Prescription for Change

Ownership culture: The secret to hospitalist engagement

by Elizabeth Trandel

One of the questions we hear from CMOs when we share our recent research on hospitalists is, "What can I do if my hospitalist team isn’t engaged?"

After speaking with hospitalist leaders around the country, we learned that programs with strong engagement often have something called "ownership culture." What is ownership culture? In January, we co-hosted a webconference with Dr. John Nelson and Leslie Flores, consultants in hospitalist practice management, to answer this question. Read on to learn what ownership culture is and how you can help your program build it.

Q: What exactly is ownership culture? Why is it so important for hospitalist programs?

John: Ownership culture occurs in a hospitalist program when the hospitalists think of themselves as owners of their practice. They believe they have control of their outcomes, and feel invested in their performance. This a mindset, not a legal description—it’s important to note that hospitalist groups can have ownership culture regardless of their employment status.

Leslie: We really believe that ownership culture is an absolutely crucial component of effective hospitalist programs. In fact, I’d even say that it’s the attribute of hospitalist programs that best predicts high performance.

Q: How can you tell if a hospitalist program has a culture of ownership?

Leslie: Based on our experiences visiting hospitalist programs around the country, John and I have come up with five attributes of hospitals programs with ownership culture:

  • Hospitalists don’t blame their employer or feel as if they are unable to make decisions about their practice
  • They openly discuss their weaknesses
  • The group shares unblinded individual performance and financial data
  • Every hospitalist is familiar with their program performance data
  • Hospitalists think about improving the system of care, not just seeing the patients on their list

Q: What advice would you give to hospitalist practices looking to develop a culture of ownership?

John: There are a few essentials to building an ownership culture in hospitalist programs. First, hospitalist groups should use their structural elements—like compensation, scheduling, and performance reporting—to promote a personal stake in program performance. Programs should also ensure strong program leadership with appealing leadership roles and an effective governance structure. Interested hospitalist leaders can download sample group internal governance guidelines.

Leslie: Groups must also recruit the “right” people. I can’t overstate the importance of ensuring new hospitalists are a good cultural fit for the group.

Q: How much does hospitalist compensation factor into program culture?

John: Compensation alone doesn’t create a culture of ownership, but it is one lever to get there. We think it’s best if compensation generally mirrors the way the practice earns revenue—so, practices today should usually include compensation elements tied to productivity and performance on quality metrics.

Q: Where would you direct people interested in learning more about hospitalist compensation?

John: Well, we’re actually giving an entire webconference on how to optimize compensation plans on March 15.

Leslie: We also rely heavily on data from the Society of Hospital Medicine’s biannual State of Hospital Medicine report. We’re diving into this compensation survey data in our upcoming webconference. The 2016 State of Hospital Medicine survey is actually live until Friday, March 18—if you are a hospitalist group leader, you can take the survey here.

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