Physician-Hospital Alignment: 4 Strategies to Align Physicians

The need for physician-hospital alignment is well understood by hospital administrators around the country.  Additionally, cases studies abound showing how various alignment strategies work in settings around the country.  However, since every situation of physician-hospital alignment deals with individuals and their unique desires and motivations, it is important for hospital leaders to consider the types of strategies that are most appropriate for their settings.

Beyond the important tool of creating an efficient workshop for physicians to practice, there are four groupings of alignment strategies that have been proven in markets across the country. These four groupings include:
•    Business services
•    Contracts
•    Structured communications
•    Employment/foundation

1. Business services. The business service grouping includes strategies that are geared towards strengthening the relationship on the business aspects of the physician practice and hospital operations. As such, this grouping of strategies most impacts economic alignment.  Examples of business services strategies include: back-office physician services and practice supports, information systems and physician hospital-organizations.

2. Contracts. The contracts grouping includes strategies that are built on a contractual relationship for specific physician clinical, managerial or investment services and are typically targeted towards a combination of improving clinical quality, operational efficiency and programmatic development. As a result, this grouping of strategies most impacts clinical activity alignment. Examples of contract strategies include: physician recruiting support, medical directorships, clinical co-management agreements and joint ventures.

3. Structured communications.
The structured communications grouping as the name implies includes strategies that are built on a highly structured process for communicating between hospital executives and physicians. Because the topics are about strategic intent and direction, this grouping of strategies most impacts alignment of purpose. Examples of structured communications strategies include: blogs and social media, town halls, physician advisory councils and direct physician leaderships.

4. Employment. The employment grouping includes variations of strategies that meet the legal definition of employment. Because these strategies can be applied in a variety of ways and often incorporate many of the other strategies as part of the employment agreement, this grouping can impact all three elements of the Physician-Hospital Alignment Triangle, which includes clinical activity alignment, economic alignment and alignment of purpose. Examples of employment strategies include: individual employment agreements, large single specialty group employment, formation of multispecialty groups and foundations.

The need for alignment with physicians in a variety of settings and situations means no one strategy or even grouping of strategies will be appropriate. Instead, most organizations must take a pluralistic approach and use strategies from all four groupings to achieve the physician alignment needed.

Understanding how a hospital rates on physician alignment is the first step in determining what actions can best be taken to create greater alignment.  With a full understanding, proven tools can be used to improve the alignment and thereby rebuild the trust that is lacking between physicians and hospitals today.

Kate Lovrien is a senior strategy manager from Kurt Salmon's Minneapolis office. She has focused her career on advising community and regional referral hospitals and healthcare systems on their strategic and physician alignment challenges. Kate is the lead author of the Physician-Hospital Alignment Diagnostic located at She can be reached at 612.865.6088 or

Luke Peterson is the national director of Kurt Salmon's Strategy Practice. He has focused his career on advising community and regional referral hospitals and healthcare systems particularly on the physician-hospital relationships and healthcare system organizational structures and roles.  He can be reached at 612.810.8188 or at

More Expertise From Kurt Salmon:

Creating Stronger Physician-Hospital Alignment
Physician Employment & Beyond: The Current State of Physician Integration

Accountable Care: The Top Five Things the Community Hospital Can Do Now

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