ABCs of engaging physicians in clinical supply chain

In June 2005, a physician colleague and I published an article in The Physician Executive magazine entitled: "ABCs of TJR – Physician Involvement Helps build a Profitable Program."

The premise of the article was that healthcare organizations seeking top-decile performance in total joint replacements needed to actively engage and involve physicians in product selection, supplier choice and overall supply chain decisions. Our field research – conducted nationwide over a two-year period with top-performing health systems – validated that healthcare systems that actively, frequently and genuinely collaborate with their physician leaders reap rewards. Our research showed the "rewards" lay in more efficiently run orthopedic joint replacement and revision programs, which in turn yielded more profitable programs for healthcare administration and more overall job satisfaction and retention of physicians.

Fast-forward to 2016 — more than 11 years later — and we are still talking about how to effectively engage physicians in clinical supply chain management. To say we have not made progress in these past 11 years would be inaccurate; but to say we have conquered the challenge would also be inaccurate. We've made dents here and there, but we have not slayed the dragon.

We've observed that many healthcare leaders have the desire, but not necessarily the know-how or the effective building blocks to develop physician engagement programs. In 2015, supply chain executives surveyed as part of a national IDN Summit Series in Phoenix, AZ, named one of their top-two challenges for 2016 as physician engagement to help manage the cost of physician preferred items. [1].

Developing successful physician engagement programs in the supply chain area — or any area for that matter — doesn't just happen. Better-performing healthcare executives we have worked with over the years have provided a window into what works and what doesn't. Throughout this article we will take a look at why, in our experience, many hospitals' physician engagement programs have failed. We then will provide you with a set of five building blocks to help jump-start successful physician engagement.

Why many healthcare physician engagement strategies fail
Talk to most physicians today, and like all of us, they are juggling family and work with little to no down-time for play. We live in a fast-paced, technology over-loaded and highly regulated healthcare world. So it's not surprising that many physicians feel overwhelmed. Adding to that stress, many coming out of medical school are deeply in debt from student loans and likely to be employed practitioners of a hospital that is run by business-minded bosses who want them to see more patients, drive more business and at the same time cut cost — the antithesis of what they believed medicine was supposed to be all about. As a result, one challenge of the new employed physician model is that physicians don't do "healthcare business or management speak." Therefore, when you use business-type terms, physicians' eyes are likely to glaze over. As a colleague and I recently experienced in a meeting talking with a group of orthopedic surgeons about cost-reduction strategies for orthopedic implants, when one of my colleagues said, "We sent the RFP out to the suppliers," one of the physicians stopped him and said, "Excuse me, what is an RFP?"

It is those kinds of moments when you realize healthcare business and medicine sometimes just don't speak the same language. So when business-educated hospital administrators and supply chain executives go into meetings with physicians to discuss clinical performance and supply chain performance improvement initiatives, you realize why physicians are reluctant to actively participate in quality and cost-saving improvement projects. They feel ill-equipped to facilitate change. That takes us to Building Block #1: understanding your customer.

Building Block #1: You need to understand physicians to engage and communicate with them
Relationships, particularly in supply chain's physician preference products space, tend to run deep, and memories run long. As a result, one key strategic mistake many supply chain and healthcare executives make when trying to get physicians to engage in cost-cutting or product standardization projects is opening the conversation like this: "Bob, you've got to help this hospital save money."

That phrase is likely to be received like nails on a chalkboard by a physician (either employed or in private practice — it doesn't matter). Physicians generally interpret that phrase as: "You don't know how to manage this hospital's supply costs, so you need me to give up something so that you, Mr. CFO, Mr. Supply Chain Exec, can improve your department's bottom line and get your bonus. What's in it for me?"

As one high-volume (employed) orthopedic surgeon told me recently, "I'll be happy to work with this hospital's administration on this project, when they talk to me, when they listen to me and when they acknowledge me as a partner in their success more than just when they need to cut-corners and save money. But until then, why should I bother?"

In general, FTI Consulting's work with clients in the physician preference supply chain space shows physicians have three primary motivators:

1) Professional success, which includes removal of daily hassles that impede the productivity, efficiency and quality patient care they can deliver.

2) The ability to work in a "healthcare workshop" (e.g. operating room, cath lab, radiology, GI lab, etc.) where they feel comfortable and which enables them to do their best work.

