It's 2017 and accountable healthcare delivery is on every healthcare executive's mind. In order for healthcare organizations to excel, it is imperative that physicians and executives maintain a supportive and productive working relationship. One without the other simply will not suffice.
In this article we discuss the historical context for the cultural differences between physicians and hospitals and how clinicians think and see their professional role. You will be able to describe characteristics of physician champions for quality care and organizational health and discuss hospital-physician interdependence in achieving quality care.
Perhaps you've heard the following in a hospital, nursing staff and administration saying, "Are the physicians going to do this, too? And what about the doctors? We need to get the medical staff on board. How can we get this done?" Or maybe you've heard physicians saying, "Why don't they (administrators) ask us our opinion? They need to hold people accountable. Why should we? We get no support when we need it."
Healthcare Executives Greatest Challenges
In order to build a successful, integrated health care system the hospital c-suite needs to overcome certain obstacles. Here is a breakdown of healthcare executives pain points:
- 7% say it is aligning employees
- 7% that it is aligning health plans
- 7% that it is effective governance structure
- 17% say it is creating management incentives
- 57% say it is aligning with physicians
Now, what can hospital administrators and physicians do?
The current status is a product of a long history of medicine and health care. It is shaped by physicians in medicine and its unique culture, the AMA and a guild ruled by gentlemen. It is shaped by decades of evolution of medicine, hospitals, and events in health care today.
This is a meeting of two cultures, education and training, social and management sciences versus biomedical sciences, physician education and training as an inward and an individual endeavor, focus of career preparation on individual patients versus the goal of a team or organization.
A physician's identity is tied to the profession versus identifying with an organization. A physician's view of time is tied to immediate needs versus medium to long time frames of projects and organizational goals. A physician views cost of care as a secondary consideration versus a view of the larger financial context of the organization. A physician views reimbursement as a personal issue versus an organizational issue for administrators.
In order for hospitals to succeed in this new era of accountable care, care and quality must also be applied to improving hospital-physician relations.
Cultural Differences Between Clinicians and Managers
Clinicians are doers. They focus on one-to-one interactions and value autonomy. They are independent. Clinicians are the patient advocate. They identify with the profession. They detest meetings and organizational politics.
On the other hand, managers are planners and designers. Managers focus on one-to-many interactions. They value collaboration. Managers are participative. They are an organizational advocate and identify with the organization. Meetings and politics are part of the model.
Historically physicians, as defined as a profession, have valued and exercised autonomy. Their professional standards value service over proprietary interests; control training, admissions, and licensing; have a code of ethics governing practice, have peer-review and inner compass for accountability, influence policy and legislation, and desire freedom from the corporate practice of medicine.
Physician Leadership Roles
We are facing a paradigm shift in the fundamental physician leadership roles.
Traditionally, effectiveness was not critical to organizational success. Formal preparation was not necessary. Previously leaders were selected by rotation or clinical expertise. Traditionally they advocated for medical staff interests to administration. Previously they were available around a packed schedule.
Fast forward to today and value-based care is essential for promoting quality, safety, and efficiency. Formal orientation and development is needed.
Now physician leaders are selected on specific qualifications, a physician as a leader. Now physicians advocate broader patient care interests. Today physicians are engaged in participating.
Physicians play an important role in successfully improving quality and hospital performance. They are champions of clinical projects, are medical leadership and committee members, and are team players and adopters. Physicians are willing to use administrative tools once they are ready for deployment.
The Right Physician Leader
As a healthcare leader you might ask yourself, "How do I select the right physician-leaders?"
An effective physician-champion:
- is respected as a physician
- is good at communicating
- is willing to stand up when needed
- has good social skills and relationships
Be cautious, however, with physicians who are too far out front.
Ask yourself, "Is my physician-champion an innovator or an early adopter?" Innovators are the first to adopt change with early adopters coming shortly thereafter.
What can hospitals offer physicians?
In order to prosper as a healthcare organization in 2017, executive hospital management and physicians must work symbiotically. This means both parties need to acknowledge the value of one another and agree to work towards to vision of shared success.
Hospitals can offer physicians an alignment of common interests such as vision, shared values, and community. Hospitals provide expertise and resources in areas such as administration, capital, and technology.
Healthcare organizations achieve influence in effective hospital board governance with a strategic direction and priorities that benefit physicians. Hospitals can also offer autonomy for the physician group while maintaining constraints on individual practice.
To achieve optimal hospital-physician alignment executives need to believe in physician-leaders.
What can physicians offer hospitals?
Physicians can protect the existing markets for hospitals and offer potential expansion to new markets. Physicians can assist with the integration and coordination of care delivery. They can increase managed care contracts with shared risk and rewards. Physicians can promote multi-disciplinary collaboration.
One implication to keep in mind is that society is not tolerating inefficiencies and inattention to quality and safety.
Improving quality and patient safety is impossible without the bond between hospitals and physicians. We need the new philosophy that preserves physicians' best practices and autonomy yet also has individual constraints.
A common vision is the starting point when designing a model for integrated care. The duty of physician engagement is to advance and preserve physician professionalism.
As John Gardner said, "Liberty and duty. Freedom and obligation. That's the deal. We are free within a framework of obligations and the obligations we accept may be different from each other. But it is not in the grand design that we can have our professionalism without obligation. Not for long."
The University of Southern California teaches Physicians, Hospital Administrators and Management the strategic leadership and administrative skills to fast-track executive healthcare careers with an Online Executive Master of Health Administration Degree.