February 11, 2020
Physician Engagement – Building Loyalty and Decreasing Burnout
The business relationship between physicians and hospitals is shifting.
It’s thanks to new compensations models and new models for patient care, largely (but not exclusively) driven by the move towards value-based care. And as those changes are happening, administrative responsibilities add stress and contribute to burnout. Change fatigue and overall stress can lead to significant friction when necessary moves must be made by hospital administration.
James Cervantes, associate vice president in the National Practice here at Jarrard Inc., brings a wealth of experience working on leadership structure, professional development and physician group management for hospitals and health systems. And, he’s been watching the evolution of the physician-hospital relationship closely.
Here, he talks about some of the changes happening in physician employment models, including compensation and care delivery, and how administration can best work and communicate with physicians during this evolution of the care team.
Listen to the podcast, watch the videos or read the transcript below:
Read the transcript
David Shifrin: We’re talking about physician engagement. There’s a lot going on in changing employment models, there’s a lot going on with just the changes in the administration and sort of execution of healthcare. So set up some of those changes, first of all, and then we’ll talk about ways that health systems can work with their physicians to get through it all.
James Cervantes: Sure. There’s a lot going on in healthcare in general. At the provider, specifically, the physician level. What we’re seeing right now are a lot of changes to how they’re paid, and that reveals itself through the value-based work. for them that means changes to compensation, which is ultimately their pay.
We’re also looking at new ways of caring for patients. So changing the way that they’re formed as a team and how they’re working with other clinicians: advanced practice providers, nurses, MAs. That entire care team model is being looked at with a much finer lens than it ever has been before.
And I think thirdly, looking at how the physicians are structured, so whether it makes sense to have them be employed or contracted or remain independent, but closely aligned as systems continue to grow and as the need for patient management and managing the continuum of patients over the course of their healthcare need evolves.
The systems, both academic medical centers and health systems are trying to figure out how tied physicians need to be. And I think they’ve landed on the answer that they need to be tied pretty closely. And so for them, that means structures are changing.
DS: Okay. So, talk about how they can work with the physicians as they either work to land on that point, or, as you said, there they are landing on being pretty tied to the physicians. How can they work with the physicians to communicate with them to make that process as effective as possible.
JC: Right. What I just listed were significant transformative changes that would happen and are happening in a lot of systems around the country.
I think there’s really three things that a health system leader can do to ensure that their physicians are not only aligned to the work, but along for the journey. The first is really involving them in the process from the beginning. Give them a seat at the table, involve them in the decision making and the development of the guiding principles.
I think next is, you know, allow them to lead. If there is an initiative as part of the integration work or as part of the transformation, give them a role to be a leader so that they can be the messenger and communicator to their teams, to their colleagues and to their practices.
and the other component to that is leverage their clinical expertise. They shine when they’re able to weigh in on how care should be delivered, how care should be coordinated, and what is really the best for the patient. And so I think health system leaders sometimes forget that.
The more that they can leverage the physician leader or just a physician within a practice, their clinical expertise, the better off the system will be.
So I would really kind of boil it down to those three principles. Allowing them to lead, leveraging their clinical expertise and involving them in the decision-making process.
DS: What are some of the deficits that you’ve observed with healthcare organizations when it comes to communicating with their physicians through these changes?
JC: Sure. That’s a great question. I think there’s a few pitfalls. The first is, I think we rely too much on email and we assume that a physician is going to read their email and check their inbox as much as an administrative person might throughout the day. The reality is that’s not true.
They’re much less likely to check their inbox when their schedules are full and when they’re moving from the OR to the office. So we have to think of other ways that we’re communicating with physicians. Oftentimes too, it’s not just one vehicle.
The second is, I think we underestimate the value of hard eye contact and having face time with them. As systems grow, it becomes more difficult to meet one on one. It becomes an issue of scale. But I think, having one on one time with the physician to hear what they have to say, to listen to what their issues are and give them sort of the space to share their ideas goes a long way – whether you’re implementing a small change or a large change.
And then last, I think we sometimes make the assumption that all physicians are equal. That’s also not true. We need to respect that primary care functions very differently than specialty care. And that what an oncologist is thinking about is very different than what a GI doctor might be thinking about versus what a primary care doctor has on the top of their mind.
So I think we really need to respect that. Sometimes they’re looked at as a collective group, which they are, but there are nuances within each, group of doctors and certainly within each specialty that we need to consider.
DS: When you’re looking at all the different specialties that an organization needs to consider with the subgroups within their physician group as a whole, I could see that being somewhat intimidating because now you have to segment even further. So how should healthcare administrators, healthcare leaders think about sort of tailoring the message and the communication channels for each of those? You had mentioned primary care versus GI, how should they tailor those?
