Paperback
-
PICK UP IN STORECheck Availability at Nearby Stores
Available within 2 business hours
Related collections and offers
Overview
Physician engagement in a hospital or health system can be powerful. It can drive culture change; it can knock down operational, financial, and strategic challenges; and it can lead to better outcomes. But in many organizations, physicians are demoralized and disengaged. Why do physicians in one hospital demonstrate ownership in improving their organization’s performance while those in another hospital show no personal commitment to organizational success?
This book guides leaders in creating environments where executives and physicians jointly work toward shared goals. Concise, accessible, and packed with real-world examples, An Insider’s Guide to Physician Engagement presents a practical plan of action for healthcare executives and clinical leaders at all levels of the organization. Each chapter offers pearls of practical wisdom and shares inside tips to help leaders move from understanding to action.
The author, drawing on more than two decades as a physician, health system CEO, and consultant, takes a seen-it-from-all-sides approach to topics that include the following:
Busting the myths to change the culturePresenting data effectivelyLaunching cost–quality campaignsArticulating a clear visionLearning how physicians thinkEmpowering physician leadersMeasuring successPhysician engagement is both an art and a science. By uniquely addressing the challenge from the perspective of both executives and physicians, this book provides an inspiring, achievable plan for physician engagement that has been sorely lacking until now.
Product Details
| ISBN-13: | 9781567939194 |
|---|---|
| Publisher: | Health Administration Press |
| Publication date: | 07/01/2018 |
| Series: | ACHE Management |
| Pages: | 121 |
| Sales rank: | 529,941 |
| Product dimensions: | 6.00(w) x 9.00(h) x 0.40(d) |
About the Author
Books published by Health Administration Press:
An Insider’s Guide to Physician Engagement
An Insider’s Guide to Working With Healthcare Consultants
Read an Excerpt
CHAPTER 1
Recognize Disengagement
Physician disengagement has been growing inexorably for decades. What's really unfortunate is that physicians have stopped struggling against it; disengagement has become the new normal for physicians just when health system executives need their help the most. The premise of this book is that the solution to most challenges health systems face in today's era of decreasing reimbursement, value-based care changes, and brutal market competition is for executives to engage physicians as coleaders.
COLEADERSHIP
Coleadership goes beyond asking physicians to be partners on specific initiatives, such as reducing length of stay. It means a radical culture change where executives and physicians jointly guide the organization. The premise behind the premise is that health systems, as healing organizations, are best run by both healthcare executives and healthcare providers.
When I refer to physician coleaders, I don't just mean medical directors or department chairs; I also include rank-and-file doctors. A culture of physician empowerment is impossible unless all physicians feel ownership, because regardless of whether physicians are formal leaders, they lead the care for their patients. Coleadership, therefore, refers to shared leadership between executives and the medical staff.
True, the pendulum of attitudes about physicians as leaders has started to correct. More doctors are being hired as health system CEOs, and in some systems, a dyad model pairs executives with physician leaders to promote a balanced management approach. These are good trends, but they don't go far enough. For example, only 5 percent of health systems have a physician CEO, and in most systems using the dyad model, the culture doesn't change to support true coleadership: The dyads exist, but the executive half of the dyad still leads the physician half (Robeznieks 2014).
I hear less about dyads today. Instead, there is movement toward physician leadership development programs. This evolution is fine, but executives are often confused about what to teach physicians and what to do with them once they are taught. This confusion results from a lack of a clear premise or goal for the leadership development programs and causes many of them to fall short and fizzle out over time.
Coleadership is a difficult concept for many executives, and even some physicians, to embrace. Therefore, it is hard for health systems to achieve. It's difficult for executives to embrace because not only must they share power, they also must share power with a group that is indifferent (at best) or antagonistic (at worst). For physicians, coleadership is difficult because they feel so marginalized and disengaged that the concept of leading anything outside of direct patient care is inconceivable.
