Medical Groups and Hospitals Striving for Culture Change Must Get Physicians on Board

GULF BREEZE, Fla. -- If you work for a hospital or a medical group, you're probably familiar with the phrase “organizational excellence.” Culture change in healthcare has become more than a trend, it's a movement. Managers at all levels are undergoing rigorous training aimed at creating exceptional patient experiences and nurturing employees. But one group of pivotal professionals has been somewhat underserved in the national push for excellence in healthcare -- physicians. Stephen C. Beeson, MD, wants to change that.

"The process of physician engagement and training is a necessity to creating organizational excellence," asserts Beeson, author of Practicing Excellence: A Physician's Manual to Exceptional Healthcare (Fire Starter Publishing, 2006). "Physician alignment and tools to improve the care provided to patients by physicians are powerful drivers for performance change. Organizations that possess the ability to change and rise to the top are the organizations that are led by engaged physicians who create excellence by leadership and example."

First things first: what does a culture of excellence look like? Practicing Excellence describes it this way: "The organization that has implemented a Culture of Excellence becomes a living, breathing advertisement for itself from the testimony of every patient who walks through the doors. The pride that invariably comes with prescriptive excellence yields tangible results with objective measures. More importantly, the pride that comes from making a difference for patients continues to drive the organization to higher levels of performance and achievement."

This book thoroughly explains the physician's vital role in creating such an outstanding organization. But first, it spells out exactly why you should fully engage your physicians in your quest to provide outstanding patient service. Here, excerpted from Practicing Excellence, are five benefits your organization will reap when you get physicians on board with your change effort:

· You'll improve patient compliance. Patient noncompliance is one of the most important problems in healthcare today. But the good news is that physicians' communication skills can heavily influence patient compliance and will impact clinical outcomes. Many studies have demonstrated that when a physician is approachable, gives serious consideration to the patient's concerns, and communicates well, better patient compliance is likely.

"How is it that in the United States we spend over $200 billion per year on prescription medications, and billions more on the development of pharmaceuticals, but physicians often fail to spend the two critical minutes to provide the information and communication to patients that is the necessity of compliance?" queries Beeson. "Our ability to be clinically effective and to drive outcomes with proposed treatment is clearly dependent on our ability to communicate and partner with patients."

· You'll see substantial improvements in growth, market share, and loyalty. It has been shown that patients who are extremely satisfied with the care and services provided by their physicians are willing to make financial sacrifices and endure inconvenience to stay in their care. The requisite for this loyalty is something special about the service provided to patients that occurs with every encounter. If patients are merely "satisfied," they can and will go elsewhere should circumstances for change arise. Communication, attitude, respect, reliability, empathy, and kindness are physician and organizational traits that distinguish a practice that creates loyalty amongst the patients they treat.

"Nearly 70 percent of all healthcare choices are made by word of mouth," points out Beeson. "What patients say to their friends, family, and colleagues about a medical group and its physicians can determine the competitiveness and long-term viability of an organization."

· You'll lower your risk of malpractice litigation. Physician conduct and communication, and not necessarily untoward clinical outcomes, appear to be the principle predictors of malpractice risk. Practicing Excellence cites several studies that back up this truth. For example: In primary care, a study was performed looking at communication styles of "no-claim" physicians with no prior lawsuits vs. "claims" physicians with more than one prior claim. In comparison, no-claim physicians spent more time educating patients about what to expect next and the flow of the visit. They laughed and used humor more and spent more time partnering with patients and soliciting their understanding. On average, the no-claim physician spent two to three minutes more per patient visit compared to the claims physician.

"Numerous studies have made consistent conclusions regarding the most protective strategies against malpractice claims," writes Beeson. "Physician service excellence, delivered through communication, collaboration, respect, and trust with patients, correlates highly with significant reductions of lawsuit probability."

· You'll improve staff performance through physician leadership. A healthy physician-nurse relationship is not just a nice thing to have; it is a competitive advantage driving clinical outcomes, patient safety, and staff retention. Interviews of nurses demonstrate that when physicians intimidate and behave disruptively, clinical care is impacted. Ninety-two percent of hospital-based nursing staff have witnessed disruptive physician behaviors and report a compromise in communication, collaboration, and information transfer. Nurses also reported disruptive physicians increase frustration, stress, and the quality of workplace relationships. When respectful, collaborative physician-nurse communication is in place, and nurses are encouraged to speak up in the face of patient danger, errors are reduced and care for patients improves.

"The physician's role in workplace operations and performance is critical," says Beeson. "Physicians are in a leadership position and will influence the perception, attitudes, and behaviors of others. A vested physician committed to reward and recognition, who clearly articulates expectations, who gets to know and takes care of staff, and models the behaviors consistent with their organizational mission, will create a high-performing unit."