JC: Right. I think you can approach it two ways. One is you can, where it makes sense, bring them together. So, you know, it may make sense to bring your primary care leaders together and talk about issues because they might have similar issues or ideas that they’re trying to tackle or pursue together.
In surgical care or in specialty care it may make sense for general surgery and oncology to come together because they share common patients. But that being said, realizing that there tends to be a lot more primary care offices and geographically it’s just different. It’s more difficult to connect with them one on one or to all come together around the table.
It’s really meeting them where they are. And so delivering and constructing communications tools that are not only an email, but maybe something that comes through an application that they’re using or through the EMR system or a flyer that is in their office that they can refer to and look at to see an update on some change effort that’s happening around the system.
So I do think it’s certainly a multipronged approach, but I think where it makes sense we do need to bring them together, but then also recognize that how they’re going to want to receive the information is going to be slightly different within each group and sometimes each provider.
But at the same time, I think we just need to be realistic about what’s achievable and make sure that whatever messaging that we’re creating in vehicles that we’re exploring are consistent.
DS: What are some of the tools that provider organizations should be thinking or could be thinking about that will allow more streamlined communication and then as a downstream effect of that, helping physicians and other clinicians as well just practice at the top of their license. They’re spending less time dealing with, as you said, email, and just kind of getting back, getting the information they need and getting back to the patient care.
JC: Yeah. So the first part, I think there’s some things that I’ve seen work effectively. Certainly, as I mentioned, those one on one conversations. So having a regular touch point, even if it is 15 minutes or 20 minutes a quarter, or even once or twice a year. That does go a long way – giving them the face time.
I think the other component is quick surveys or our pulse polling where they can respond to a few questions through a survey or an email where they’re weighing in on something and giving their ideas and thoughts. I think the point here is to keep it brief, keep it concise, and really make it relevant to what they’re interested in responding to and weighing in on. So, making sure that it’s specific to their needs and to what their interests are. Otherwise they’re not going to answer it or open the email or respond to the survey.
DS: And giving them a seat at the table at the beginning will help tailor the questions and the needs and the interest so that when they do put together the pulse polls, you’re ensuring that those questions are relevant because you’ve heard from them.
JC: Absolutely. If we think about it in a process, we would want to make sure that there’s a physician voice as we’re building that survey or as we’re constructing that email to not only make sure it captures the right information, but that it’s accurate and that it’s relevant and that it considers exactly what you just described.
DS: What are some of the practical outcomes, the downstream effects of implementing these ideas and tips that we’ve talked about?
JC: well, I think there’s always things you have to be cautious of. That being said, I think we’re at the point right now where we need to be trying different solutions to see what’s really going to sort of move the needle on bringing in physicians closer to a lot of the topics that we talked about.
As we think about the strategic priorities for a lot of these larger organizations, they are similar. We know that we want to improve access for patients. We want to connect closer to patients through engagement and surveys. We want to make sure that we’re meeting their needs.
There’s also the fiscal responsibility that all these systems need to have in the back of their minds so that they can be around for years to come. And so with a lot of these sorts of metrics being similar, where I think systems are more likely to succeed is when they have physicians at the table and when they’re involved in, the beginning and the forming of the work around these initiatives.
So I think as systems and other hospitals are creating the vision for what their future looks like and how they’re going to tackle a lot of these issues, they need to be thinking about where the physician leader, where does the physician platform fits within all of this.
And even beyond that, how do we engage them more deeply in the development of all that work so that we’re not just shoving some initiative through? It’s really considering the physician, because at the end of the day, healthcare is a people business and the physician is delivering the care with their clinical team to the patient. Rightfully so, they should have a say in a lot of these developments and in the formation of this work.
DS: You bring your significant background in physician engagement in some of these models to Jarrard. What are some of the projects that you’re working on and how does the firm work with provider organizations to implement some of these exchanges?
JC: We’re thrilled to be working with a system in the Midwest that has an employed physician group and they’re making some significant changes to their compensation. What we’re doing with them is holding listening sessions to understand what are the pain points that the physicians, the employed faculty have, and hear what they have to say about the system at large.
All that information will really help inform to the vision that we’re creating at the table with the organization and with the physician leadership team. We’ll then take that vision and build out a full plan and campaign that brings physicians and physician leaders along that journey, so that at every step of that compensation planning and designing and implementation, there is a physician leader, if not more than one, at the table.
And that the physician larger group is receiving information, that there’s a sense of transparency, a sense of inclusivity and really space for them to weigh in at every step of the way. And, so far, that’s worked well.