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