How Reform Can Help Executives Foster a More Stable, Reciprocal Relationship with Physicians

Health care leaders have been balancing increased demand, a growing aging population and increasingly constrained resources for some time now. However, even though organizations are taking steps toward executing more integrated care — such as acquiring physician practices and hiring more primary care physicians — few are prepared to deal with the cultural and leadership challenges these changes will ultimately require.

To comply with reform and measurably improve care, executives are faced with a new reality: they’re going to have to start actively collaborating with the providers of care — a challenge for both clinicians and leaders.

The reasons executives and clinicians don’t work closely together already are complex — and not new. Physicians in the U.S. can feel disengaged from the “system” and perceive new standards as stumbling blocks in their quest to personally deliver care. On the other hand, executives face equal pressure to meet increasingly more complex and data-driven standards and targets — without the resources (in terms of cash, people or time) to do so. Both need the other group to understand their working situation in order to truly collaborate.

Health care organizations can’t simply conjure up needed resources. But they can be the ones to lead a cultural change.

The Growing Need for More Collaborative Leadership

Health care reform is shifting more of the risks for inefficient care and poor outcomes onto the health care organizations themselves and, therefore, their physicians.

As many experts have pointed out, putting patient outcomes at the center of the health care system (at both the individual and population level) isn’t a bad thing. But actually coordinating it — through ACOs, IT-led initiatives like EHR implementation, and increasing colocation of services — is less of a technical or execution problem than a cultural one.

Much of the friction boils down to the way health care organizations are led. As Richard Bohmer points out, their almost bureaucratic nature means that key workers — those at the clinical level — and leaders don’t necessarily know each other. They don’t always understand each other. And this disconnect is profound, and growing wider.

Luckily, there’s hope in the overlap.

Better Communication Starts with Values

Writer J. Deane Waldman and Kenneth H. Cohn in their book, The Business of Health care, “The common values and concerns shared by physicians and health care executives could provide the framework for successful communication leading to a bridge across the gap and a collaborative rather than a confrontational relationship.”

Physicians and management are equally concerned by the current regulatory reforms and business realities — and those on the horizon — that make their jobs more difficult to perform. But they meet in the middle on values — it’s why they go to work every day.

Of 670 U.S. hospital CEOs surveyed by the authors, most CEOs chose their careers (partly or entirely) based on one value they share with providers — altruism.

Build Trust by Aligning Goals

As Dr. Thomas H. Lee notes in Harvard Business Review, physicians are trained to make reactive decisions; they set individual goals and value autonomy — and have, for many years. The idea that they must now manage and lead care is worrying to them. The bottom-line management style that characterizes the management of health care is very different from a physician’s day-to-day reality. It’s the job of health care leaders must to work collaboratively alongside physicians, explaining — and aligning — their goals with the goals of the physicians. When you have alignment, you create trust. And trust is what facilitates real collaboration and dialogue.

After all, those goals aren’t so different.

Imagine this. If physicians could communicate to their managers which technologies are actually proving useful on the ground, leaders could make better IT decisions. Likewise, leaders could provide physicians with the managerial training and tool kits they need to better run departments and work collaboratively with clinicians who matter so much to them on the ground, like nurses.

A Call for Data-Driven FeedbacK

Leaders must proactively implement best practices so they can collect, understand and share data across their organizations more freely. The data itself becomes a kind of “common language” for executives to get what they want out of clinicians — and vice-versa.

Even if data sharing comes with its own set of concerns for clinicians (who may fear privacy breaches and litigation), physicians are highly self-motivated to improve their own performance as measured by metrics such as the rate of readmissions. This is one area where clinicians and leaders share common ground: a mutual desire to improve the standard of care.

Combining objective data with financial incentives to create more sophisticated performance measurement tools is one highly successful management approach, as evidenced already in organizations like Partners Health Care and Hawthorn Medical Associates, two organizations cited by Lee in HBR. At one point, orders for radiology tests fell 15 percent after physicians saw how they compared with other colleagues.

Perception varies, but data doesn’t lie — and when financial outcomes and payment are tied to these kinds of results, the biggest beneficiary is one managers and physicians can agree deserves it: the patient.

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