5 Ways to improve physician hospital alignment

As health care reform marches forward, the need for closer alignment between the hospital and the physicians on its medical staff has never been greater.

The shift from volume-focused to value-focused care has mandated a shift from frequent competition to continuous collaboration. As is often the case, the industry jargon has evolved to capture this movement toward cooperation – from alignment to engagement. So, how can a hospital create a culture that integrates physicians more fully into its day-to-day operations and strengthens their enthusiasm for and engagement with the health care organization's strategic objectives?

Dighton Packard, MD FACEP, chief medical officer for EmCare and its parent company, Envision Healthcare, offers these five ways to improve physician hospital alignment/engagement.

1. Develop and promote strong physician leaders. An increasing number of hospitals and health systems are putting physicians at the helm. This is especially true of high performing health care organizations. At the same time, many hospitals are discovering that developing a solid core of physician leaders requires support from the top, dedication of resources, organizational commitment and a spirit of collaboration. "Even the best clinicians may not be equipped to be leaders of departments or divisions within today's rapidly changing hospital environment," says Dr. Packard. "That's why developing a physician leadership core curriculum is so important. Effective physician leaders must grasp leadership concepts and use tools to help them operationalize those concepts. They must also be given the appropriate opportunity to lead and receive support from the organization for their efforts. As with all leaders, they must be held accountable for the results of their leadership. Finally, they need the support and insight provided by fellow physician leaders. Leadership development is a core value of EmCare and we are committed to helping our physicians succeed in helping to lead the hospitals where they practice."

2. Evaluate and right-size incentives. Providing the right incentives to the right physicians for the right actions is critical to strengthening alignment with your hospital. This is especially true as an increasing number of reimbursement models incorporate risk sharing components. Co-management and gain sharing are also strategies that hospitals employee to encourage physician engagement and alignment. There are many regulatory hurdles in the world of physician incentives and legal advice is needed. Metrics and rewards need to be crystal clear to all parties before embarking on specific incentive plans. Surprises are not acceptable. Expected results also must be universally understood and spelled out in any incentive plan. Physician buy-in is key and can either sink or float the alignment boat.

3. Use data to drive decisions and resolve disputes. Most hospital CEOs understand this fact. The Affordable Care Act's emphasis on quality outcomes, satisfied patients, cost-effective care and continuous improvement, which is the reality for all hospital leaders today, is grounded in the availability of meaningful data and leadership's ability to analyze and use it to benefit patients and themselves. The adoption of data-rich methodologies like LEAN require that physician leaders who are often championing efforts to improve processes and eliminate waste are able to access real-time and historical data that pinpoints historical trends, establishes benchmarks and highlights opportunities for improvement. "Hospitalsand physicians can be overwhelmed by "Big Data"," says Dr. Packard. "A stronger alignment between hospitals and physicians depends on the ability of the organization to segment the right information and analyze it in various ways to help leaders gain strategic insights and develop action plans that will help the organization reach its desired goals. Objective data is also the great equalizer, so making dashboards and other aggregated data reports available to physician leaders can help resolve disputes."

4. Promote win-win approaches. From competition to collaboration, that pretty much sums up today's formula for success in health care. The push toward better quality, lower cost and more satisfied patients has caused clinical care and operational excellence to converge. Doing what's right for the patient, based on solid evidence-based medicine helps both physician and health care organization deliver what each strives for and expects. Many organizations have been pleasantly surprised to discover that process improvement projects have not only benefited patient care, they have also resulted in lower costs and improved quality. When physicians are part of the team, that has accountability to help meet and exceed goals; then all parties, including their patients, will be rewarded by achieving success. This is the key to developing a win-win approach.

5. Generally, the problem is with the process, not the people. The blame game has no place in today's successful health care organization. "Experience has shown me that most people who decide to pursue a career in health care want to a good job," says Dr. Packard. . Continuous improvement is not a new phenomenon, but it has taken on new importance with the emphasis on eliminating waste, breaking down barriers and fostering a culture of collaboration. The meteoric rise of process improvement approaches such as LEAN are clear examples of how organizations are sensing a need to dramatically fix broken processes so that its greatest resource, its people, can thrive and achieve their full potential. That's good for the organization, for its people and for the patients and their families."

Dr. Packard has practiced emergency medicine for more than 30 years. In addition to his duties as Chief Medical Officer for EmCare, Dr. Packard also serves as Chief Medical Officer of Envision Healthcare, the parent company of EmCare Inc. For many years, Dr. Packard served as the chairman of the Department of Emergency Medicine at Baylor University Medical Center in Dallas, Texas, and is a member of the Board of Trustees for Baylor University Medical Center. He received his BS from Baylor University at Waco, Texas, and his MD from the University of Texas Medical School at San Antonio.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.​

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