Read this if you are looking to keep your physicians and other team members engaged.
According to recent estimates, three quarters of physicians are employed by hospitals, health systems, or corporate entities. As a result, leaders in healthcare administration are increasingly confronted with the challenges and opportunities associated with engaging their physician workforce.
What is physician engagement?
The verb "engage" is used in common speech to convey a spectrum of messages and has a wide semantic range. Engage and its word family are used to impart diverse ideas. It can convey a range of meanings, from entering into battlefield combat to the promise of future matrimony. Considering this, the term used in today’s workplaces is not monolithic and its true definition should not be assumed. Instead, organization leaders should be clear on what engagement means to them—and clear about their intentions—if they want engagement to improve physicians’ job satisfaction and attain organizational goals.
Why engage?
According to the Centers for Medicare and Medicaid Services (CMS), the US spent more than 17% of its GDP in the healthcare industry in 2022. Healthcare organizations are continually challenged to demonstrate improved quality and outcomes while lowering costs. Physicians face higher patient acuity and increasing time pressures, in addition to changing and growing regulatory burdens. So, it comes as no surprise that physician burnout is on the rise.
A recent Gallup poll found a strong relationship between physician engagement and productivity. Physicians who were fully engaged were 26% more productive than those not engaged or actively disengaged. Moreover, physician care is the key revenue generator for hospitals. According to Merritt Hawkins’ 2019 Physician Inpatient/outpatient Revenue Survey, the average net revenue derived from admissions, tests, prescriptions, and procedures performed or ordered per physician was $2.4 million per year. Succinctly put, physician engagement positively affects healthcare organizations’ bottom lines.
A model for employee engagement
There exist numerous models for employee engagement. One such model from DJS Employee Research focuses on the six Cs of employee engagement:
- Career: Employees have an opportunity to develop themselves
- Clarity: Employees believe there is an open, honest culture with trust and transparency
- Confidence: Employees have confidence in their leaders and see them role modeling values
- Communicate: Employees participate in decisions that affect their work and feel free to speak up
- Care: Employees feel valued and recognized for the work they do
- Collaboration: Employees feel able to innovate and suggest new ways of doing things
While each one of these Cs could be the topic of its own article, when viewed together they provide a helpful summary of all the components affecting a physician employee’s (now 75%) engagement with their organization. How is your organization faring in these categories?
Why physician engagement efforts fail
Physician engagement efforts often fail due to an inability to understand the importance of engagement activities and, sadly, a simple lack of effort. When efforts are made, yet fall short, it is frequently a result of three Ms: misalignment, misunderstanding, and missed opportunities.
- Misalignment of vision and goals
Misalignment arises when a vision is not created and effectively shared, and goals are divergent, as administrators and physicians are not on the same page. The term “physician alignment” is often used inappropriately, frequently to describe strategies of how to maximize organizational outcomes (usually financial). As a result, alignment has come to mean the business relationship organizations have with physician groups, rather than the alignment of vision and goals.
- Misunderstanding and lack of communication
Misunderstanding arises when time and effort aren’t expended to listen, understand, and confirm clarity in communication. When misunderstanding occurs, even in the presence of a good foundation of shared vision and goals, administrators and physicians may still be at odds. What do organizations want from their physicians? Referrals? Enhanced revenue? Increased patient throughput? Quality, even though metrics may not accurately reflect what is considered to be true quality? Better documentation? No complaints?
Healthcare administrators not only need to clearly communicate their priorities, they also need to make a sincere effort to seek physicians’ perspectives, listen to them, and value that feedback. Lack of clarity leads to poor communication, which undermines collaborative efforts and breaks down confidence, resulting in individuals not feeling cared for and consequently more likely to find career opportunities elsewhere.
- Missed opportunities: Quadruple aim and physician turnover
Missed opportunities are the unfortunate result of a continued cyclical pattern of misalignment and misunderstanding. They become a cost to the organization, hampering the attainment of healthcare’s quadruple aim: improving population health, the patient experience, and the work life of health-care providers, all while reducing cost.
