Healthcare Change Happens—But Only if Physicians are Engaged

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 - Doc Silhouette

Healthcare in the United States is in need of a serious makeover, according to two experienced healthcare physician executives. If physicians aren’t properly motivated, the required changes will never come.

That’s the honest assessment of Thomas H. Lee, MD, chief medical officer at Press Ganey and former network president of Partners HealthCare, and Toby Cosgrove, MD, CEO of the Cleveland Clinic, in an analysis in the Harvard Business Review that looked at how healthcare organizations can engage physicians and bring about real change.

The psyche of physicians in today’s healthcare environment is fractured, according to the authors. Regulatory changes are escalating at a rapid pace, and there appears to be no end in sight.

“Many physicians are deeply anxious about the changes under way and are mourning real or anticipated losses of autonomy, respect and income,” Lee and Cosgrove wrote. “They are being told that they must accept new organizational structures, ways of working, payment models and performance goals. They struggle to care for the endless stream of patients who want to be seen, but they constantly hear that much of what they do is waste.”

This mix of stress, confusion and uncertainty leads many physicians to feelings of denial, even anger. But there is no stopping the wave of change—and it will only grow larger.

To help healthcare organizations engage physicians, the authors adapted sociologist Max Weber’s four motivations that drive social behavior to be specific for healthcare professionals: engage in a noble shared purpose, satisfy self-interest, earn respect and embrace tradition.

Motivation No. 1. Engage in a noble shared purpose. Leaders must strike a delicate balance, asking physicians to remain positive (with a continued focus on improved patient care), while also acknowledging that personal sacrifice will be required to achieve any long-term goals.

The patients’ interests, not those of anyone else within the healthcare organization, must be the priority. And even though physicians may sometimes seem emotional or too focused on their own situation, they feel the same way as well.

“During Hurricane Sandy and the Boston Marathon bombings, no physician worried about compensation or hours worked,” Lee and Cosgrove wrote. “All were solely focused on helping patients. In less dramatic contexts, when faced with individual patients whose lives are in crisis, a physician’s instinct is similarly to put the patients’ needs first.”

Discussing that shared interest in patient care, and not individual concerns about money or power, engages physicians. The next step is crafting an official statement of shared purpose for your organization. The Mayo Clinic’s (“the needs of the patient come first”) and Group Health Cooperative’s (“transform health care [by] working together”) official statements are listed as two impactful examples.

Motivation No. 2. Satisfy self-interest. Of course, physicians can’t be asked to completely ignore their own interests. Focus on patient care, yes, but employees need both job security and to feel that they are being compensated fairly for their efforts.

The authors found that organizations experiment with compensation in different ways. Geisinger Health System, for example, determines 20% of a physician’s total compensation by how they perform in certain areas, either as an individual or as part of a larger team. The Cleveland Clinic, on the other hand, gives no special bonuses or incentives to its physicians. Instead, they are signed to one-year contracts, and renewal is determined by detailed annual performance reviews.

Either strategy can be helpful, and both Geisinger Health System and the Cleveland Clinic have found success. What’s most important, however, is that the organization’s strategy is used to achieve its shared purpose.

Motivation No. 3. Earn respect. Incentives don’t always have to be of the financial variety. Positive—or even negative—feedback can make a big impact on physicians, especially when their own feedback is being measured with that of their co-workers.

We grew up being advised that peer pressure was bad, but clearly that message never got across to U.S. physicians. Using it to motivate them only makes sense.

The authors included the example of University of Utah Health Care, where leaders began sharing patient-experience data with physicians in private. Then, the data was shared internally, so colleagues could see each other’s ratings. For the final step, the data was moved to public websites, giving anyone with a computer access to those once-exclusive bits of information. Performance within the organization improved each step of the way.

Motivation No. 4. Embrace tradition. If you want physicians to work toward a group’s shared goal, it helps if they actually want to be a part of that group. “When physicians value membership in an organization—out of pride, a need for security, or some other reason—they are motivated to adhere to that organization’s standards and traditions,” Lee and Cosgrove wrote.

The Mayo Clinic, with its out-of-the-box customs, is an example provided by the authors. Men are required to wear neckties at all times, and women are expected to wear hosiery—even in the Mayo’s Arizona facility, where it can get uncomfortably hot.

In addition, physicians must communicate with one another in a specific way, immediately responding to all pages, and physician-patient interviews are commonplace. These requirements may seem out of touch to an outsider, but the physicians there take them seriously. They’re proud to be a part of the Mayo Clinic, and they’ll do what it takes to stay there.

All together now

Emphasizing just one, two or even three of these four motivations may fail to keep physicians fully engaged, the authors wrote. Instead, it is best for leaders to use them in unison to make the greatest potential impact on their organization.

One example of an organization using all four motivations is what happened when Ascension Health launched its “full disclosure” initiative in 2006. Disclosure about medical errors was only happening 10% of the time, so Ascension leadership reminded its physicians that their shared purpose was to put patients first and provide great care (motivation no. 1).

Next, Ascension developed an incentive that gave physicians “premium credits from malpractice insurers” for participation in the program (motivation no. 2). In addition, Ascension brought in local leaders to encourage participation (motivation no. 3), and “event response teams” were created for the discussion of possible errors (motivation no. 4).

Using these motivation types together produced results. These changes rapidly updated the organization’s culture, and disclosure went from 10% to 53% in 27 months.

Leaders have the power to give the healthcare industry the makeover it needs. Properly motivating physicians won’t always be easy, but by using the four motivations detailed by Lee and Cosgrove, it’s certainly possible.

“The organizations that can help physicians to live up to their aspirations as caregivers—to understand that giving up their autonomy is not actually surrender but a noble act of humility in the interest of their patients—will be the ones that improve efficiency, deliver the best outcomes, increase their market share and retain and recruit the best people,” the authors concluded.