Steps to improve physician engagement

Handling more than 1 billion patient encounters per year, America’s 1+ million physicians are the foundation and primary economic drivers of U.S. health care. To give an idea of physicians’ impact, the average full-time physician creates nearly $2.4 million in hospital revenue per year, according to a recent survey. The significance of physicians to their health care organizations cannot be overstated.

However, the critical role and contributions of physicians is often portrayed differently in the daily news – or by physicians themselves. Despite an abundance of positive physician stories, the media tend to focus on “bad apple” doctors gaming the health care system, overprescribing or being arrested. More critically, America’s physicians are wearing out. In a recent Harvard report on physician burnout, calling it a “public health crisis that urgently demands action,” half of all physicians report depression, exhaustion, dissatisfaction and a sense of failure.

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Much of physicians’ frustration stems from dealing with a changing health care system seemingly beyond their individual control. For example, due to payers’ reimbursement cuts, physicians must now see more patients to maintain prior earning levels, potentially fraying traditional physician/patient interactions. Similarly, physicians no longer have as much latitude in their medical decisions, with the growth of evidence-based protocols, utilization management, and formularies. Contextually, this is why, more than ever, health care systems employing or contracting with physicians need to proactively enhance their physician engagement – or risk losing their doctors to more physician-centric competitors.

Why is physician engagement so important? It creates more positive, stable relationships between health care organizations and their physicians. It also correlates with greater efficiency and productivity, improved patient care and safety, and lower operational costs.

Consider the results of a Gallup study of a hospital system in which physicians rated “fully engaged” and “engaged” delivered an average of 51% more inpatient referrals and 3% more outpatient referrals than counterparts rated “not engaged” or “actively disengaged.” Financially, the most engaged physicians were 26% more productive than those less-engaged, adding an average $460,000 in additional patient revenue per year.

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Improving Physician Engagement

Achieving high levels of physician engagement can prove difficult for many health care organizations. So what is the roadmap for success? Consider the following 10 sequential steps to improve physician engagement.

• Step 1: Leaders should lead engagement efforts – Top leadership should fully understand and champion the linchpin role of physicians to their organization in the new health care economy. Physicians should be involved not only in all facets of clinical decision-making within the organization, but also in organizational strategy and business management.

• Step 2: Create an enterprise-wide strategy for engagement – Attention to physician engagement should start and stay at the top of an organization – at the board and CEO level – and permeate throughout administrative strategy-setting and decision-making. If physician engagement is an organizational priority and defined as a key goal, then initiatives, projects, and decisions should be required to consider and address their impact to engagement.

• Step 3: Set targets, measure outcomes and align incentives – Like any improvement initiative, team and individual incentives should be aligned with desired outcomes. Determine key metrics to measure physician engagement, then include them in performance expectations and incentive programs, as well as project selection and success criteria.

• Step 4: Recruit and retain effective physician-leaders – Organizations lacking effective physician-leaders should recruit them now. Organizations with great physician-leaders should take steps to retain them, by developing their leadership and providing leadership opportunities. Empower, embolden and develop physicians by allowing them to lead the most important clinical efforts, like those around population health management.

• Step 5: Align physician leaders with dyad operational partners – Physician leaders should have tightly aligned roles and relationships with operational leaders to share their expertise and decision-making. Just as operational leaders need to understand the clinical impacts of decisions, physician leaders should know about health care finance and payment methodologies, growth projections and capital availability, staffing and human resource considerations, and non-clinical strategic initiatives.

• Step 6: Link clinical performance and outcomes to financial performance – Help physicians understand the link between their clinical performance and outcomes to financial performance. For example, show how their patients’ emergency department utilization compares with peers’ and industry norms.

• Step 7: Provide sufficient data: Trained as scientists, physicians are data-driven. To gain physician buy-in on operational or change-related efforts, like steps needed to reduce readmission rates or improve outcomes, buttress arguments with supporting data.

• Step 8: Determine optimal motivators – While competitive compensation is an important baseline for physician engagement, greater compensation will not necessarily buy higher engagement. How physicians are engaged often matters more than their income. Some physicians are equally motivated by a desire to improve clinical performance or to have more time with their patients. Ask physicians what they would like or what might make improve their role.

• Step 9: Communicate, communicate, communicate – Physician engagement requires robust communication and transparency. Do not assume information is trickling down. Reaching busy and possibly disengaged physicians can be a challenge without a rigorous communication plan. Physicians need to understand what’s behind organizational policies, decisions and changes. Communicate how physician leaders are involved in specific decision-making to reinforce physician influence and impact.

• Step 10: Gain fresh input – Organization struggling with achieving higher levels of physician engagement might consider getting a new perspective. Bring in an external consultant experienced in developing and implementing successful physician engagement strategies.
   

Conclusion

Forward-looking health care organizations realize that physician engagement is key to their clinical and financial performance. At a time when physicians are feeling bombarded by economic and operational changes in health care seemingly beyond their control, and under greater personal pressure to heighten performance, ongoing organizational support and engagement can make a critical difference to their success.

Katherine P. Redmond is a consultant with Freed Associates, a California-based health care management consulting firm.