Michael Dowling: How to gain physician trust? Get back to the basics

Preventing physician disengagement and burnout is an issue all health system leaders deal with. No one factor alone is responsible. Instead, it's a combination of internal and external factors that can diminish clinicians' wellbeing and ultimately interfere with the care they deliver. Therefore, it's crucial that administrators identify the main contributors of these issues and implement effective solutions to correct them.

Physicians and nurses, as well as other hospital staff, are vulnerable to disengagement and burnout. There are numerous reasons why. At Northwell Health, the most significant factor physicians express to me is the increased volume of administrative tasks and regulatory requirements. A 2016 study published in the Annals of Internal Medicine found that for each hour physicians work directly with patients, they spend about two hours inputting data into EHRs and completing clerical work. Because of regulations like meaningful use and insurance verification, physicians are forced to spend more time on administrative duties and less time treating patients. This is a major point of dissatisfaction for physicians, who entered the medical field to help patients, not to do paperwork.

Patients feel the effects of this, too. Patients see their physicians when they're sick and vulnerable. They want to feel heard, respected and dignified. They don't want to feel like a bystander while the physician stares at a screen and types throughout the encounter. Yet, the regulatory demands physicians face are not likely to subside any time soon.

What to do about it

Physician engagement is driven by a few key characteristics, many of which are influenced by the health system's leadership and governance structure. For example, something as basic as communication can have an outsized effect on physicians' level of engagement. Especially during times of change, physicians — as well as other hospital staff — want honesty and transparency from leadership. They also want the ability to join the discussion in a meaningful way.

Here are five specific measures health systems can take to improve physician engagement.

1. Revamp medical school curriculum. Despite the dramatic changes in the healthcare industry over the past 15-20 years, many medical schools have been slow to change the way they train budding physicians. All healthcare leaders should be advocating to retool the curricula in our nation's medical schools so that students are taught how to work in teams, respond to patients experiencing health crises like opioid abuse and navigate the industry's complex regulatory environment.

2. Put physicians in formal leadership roles. There is nothing that goes on at Northwell Health — budget-, technology- or capital-wise — that our physicians aren't involved in. Including physicians in the decision-making process from the very beginning is how you build trust, and if you fail to build trust, you won't get the engagement you want.

3. Focus on integrative care. With the focus on team-based care delivery, it's essential that physicians work with their colleagues across clinical service lines and departments. The more you break down the walls between them, the more you will naturally foster trust. It's also important to share clinical, financial and IT data among clinical leaders, so that they can talk to each other about that information.

4. Communicate openly and often. Three or four mornings a week, including Sundays, my clinical and operational leaders and I meet with different physicians at local diners for early breakfasts. In that setting, physicians feel more comfortable opening up and telling us about concerns and issues that they might not otherwise bring up during more-formal meetings. It's also a great way for us to get to know our physicians on a personal level, and for them to get to know us. Clear communication practices should be embedded in the formal organizational structure. But the most honest, candid conversations often take place in less-formal settings.

5. Be an inspirational leader. Anxiety is natural during periods of change. That is why leaders must continuously promote a positive culture. Despite all of the challenges providers face, we can't lose sight of the many positive things that happen inside our walls every day. We must recognize and appreciate the success we achieve and maintain an upbeat outlook about our goals. Leaders who project optimism inspire others to do their best work.

When we speak of the epidemic of physician burnout and disengagement, the conversation often turns dismal fast. But improving engagement and physician satisfaction is easier than many people think. Although we cannot fully control the external factors — such as federally- or state-mandated regulations and standards — that contribute to burnout, we can control the practices and structures inside our health systems to give physicians greater authority and a louder voice. They are the captains of the healthcare delivery ship, and if they are not on board with the leaders, no one will get far.


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