Practice Notes

Administrators: Move over to let your physicians drive innovation

This is a guest post from Advisory Board Consulting.

My colleagues in the Physician Engagement Initiative asked 55,000 physicians, "What drivers correlate most with physician engagement?" Top levels of engagement came down to two main things: autonomy in practice and input in organizational decision-making.

But as important as these elements are to physicians, many administrators (often inadvertently) have created quite the opposite culture—making demands of physicians and decisions on their behalf, rather than treating physicians like strategic partners. So it's really no surprise that in conversations I have with hospitals and medical groups around the country, it's often a deep-seated culture of disengaged physicians that is the culprit behind hindered system strategies, subpar clinical outcomes, and medical staff attrition.

Since poor engagement harms not just physicians but the entire system, administrators must think outside the "cost-benefit" box and invest in a culture of engaged physician employees and leaders.

Hand over the car keys

Some administrators still confuse engagement with compliance, and focus more on tactics to achieve short-term results than they do on sustaining a culture of engagement. But a compliance-driven relationship with physicians does little for building a strong, committed culture over the long term.

Imagine that senior executives at a health system want to make a certain change, so they pull in a group of physician leaders to oversee implementation. Those executives have already created the agenda and are simply asking for it to be followed—leaving minimal decision-making power for the physicians. At best, administration will get only what is asked for and nothing more; at worst, they will struggle to see any improvements at all.

It reminds me of something my previous CEO at Piedmont Atlanta Hospital once said: "You need to fill up the car with gas and give physicians the keys." While it might sound frightening for some administrators to follow the lead of their physicians, with proper guardrails in place and clear accountability for outcomes, they can create a breeding ground for innovation.

At Piedmont, for example, I had a first-row seat when a cardiologist came up with a new way to get patients from the ED to the cardiac cath lab, significantly dropping door-to-balloon time. It was a stunning improvement for patients who required emergency cardiac care. And as an executive leader, I personally wouldn't have been able to drive that sort of clinical change, or inspire the level of clinician engagement required to see it through.

Pay attention to the disruptors

The bottom line: Health system executives can't simply communicate their plans unilaterally, or rely on "transparency" to sustain physician engagement. Here are some questions I ask administrators to know whether or not they have truly committed to a partnership with their clinicians:

  • Do you involve physicians in determining whether changes need to occur?

  • Do physicians provide input when designing a new model or process?

  • Have you ever drafted a hospital-physician compact or a set of guiding principles to memorialize commitments on both sides?

Reality is sinking in for some employers who haven't made this cultural investment. I recently connected with a physician who was employed by a prestigious community health system in the South. Over his tenure there, he helped develop innovative clinical models in the primary care group. He was a highly valued leader, but never had true ownership of strategy or autonomy in execution, and became quite disengaged.

Long story short—he moved to Privia Medical Group, a less traditional employer that is known for giving physicians more autonomy in management. Administrators need to take stories like this to heart and learn a thing or two from Privia and other emerging industry disruptors—otherwise, top-tier talent might slip away.

This article previously appeared in Becker’s Hospital Review.


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