6 Tips for Improved Relations Between Hospital Leaders and ED Physicians

With increased coverage and reduced reimbursements, hospital emergency departments will face a challenging time as healthcare reform unfolds. Thus, hospital and emergency medicine leaders will need to strengthen their relationship, combining both financial and clinical priorities to meet quality metrics. Here are six tips on communication and leadership to improve engagement and understanding between hospital and physician leaders.  

1. Find an intermediary to solve communication problems between physicians and hospital leaders.
If hospital and physician leaders have a tense relationship over a particular issue, it may be most beneficial for both to rely on an intermediary party to moderate communication. "This might be the COO meeting regularly with a physician group representative. Or, the CFO might play a larger role. It varies from place to place," says Lynn Massingale, MD, FACEP, Executive Chairman  of TeamHealth, which provides emergency department and staffing services to hospital clients. Conversations may become uncomfortable, as physician and hospital leaders share individual priorities, but meetings such as this establish common goals, measurements and incentives.

2. Recruit physician leaders who listen, articulate visions and manage. Accountable care organizations have sharpened the industry's focus on physician leaders, or those able to lead their peers in a shift to evidence-based medicine. Hospitals should look for physicians who hold people accountable, build consensus, listen well and can articulate visions. A physician with these qualities might be well-suited for a leadership role. "There was a time when people in hospital leadership could get by just by getting along or playing golf. That is not efficient  today. Both physicians and hospital leaders need to hold their respected teams  accountable," says Dr. Massingale. "Physician leaders need to do this , firmly but lovingly. It might be hard, but they need to sit a fellow physician down and say, 'Listen, we love you, but our nurses don’t like working with you. We need to figure out why and change this.'"

3. Invest in leadership courses for physician leaders. While much of the success of accountable care organizations basically relies on physician leadership, most physicians don't have much training to be managers or leaders. "We didn't get that in medical school," says Dr. Massingale. "If it's 3 a.m. in the ED, you don't need a committee to know what to do, but in most circumstances consensus building is critical." Hence, leadership courses may help physicians understand their own leadership style as well as that of hospital leaders. Personality evaluations, such as DISC assessments, role playing, scenarios and peer-feedback are valuable tools in helping physicians develop and refine leadership skills.  

4. Acknowledge the special challenges of EDs and the reasons behind wait times.
More and more hospitals are advertising their ED wait times, with some going to great measures such as renting billboard space to feature a live wait time. Unlike most of the hospital, the ED patient volume and arrival times are completely unscheduled and not based on bed availability. EDs require extraordinary planning and special considerations in order to deal with these unscheduled visits.

5. Provide physicians positive feedback; don’t focus on shortcomings. "The best institutions do this," says Dr. Massingale. "It's so easy to focus on the negative and not give enough positive feedback." Hospital leaders and CEOs should attend physician meetings to offer encouragement and appreciation. It doesn't have to be a grand gesture, says Dr. Massingale. "Celebrating upward movement in metrics in small or modest ways is very reinforcing."

6. Focus on a handful of metrics identified as most important. Rather than focusing on the entire spectrum of metrics, it's best if hospital and physician leaders decide which are most important to them at this time and focus on those. "You can't have everything be top priority all the time," says Dr. Massingale. For instance, some hospitals may prioritize patient experience or patient satisfaction scores, but still maintain focus on other quality and safety metrics. Organizing metrics will also help physician and hospital leaders reduce mixed messages and keep them from being overwhelmed.

Read more about hospital emergency departments:

- Is Your Hospital Embracing Its ED?

- 4 Best Practices for Increasing Efficiency in Emergency Departments With Information Technology

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