By William Choctaw, MD, JD, CSSBB, physician advisor for the Joint Commission Center for Transforming Healthcare
Few would argue that physician leadership is an important part of highly reliable health care and the quest to achieve “zero patient harm" in our healthcare organizations. Nevertheless, the challenge most hospitals face is how best to effectively engage physicians as collaborative partners.
I have practiced general surgery for over 30 years, been a hospital physician executive for seven years, and led an RPI®/Lean Six Sigma program for more than four years. I’ve learned a great deal over the years on how help hospitals engage physicians effectively.
There are four basic principles of hospital physician partnership:
1. Identify physician champions – The champions are known medical staff leaders with or without an elected title (past/present department chairs, past/present committee chairs, natural leaders, etc.). They are your physician superstars. In general, these physicians usually have these characteristics:
• patient centered value system
• progressive and passionate mindset
• strong strategic communications
• consensus building
• support for system-based care
• strength when challenged
• openness to continuous training, especially Robust Process Improvement/ Lean Six Sigma (RPI/LSS)
2. Physicians are not monolithic – A frequent mistake when attempting to engage physicians is to assume that they think alike. Generally, health care systems have medical staffs that are extremely diverse: physicians who are hospital-based, private practice, generalist, specialist, contracted, employed, and so forth. To motivate and engage doctors, it is important to identify these diversities and develop targeted solutions to meet their needs.
3. Hospitals should go first – Hospitals are the natural leaders in health care, and leaders go first. The hospital is the larger, better capitalized entity. It is the health leader by scope and scale, and should be first to actively engage physicians instead of waiting passively for doctors to engage them. There should be a well-developed physician alignment plan.
4. Provide financial support for physicians leading quality efforts – The administrative duties of physician champions and medical staff leaders have significantly increased over the years due to growing healthcare complexity, increased state and federal regulations, and additional factors. Nevertheless, the physician leader’s involvement is vital to improved healthcare quality and patient safety. Their involvement also helps the hospital financially. Physician leaders are under increased financial strain, especially those in private practice. As payment methodologies shift toward quality and value, doctors are challenged to receive full reimbursement. Acknowledging this reality and providing assistance would be invaluable. Appropriate payment to the engaged doctor would show respect and solidify the hospital physician relationship.
If there is not effective physician-hospital collaboration, most quality and safety hospital initiatives will fail or not be fully sustainable. Hospital employees view physicians as natural leaders in the hospital environment. In Citrus Valley’s previous RPI®/Lean Six Sigma Green Belt training program, 20 percent of the class each year included physicians. It is the physician champion’s added diversity to any patient care and patient safety initiative that increases success and sustainability.
Finally, the hospital executive/management and physician champion partnership is a relationship. All relationships are based on three things:
• good communication
If any of the three is missing, the relationship falls apart. With our physician partners, it’s essential to resist the temptation to find fault and place blame and rise to the higher level of accountability and responsibility. Hospitals must find common ground with our physicians and work together as a team. When that happens, everybody wins: patients, families, employees, management, and physicians. Our patients and their families are depending on us to make the relationship work.
William Choctaw, MD, JD, CSSBB is Physician Advisor for the Joint Commission Center for Transforming Healthcare, where he contributes on a variety of topics. Previously, he was Chief Transformation Officer at Citrus Valley Health Partners (CVHP) where he practiced surgery and was a member of the hospital executive team for seven years. In 2013, Dr. Choctaw launched a Robust Process Improvement/Lean Six Sigma program at CVHP, in partnership with the Joint Commission Center for Transforming Healthcare.