Creating alignment for healthcare executives and physicians through a shared vision

In healthcare, we often discuss the positive patient impact that care coordination across the entire continuum of care has on outcomes.

It's easy to understand how important it is for surgeons to coordinate with primary care and other specialties to make sure a patient is properly prepared for surgery. Then of course, post-surgical disposition becomes a focal point – both location and any additional providers of care. For instance, physical therapists should be informed of any specific concerns or unforeseen issues. It is easy to see how things can go wrong if care is not coordinated.

With those same coordination principles in mind, it seems like an obvious concept that healthcare executives and physicians should have a similar set of rules and guideposts to follow as they navigate issues surrounding quality of care, value-based payment and other common concerns. The truth is that most healthcare systems don't – especially with their employed physician network. There is still a divide between physicians and executives and if you want to get them all singing from the same page, you need to outline what's on it.

For a physician network to function well together and advance, as well as meet the demands of value-based reimbursement models, it needs to have a shared set of goals and strategies mapped out. Otherwise, the different practices will continue to operate autonomously and perpetuate a discordant, inefficient and largely ineffective network. This shared set of goals and aspirations cannot be a top-down edict from network leadership or health system executives or established in a vacuum. It must be jointly created by the physicians and administrative leadership, must be aligned with the health system strategy, and fully endorsed by the executive suite to be effective. Setting a vision for operations and growth needs to have input from all sides to generate buy-in and be successfully implemented.

The people who know how physicians can best serve patients, are, of course, the physicians themselves. They see practical opportunities that may be missed by those who do not have as much direct contact with patients. However, concepts around quality of care improvements and other physician-influenced initiatives need to fit with industry and network standards. This is what makes collaboration and synergy between physicians and administrative leaders crucial.

The process that we have developed to facilitate the creation of a shared vision starts with communication. Conducting a series of interviews and augmenting with brainstorming sessions, including both formal and informal leaders, other interested physicians and advance practice professional, allows the development of a list of shared goals and aspirations for the network. Which initiatives should be expanded? Which aren't working? What are some new programs that could be implemented to benefit both patients and physicians?

The focus of the exercise should be on what the group envisions the network will look like in the future. This should consist of broad, long-term thinking, casting thoughts ahead ten or fifteen years. What can this group of leaders do to ensure that the organization will succeed in the future? Will it be a network worthy of praise? What characterizes a network in which you would be proud to participate?

The resulting document should be lengthy and detailed upon completion so that all involved in the network, now or in the future, will clearly see where the network intends to go and what it intends to be. Though this may seem like an arduous process, the outcomes are worth the effort. Plus, the more detailed the plan, the easier it is to develop strategies to achieve it and to put it into practice.

To create a detailed vision and resultant strategies, it can be very helpful to have an outside organization conduct the interviews to be able to ensure anonymity, total honesty, and complete objectivity. The third-party should have extensive experience in the healthcare industry and with projects of this nature to achieve optimal results. They should

• Spend time with physicians, advance practice professionals, administrators and executive leadership to determine their individual opinions on current initiatives and discover shared aspirations and problems;
• Access pertinent health system data to allow them to define the strengths and weaknesses of the network and support or refute subjective opinions; and
• Inject successful strategies that worked for other networks and may be pertinent to this one.

The documents created from this process will necessarily go through a long series of edits by an assembled steering committee. This is an important stage of development for the shared vision as it helps focus on content, clarify ideas and ideals, and amplifies a sense of ownership. Once a final draft is created, present it to the entire physician group to establish acceptance and buy-in from the entire force. Infuse their additional insights into the final document.

The final shared vision statement serves as an internal manifesto to align healthcare leadership and its physicians. It becomes the backbone of a unifying culture that has been co-created, not forced or inflicted upon employed physicians. And as with any policy or articulation of strategies, it must be regularly reviewed and re-evaluated to ensure continued relevance. Consider two important questions as you re-evaluate the shared vision and associated strategies over time:

1. Have market changes created new insights or altered the way we see our vision?
2. Are our priorities in the correct order and still germane?

Your shared vision statement is a roadmap for navigating market changes and a compass for driving a high-performing network. When you start by enjoining both executives and physicians in a conversation where all parties are heard, the outcome is a system that works for not only internal stakeholders but also for the community.

Terrence McWilliams, MD, is a board-certified family physician who spent ten years as the Vice President of Medical Affairs and Chief Medical Officer at Newport Hospital in Rhode Island. Terry was heavily involved in numerous system-wide initiatives to improve broad-based performance improvement efforts. He is now Chief Clinical Consultant at HSG, and can be reached at TMcWilliams@HSGadvisors.com or 502.614.4292.

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