· You'll improve physician satisfaction through collaboration and collegiality. Physician groups flourish when physicians simply get along with each other and are willing to create cooperation and consensus on the fundamental operations of the group. Physician groups thrive when there are systematic efforts to share clinical knowledge and expertise where the skills and talents of each physician are best utilized for the collective good. Physician groups thrive when physicians position each other well in the eyes of patients and staff, and where differences are clarified respectfully and openly for the good of patient care. Physician groups thrive when the needs of the patient, and the prevailing mission and culture of the organization, supercede the personal agenda of any single physician.

"Physicians' serving each other never will be measured on any outcome matrix; however, it is crucial to sustain the health, commitment, sanity, vigor, and spirit of your physicians to do the work of caring for others," concludes Beeson. "You will find that physician camaraderie, collaboration, and friendship lie under the hood of the medical groups in this country who have established distinguished histories of being the best. Never underestimate their importance."

In Practicing Excellence, Beeson explains exactly how your organization can implement service and operational excellence among its physicians. What's more, he issues a clarion call directly to these men and women in white to lead the way in making excellence a top priority right now.

"The culture of excellence will never come passively into our practice," Beeson writes. "A culture of excellence comes from the leadership of those who have the greatest impact on the conduct of others. Physicians cannot wait for operational excellence to justify their commitment; they need to achieve excellence through influence, example, and leadership."

Beeson is a nationally recognized presenter who has provided tools and tactics for engaging and training physicians to medical groups and hospitals throughout the country. Beeson's physician training efforts have focused on providing tactical behaviors to physicians to improve patient care and drive organizational performance through physician engagement, leadership, and excellence by example.

Beeson is a board-certified family medicine physician practicing with Sharp Rees-Stealy Medical Group. In 2002, Beeson was selected by Sharp HealthCare leadership to serve as the physician Fire Starter for the Sharp Experience, an organizational commitment to service and operational excellence. Beeson's patient satisfaction ranks him in the 99th percentile nationwide, and he was voted one of San Diego's best physicians by the San Diego County Medical Society in 2005 and 2006. Beeson was also a recipient of the Center of Recognized Excellence Award for Individual Service Excellence in 2006.

In Practicing Excellence, Beeson takes readers through a stepwise sequence of performance implementation for physicians with the overarching mission of physician and organizational success by providing exceptional care to patients in a purposeful and collaborative work environment.

Step 1: Physician Leadership Commits to Excellence. In the medical group environment, physician leadership must be willing to lead constituent physicians hand in hand with your administrative leadership as a unified effort. Physicians are the perceived leaders of your organization for those doing the work of patient care, and their visibility and support in this effort is a necessity. Individual physician behavioral change does not occur in a vacuum. Behavioral change begins to occur when a medical group communicates a vision for group and individual success through the consistent execution of service and clinical excellence. Individual physician engagement and change are more probable when the strategic priorities and mission are communicated to physicians by respected physician leaders, and they understand that their role is central to success.

Step 2: Select a Physician Champion. Who communicates and coordinates the change effort and how it is done is critical for effective engagement of your physicians. Instilling and creating physician behavioral change is a challenging proposition, and to whom physicians listen is highly selective. It is very impactful when a respected colleague, who does the same things, sees the same patients, and works as hard as anyone else, stands up and says: "This is the right thing to do for our patients, the right thing to do for our staff, and the right thing for us to do. We will succeed by providing exceptional care to patients in the kind of collaborative, purposeful work environment that will make us the best..."

Your physician champion should meet the following criteria: high peer review, high patient satisfaction, strong collaborative abilities, strong communication skills, and, most importantly, commitment to the organizational mission.

Step 3: Define the Role of Your Physician Champion. Responsibilities include:

-- Communicate the vision of service and operational excellence as foundational to medical organization success.

-- Communicate with physician leadership the strategy and progress regarding physician performance improvement.

-- Maintain service excellence as a principal strategic priority for physicians.

-- Coordinate and conduct physician service excellence training.

-- Develop patient satisfaction feedback that provides physicians their comparative performance and identifies opportunities for improvement.

-- Coach low-performing physicians as measured by patient satisfaction.

-- Collaborate with administrative leadership to assist with staff training.

-- Create reward and recognition tools for high-performing physicians.

-- Collaborate with physician leadership to create and implement behavioral standards for staff physicians.

-- Monitor physician satisfaction to assure physicians' concerns are heard and addressed.

Step 4: Train Your Physician Champion. In order for your physician champion to be effective, not only do you have to select the right leader and provide vigorous organizational support, but, most importantly, you must train him or her to lead. Even high-performing physicians will not necessarily have the skill set to lead this effort effectively. High-performing physicians know how to take excellent care of patients and to get the best from their staff, but receive little training in physician leadership. When selected to lead this effort, one must assume the role of a student, learning all he or she can about drivers of patient satisfaction and physician satisfaction and predictors of physician behavioral change.

