Culture
Hospital-provider alignment has as much to do with culture as it does with goals.
"Culture is the thread that runs through an organization and keeps it together," Dr. Schillinger said. "It is both tactile and visual, apparent to everyone that encounters the organization."
Lead by Intention
"Leading by intent is the ability to see a vision, create a path and work the entire organization toward the success of the mission," he said.
Aligning providers with facility goals does require a certain level of change. It must be fostered by leaders who are committed to provider success and dedicated to imparting a clear vision of what healthcare can become once goals are understood, purpose is shared, financial incentives are properly prioritized and balanced with nonfinancial, and tradition is embraced. In an era characterized by constant change and uncertainty, never has such alignment been needed more than now.