For both sides, the challenge is compounded by a lack of trust. In fact, trust between executives and physicians has eroded so completely that what I once described as abutting silos are now distinct workforces separated by a demilitarized zone.
Although hard to accomplish, the concept of coleadership is simple to describe: Executives must share decision making with physicians, while physicians must take responsibility for the success of the whole health system.
Shining examples of physician authority and accountability still exist. One such example is Mayo Clinic. As John H. Herrell, chief administrative officer of Mayo Clinic from 1993 to 2001, observes in Management Lessons from Mayo Clinic (Berry and Seltman 2008, 102):
What differentiates Mayo Clinic is the structure that makes the physician accountable for what happens throughout the institution. If the institution fails, the physicians have only themselves to blame. This fact affects physician behavior at Mayo Clinic in a positive way. They must keep the institution's interests in mind because those interests are aligned with their own.
Creating such a structure and culture isn't easy; Mayo Clinic has the advantage of having been founded by physicians more than 100 years ago and it still isn't perfect. The good news, however, is that just as fallow land can eventually produce bountiful crops, even health systems that have never engaged their physicians have the potential to achieve unimagined levels of success with physician coleadership. Full coleadership will be impossible for most, but health systems that reach even partial coleadership will gain immense competitive and financial advantage. Like Mayo Clinic, they will rise to the top.
THE PHYSICIAN ENGAGEMENT CONTINUUM
It's helpful to start a book about physician engagement with a definition. Put simply, physician engagement exists when physicians care about the well-being of their health system and want to work with executives to solve the system's problems.
This simple definition will likely fit most executives' understanding of physician engagement, but it is too narrow for this guide. It lacks the necessary tautness of physician engagement, analogous to prongs plugged into a socket. It also misses physician accountability and decision-making authority, which are essential. We can address these shortfalls by recognizing that physician engagement exists on a continuum (exhibit 1.1):
• Physician engagement is the first phase — the essential first step — in a coleadership process that, if implemented intentionally and properly, progresses to physician empowerment and ultimately to physician ownership.
• Physician empowerment is like the unfolding of a flower. It captures the amazing transformation in confidence, motivation, engagement, and satisfaction that physicians undergo when they are given decision-making authority beyond their traditional realm of patient care.
• Physician ownership, the result of continual empowerment, exists when physicians begin to feel as accountable as executives for their health system's success.
One term commonly used in health systems, but which I don't use, is physician alignment. It suggests that physicians are the problem, and that the solution is to bring them into line with executives' goals and views. In reality, executives' goals and views are suboptimal without physician coleadership.
A Health Leadership Lexicon
As I wrote this book, I encountered a challenge I've met while writing articles and delivering talks: namely, the lack of unambiguous words to describe ourselves as healthcare leaders and what we do.
For example, administrator is often used as a synonym for CEO. However, chief operating officers (COOs) and other executives are also frequently described as administration or administrators. Physicians in administrative roles are sometimes referred to as physician executives, but there is no clear distinction between which physician leaders are also executives and which are not.
For clarity, I will define three terms the way I intend for them to be understood in this book:
1. Health system is a hospital, or multihospital organization, and all the services it provides including outpatient services, office-based practices, and post-acute care services.
2. Executives are nonphysician CEOs, vice presidents, assistant vice presidents, and directors.
3. Physician leaders are any physicians in a formal leadership role such as the chief medical officer, medical director, department chair, division chief, and chief of service.
Physician leaders and executives become health
system coleaders by sharing decision-making authority and goals and by treating each other as equals.
USING THIS BOOK AS YOUR GUIDE
This book is a guide to driving culture change, and culture change starts at the top. Its message is most effective when executives read the book, meet to discuss and adopt the philosophy, and then infuse that message throughout the organization. Executives at all levels should then use the book as a step-by-step guide to implementing physician engagement initiatives.
Each chapter includes a collection of pearls of practical wisdom and some tips to help executives move from understanding to action.
