6 Ways to Enhance Physician Communication, Alignment

Hospital executives participate in a balancing act everyday. They have to keep many different people and organizations satisfied, and it isn't always easy. Further, the transformation from fee-for-service to pay-for-performance models throw another to-do on an executive's agenda: How to keep hospitals running smoothly and physicians satisfied with their reimbursements in a time when many hospitals are acquiring physician groups and changing payment models?

To keep physicians happy in a rapidly evolving era of healthcare, hospitals need to evaluate its relationships with their physicians — something that is easier said than done.

1. Work on breaking down historic differences. The different cultures of a hospital administration team and physicians group, each with a potentially contradictory business plan and strategy, may put the two at odds. Moreover, hospitals and physicians may have different interpretations of how to best care for the health of a patient, as well as the role each party plays in meeting patient needs.

"Often the physicians will have been members of the medical staff through several leadership changes and have seen several different hospital strategies or leaders 'come and go'," says Peggy Naas, MD, MBA, and vice president of physician strategies at VHA. It's important that hospital leaders appreciate and respect the different historical cultures of physician and hospitals, while working to breakdown barriers and silos that, experts say, have limited access to care. The important thing is for hospital leaders to forge ahead despite barriers, working in concert with physicians and all parties involved in patient care.

"The market, payors and patients themselves are asking us to be health systems," Dr. Naas says, acknowledging the evolving and growing role of hospitals in more coordinated care models.

2. Listen to what physicians say, know who they are. Taking the time to flesh out the results of physician satisfaction surveys to identify a consensus opinion, or shared concerns, might go a long way. Perhaps the hospital's physicians want access to more education or training opportunities, or feel work puts too much of a strain on their personal life. It's important for both hospital and physician to compromise at times.

Dr. Naas says a useful strategy for physician integration is "getting hospital and health leaders out and visible in the halls of care." She suggests executives make leadership rounds, talk to doctors where they're working in the hospital and the community. While meeting with physicians face-to-face, Dr. Naas suggests hospital leaders ask physicians' opinions on what improvements are needed, finding out what is and isn't working. Then, the task is to report on the hospital's or health system's progress towards those improvements.

Thirty-years into working with hospitals, Rick Carter, CEO of Equation Consulting, a healthcare consulting firm in Salt Lake City, says he finds it amazing the number of CFOs, CEOs and even CMOs who don't know many of the physicians working at their hospitals by name. Greeting physicians in the hallway or thanking them for their effort is part of creating a physician-friendly environment. CEOs that rarely interact with physicians may be perceived as standoffish, disinterested or even untrustworthy by the people providing crucial care. "Go meet physicians in your community," Mr. Carter tells executives he consults. He insists the short time investment will pay off in the long run.

3. Prepare for and embrace cultural shifts in the hospital. When it comes to establishing relationships with employed hospital physicians and physician groups, Mr. Carter says hospitals purchasing physician groups need to undergo a "culture shift." They need to ramp up the customer service offered to those physicians because they are an especially important component of hospital care. "You want them to be salesmen," Mr. Carter says, referring to the physicians who practice at a hospital. A hospital with three basic elements — good support staff, good equipment and respect for its physicians — will likely have a successful relationship with most physicians.

This cultural shift, which in many ways involves paying more attention and bringing physicians to the forefront of the hospital, needs to be genuine. It's not enough to rewrite rules or establish updated guidelines; hospitals will have to live the words they use regarding integration and accountability in order to really transform the hospital's identity.

"It's not just about the culture, it's about the objective of the culture," says Ken Holmen, MD, vice president of medical affairs and physician strategy at Regions Hospital in St. Paul, Minn.   "It's about knowing the culture's standpoint."

While most hospital boards are not physician-controlled — and some lack any physician representation — part of a cultural shift toward accountable care and integrated delivery will involve creating participation opportunities for physicians on a governing level. It's not that physicians seek control of a hospital board, but they want influence on it. There may be a "president of a physician group who is the token member on a hospital board," Mr. Carter says. But that physician will be "out-voted every day of the week." A board with sincere integration of physicians, medical members who are politically involved and willing to express their opinion, may improve the hospital's relationship with the overall physician body. In short, physicians will feel their voices are being heard. Hospitals with an ACO model may move beyond having one or two physicians on a board to having 40 or 50 percent physician membership. Proper representation on the board will help things run smoothly, and physicians will have more say in establishing a hospital's vision.

4. Involve physicians in conversations at the strategic level. "Many hospitals or large healthcare systems come at it from their viewpoint," says Dr. Holmen. This one-sided approach is likely to cause conflict between the physician and the hospital, as the physician is uninvolved in the decision-making process and more like a commodity than partner. "If there can be a mutually respected dialogue with physicians, it allows for a discussion that is not so much 'we-they' but 'us,'" Dr. Holmen says.

The dialogue between physician and hospital leadership needs to occur on several fronts. First and foremost, physicians should be an integral part of most discussions. When hospital executives brainstorm where the organization is going, physicians need to play an active role — this is especially true in accountable care organizations or integrated care models where parties are sharing in financial successes and risks. "Because you have to have coordination, you need the major players all at the table in relatively equal capacity," says Bill Frack, vice president of L.E.K. Consulting, a global healthcare consulting firm. Neither hospitals nor physicians should dominate the conversation.

5. Move from the strategic to operational level. Conversations can't stop at the strategic level — they need to move to discussing operations of the hospital. Physicians and hospitals need to come together to develop everything from cost savings initiatives, quality of care metrics and shared savings plans. If a hospital has a strategic objective based on quality, it should invite physicians to the table to discuss the core measures to gauge whether those objectives are being fulfilled. For instance, a hospital might want to implement better data delivery systems, drive down infections or decrease readmission rates. If that's the case, the physicians need to be a part of the conversation on how to get there. Coordinating care and sharing records and data whenever possible will result in fluidity and ideally more efficient patient care.

Physicians should be involved in important operational discussions, including cost saving initiatives. This involves breaking down the longstanding silos within a hospital and "figuring out tools for how we can work together," Dr. Holmen says. "If a hospital wants to achieve certain cost savings, engage the physicians in what the objective is," he says.

Ensuring physicians are comfortable with hospital administrative goals will allow for smooth operations and greater likelihood those specific goals will be met. Be transparent and upfront about what the hospital is seeking. If an operational goal is to reduce costs by 10 percent, for example, hospitals can work with physicians to figure out a way to get that accomplished without reducing quality of care. Honesty and transparency goes a long way and can act as a backstop for when things go awry.

6. Empathize with physicians as they go through major care delivery reform. With new payment models and accountable care organizations, physicians are being asked to make, in some cases, dramatic changes in care delivery models. For some, this era of health reform may be overwhelming at times. Hospital leaders need to ensure they are aware of the magnitude and potential pressures this care transformation places on physicians and maintain direct dialogue with them as new payment models and integrated care methods continue to develop.

Timothy Ogonoski, managing director and physician solution leader with Huron Consulting group in Chicago, notes how important a strong physician-hospital relationship is in integrated care and new payment models. "If the physicians are not on board with the care and documentation requirements for the new models, there is little chance of having a successful financial or patient care model," he says.


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