6 Strategies for Holding Physicians Accountable

The Health Care Leadership Institute Executive Series presented by BestPractices, an affiliate of EmCare, recently held a day-long educational event for hospital executives in Chicago.

Presenters included Chuck Lauer, former publisher of Modern Healthcare; Thom Mayer, MD, founder and CEO of BestPractices; Kirk Jensen MD, MBA, CMO of BestPractices; and W. Mark Hamm, MBD, CEO of EmCare Hospital Medicine.

In the final session of the day, "Holding Physicians Accountable: Changing, Managing and Influencing Behavior," Dr. Jensen shared best practices for changing physicians' behavior to improve quality and lower costs, based on some of the more prominent academic theories on change management.

Physicians drive cost, quality

Dr. Jensen began his presentation by discussing the importance of physician buy-in for clinical and process improvements, such as clinical best practices and standardization of care. He explained that administrators alone can not drive improvements. Instead, "It's about those docs; how do we get those darn docs to change?" he asked.

Dr. Jensen also cautioned hospital executives to be prepared for resistance. "Physicians are better at resistances than you are at change management," he said.

Getting physicians on board

How do executives get physician buy-in for improvements? Dr. Jensen says it's all about making them feel like "owners," rather than "renters." Owners are engaged in the best possible outcomes and play an active role in improvements, rather than simply being on the tail end of receiving information about process change.

How does one make a physician feel like an owner? Dr. Jensen recommends using intrinsic, rather than extrinsic, motivators. That is, rather than simply offering money for time spent on an improvement committee (an extrinsic motivator), appeal to physicians' intrinsic motivations, such as explaining the impact their involvement could have on the quality of patient care and patient experience.

"By and large, it's about intrinsic motivation for meaningful change," said Dr. Jensen, adding that healthcare already has one of the most highly motivated workforces in the world because of the desire to help others. That desire simply needs to be appealed to, he explained.

Dr. Jensen then shared seven strategies for holding physicians accountable, either for involvement in improvement processes, or for the quality and satisfaction of the care they provide after initial processes have been put into place.

  • View physicians as key customers of the process or change.
  • Determine and implement evidence-based clinical and operational practices.
  • Obtain nursing and clinician alignment on performance and objectives.
  • Align financial incentives and disincentives.
  • Provide transparent metrics on physician performance.
  • Compare physicians to peers for benchmarking.
  • Provide regular feedback and coaching.

Hospital executives should use these seven strategies, Dr. Jensen explained, to reduce variation, shape culture and improve overall quality and patient satisfaction. He warned, though, to focus a majority of efforts on making high- and middle-performers better, rather than focusing all efforts on the lowest performers.

Change management theory

Dr. Jensen then discussed some of the change management theories that informed these strategies.

Everett Rogers' Diffusion of Innovation Curve — This model states that innovation diffuses through a population over time, with innovators (2.5 percent of the population) adopting the change first, followed by early adopters, the early majority, the late majority and, finally, laggards (16 percent of the population).

What it means for physician accountability? Executives have a tendency to involve innovators and early adopters in early change management efforts. "There's a natural tendency to work with these people," said Dr. Jensen. However, he recommended that executives also reach out to laggards in the early stages. "Engage your skeptics and cynics early," he said. If there's going to be a major point of resistance, "it's better to know that early."

BJ Fogg's Behavior Model — This model posits that behavior is a combination of motivators + ability + triggers. The model advocates assessing ability first, then setting a trigger and, finally, creating a motivator. Dr. Jensen explained that, often, healthcare leaders focus first on the motivator. For example, an administrator might tell employees to improve HCAHPS scores so patients will be happier, with happier patients serving as the motivator. However, if the employees don't know what specific behavior they need to change or how to change it, their motivation alone won't bring about meaningful change. Instead, they need education and training to improve specific behaviors. This is especially true when it comes to patient experience and satisfaction. Dr. Mayer, in an earlier session at the event, explained that service excellence is something that can be taught and must be created through behavior triggers and culture change. "Service excellence is a discipline, not a character trait," he said.

The event is one of four regional seminars; the fourth and final will be held on March 20 in Boston. To learn more or register for the upcoming event in Boston, click here.

More Articles on Change Management:

Dealing With Resistance to Change Through Questions, Not Demands
4 Approaches to Implement Evidence-Based Care Practices

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