Health system executives: Wake up! Your physicians aren't listening to you

Yes, it is hard to hear. You may even disagree. You may believe think that your position, level of authority and professional credibility make things different for you. You may actually believe that those lengthy emails that took hours to author are being read before your physicians reach for the delete button. Or, maybe you think that those long memos posted on your portal are being consumed with great attention because you wrote them. They aren't. 

Perhaps you think that because you have so many employed physicians, things are different. This isn't the case. At the end of the day, the inconvenient truth is that most of your physicians just aren't paying attention. The truth hurts. Now let's explore why.

Why are physicians not listening? There are lots of reasons. but here are the big ones:

1. They are overwhelmed.

2. You aren't engaging them the right way.

3. You aren't listening to them.

The transformation happening across our healthcare system demands meaningful collaboration and clinical alignment between physicians and hospitals. With healthcare costs in the United States soaring to nearly 20 percent of our GDP, things need to change, and the physician is at the center of this transformation. For healthcare reform to yield any positive change for our society's health and our nation's economic viability, we need to recognize how our physicians perceive these changes. You need them to listen to you. They need you to hear and understand them.

The available data about how physicians feel is alarming. According to the 2013 Physicians Foundation survey on physician perceptions of their profession, 84.2 percent of United States physicians believe that our healthcare system is in decline and 92 percent do not understand how they will fit into emerging healthcare models. Close to 45 percent of physicians believe that money trumps patient care decisions, and 57 percent of practicing physicians would not recommend medicine as a career to their children. With our dependency on physicians as the key stakeholder in healthcare, we need to pay attention to what they are telling us.

As pessimism among physicians increases, it is becoming increasingly difficult for physicians to maintain their clinical competencies. According to the University of Virginia, "about half of all medical knowledge becomes obsolete every five years, and every 15 years, the world's body of scientific literature doubles." Consider this. In 1933, only four specialty examining boards even existed. Fast forward to 2014, and a physician today can be board certified in over 145 different specialties and sub-specialties, according to the American Board of Medical Specialties. Emerging clinical domains such as genomics, proteomics, pharmacogenetics and nanomedicine didn't even exist when most of our practicing physicians attended medical school but will now be the future of clinical intervention. Last year, physicians in the United States participated in more than 1.2 billion patient visits lasting, on average, between 8 and 15 minutes. During these short segments, we expect physicians to perform comprehensive screening, adhere to complicated population healthcare best practices and counsel patients in sensitive areas like obesity, lifestyle choices and chronic condition management. We then expect them to then spend on average 24 percent of their working hours performing documentation and non-clinical tasks. No wonder physicians are overwhelmed.

Physicians also feel out of the loop. They don't understand the basis for your decisions. And, they don't feel like that they are considered. According to the 2013 Physician's Foundation survey, 82 percent of physicians agreed with the statement, "physicians have little influence on the direction of healthcare." Additionally, when asked to cite the biggest source of negativity about medicine, 64 percent of physicians stated that they lost their clinical autonomy and decision making. How can this be? The changes that you are implementing are balanced, thoughtful and necessary for the system. Right? New clinical protocols and best practices that are being configured into order sets in your EMRs are based on the latest literature, and evidenced based medicine. Correct? Organizational changes, incentive structures and compliance policies are created in recognition of your greatest stakeholder, the physician. Yes? Then why do physicians feel the way they do? Why do physicians feel that money trumps patient care and that they operate inside a health system without influence?

They feel this way because you are failing at engagement. You are communicating. You are informing. But you aren't engaging. There is a big difference.

Communicating happens when information is sent in a one-way fashion with the expectation that the intended recipient will simply view. By contrast, engagement happens when the recipient:

• Consumes the information

• Interacts with peers about the information

• Provides feedback about the information

• Considers differing points of view about the information

• Applies the information

Stop and consider what you are doing. Are you engaging? Or, are you communicating and informing? Physicians are data driven and innate problem solvers. More than 70 percent of physicians state that intellectual stimulation is the most satisfying part of practicing medicine. Are you engaging your physicians in way that accommodates this? Are you leveraging the innovation of engagement science that other industries have figured out? If you are like most of your peers, you aren't.

Stop relying on the tactics that you know don't work. Don't think that because you wrote a complicated contract for your employed physicians that they are "aligned" with you. Don't think that because you sent an email with updates that you have "engaged" anyone. Think differently. This needs to be fixed and you can do it. We can't accomplish anything in healthcare if our physicians feel disenfranchised. You have the power to change this. Make it happen. Please.

Maureen Ladouceur has 20 years of healthcare experience across the hospital, payer and long-term care sectors. She is a registered nurse, holds an MBA in healthcare administration and finance from Pennsylvania State University and a BSN from the University of Pittsburgh.



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