7 Tips on Avoiding, Resolving Hospital-Physician Conflicts

The following content is sponsored by The Greeley Company

Hospitals and physicians are grappling with major changes to their industry, as both parties strive to improve quality and outcomes and reduce costs while dealing with changing payment structures. This goal of achieving the triple aim will be impossible to attain without achieving alignment and collaboration between physicians and hospitals, according to Rick Sheff, MD, principal and CMO of The Greeley Company.

"We cannot improve quality and reduce costs without changing how we take care of patients. The corollary to that is physicians have to change how they practice medicine, and hospitals have to change how they take care of patients," he says. Ideally, they would do that in partnership with one another. However, there are several other issues at play in healthcare today that can lead to conflicts between the two groups and hinder advancement toward the shared goal.

For example, one source of conflict can be the issue of competition. To stave off the effects of the nationwide physician shortage, many hospitals are recruiting physicians at an accelerated pace. However, an organization may recruit a physician in a certain specialty, and physicians already in the market in that specialty can perceive this as a threat to their practice, leading to trouble.

The installation of electronic health records at a hospital is often another sore spot for physicians, who may see the new workflow as something that slows them down and takes time away from treating patients. "It's important to recognize that when the hospital changes to an EMR, physician productivity goes down on the order of 20 percent," Dr. Sheff points out, which also affects their livelihood and forces them to spend more time at work and less with their families. This can lead to resentment among the medical staff, and a possible conflict.

One other major source of conflict stems from hospital CEO tenure time. Physicians typically stay in one market for an extended period of time, while the average hospital CEO tenure is three to five years. That means physicians see executives come and go while the physicians remain stalwarts in the community. According to Dr. Sheff, this causes physicians to think, "Why should I trust you, believe in you or work with you when in three to five years there will be someone else who comes in with their own programs?" This lowers trust between the parties and can lead to disagreements.

Preventing conflicts

While there are factors at play that can lead to these disagreements, hospital leaders can use the following three best practices to foster positive relationships and alignment with area physicians and thus avoid conflict.

1. Communicate, communicate, communicate. "Communication is critical," Dr. Sheff says, but there is one major issue: Communicating with physicians is anything but simple. Physicians tend to be extremely busy and many no longer call the hospital their home base, making them difficult to reach. Therefore, hospital leaders need to reach out to clinicians through different types of media and use multiple touches. "And, when it's really important, do the communication person-to-person, face-to-face," he says.

2. Be transparent. The perception of hidden agendas undermines trust, Dr. Sheff explains. Therefore, hospital C-suiters need to be as transparent as possible with their physicians when it comes to anything that will affect their practice.

3. Be impeccable with your word. In other words, hospital executives need to mean what they say, say what they mean and follow through. "It takes years to build trust, but it takes seconds to destroy it," Dr. Sheff says. After all, it is difficult to have trust and a positive working relationship after promises have been broken.

Resolving conflicts

While these best practices can certainly help prevent major hospital-physician conflicts, some differences do arise and conflict occurs anyway. "We've had situations where a community group practice and the hospital have had their guns fully loaded, locked and pointed at each other with itchy trigger fingers, ready to go to war," Dr. Sheff says.

So what can hospital leaders do to resolve these situations peacefully? He recommends the following:

1. Listen to everyone and honor their truths. Dr. Sheff refers to a well-known parable of the blind men and the elephant: Each man approaches the elephant at a different point and is asked to describe what they believe an elephant to be like. Each man has a vastly different answer based on where they approached the animal. For instance, one man touches the side of the elephant and describes the animal as a wall. One at the trunk says an elephant is like a snake. Another at the tail disagrees, believing the elephant to be similar to a rope.

In other words, perspective matters, and generally in a conflict the parties have different perspectives of the situation. "Each party has their take on the truth, and their perspective is valid and needs to be heard, honored and understood," Dr. Sheff says. In these types of situations a third party that was not originally involved in the conflict can bring value, he adds, since they are not emotionally intertwined in the situation and can listen to all points of view in an unbiased way.

2. Recognize and work with the dynamic of impact and intent. This is critical to rebuilding trust. "In every human relationship, there are moments when someone says or does something that has an impact that was not their intent," explains Dr. Sheff. "When that happens, it creates a scar."

One illustration of this is a husband, weary from business travel, who returns home to his wife, who is angry. The husband, realizing he forgot their anniversary, immediately starts telling her he'll make it up to her. In that instance, the husband is talking about intent, while the wife is in the "world of impact," as Dr. Sheff puts it. "Can she hear one word of [his] intent? The answer is no."

In these situations, what the wife — or anyone in the world of impact — needs most is not the explanation of intent, it's the acknowledgement of the impact, Dr. Sheff explains.

"In every medical community Greeley has ever been in, they have a history of moments of impact and intent, and every one has left a scar," he says. To rebuild trust and help heal those moments, it can be helpful to go through and name those past moments to acknowledge their impact. "That can be very powerful."

3. Create clear ground rules for how parties will treat each other going forward. These rules should emphasize honesty, transparency and respect. That way, trust can build and large disagreements can hopefully be avoided in the future.

4. Do a substantive piece of work together, well. "You don't build trust by singing kumbaya together," Dr. Sheff says. Rather, trust is built from completing a collaborative project together. During negotiations, hospitals and physician groups can identify some opportunities for collaboration that would meet the interests of both parties and choose one that is doable in a short time frame, like two to four months. "It should be short and straightforward," he says. Once that project is completed successfully, the groups can tackle a project that could take four to eight months to complete. "And then trust is growing between the two organizations," Dr. Sheff says.

Though there are forces at play that can create conflict between hospitals and physicians, hospital leaders must recognize that alignment with physicians is crucial to future success in the industry and work to heal old wounds and prevent disagreements in the future.

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