Perhaps the ultimate missed opportunity is the physician who has chosen to take their career somewhere else because of a lack of attention to the six Cs described above. Physician turnover is extraordinarily expensive. Estimated hospital opportunity costs in 2019 (in terms of lost revenue) range from $175,000 per month for a family physician to $273,000 for an orthopedic surgeon. Additional expenses include new physician onboarding, estimated in 2016 to cost between $200,000 and $300,000 (8), a figure undoubtedly higher today.
Communication and Clarity
While all the six Cs are important as a framework for capitalizing on opportunities, two stand out as particularly illustrative: Communication and Clarity. Physicians and associated medical staff are highly educated and trained. They have valuable ideas and contributions, yet frequently don’t share their thoughts outside the protected bubble of their peers. Healthcare administrators need to create a safe space for physicians to communicate their thoughts, insights, and suggestions.
Missed opportunities also result from lack of clarity on the purpose of contemplated changes. Unintended consequences may result. At times, actually implementing a change can itself be a missed opportunity. How often has a change been made to reduce costs, only to result in adverse impact on physicians?
An example is the large physician group that wants to streamline and eliminate some administrative tasks. Administrators institute use of a new online platform for expense reimbursement, requiring physicians to input information on their own, including scanning, uploading, etc. Administrators may reason because they themselves perform the task routinely, shouldn’t physicians as well? Often too late, they realize, that imposing this seemingly minor administrative burden has yielded unintended consequences. In this example, chasing potential savings through an ill-advised change resulted in negative physician impact, disengagement, and eventually, organizational loss.
Beyond physician compensation
Competitive compensation packages are certainly important, and organizations wrestle with providing appropriate incentives and integrating value-based metrics into their models. Organizations should strive to provide compensation models in which incentives align with values. Equity is important, as is avoiding models that cater to ‘squeaky wheels’ or are prone to special deals.
Organizations should understand that simply raising compensation to above-market levels does not necessarily buy positive physician engagement. Undoubtedly, physicians want to be fairly and equitably compensated. However, it is just as important that physicians feel listened to and heard, proving their opinions matter and that they are valued.
Words matter, as does professional identity. Physicians want to feel they have some measure of autonomy. Physicians often feel they have no control, sensing decisions are made by others. They perceive private equity firms deciding overall budgets, insurers approving or disapproving procedures, administrators controlling hours, hiring and firing, and staffing without their input. Physicians bemoan lack of organizational power, yet feel they are held responsible for poor outcomes.
Physicians frequently report disliking and being demoralized and devalued by use of the term “provider.” A Mayo Clinic blog author has emphasized that the word “provider” is a nondescript term that confers little meaning. It does not convey to patients or to anyone else who will be caring for them. It implies that the relationship between physician and patient is one of simple commercial transaction. Titles matter. Imagine a Chief Financial Officer of a hospital being referred to as a “finance provider.”
Physicians care deeply about their patients and providing quality care. Tasks that physicians perceive as taking time and not directly contributing to patient care are not viewed as important. Administrators can avoid potential goal misalignment by communicating their needs to physicians from a patient care and quality standpoint. Goals do not necessarily need to be the same.
Administrators can succeed by framing their goals in terms of what is important to their physicians. While it might be particularly important to a hospital administrator to improve medical record documentation to facilitate coding and revenue cycle management, physicians are less likely to respond to a pure financial argument. They will be more likely to participate in a medical record completion initiative by appealing to quality-of-care issues and the impact of poorly documented medical records on continuity of care, risk management, and the ability for physicians to effectively treat patients post-discharge.
Improving physician engagement
When seeking physician engagement for a contemplated or planned initiative, it starts with listening. Administrators should hear and understand physician concerns and actively seek their input. Develop a communication plan. Depending on the issue and nature of the organization, communication can take the form of personal meetings, town hall sessions, written communication, or optimally, a combination of all three. Enlisting help from the medical team can be especially useful. In larger organizations, the identification of physician champions can be particularly beneficial to model behaviors and carry messaging to peers. A consistent, clear message is paramount to successful physician engagement.
Through understanding the importance of physician engagement, how it can go awry, and truly appreciating a physician’s perspective, healthcare administrators can build allies, not adversaries, and create an environment of collegiality, cooperation, and collaboration. Success conjures images of wedding bouquets rather than of the battlefield.
BerryDunn champions a unique approach to the physician-administration relationship. Reach out to us if you would like more information or would like to discuss how to improve physician engagement at your organization. We’re here to help.
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