Step 5: Launch the Commitment to Excellence and Train Your Physicians.

The "launch" of your commitment to excellence should be a dedicated event with mandatory or "incentivized" attendance.  The objective of this launch will be to define the physicians' role in the organizational mission and to provide tactical training to create results. Follow these six steps to effective physician training:

1. Profile the positive things about your medical group. Remember, physicians are more inclined to "get on board" when vision and accomplishment are evident.

2. Create the "burning platform." In order for physicians to become receptive to change, they need to understand why change is necessary. Physicians must understand the data that is driving this effort.  

3. Review the compelling evidence for service excellence. The case for service is strong in the literature and has demonstrated that it will improve patient satisfaction and patient loyalty and reduce malpractice exposure. It will improve economic returns, patient care, clinical outcomes, and will ultimately drive physician satisfaction.

4. Provide practical tools. These prescriptive behaviors are best formatted into how physicians treat staff, patients, and each other within a new Culture of Excellence.

a. How Physicians Treat Staff—Physicians will need guidance and training to understand how their treatment of staff will predict staff performance, loyalty, and retention, and will significantly affect the bottom line of the organization.

b. How Physicians Treat Patients—Physicians must implement simple prescriptive tools that work to drive service excellence and clinical effectiveness.

c. How Physicians Treat Each Other—Physician satisfaction and professional fulfillment is tightly correlated to the relationships a physician has with colleagues.  Collaboration, cooperation, support, respect, friendship, and positioning each other well in the eyes of patients should be core values that are trained and expected of your staff physicians.

5. Provide physician testimony. An effective way to close training is to find a respected physician within your group to stand up and provide a personal testimony as to why this effort must be done.

6. Provide physicians their personal patient satisfaction data. Following physician training, provide individualized patient satisfaction data to each of your physicians, including national comparative data as a starting point for your efforts.

Step 6: Measure Performance and Provide Feedback. Once your commitment to service excellence has been clearly and repeatedly disseminated to your physicians, and tools and training are provided, the time comes to track and use patient satisfaction to drive performance. Patient satisfaction data is most effective in creating physician behavioral change when it is fully transparent within your organization, and this should be the ultimate goal of patient satisfaction measurement. The process of providing physicians with progressively visible patient satisfaction results must proceed in a stepwise fashion, depending on the maturation of the culture of your group. When individual performance is visible to everyone, physicians become receptive to implementation of training that improves the patient experience.

Step 7: Use Measurement to Drive Results. Tools and training for your physicians will be a continual process led by your physician champion. Measurement of patient satisfaction with progressive transparency of data will proceed as your organization matures. Next, data and tools must be used to drive results. Patient satisfaction percentile goals must be formally established and communicated within your organization. To truly impact physician behavior, individual physician compensation must, in some way, be impacted by patient satisfaction performance. The amount and distribution of income based upon performance will need to be a medical group leadership decision.

Step 8: Celebrate Success. High-performing physicians must be recognized as you roll out visibility and accountability for performance. Recognition for the individual physician is more important than many realize and ranks consistently as a principal predictor of physician satisfaction. Strategies for recognition are numerous, and the methods selected are relegated to the medical group leadership. Options may include:

-- Individual quarterly certificates, handed out and profiled at medical staff meetings for all those finishing the quarter in the 90th percentile and above, as measured by patient satisfaction.

-- A physician award system, where several physicians who represent exemplary performance are selected per quarter and are profiled amongst their colleagues.

-- Personalized letters written by the medical director, sent to physicians' homes, simply thanking physicians for the extraordinary work that they do.

 -- A bi-annual physician excellence dinner, hosted by the medical leadership, where the top performing physicians are invited, dined, and thanked for the great work they have done.

Step 9: Deal with Perpetual Low Performance. As you measure patient satisfaction performance, you will find the same group of physicians will cluster at the bottom. As an organization committed to excellence, you must implement a strategic plan for these physicians. Three options exist. First, you do nothing and ignore them. This option will eventually impact your group's progress and is not a good option for the physicians, the group, or your patients. Second, you can fire them. Though this option unfortunately can become a necessity, it is expensive, it damages your reputation in the physician community, and it can negatively impact physician morale. Third, you can engage your physicians in individual coaching and mentoring and make them accountable for their own improvement.

Share this article: Email, Slashdot, Digg, Del.icio.us, Yahoo!MyWeb, Windows Live Favorites, Furl
Add this article feed to: RSS, My Yahoo, Newsgator, Bloglines

Read Comments [0]