The responsibility matrix: A strategy for stronger physician/administrator partnerships

"I want to help people." In medical school interviews and later at matriculation, that was how I, like many aspiring physicians, articulated my reason for wanting to be a doctor.

The desire to help people through healing was the "why" of my career choice. But even in speaking those words, I had only a vague sense of what they really meant. I struggled to bring real meaning to what was a nebulous definition. The true meaning would come later, through the countless snapshots of patient interactions that define every physician's career.

One especially vivid picture in my own "photo album" occurred early in my career when I was the trauma surgeon on-call and a young man was brought into the ED with a gunshot wound to the chest. The patient, who was initially awake, alert and sitting up on the gurney, suddenly lost consciousness before our eyes. We sprang into action. An emergency trauma ultrasound showed blood accumulating around his heart, indicating the bullet had penetrated the chest, struck the heart and triggered a life-threatening pericardial effusion. We rushed him to the operating room, opened his chest and stopped the bleeding. Six days later he walked out of the hospital.

On my way back to the call room, my adrenaline was pumping and it felt awesome! I was in awe of the fact I had just helped to save a life. That experience of being part of an incredibly gifted team of professionals who came together like a well-practiced symphony validated my career choice. The experience—one among many—provided me with clarity on the "why" I went into medicine. Collectively, such stories sustain our passion for the work that we do and help us keep our sights set on our overarching goal to improve the care that we deliver to patients, something my colleague Dr. Thomas Lee refers to as our shared "higher purpose." In the words of Dr. Charles Sorenson, CEO of Intermountain Healthcare: "There is no greater 'why' in what we do."

Remaining mindful of that higher purpose—that greater 'why'—can be challenging as we grapple with the complexities of our ever-changing health care system. This is as true for hospital administrators as it is for physicians.

On the physician side, the increasing complexity of medical decision-making and the growing difficulty surrounding the business of medicine parallel record-high levels of physician burnout. Physician personalities and cultural expectations also play a role. In an article published earlier this year, Dr. Steven Adelman, director of Massachusetts Physician Health Services, described physicians as "rugged individualists" with a "problem-solver orientation" who generally feel they can figure things out for themselves. This mindset, he said, requires them to tackle their own problems, as well as others, while maintaining their environment and controlling their destiny.

Such clinical autonomy is a cultural barrier to change, because it is at odds with the tenets of value-based health care, which requires collaboration, teamwork, transparency and accountability. Physicians who are reluctant or uncomfortable with change feel burdened by the new rules, as the "why" of their career choice becomes buried in more paperwork and bureaucracy.

At the same time, hospital administrators are also struggling as they try to wade through an increasingly complex environment for physicians and for the hospitals they serve. The goals and objectives of the two groups may not always mesh, which can strain working relationships and cause distrust, poor collegiality and, in some cases, outright anger.

Bridging this "us" vs. "them" divide is one of the critical strategies for meeting the complex challenges facing health systems today. Although it may feel as if physicians and administrators are navigating through separate waters, the "why" of what both are doing is usually driven by the same motives—to help the patients we serve. And the only way we will reach our destination is by working together to get there.

Our responsibility as leaders requires that we enhance our working relationships to create high-performing teams of professionals focused on improving the safety, quality and experience of care for patients, while also ensuring the operational and financial health of our organizations. We must leverage our shared passion to serve people by developing relationships built on trust and mutual respect and by working to understand the skills and values physicians and administrators bring to table. An adaption of an effective project-management tool—the responsibility matrix—can be invaluable in this regard.

In project management, the responsibility matrix is a tool used to define the powers of individual project team members for various parts of project works. It provides an organizational prompt for all stakeholders to understand the responsibilities and accountabilities of each person.

When adapted for health care delivery considerations, it can provide transparent insight into the overall relationship between administrators and physicians, and it can help both better understand the different personalities, perspectives, and skill sets that each brings to hospital operations. Created honestly, it can identify our personality blind spots, and allocate responsibility based on our individual strengths and expertise. In so doing, the matrix can help us better manage together and ultimately deliver better health care to our patients.

Building the Matrix, Block by Block

Having been a hospital trustee, a C-suite leader, a private practitioner, an employed physician and a patient, my career has afforded me a tremendous 360' view of health care operations to inform a balanced matrix that delineates the responsibilities of physicians and administrators.

The items in this matrix are meant to be a starting point to identify some of the difficult issues we often don't talk about. The list is not comprehensive or definitive, and there are certainly overlapping areas of responsibility. However, working through it and adding items that make sense for individual organization can help hospital leaders, administrators and physicians nurture empathy for each other and develop a clearer understanding of each other's roles, all with an eye for achieving better team work and, ultimately, better patient care.

By calling out some of the proverbial "elephants in the room," such as our reluctance to address physician bad behavior, a responsibility matrix is a good way to create candid, transparent dialogue that allows physicians and administrators to work on problems together, without acrimony. If we better understand each other's roles and perspectives—in a sense, if we develop empathy for each other—our ability to function as high-performing teams to serve our patients will be greatly enhanced.

Physician Responsibility Matrix Table

Dr. James Merlino is an accomplished surgeon and industry leader in improving the patient experience, drawing from more than two decades of health care experience to oversee Press Ganey's consultancy division. Prior to joining Press Ganey, he served as chief experience officer and associate chief of staff at the Cleveland Clinic health system.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.


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