PHYSICIAN ENGAGEMENT PEARLS
Submerge Your Ego, Treat Physicians as Equals
When interacting with physicians, executives should avoid intimidating or appearing to be intimidated. This requires a tricky balance of humility and diplomatic assertiveness. Just as executives are used to being in charge of other executives and employees, physicians — even the most junior — are used to being in charge of care teams.
And, like executives, physicians summarily reject input they feel is wrong. When these propensities to take charge come together, there may be the potential for a clash of egos. In such situations, executives should submerge their egos because winning is really losing. The physician who loses such an arm wrestle leaves resentful, more disengaged, and less cooperative. The executive who wins validates a negative stereotype and finds physician engagement even more difficult.
Conversely, an executive who comes across as intimidated runs the risk of being considered unknowledgeable. So a balance must be struck. The best way for executives to achieve this balance is to treat physicians as equals.
Being courteous and listening to physicians is a fundamental part of treating physicians as equals.
As these two cases demonstrate, treating physicians as equals is more work for executives. But in the long run, not proactively doing so can generate exponentially more work — and physician disengagement.
Suppress Mistrust and Take Leaps of Faith
In many health systems with an environment of mistrust, problem-solving meetings between executives and physicians are more like poker games than team discussions. Executives privately disbelieve verbal commitments from the physicians, the physicians privately question the motives of the executives, and both parties withhold information that would weaken their positions. In addition, they bluff to advance their agendas.
To stop the gamesmanship, executives must take leaps of faith that demonstrate their willingness to trust physicians, even when experience does not support this trust. For this approach to be effective, executives must at the same time explicitly state that they will hold the physicians accountable for delivering on their promises and will rescind confidence if they fail to deliver.
INSIDE TIPS
1. Achieving physician engagement, and ultimately ownership, requires a culture change that can only happen if the CEO and other executives want it to happen and understand their role. One approach to consensus is for everyone on the executive team to read this book at the same time and then meet to discuss a chapter at the beginning of each senior leadership meeting. Once team members agree to drive this culture change, they can influence the rest of the organization.
2. Physician engagement is hard and involves sharing some executive decision-making authority. Assess whether you possess the personality and facilitation skills to accomplish this yourself; if not, identify executives who can partner with you to help you along the way.
3. Once you commit, gear up as you would for any other culture change, such as improving patient satisfaction or employee engagement. Take stock of the existing culture through survey reports and other sources of data; set your goals for year one, two, and three, and then communicate the plan to board members, other leaders, and employees.
4. Implement easy actions for early wins to start the promotion of physician engagement and gain the attention of other executives. These may include eliminating ambiguous terms like physician alignment, introducing the term coleadership, and modifying your communications to physicians so that the words and tone demonstrate that you view them as equals.
REFERENCES
Berry, L. L., and K. D. Seltman. 2008. Management Lessons from Mayo Clinic: Inside One of the World's Most Admired Service Organizations. New York: McGraw-Hill.
Robeznieks, A. 2014. "Hospitals Hire More Doctors as CEOs as Focus on Quality Grows." Modern Healthcare. Published May 10. www.modernhealthcare.com/article/20140510/MAGAZINE/305109988. CHAPTER 2
Bust the Myths to Change the Culture
Achieving the ultimate goal of physician ownership starts with physician engagement.
Basically, engagement is what you want from people who create or support your health system's services. Ownership is what you want from people who essentially are the service — that is, the physicians. Fortunately, physicians excel at ownership, as evidenced by the responsibility they take for direct patient care. The trick is getting them to also own the operational, financial, and strategic goals of the health systems in which that care occurs. When they do own those goals, as in many freestanding ambulatory surgery centers, performance improves (Ambulatory Surgery Center Association and Ambulatory Surgery Foundation 2017). When they don't ... well, that is why you are reading this guide.
