The three Cs of physician engagement

Why do physicians feel largely disengaged from their workplaces? What factors contribute positively or negatively to engagement? How might we begin to improve the daily experiences of physicians within their organizations?

The team at athenaInsight set out to answer these questions and investigate the causes, as well as potential remedies, for the pervasive issue of physician disengagement. A news hub reporting from the heart of athenahealth's nationwide network, our goal is to connect healthcare leaders to information and data that allow them to do their jobs more effectively. And there are few priorities that are more important to healthcare leaders than ensuring that physicians are engaged—in their work and with their organizations—and that their jobs are sustainable.

Our stepping stone into the conversation was the Physician Leadership and Engagement Index, a survey that we fielded through our Epocrates mobile app. The survey asked for basic personal information, as well as ratings of various situations, like job commitment and satisfaction, that fell on a sliding scale from 1 ("strongly disagree") to 6 ("strongly agree").

The results were stark. Eighty percent of responding physicians were unengaged, according to our definition. Men were more likely to be engaged than women, and primary care specialties scored lower than procedural or medical specialties. Physicians who worked in large hospital- or health system-owned groups had only half the engagement rate of those in independent, physician-owned medical groups or practices.

However, further analysis showed that there is cause for optimism—there are specific environmental attributes that correlate with higher levels of physician engagement, and they are attributes that we believe most organizations can influence.


A common sentiment throughout the leadership index is that physicians who trust their leaders, and whose organizations follow through on commitments to employees, are engaged at three to four times the average rate. This trust, so crucial for physician engagement, is directly influenced by the clarity with which leaders discuss important aspects of their workplaces.

In the same way that patients expect their physicians to be clear and concise, physicians require clarity from their own leaders. A clear outline of strategic vision, core values, and expectations is foundational to engagement.


In order for those in leadership roles to express their expectations and beliefs clearly, they must also build effective two-way communications structures. Organizations should not only clearly communicate their unique missions and the role that physicians play in delivering on that mission, but they also must build channels for front-line physicians to communicate their perspectives and experiences back up to the top.

And it's that latter component that often goes missing when leadership teams think about communication strategy. Most organizations think hard about downward communication—everything from the format, to the channel and frequency. They are less likely, however, to have intentional strategies for a reverse flow of information, where physicians provide input and feedback on what they are seeing, hearing and experiencing at the front line. Closing the communications loop is critical for physician engagement.

Communication should also be multimodal; it should take place in the form of email, call, and particularly face-to-face. Leaders must not be simply accessible; they should actively create space for conversation and pursue open-ended discussion, holding one-on-one sessions and opening up forums for feedback.


Finally, physician engagement thrives when there is a strong sense of community and collegiality. Strong social networks provide access to clinical expertise as well as emotional support, and high performing organizations make explicit investments in both formal programs and informal mechanisms for building them. Many of the organizations we interviewed spoke of the importance of sharing a meal together—whether through regular meetings of cross-functional groups, quarterly meetings that bring people together from disparate locations, or one-on-one conversations. It was fascinating to see that recurring theme of "breaking bread" continue to surface.

Community building is also an important goal of the best leadership development programs. As organizations grow in size and complexity, social connections become harder to maintain. This is an area that feels abstract, but its absence is palpable.

The future of a tumultuous healthcare industry rests on many shoulders, but physicians bear much of the burden of change. These values of clarity, communication, and community, when intentionally reinforced by leaders, can positively influence the degree to which physicians feel connected not only to their jobs, but to the larger purpose and mission of the organization. It's only with this connection that today's healthcare delivery system can deliver on its potential to transform for the benefit of all stakeholders—physicians, hospitals, and especially patients.

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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