A new physician-hospital relationship: 4 steps to break the status quo

As care delivery models, technology and new management priorities complicate the relationship between hospitals and physicians, hospital executives are using new leadership strategies to facilitate better collaboration and stronger partnerships at their organizations.

During a Jan. 21 webinar hosted by Becker's Hospital Review and sponsored by MEDI Leadership, one of those leaders, Matt Troup, president and CEO of Conway (Ark.) Regional Health System, spoke about how shifting the hospital-physician relationship approach helped his hospital avoid a major strategic threat.

In 2008, a group of Conway Regional physicians decided they wanted to run their own surgical hospital. Fueled by an ambition to grow independently and have more of a definitive say in their operations, 30 physicians prepared to leave Conway Regional. Mr. Troup said for the small hospital, the departures would have dried up between 30 and 40 percent of its revenue stream. 

"If you step back for a moment and think of your own organization and what would happen if you lost 30 to 40 percent of your revenue, even the most fiscally healthy of us would have a hard time surviving that for very long," Mr. Troup said. "That's just an incredible gap to make up. It was a really, really significant threat."

Mr. Troup knew his hospital had to galvanize its relationship with physicians, appealing to their sense of independence and desire to have more say. He recognized bringing the group back couldn't be done through transactional leadership, or "checking the boxes," but rather through transformational leadership, intentional and authentic relationship building to move the team to a shared vision.

To transform the hospital-physician relationship, Robert Porter, senior vice president and executive coach at healthcare executive coaching firm MEDI Leadership, and his colleagues helped Conway Regional work through four steps to break the organization's status quo and create a new way to lead the organization. The steps were: rebuild trust, build skillfulness, create an economic model and track critical metrics.

Still, Mr. Porter suggests healthcare leaders don't have to wait for things to be "bad" to focus on transforming their organization's culture to one of high-trust and high-performance. In fact, he argues, preemptively following these steps will result in positive outcomes and improved working relationships.

Step 1: Rebuild trust

The first step to transforming Conway Regional's hospital-physician relationship was to begin building relationships based on trust instead of power, Mr. Troup said. 

Building trust is about communication. When Conway Regional was undergoing its transformation, Mr. Troup brought in physician leaders who were highly regarded among their peers for a meeting once a month to openly discuss the best path forward.

"The meetings were intended to address questions about trust, because there's really two forms of trust: your moral ethical compass and confidence in your ability to complete what you need to do," Mr. Troup said. He said the sessions helped "build relationships, build trust, [and allowed us to demonstrate] we had the competence and the character to be able to implement our strategy." 

Along with communication, both Mr. Troup and Mr. Porter emphasized the importance of creating a supporting structure, by allocating both time and resources that enable the new model to be successful.

Step 2: Equip the new model by building skillfulness 

The intent to improve hospital-physician relationships is not enough. To build a high-performing team, hospital leaders must create space for team members to learn about one another and sharpen their team-building skills. 

For executives, this may mean "letting go of the need to control in favor of designing solutions where you share control, reflecting a commitment to the needs of one another in the pursuit of your common goal," Mr. Porter said. "It replaces positional power or coercive power with creative power — power that's created through collaborative decisions formed out of that mutual purpose and respect."

Step 3: Create an economic model reflective of leadership engagement and commitment

Lasting partnerships between hospitals and physicians require accountability. Conway Regional infused accountability into its physician partnerships by tying compensation to committee appointments and to the success of collectively achieving the defined metrics.

When forming physician-led committees, Mr. Troup said hospital leaders must recognize committee roles are not volunteer positions, but real jobs. He said if physicians aren't engaging in discussions during committee meetings, don't reappoint them. Accountability, he found, supports the integrity of the new relationship.

Step 4: Determine critical metrics to track and ensure success

When setting metrics to track success, it's necessary to evolve from an organization that focuses on physician performance metrics to one that has all needles pointing toward hospital and health system performance metrics, Mr. Troup said.

"As we're establishing the metric, we'll talk about action steps … that speak adequately enough to the progress we need to make and the things we need to do as a team to gain headway on that metric," he said. 

Conclusion

To revitalize the hospital-physician relationship, hospital leaders need to move away from controlling the way physicians practice to building trust among physicians and cultivating a shared belief in mission. Mr. Troup admitted the work was not easy.

"Some of the team and I have reflected on our experience, and the number of meetings and discussions we had — you're going to have a fair number of cynics within any organization," Mr. Troup said. 

Still, he strongly believes partnering with MEDI Leadership helped Conway Regional reestablish trust with its physician partners and overcome cynics. MEDI Leadership helped the hospital become intentional about its hospital-physician relationship, both through the transformation and today. And while the work continues and the journey is never complete, Mr. Troup pointed to their "most recent physician engagement score in the 95th percentile," as evidence that their new leadership approach is working.

To learn more about MEDI Leadership, click here.

To view a recording of the webinar, click here.

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