Addressing Physician Engagement

In our September Intelligence Report, healthcare leaders, by far, cited physician engagement as the most difficult aspect of managing physicians. What elements of physician engagement have been most challenging at your organization and how is leadership addressing it?

Chris Van Gorder
CEO
Scripps Health, San Diego, CA

On engagement and culture: Engagement has not been an issue for us. Maybe it is because we have a physician leadership cabinet that we established 14 years ago where all of our elected chiefs and vice chiefs meet with us monthly to work on all the issues affecting the healthcare system. We established our ScrippsCare accountable care organization and brought all of our independent practice associations and medical group physicians together several years ago and they are extraordinarily engaged.

On expanding engagement: Technically the physician leadership cabinet is an advisory body but I would argue that it is the second most powerful organization at Scripps, second only to the board of trustees. And that was easy. That was just bringing them in and transparently sharing information. We did the same thing with our affiliated medical groups through what we call the physician leadership academy.

On trust and authority: Engagement is not just a word. You have to give physicians decision-making authority. If they have the same information, they make the same decisions we would have made but they make it faster. I feel better about the decisions in the end because I know that the clinical needs of the patients are being met. They aren't just business decisions being made. They are joint decisions. I am not going to abdicate my role as CEO but I am willing to share it with them. If you are not willing to share it then engagement is really going to be difficult.

David Tilton
President and CEO
AtlantiCare Health System
Egg Harbor Township, NJ

We looked at this in the context of the Baldrige journey we were on at the time. An important moment for us happened when we began to view physicians not as independent but as members of our workforce. With that we began to give the physicians the responsibility, the authority, and the accountability around key elements of our strategic and operational plans.

We brought them in at the top of the first inning rather than the bottom of the ninth. That just added to the full engagement of these physicians and their ownership of the efforts we have.

Physician-to-physician puts it on a very high professional level in an area where I don't play. I would like to, but I am not a physician. It's about professionals establishing a standard of performance and saying, "In this particular situation, you don't seem to be participating at that level." When those conversations are not prompted by the CEO or an administrator but by professionals talking to one another, it gains momentum and it changes the whole professional environment within an organization.

Like anything else it is never perfect and it is always evolving. We continue to shine a bright light on those professional relationships and demonstrate our willingness to make this a better practice environment for our physicians.

Jeffrey DiLisi, MD, MBA
Vice President and Chief Medical Officer
Virginia Hospital Center
Arlington, VA

To provide high value, quite simply you want to provide the highest possible quality at the lowest possible cost. And to do that you need physician leadership and to have good physician leadership you need physicians who are engaged and in tune with the idea of providing value and are likely in tune with the hospital's mission statement.

We have employed more physicians to try to provide more value to our patients and to our community, and we see that with our employed physician group. But you can't only have your employed physicians engaged. So how do you get the rest of the physicians engaged? To me it's about being very transparent about what our data looks like. That is one of the things I do personally as CMO. We have a very detailed physician quality scorecard that we put together every month. We want all of our doctors to know, whether they are employed or not, how well we are doing and what we look like with that communication-with-doctors metric on the HCAHPS survey. What are our mortality rates? What are our readmissions rates? If you can get the data in front of them and get them focused on the things we need to do better, it is easier to get them engaged. That has been effective as well for our nonemployed physicians in getting them engaged.

Scott Trott
Vice President of Payer Management and Faculty Services
UNC Health Care System
Chapel Hill, NC

What we've done in the last five years is really promote more physician executives in the system oftentimes creating new positions or formalizing their expected roles within the organization in ways that maybe weren't apparent before.

I have always had a physician committee to do managed care contracting–related guidance because I've been engaging them to help them understand what is happening in the financial world for them. We've tried to really enhance that committee and all of our physician governance committees' roles within studying the general directions for our healthcare system. There has been a lot more cross pollination of physicians getting involved more in what I would call hospital operational decision processes than we ever had before.

The CEO of our system is Bill Roper. He is an MD. He has invited or appointed physicians to be part of our senior leadership team. So they are sitting with him and hospital executives helping chart and debate things of importance to our health system. He engages doctors who weren't necessarily department chairs. They aren't necessarily division leaders. They are just either really astute clinicians or otherwise in some of those kinds of environments where they have helped build enthusiasm. We tell them: "We want to listen to your input. We want you to help guide us through this."