First, ask yourself whether you really want physician engagement, empowerment, and ownership. Although physician ownership brings commitment, it also requires shared decision making, and that puts many executives at varying degrees of unease. As one executive once asked me, "Why are you trying to share business decision making with the physicians? That's what administration is here for. Let physicians do what they do best: see patients!"
If that declaration sums you up, this chapter is for you because deprogramming is urgently required. If, on the other hand, you're ready to share, this chapter will help you deprogram the many executives at your health system who are not ready. Deprogramming starts with dispelling three myths that perpetuate the status quo.
MYTH 1: THE DUMB DOCTOR
The most pervasive and destructive myth is usually expressed as "doctors don't understand business," but the subtext is "doctors can't understand business." This myth underpins the usual approach of seeking physician input into already-completed business decisions rather than involving them in the formation of those decisions. Worst of all, this myth has permitted executives to undervalue and even belittle the opinions of physicians.
It's unfair to blame only executives. True, they planted the seed long ago (perhaps to ensure job security), and today many happily nurture what they sowed. But insecure physician leaders have nurtured it as well.
MYTH 2: THE GREEDY DOCTOR
I encountered this myth at almost every client site during my years as a performance improvement consultant to health systems. After my usual spiel to the CEO and executive team on how to empower their physicians, somebody would inevitably retort with something like, "Physicians won't do any of that unless there is something in it for them." The subtext? "Only money will motivate physicians." Every head would nod and the conversation would deteriorate into complaints about the problematic precedent of paying physicians for meeting attendance, the weakness of comanagement agreements, and the regulatory hurdles of gain-sharing — the Gordian knot formed by the undesirability of paying physicians to engage and the futility of empowerment efforts that don't include paying them to engage.
Only nonphysicians could have created this myth. Physicians know too well the free service that a healer routinely provides: after-hours phone calls and chart completions, curbside consults, rounding on evenings and weekends ... doing what it takes to ensure good patient care. That's the sense of ownership that medical schools embed in students and residents, most of whom already have an altruistic mind-set. The weak influence of capitalism on many young doctors also explains why medical students incur monumental debt to enter pediatrics and other relatively low paid medical specialties. If physicians felt the same ownership for the operational, financial, and strategic goals of health systems that they do for patient care, the myth would die. Yet it survives because, in the absence of an approach that fosters ownership, physician engagement must be bought.
In fact, physicians aren't disengaged because they want money; they want money because they are disengaged.
MYTH 3: THE INCOMPETENT DOCTOR
Another myth underlies conversations in health systems about reducing clinical variation. The myth is couched in statements such as, "I can't believe some doctors use one suture material and others use a different suture material for the same operation." The subtext is, "Doctors don't know how to practice good medicine."
To be clear, the problem isn't the drive to reduce clinical variation. Variation is real, and it can add to costs and lower quality. The problem is the insinuation that clinical variation equals physician incompetence. With few exceptions, physicians are highly skilled and render what they believe to be the best care for their patients. Unwanted variation is sometimes caused by physician customization and shortcuts, but even when comparing the top five US doctors in a single specialty, variation exists because medicine is complex, each patient is different, physicians are trained differently, and medicine is both an art and a science.
(Continues…)
Excerpted from "An Insider's Guide to Physician Engagement"
by .
Copyright © 2018 Foundation of the American College of Healthcare Executives.
Excerpted by permission of Health Administration Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Foreword,
Preface,
Acknowledgments,
Chapter 1 Recognize Disengagement,
Chapter 2 Bust the Myths to Change the Culture,
Chapter 3 Treat Physicians as Independent Employees,
Chapter 4 Tackle the Engagement "Whys" and "Why Nows",
Chapter 5 Dive into the Data,
Chapter 6 Launch Cost — Quality Campaigns,
Chapter 7 Empower Physician Leaders,
Chapter 8 Communicate with Substance and Style,
Chapter 9 Update the Chief Medical Officer Role,
Chapter 10 Learn How Physicians Think,
Chapter 11 Measure Progress to Ownership,
About the Author,