Doctor’s Orders: A Prescription for Getting Management and Physicians on the Same Page

// By Lisa D. Ellis //

Roger Kaiser Jr., MD, managing director, Berkeley Research Group, LLC

Is your organization truly on the same page as your physicians? If not, you may be missing important opportunities to maximize the quality and costs of the care you provide. Poor alignment among management and medical staff can cost you greatly—in lower patient satisfaction, lower physician retention, and reduced profit margins.

“The relationship between physicians and health care organizations has been strained over the past number of years,” according to Roger Kaiser Jr., MD, managing director of Berkeley Research Group, LLC, a global strategic consulting firm that includes a focus on the health care industry. Kaiser spent many years as a practicing physician and a health care CEO before moving into the consulting side of the field. Here, he shares insights as to where—and why—these relational gaps exist, and offers his prescription for setting the situation right so everyone wins.

The Background

“I started practicing medicine in the early ‘80s. Back then, there were a lot fewer regulatory and bureaucratic regulations and requirements,” Kaiser says. “We didn’t have electronic medical records (EMRs), for example, and nothing came between me, the nurses, and the patients we cared for. Many of these additional time commitments are viewed by medical staff as non-value-add and a distraction between what they are trained to do best, which is care for the patient,” he explains.

He points out that the current requirements of health care thus hamper physician-patient relationships, leading many doctors to experience dissatisfaction and frustration on the job, and this feeling is especially common among physicians who practiced in the ‘80s and ‘90s.

“Hospitals and large physician practices need engaged and aligned physicians to optimize their cost and clinical outcomes. It is essential for an administration to have a clear strategy to align and motivate medical staff with around a common set of goals,” Kaiser says. “There are a couple of core elements that are important if a hospital is going to create a good physician relationship culture,” he adds.

Prescription for Healthy Organizations

Here is Kaiser’s prescription for helping to create a supportive organizational culture where the administration and medical staff can work together for a common vision:

1. Ensure you have accurate data to drive clinical decision-making: Cost and outcome data is increasingly important in health care, especially now with the move to a value-based reimbursement environment. Many organizations use third-party vendors to track physician performance, costs, and outcomes. The problem is that there are often gaps or inaccuracies in the reports. When health systems sit down with physicians and use the reports to compare a clinician to his or her peers, the report is often incorrect. Physician attribution is a common area of inaccuracy. “Physicians will quickly identify data errors, thereby casting doubt over the credibility of the entire report. The odds of engaging them to make practice pattern changes has been greatly reduced. Ensuring accurate and actionable data is the critical first step to aligning with your physicians,” Kaiser says.

2. Be transparent with your clinicians: When administration asks a physician to embrace a change, you need to be upfront with why this change is important. “For instance, if you are asking a physician to change from the supply vendor they have been using to one that is less expensive, you need to explain why this is important to the organization over the long term,” Kaiser says. Since physicians can’t always know what motivates administration, such transparency and open communication are essential.

3. Look at the big picture: Another mistake hospitals make is to look at cost opportunities in a vacuum, focusing on one item that jumps out at them instead of seeing how it all fits together across the continuum of care. Kaiser gives the example of a surgeon ordering an expensive drug preoperatively to reduce the incidence of postoperative pain and nausea/vomiting. While this surgeon may have a higher pharmacy cost profile on the front end, he or she may have a much lower incidence of complaints of post-op pain and opioid usage, a shorter length of stay, and better patient satisfaction than peers on the back end. Understanding the cost of care across the entire care continuum is more important than focusing on one costly drug or supply preference.

4. Trust your physicians: “Physicians are very analytical thinkers and one of the smartest people in the room,” Kaiser says. Therefore, if a health system attempts to dictate what drugs are supplied or the clinical approach the physician should use, most of the time the administration will lose that clinical argument and most likely will have poisoned the relationship, too. He suggests that a better approach would be to discuss with a physician more general goals such as reducing the cost of a procedure by a specific amount and then giving the physician leeway to determine where to reduce costs to get to this goal. “It’s important to give physicians the control to make their own clinical decisions to do what they feel is best while moving toward shared goals,” he says.

5. Pick your battles wisely and wage them thoughtfully: Physicians are commonly subjected to what they perceive as trivial changes. “Today it’s a new form I have to fill out to order an antibiotic, tomorrow it’s that you have pulled my favorite scrub nurse to assist another surgeon. These things drive physicians crazy,” Kaiser says. If you bother clinicians with a lot of trivial changes that they don’t see as adding value, or worse, that negatively impact their workday, then when you need some truly important change, your medical staff will be less likely to embrace your request.

This makes it essential to be strategic in what you ask of your physicians. “For example, we see EMRs rolled out in many offices and hospitals for primarily financial benefit, but the impact of these EMRs on a physician may not be perceived as beneficial. For example, a new EMR can add 5 to 7 minutes per patient to the physician’s day. For a physician seeing 20 patients a day, that’s 2 or more additional hours of work per day,” he says. He suggests that if you are going to implement a process that will add more non-clinical work for a physician, it’s worth offering alternatives to mitigate that additional time commitment. In the case of EMR implementation, consider offering to provide a scribe to the physician to reduce the negative impact on their productivity. This will go a long way in demonstrating to clinicians that management is a true partner.

6. Identify a physician champion: Kaiser points out that in the past, traditional medical staff meetings were well attended, and the medical staff committees had clout in the hospital and served the purpose of advocating for change. More recently, the influence of medical staff has changed. For example, since the widespread adoption of hospitalists, most primary care doctors no longer set foot in the hospital and many of them no longer attend medical staff meetings. Kaiser adds that the hospital no longer offers the same social atmosphere for physician interaction it once did.

Health systems must find new ways to communicate with physicians and share important changes, regulations, and policies that in the past were disseminated at well-attended medical staff meetings. His suggestion, then, is to identify physician champions whom the administration can work with behind the scenes to represent the medical staff and who can serve as a link to share information, ideas, and need for change. A physician will almost always be more effective in advocating for change with his or her peers than a non-physician. “Strategically leverage your physician leaders to help you drive change and help you more effectively communicate with your medical staff,” Kaiser says.

7. Learn each physician’s preferred communication styles: “Every physician has a preferred communication model,” Kaiser says. This may be email, phone calls, text, face to face, or messages sent through an office manager. “Whoever is in charge of physician communication must get to know the medical staff members well and learn how each person prefers to communicate,” he points out. Taking a personal approach to connect tells physicians that they are important and valued. Kaiser also says that with all the information within a hospital system that needs to be communicated, it’s important not to flood doctors with information but rather to be strategic in what you share so your messages don’t get lost in the noise.

Many physicians don’t read emails or system newsletters, he adds. A personal note or phone call to convey an important message may be more effective. Further, he says that rather than the administration or marketing staff contacting physicians only when they need something, consider checking in with physicians periodically to say hello and ask them if there is anything you can do for them. This simple act will go a long way in building better physician alignment and engagement.

Lisa D. Ellis is editor of Strategic Health Care Marketing. She is a journalist and content development specialist who helps hospitals and other health care providers and organizations shape strategic messages and communicate them to their target audiences. You can reach her at editor@strategicHCmarketing.com.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions, position, or policy of Berkeley Research Group, LLC or its other employees and affiliates.