Improving Physician Engagement

In our September 2015 Intelligence Report, hospital and health system leaders indicated that physician engagement is the most difficult aspect of aligning physicians. HealthLeaders Media Council members discuss ways they have succeeded in improving physician engagement.

This article first appeared in the March 2016 issue of HealthLeaders magazine.

John Haupert
President and CEO
Grady Health System
Atlanta, GA

The No. 1 initiative we've taken to improve physician engagement is addressing and resolving the operations pain points physicians felt were interfering with their ability to be efficient in their work. Our physicians felt they were having to create workarounds in order to work through the system, so we extended efforts on operational process improvement using Lean and Six Sigma to streamline the processes that the physicians touch most, such as scheduling, electronic medical record optimization, and reducing the number of steps physicians have to take to access patient data.

The second area we've improved is communication with the medical staff by keeping them in the loop and involving them more in governance of the organization. We've created more positions for physicians on our board of directors and added senior executive rounding alongside physicians so that there's better communication between our docs and upper management.

We've also implemented yearly physician engagement surveys. We make it a point to ensure that the physicians know that their opinion is heard, as we create action plans for the organization based on the survey results.

I think physicians respond best to an environment where they can do the best work possible—the work they enjoy doing—with the operational and bureaucratic barriers that sometimes frustrate them eliminated.

Lewis Marshall, MD
Chairman of Ambulatory Care
Brookdale University Hospital and Medical Center
Brooklyn, NY

The first thing we attempted was direct employment for all docs practicing in our hospital. Previously, we had some nonemployed primary care and specialty care physicians, and we converted them to hospital employees. When you provide the physicians with a salary, benefits, malpractice coverage, office space, and support, it can be a meaningful step toward getting them on board. We learned, however, that this is no guarantee of engagement.

Our next step was to get these physicians involved in our processes. We decided to involve physicians in decision-making in areas that will improve patient experience or care, reduce hospitalization, or save money. We also developed an education and training program around meaningful use, which we got our entire staff involved in—nurses, doctors, even housekeeping and security, so that everybody understands that everybody has a role.

The next thing that we're trying to do is identify physician champions of different healthcare processes. For example, I've been a physician champion for information technology for years. I have three or four colleagues who have also become champions for information technology. I have them test out new things before I implement them in the hospital at large. So that's another way that we're trying to get physicians engaged: We identify champions among the medical staff and further engage them.

James Irwin, MD
Medical Director of Anesthesia and retired Chief Medical Officer
Samaritan Healthcare
Moses Lake, WA

On the obstacles: The greatest obstacle to physician engagement is time. Most physicians are trying to balance their professional lives with their home life and earning an adequate salary. That's one of the greatest hurdles to getting people involved. Helping doctors to find the balance between home, work, and reimbursement might improve this. Another barrier can be the electronic health records, although, as EHR systems become more sophisticated, I do think it is becoming less of a burden.

On the solutions: We've found that physician engagement is really about getting the right people involved. In other words, you don't put somebody in medical staff leadership just because they've been in the organization for 20 years. You put in people who are interested in expanding their horizons, but you also have to provide support.

We're finding more and more that many times we are having to provide some type of reimbursement for physician leadership. If they're employed, that's relatively easy; if they're a member of another organization, hopefully your relationship with that organization is good enough that you can get them to make sure they get RVU credit for their time spent leading hospital committees, or something similar.

My advice to anyone taking ownership of this would be to be careful who you select as an engagement leader, and continue to mentor and nurture them. Don't just turn them loose. Provide them with some expectations and develop the engagement program with them.

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

I think the greatest obstacle toward keeping our physicians engaged is the amount of things we're asking of them. Between new EMRs, ICD-10, quality, and cost initiatives, there's just a lot on their plates. It's important to be transparent, and that transparency is a big part of getting physicians on board. There are many different initiatives and pressures on hospitals to be more efficient and really provide the best value to patients, and to be able to do that, you need your doctors to be part of the conversation.

In our hospital, we make decisions based on what will be best for the patient, and we believe that encouraging your medical staff to think in a patient-centric way really helps.

For example, if you want to extend office hours, a doctor might object, saying you're already asking so much of them, and now you want them to work nights and weekends, too. They might not like that, but if you can get them to see it from the patient's perspective—when does the patient have time to see the doctor, when is most convenient for them?—they might better understand. Organizations that will thrive in value-based care will be the ones that can encourage a collaborative atmosphere among their staff and get the most physician engagement.