3) The ability to be heard and have action taken when they raise concerns about safety and quality, because these are hallmark elements to their brand as a practitioner.

The medical device and pharmaceutical community figured these out a long time ago. Most savvy medical and pharmaceutical sales representatives use this knowledge as a means to cultivate their deep-rooted and increasingly personal physician-business relationships. The account manager's goal is to make him or herself and the company they represent indispensable to this valued customer – the physician. So it is not a coincidence that Fortune 500 healthcare companies position key supplier account managers for physician preference medical devices and pharmaceuticals in neighborhoods where high-volume physicians work and play. It's all about building and maintaining the relationship.

Supply chain and healthcare executives could take a page out of the sales representative's playbook: get to know your medical staff as your customer – the person who brings your patients to your door. Listen intently to determine what their hot-buttons are. Learn what drives them and what frustrates them so you can have open, honest and genuine conversations with them. Only then will a foundation of mutual trust and respect begin to take root.

Building Block #2: Physician engagement must be built, not bought
Over the course of 30 years of clinical practice and field research, one thing I have often observed within our industry is that some healthcare administrators believe if they just pay physicians or employ physicians, then they can engage with them and facilitate change.

The field research that my physician colleague and I completed in 2005 validated, and subsequently others within the industry have concluded, that the tactic of buying a physician's loyalty rarely works. Remember our earlier quote from the orthopedic surgeon who asked, "Why should I bother?" He was a well-compensated, employed healthcare system physician, yet he had no real motivation to jump on his healthcare system's orthopedic cost-containment bandwagon.

Behavioral science suggests there are four basic areas which can significantly alter or cause a person's behavior to change: [2] [3]

1. They have to understand why they need to change.

2. They are more likely to change if they see respected peers changing.

3. They understand and believe the change will enhance their day-to-day life or well-being, or propel them to a better place within their profession or employment status.

4. Once they do change, they feel there will be a pay-out or reward to them as a result of their change.

The only area where money could come into play is under #4, where monetary compensation might be a driver over less-tangible attributes. Does money talk with some physicians? Yes. But, as human resource and change management leaders will tell you, money does not show up in most employee satisfaction surveys as one of the major reasons why employees stay with their company. Instead attributes like, "I feel like I'm a valued member of my team" or "My organization values my contributions" are the ones most likely to be in the top-10 employee motivators or employment satisfiers.

Top-decile, better performing healthcare systems have learned to listen first, try to understand second, and hone in on which behavioral attribute they're dealing with in a given situation before bringing physicians into performance improvement activities. Remember, physicians by nature are fixers. Fixers need and want to have something to "fix" in order to feel satisfied. This leads us to our next building block.

Building Block #3: Define your objectives clearly and measure results
In general, physicians by nature are competitive creatures, especially surgeons. Healthcare and supply chain executives can capitalize on this trait by providing a competitive challenge through benchmarking and blinded physician profile data of cost per product, per procedure, per physician as a means of creating a performance improvement challenge.

But beware, as un-vetted data or the presentation of data without a clear ask of the physician to act on that data will likely fall on deaf ears and prove to be more of a dissatisfier to your medical staff than a motivator. Whatever project for which you need the engagement of physicians must be clearly defined and articulated. Remember "fixers" need blueprints.

Healthcare systems which demonstrate the connection that cost-cutting projects in PPI can and will reduce physician hassles (Behavior Basic #3) or provide physicians with the ability to maintain or enhance the quality of care being delivered to their patients (Behavior Basic #1), and who provide data that directly reflects the physician's current reality (Behavior Basic #3) that changes are necessary, are the ones who successfully recruit physicians for change. When physicians feel their needs are being met and understand why you need them to fix a problem they themselves perceive to be problematic as well will join the cause. Otherwise they are likely to feel engagement is simply a waste of their time and effort.

Building Block #4: Shared purpose, common vision
If you know what your customers want and you fulfill their wants as well as their needs, you create a shared purpose. When you and your customer have a common vision for the future, you create a bond from which to build trust, and with trust you can build a relationship. It is a lot easier to say "No" to a stranger than it is to a trusted friend.

