Best practices on how to align the new physician workforce
The following content is sponsored by Select International.
New expectations
The business of medicine, the relationship between physicians and hospitals and the demands on physicians are changing at an unprecedented rate. Hospitals are often disappointed with the degree of alignment with their medical staff and with the performance of employed physicians. Physicians struggle to succeed and find career satisfaction. Having been trained in a model of professional autonomy and a culture of expertise and competition, physicians are now asked to function as part of multidisciplinary teams. They are facing rapid advancements in diagnostic treatment and information technology, and facing increasing complexity in managing a private practice. There is uncertainty about the role and function of the independent medical staff and the employment trend challenges the traditional sense of professional autonomy. New payment methodologies and an emphasis on patient expectations and satisfaction are forcing them to rethink how they practice.
At the same time, hospitals and health systems need to expect more from physicians. An emphasis on value-driven care assumes a new level of collaboration between physicians and hospitals, and a new set of physician behavioral skills, including:
• Adaptability
• Innovation
• Collaboration
• Patient-Focus
• Business Acumen
• Leadership
• Emotional intelligence
Additionally, expectations have changed in two other important areas.
Physicians are faced with a new emphasis on performance metrics. Bonuses are tied to productivity and patient outcomes. After negotiating what seems to be a fair bonus structure, though, physicians often discover that operational efficiencies make those goals unattainable.
There is less patience with disruptive behavior. It is costly. It can de-rail a career and impacts organizational success and the quality of patient care. There is plenty of discussion about managing disruptive behavior but little about how to prevent it. Disruptive physicians often share common personality traits that tend to manifest themselves under pressure. This pressure is often created by unrealistic or poorly aligned expectations, particularly in the face of insufficient operational support.
A failing approach
Little has been done to prepare and develop physicians to succeed.
Physicians are poorly equipped to handle the changes
Most physicians begin their career unprepared for all they'll face outside of the exam room or operating suite. They have little training on how to function within an organization, to work in teams, to lead, communicate with patients, how a hospital or practice operates and how our healthcare system operates around them, or how to take charge of their own career.
Older physicians struggle to adapt to a changing world, while younger physicians have unrealistic expectations and a poor understanding of the variables that determine success.
An out-dated approach to recruiting and turnover
Physician recruiting remains a numbers game. The hospital is looking for physicians to build its network. Recruiters are trying to meet their "time-to-fill" goals. The physician candidate is unaware of what he or she needs to succeed and knows nothing about the infrastructure and support necessary to meet his or her goals.
Physician turnover is increasing, and the bulk of it takes place in the first few years of practice. Surveys show that the early turnover is almost always about a poor fit or a failure to meet the physician's expectations. Losing a single physician costs a hospital as much as $1 million. Yet, with every loss, they return to the same approach and start the cycle all over again.
Hospitals assume that employment ensures alignment
Alignment is as important with employed physicians as it is with independent staff. Signing an employment agreement does nothing to ensure that a physician's goals are aligned with yours or that he or she is collaborative, adaptable and patient-focused.
A new approach: 3 simple steps
Every physician is a valuable resource and needs to assume, to some degree, a leadership role. Physician behavioral skills should be systematically evaluated and developed. We can do this without sacrificing the special nature of medicine. Rather than de-valuing physicians, this approach acknowledges that physicians aren't merely clinical commodities but the driving force behind success.
Step 1 — Define what success looks like
Attract and retain the best physicians and you increase your chances of success — that hasn't changed. The difference is in how we define talent. We need to look beyond academic, training and research credentials.
What physician behaviors align with your vision, mission and values? What are the specific behavioral competencies that predict success — perhaps some combination of collaboration, business acumen, compassion, patient-focus, adaptability and leadership? What specific behaviors are expected? Which are unacceptable?
Now define specific performance expectations related to volumes, gross revenue, patient satisfaction scores and other outcomes metrics. Finally, define non-clinical responsibilities and expectations. Do you expect the physician to participate in program development, quality and cost initiatives, administrative, management or leadership efforts?
Step 2 – Align goals and expectations
How do you ensure that the physician's goals and expectations are aligned with yours?
1. Ensure operational fit. Recruiters only scratch the surface. They aren't physician performance experts. They are physician placement experts. It's not much of an exaggeration to say that the current "fit" analysis is rarely more than the hospital deciding it needs a surgeon, the surgeon confirming that the hospital has an OR, and the courtship begins.
Take steps to understand a candidate's expectations regarding work hours, patient volumes and other productivity goals. How much operational support (staff, space, equipment) will they need? Does the surgeon have an interest in and experience with non-clinical responsibilities? Is the surgeon willing to collaborate with a hospitalist program? Has the physician ever used a mid-level provider?
If you find areas where expectations and goals aren't aligned, the relationship may still work. This process gives you the chance to resolve differences from day one, rather than finding out two years later that you have an unhappy physician. A simple, twenty minute "operational fit" survey can often prevent the $1 million turnover loss.
2. Conduct a useful interview. The traditional physician interview is useless as a predictor of success. The science and art of the interview have rarely been applied to physicians. Physicians often conduct the interviews even though they've had no training. They make the common mistake of focusing on first impressions, on the candidate's training, communications skills and on general "likeability." None of these predict performance. Of course, you cannot interview a physician as you would a nurse or patient-care technician, but you can incorporate behavioral interviewing techniques.
3. Understand behavioral competencies. More organizations are using physician-specific assessments to understand behavioral strengths and weaknesses. Well designed tools are able to predict an individual's level of emotional intelligence, ability to collaborate, adapt, respond to stress and lead. They can be used near the end of the recruiting process or early in onboarding. These are the tools that companies use to help in executive hiring decisions. In the past, organizations were leery of testing physicians, but there is a growing realization that the value of the information more than out-weighs concerns about candidate reaction. It is important, though, to choose the right tool(s) for the situation. Start with a tool designed for physicians. It must also be positioned as a way to ensure a good fit for both parties and to ensure that the physician has the best chance to grow and succeed.
Step 3 - Develop each physician
You've done all you can to address realistic expectations and goals. You understand the physician's behavioral tendencies and they fit your culture. At this point, most organizations drop the ball. They plug the physician in and hope for the best. Perhaps there is a report card tracking performance metrics. Perhaps there are meetings where performance metrics are discussed. Perhaps a more senior physician teaches them how to navigate organizational challenges. Perhaps the physician develops into the high performing leader you need — or perhaps not.
Think of each physician as an important executive hire whose growth will contribute to your success. Consider the following framework of a development program:
• A useful practice report card that tracks meaningful metrics, both individual and organizational).
• On-going evaluation of operational barriers to success, such as satisfaction with practice growth efforts, ancillary services support, facilities and staff.
• Engage the physician in creating a developmental plan with short- and long-term career goals and an action plan.
• Use a physician-specific assessment to address understand and address behavioral weaknesses.
• On-going education on leadership skills, practice and hospital economics and related topics.
Conclusion
No area has been so ignored in the push for healthcare reform as the need to prepare and position physicians to succeed —in their careers in the face of great changes and as leaders and partners in changing the way care is delivered. Hospitals, health systems, physician groups and physicians, themselves, will benefit from this relatively simple three step process of defining what the new vision looks like, putting in place a process to understand and improve alignment and then implementing a developmental plan for every one of these valuable resources.