Hospitals and health systems seem to be employing physicians and physician practices left and right in an attempt to grow or preserve their patient bases and adjust to the changes brought on by healthcare reform. The number of independent physician practices has been slowly dropping: in 2000, about 57 percent of practices were independent, and now less than 40 percent of physicians are independent, according to data from Accenture.
Affiliating and employing a slew of new physicians in short amount of time is not only stressful for hospital and health system administrators, it can be rough on the physicians involved as well. Physicians traditionally have been independent, and adjusting to becoming employees of a larger organization can be difficult; additionally, physicians may find themselves aligned with local physicians they competed with in the past. As a result, it becomes a challenge to build a cohesive physician enterprise, and many times employment does not lead to true physician alignment.
However, when physicians are engaged, cohesion becomes less of an issue and real alignment with physicians becomes feasible. "There is a lower level of anxiety between key constituencies when physicians are…engaged," says Steve Corso, managing director of MSIGHT Physician Engagement, a part of MedSynergies. "You can optimize results only if you have engagement. Management of the physician enterprise grows more effective and efficient as anxiety among physicians is lowered."
Here, Mr. Corso shares three essential actions that help lead to an engaged and relatively drama-free physician enterprise.
1. Prepare the culture. Many organizations are employing physicians for the first time, and their cultures may not be ready to incorporate employed physicians. "One of the things often missing when a system acquires practices is there is no real consideration of whether existing organizational structures and culture can adapt to accommodating thriving physicians without making significant changes," says Mr. Corso.
Essentially, the hospital or system's culture needs to be accepting of physician input and allow physicians to influence strategy and the decision-making process, according to Mr. Corso. Executive leaders need to play an active role in the culture change for it to be successful.
2. Build unity of purpose by creating a shared reason to change. Employing physicians represents a change for both the employees and employers — the physicians and the hospital or health system — and some participants may be less enthusiastic about the changes than others. To offset negativity, Mr. Corso recommends defining what is often referred to as a "burning imperative" or "critical reason" for the change.
"It needs to be developed in collaboration with the key constituencies," says Mr. Corso of the critical reason for change. The hospital leaders, staff and the physicians should be involved in the creation of the burning imperative. "People get more invested in something they feel they participated in building," Mr. Corso notes. And, once the reason for change has been developed and agreed upon, its message needs to be sponsored by top leadership and communicated deep into each organization.
Once the physician enterprise and the hospital or system share a reason for change, it becomes easier to build a shared mission and vision for the future.
3. Understanding stakeholder expectations. Assessing both physician and health system or hospital expectations, relating to the tangible and intangible deliverables produced by employment, is a crucial part of defining success in the new physician enterprise. "This is really, really important in my experience, and is often misunderstood" Mr. Corso emphasizes.
For example, some physician groups may want to be autonomous by remaining on their own electronic health records system, while the system wants to put all the newly employed physician groups on one system. To avoid situations like this, there needs to be a "resetting of expectations," Mr. Corso says. "That requires candid dialog on how original employment expectations may need to be changed in order to adapt to changing pressures in healthcare."
While a lot of what makes up these three essential actions is basic relationship building and communication, it is easy for hospitals and systems to get caught up in the chaos of change and forget to go back to the basics. However, preparing the culture, building unity of purpose and level-setting expectations are critical to moving past basic employment to into real alignment.
Affiliating and employing a slew of new physicians in short amount of time is not only stressful for hospital and health system administrators, it can be rough on the physicians involved as well. Physicians traditionally have been independent, and adjusting to becoming employees of a larger organization can be difficult; additionally, physicians may find themselves aligned with local physicians they competed with in the past. As a result, it becomes a challenge to build a cohesive physician enterprise, and many times employment does not lead to true physician alignment.
However, when physicians are engaged, cohesion becomes less of an issue and real alignment with physicians becomes feasible. "There is a lower level of anxiety between key constituencies when physicians are…engaged," says Steve Corso, managing director of MSIGHT Physician Engagement, a part of MedSynergies. "You can optimize results only if you have engagement. Management of the physician enterprise grows more effective and efficient as anxiety among physicians is lowered."
Here, Mr. Corso shares three essential actions that help lead to an engaged and relatively drama-free physician enterprise.
1. Prepare the culture. Many organizations are employing physicians for the first time, and their cultures may not be ready to incorporate employed physicians. "One of the things often missing when a system acquires practices is there is no real consideration of whether existing organizational structures and culture can adapt to accommodating thriving physicians without making significant changes," says Mr. Corso.
Essentially, the hospital or system's culture needs to be accepting of physician input and allow physicians to influence strategy and the decision-making process, according to Mr. Corso. Executive leaders need to play an active role in the culture change for it to be successful.
2. Build unity of purpose by creating a shared reason to change. Employing physicians represents a change for both the employees and employers — the physicians and the hospital or health system — and some participants may be less enthusiastic about the changes than others. To offset negativity, Mr. Corso recommends defining what is often referred to as a "burning imperative" or "critical reason" for the change.
"It needs to be developed in collaboration with the key constituencies," says Mr. Corso of the critical reason for change. The hospital leaders, staff and the physicians should be involved in the creation of the burning imperative. "People get more invested in something they feel they participated in building," Mr. Corso notes. And, once the reason for change has been developed and agreed upon, its message needs to be sponsored by top leadership and communicated deep into each organization.
Once the physician enterprise and the hospital or system share a reason for change, it becomes easier to build a shared mission and vision for the future.
3. Understanding stakeholder expectations. Assessing both physician and health system or hospital expectations, relating to the tangible and intangible deliverables produced by employment, is a crucial part of defining success in the new physician enterprise. "This is really, really important in my experience, and is often misunderstood" Mr. Corso emphasizes.
For example, some physician groups may want to be autonomous by remaining on their own electronic health records system, while the system wants to put all the newly employed physician groups on one system. To avoid situations like this, there needs to be a "resetting of expectations," Mr. Corso says. "That requires candid dialog on how original employment expectations may need to be changed in order to adapt to changing pressures in healthcare."
While a lot of what makes up these three essential actions is basic relationship building and communication, it is easy for hospitals and systems to get caught up in the chaos of change and forget to go back to the basics. However, preparing the culture, building unity of purpose and level-setting expectations are critical to moving past basic employment to into real alignment.