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Physician engagement: What not to do

Posted Jun 24 2013 5:13pm

by Jonathan H. Burroughs

Alignment of organization and physician interests depends upon successful physician engagement. Unfortunately, the traditional approaches of purchasing a physician practice or employing physicians have little, if anything, to do with alignment.

Thus, it seems instructive to share a few insights as to how NOT to engage physicians.

The following summarizes some key ways in which an organization can fail to engage physicians and lead to an unaligned environment with unnecessary conflict, division, strife and cost...

Treat a physician as you would all physicians

There is no such thing as physician "interests" any longer with so many fragmented and disparate interests based upon age, sex, demographics and personal preference. For instance, older physicians may seek long hours and high pay whereas younger Gen X/Y professionals may seek to optimally balance professional and personal life.

Men may wish to front-load their professional careers whereas women may wish to better balance work/home early in their careers and focus more intensely on career advancement later when their children are grown. Some physicians are entrepreneurial and some are not, and therefore, there is a wide spectrum of tolerance for risk and investment. Some physicians are independent and some feel comfortable in organizational and hierarchical settings.

Each physician should be treated as an individual with unique personal and professional needs and aggregating physicians together with common stereotypes ("Well you know how doctors are") will guarantee misunderstanding and defeat.

Ignore past grievances or perceptions of betrayal

The foundation of any relationship is trust.Past grievances or negative perceptions do not provide a basis upon which a relationship can grow or even survive. Prior to any attempt to build a partnership, it is necessary to address the past, resolve it in a way that is acceptable to all parties and put it to rest with adequate closure. This often requires time, energy and a willingness of all participants to face the past in an open and non-defensive way, listen empathetically to perceptions of hurt and anger, and accept personal responsibility and accountability.

Failure to resolve past differences will only serve to ensure anything that is attempted will be laden with organizational skeletons that are likely to undermine efforts to build sustainable relationships.

Treat a physician as you would any employee

Can you imagine treating a CEO as a regular employee? Technically a CEO is an employee of the board with an employment agreement; however, s/he is also a strategic partner, leader, confidant, ambassador and more. Similarly, a physician is trained to be a clinical expert, interdisciplinary leader, strategic advisor, supervisor, mentor and colleague. Thus, to expect a physician to follow operational command without input, participation or active involvement will ensure psychological detachment, alienation and a deep sense of professional betrayal, disrespect and anger.

Frankly, this principle applies to any employee; however, not tapping in to all that a physician offers ensures the organization will fail to realize that physician's full potential and may even bring out the worst.

Create a one-size-fits-all approach for physician engagement

No single successful engagement approach will benefit physicians. Not every physician seeks employment, joint venture, service line, medical staff leadership, investment opportunities or part-time status. Each physician has unique needs and wants and requires a customized approach. Thus, a one-size-fits-all approach will neither be appropriate nor relevant to most physicians and will ensure the perception that management is not interested or concerned.

Tell physicians what the organization expects of them

A physician spends a great deal of effort to defend his or her right to make autonomous decisions. When management inadvertently takes away that source of professional pride and dignity, resistance, resentment and bitter acrimony is almost always the result. Physicians make personal sacrifices to lead a performance initiative they believe to be important to their patients and to their professional standing but will artfully evade, elude or sabotage an initiative they believe did not receive due consideration or approval from peers and colleagues.

Ideally, physicians should take full ownership of performance initiatives and when management inadvertently eliminates that ownership, they also remove any motivation to ensure the investment of resources and effort.

Make performance expectations nonnegotiable

The only performance expectations a physician defines as "nonnegotiable" are those s/he takes full ownership of. For instance, the University of Virginia recently modified its medical staff bylaws to inform all potential applicants that the practice of evidence-based medicine is no longer optional for those seeking appointment or reappointment to its staff. This occurred only because the medical staff took full responsibility for quality and decided to raise its own bar and demonstrate its commitment to evidence-based practice.

One vice president of medical affairs put it succinctly: "If physicians commit to a higher purpose that has deep personal meaning, they will drive it further than you can imagine; however, if an issue is forced upon them without input or discussion, they will not budge an inch."

Disregard informal physician leaders

Just because a physician lacks a formal political title, doesn't mean s/he doesn't wield enormous political and economic clout. Traditionally, the medical staff was controlled and led by informal leaders without titles who quietly and expertly orchestrated medical staff and physician initiatives from the sidelines without ever having to attend a formal meeting. Include these political masters in key initiatives and decisions or they will utilize every bit of their political savvy and finesse to outmaneuver, undermine and otherwise disruptive any legitimate, constructive and obligatory initiative from which they have been inadvertently or advertently excluded.

Look for part 2 of the post in July to learn how to leverage the best of what physicians have to offer to achieve organizational goals that require the full and willing consent of physicians.

Jonathan H. Burroughs, MD, MBA, FACHE, FACPE is a certified physician executive and a fellow of the American College of Physician Executives and the American College of Healthcare Executives. He is president and CEO of The Burroughs Healthcare Consulting Network and works with some of the nation's top healthcare consulting organizations to provide "best practice" solutions and training to healthcare organizations.

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