If you want to effectively engage physicians, you will want to identify physicians within your organization who have expressed a shared purpose and vision similar to your board's vision and C-suite team's long-term vision for your organization. To optimize physician engagement you must make effective use of informal physician leaders who have an affinity for performance improvement. This leads us to Building Block #5, identification of physician champions.

Building Block #5: Optimize engagement success through use of physician champions
The term physician champion has become somewhat of a ubiquitous term for the Chief Medical Officer or high-volume/high-revenue-producing physicians. The fact is that many times high-volume physicians are some of the least-likely champions for change within organizations because they want to run as far and as fast as they can when they see a supply chain director or CFO, because that generally means that person is coming to tell them they can't afford to buy that new toy they just asked for. Additionally, Chief Medical Officers or Vice Presidents of Medical Affairs — who used to be practitioners themselves — often don't want to take on the role of change agent, arbitrator or mediator with their former peers unless they absolutely have to. So if these folks aren't the "go-to" physician engagement people, who are?

Here's where a bit of irreverence comes in. All physicians are not the same, so you don't need to treat all your physicians the same. The truth is your high-performing physicians — your heavy-hitters who bring patients to your organization's doors — feel they should get more of your perks and attention. They are your top-tier customers, so give it to them. At the same time, if you look hard enough, you will find numerous physicians right under your nose who understand and embrace change.

Change-agent physicians many times are highly regarded for their clinical skills as well as their business acumen. Better performing healthcare providers rely heavily on these informal – many times non-titled – leaders to optimize and facilitate needed key physician involvement in PPI project work. The reason: Informal physician leaders tick the #2 Behavior Basic box of the "respected physician peer."

Physician champions are those who tend to be part of your organization's "physician ecosystem" (an ecosystem within the medical community of interrelated people who are engaged in joint problem-solving activities to accomplish a common clinical goal). These physicians are universally thought of as the clinical thought or opinion leaders of your organization or community. They are the "go-to" people, the influencers on whom heavy-hitter physicians rely to bounce ideas around, to influence other physicians within their practice and to manage conflict or deal with recalcitrant physicians. They are medical professionals who have "earned" the universal respect of a high-percentage of their peers and subordinates throughout your organization at large.

These physicians may not have the title of Chief of Surgery, etc. but they most likely among their peers will have the informal title of mentor and coach.

Physician champions have reputations of being cool-headed when clinical debates become heated and have good collegial relationships with nurses and other paraprofessionals with whom they work on a day-to-day basis. They tend to be early-adopters and future-oriented practitioners, and they focus their medical practice on patient outcomes and are data-driven. Physician champions are clinical practitioners who set the bar which other physicians often secretly aspire to emulate.

Physician champions are the peer-to-peer ambassadors needed to drive physician engagement in physician preference clinical supply chain projects because they generally are practitioners who want to work with you and have developed a strong bond of collegial trust (shared purpose, common vision). They also desire engagement because they are comfortable with the world of healthcare business and they obtain personal well-being and satisfaction (the reward) by being leaders and managers of change.

Physician engagement in 2016 is not a drill. It is a necessity.
No matter how you slice and dice healthcare delivery or cost-cutting methodologies, whether it's pay-for-performance or bundled payments, physicians remain the central players in healthcare transformation. Every healthcare system is different, for sure; but one universal truth runs throughout every healthcare system: physicians are people, just like you and me, trying their best to make healthcare the best product it can be for the patient. FTI Consulting's client experience shows that healthcare teams who follow these five key building blocks go far in not only improving their supply chain physician preference product cost, but in building the types of business relationships with their physicians that endure.

About the author
Pamela Froneberger is a Director with FTI Consulting and is based in North Carolina. She is part of the Health Solutions practice. Pamela has more than 30 years of healthcare clinical management experience, including: clinical and supply chain performance improvement, medical device national accounts, group purchasing strategic sourcing and contract management, and nursing and cardiovascular service-line leadership.

Footnotes:
[1] Schneller, Ph.D., Eugene S. Healthcare Purchasing News, Persistence and change in trends: The post-reform environment for supply chain management. September 2015.
[2] Fountaine T., Wilson F., Richard B. How to change clinical behaviour in primary care. Health Interventional, December 2012; 6-15.
[3] Lawson E., Price C. The psychology of Change Management. McKinsey Quarterly. June 2003; 31-41.

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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