"Physician champions" — physician leaders who coordinate improvement efforts between fellow clinicians and administrative staff — are increasingly called upon to address the issue of physician "alignment."
Various industry-wide factors have contributed to the rise of the physician champion as the driver of efforts to increase cooperation between fellow physicians and hospital executives. The main reason: as independent providers increasingly seek hospital employment, achieving buy-in is critical for building successful care teams and managing population health under a value-based care delivery system.
The physicians selected to undertake this important responsibility are typically those who already possess respect and credibility among their peers, have demonstrated a capacity to lead and seem intrinsically motivated to effect change.
But many physician champions fail — though often to no fault of their own. Physician champions who fall short of the expectations imposed upon them are often not set up for success by their organizations.
There are five common reasons physicians champions fail.
1. The champions don't have a formal job title or description. Dr. Tom Smith*, a hospitalist with Baltimore-based Johns Hopkins Medicine, serves as a physician champion at one of the system's community hospitals. There, he is responsible for helping create and implement programs to improve quality and patient satisfaction and reduce the rate of hospital-acquired infections, among other objectives. However, Dr. Smith says not having a formal job title reflecting his physician champion duties or an explicit description of his responsibilities creates an environment of ambiguity and directly impacts his motivation.
"When there is no formal job description or expectations," says Dr. Smith, "the motivation to carry out your own ideas or try anything new is pretty low."
Ed Howell, professor of public health sciences at the University of Virginia in Charlottesville and the former vice president and CEO of University of Virginia Medical Center, agrees.
"The question that should begin every institution's consideration of physician alignment and physician leadership is, 'What do we want the champion to do?'" says Mr. Howell. "Every physician champion either succeeds or fails based on the clarity of their role that the organization establishes."
Physician champion roles may be formal or informal, depending on the organization's objectives. Regardless, hospital leadership must define and communicate the responsibilities and expectations of the champion.
2. The champions don't have the proper support and mentorship. While it is increasingly popular for physicians to seek management or administrative degrees along with their medical education, most physicians have never received formal leadership training. As a result, when it comes to building a team or rallying clinicians to make a change, a physician champion may find him or herself at a loss. What's more, hospitals often lack adequate support and resources to guide physician champions or answer their questions.
"There is really no structure of guidance or support," says Dr. Smith. "If you come up with a new idea, you're kind of on your own to figure out a way to implement it."
Without a mentor or advisor to help with questions, a physician champion's responsibilities transform into added stress — a dangerous thing in a profession already plagued by high rates of burnout.
"I have questions on a daily basis on the implementation of the ideas I come up with, but there is no clear structure for who I would go to if I have a problem," says Dr. Smith. As a result, much of the initial enthusiasm with which physician champions enter their roles dies down, further depleting their motivation to succeed.
3. The hospital fails to address the conflict between clinical workload and physician champion duties. Most physicians who pick up leadership duties maintain their full clinical workloads and add physician champion functions on top. However, in cases like Dr. Smith’s, there is no compensation for the additional leadership role. Ultimately, this means physicians work more hours without more pay.
"The biggest challenge for me personally is the dilemma between picking up more clinical work — which pays now — or taking on more leadership work — which isn't guaranteed to pay off at all," says Dr. Smith.
Even if physician champions are interested in enhancing leadership expertise, they may not have the means to do so. For instance, Dr. Smith attended healthcare leadership conference in Chicago this past spring, but the five days he spent away from the hospital came out of his personal vacation days. "There is no separate time in my job that gives me elbow room to attend these meetings," he says.
According to Mr. Howell, if an organization wants its physician champion to succeed, the leadership must be prepared to offer adequate compensation to make up for the reduction of clinical income.
"Failure will result if the organization is not sensitive to their clinical workload," he says. Some organizations have implemented creative solutions to ensure physician champions are compensated for their leadership duties, such as creating RVUs for administrative work.
4. Champions don't have a say in decision-making. An important part of a physician champion's job is serving as a liaison between the clinical and administrative staff. However, a champion should not only act as a mouthpiece to relay information from one team to the other; instead, he or she should have a seat at the table during decision-making processes for changes that affect care delivery.
When it comes to including physician champions in the decision-making process, leaders must clarify from the outset what kind of input they expect, according to Mr. Howell.
"Physician champions must have full access to [communication with] the top leadership," says Mr. Howell. Depending on the situation, "leaders should be cognizant on when to draw the line during deliberations of strategic initiatives, but they should err on the side of inclusion." In other words, physician champions have a unique perspective and valuable insight to offer when it comes to care delivery. The rest of the clinical team will be more willing to accept changes if they feel their interests are fairly represented from a clinical leader.
5. You have the wrong physician champion. Of course, one cannot ignore the possibility that a physician champion will fail because he or she is simply not cut out for the job. Mr. Howell said the physician champions he's seen struggle most lacked leadership experience and the common characteristics that so often distinguish leaders from their peers.
"The idea that you can take a raw piece of cloth and develop a leader out of it — there is not much evidence that this will be successful," says Mr. Howell. And while formal leadership training can provide physician champions with valuable insight on how to be an effective leader, Mr. Howell contends the term "leadership development" is ill-founded: "These courses might be better titled 'leadership refinement,'" he says.
The characteristics of a physician champion with high success rates include having the respect of their clinical colleagues; the ability to communicate effectively and concisely; and a strong drive to solve problems.
*Dr. Tom Smith is a pseudonym to protect the physician's anonymity.
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