Strategic Planning

HealthLeaders Media Council members discuss how they engage physicians in strategic planning.

This article first appeared in the April 2017 issue of HealthLeaders magazine.

Joy Henry, RN
CNO
Faith Community Hospital
Jacksboro, Texas

Physician engagement is different when you're in the country. At our small rural facility, our entire clinician team consists of four physicians and two nurse practitioners. Our C-suite consists of four people including our CEO. When it comes to strategic planning, or discussing and deciding where we are headed as an organization, we sit around two tables and our CEO states his opinion, then asks everyone, "So, how do y'all feel about this?"

When practicing rural medicine, physician alignment is really about finding someone who cares for the community. Our doctors all have to work as a team—they pick up patients for each other when they are busy or go out of town. It's all hands on deck sometimes—you never know when you'll need to pitch in, or where. But having a small, cohesive group in our hospital has its advantages. We're a team, we are neighbors, and we're all taking care of patients from our community.

Cliff Robertson, MD
CEO
CHI Health, a division of Catholic Health Initiatives
Omaha, Nebraska

A couple years ago, we launched an initiative to restructure our service lines, and, as part of that initiative, the key objective was to engage clinicians in particularly meaningful decisions around strategic planning.

Our service lines are now specialty-based, and we've engaged physicians, both independent and employed, into our leadership council. One of their primary objectives is to make decisions around the strategic planning across our enterprise, which we have found keeps these physicians engaged.

There are difficulties created when you have both independent and employed physicians working together. While they are collaborators within their service lines, they are competitors as well. You must be prepared to acknowledge that there will be conflict. What we've elected to do is to plan how these conflicts will be resolved; and most often, they are resolved on a system level by our own leadership.

There will be situations where competing practices of physicians will not necessarily be able to agree on the right path forward. One example is that two groups may agree that a new surgeon will need to be hired in the next year. But what they can't decide without conflict is whether they will recruit the physician into the independent practice or employed practice, or if both practices will recruit, and whichever group finds that surgeon first wins. This level of involvement keeps the physicians engaged, but it also creates conflict.

Michael Mayo
President
Baptist Medical Center
Jacksonville, Florida

We consist of five hospitals. My facility, Baptist Medical Center in Jacksonville, is the adult flagship tertiary care center for the Baptist Health System of northern Florida. But the activities we're doing around physician alignment and engaging our physicians go across our entire system. One of the key things we're doing happens to mirror the results of your 2017 Physician Alignment Survey. While we have for many years sought input and engagement from our physicians on key decisions early on in the decision-making process, this is now a higher priority than ever. We have a dyad organizational structure that places an administrator and a physician in key positions as the leaders for each service line. That kicks off the process of placing coleadership in each of those positions, and brings together a forced opportunity for collaboration and communication, and getting input from physicians.

Additionally, we have a program that is offering leadership training to our physicians. It can be described as a yearlong program that brings potential leaders through an educational program that meets quarterly with different topics of study and discussion. It also becomes a panel for communicating challenges or issues the system or an individual hospital may be facing. And finally, we are making a concentrated effort to place physician leaders in key administrative leadership roles beyond those traditionally held by physicians.

Pat Keel
Senior Vice President and CFO
St. Jude Children's Research Hospital
Memphis, Tennessee

On activating stakeholders: Philosophically, I think all employees should play some part in the organization's strategic planning. Even if they're not in the main group that maps out the final strategy, I think it's important to activate all stakeholders and ensure that they have a shared value system and agree with the mission.

On meaningful engagement: First, make sure the physicians have the time. Our physicians are employed, but if the physicians in question are not employed, you have to make sure they can carve out enough time to really participate. The last thing you want to do is to ask them to see patients all day and then participate in "engagement activities" for four hours at night.

The participation has to be meaningful participation. If you are going to ask physicians to give you input, you have to make sure that you keep them engaged throughout the process, that they understand what you do with their input, and explain why you used it, or why you didn't.

Also, you have to make sure that the doctors are educated about the things you are talking about, especially if the topic will require them to get up to speed on background data. You really shouldn't expect them to come into the conversation blindly.

Once you get through that process, I think you have to make sure you recognize them for it. So often, organizations do a strategic plan, only to put it on the shelf. It's not a great recipe for engagement.