Read commentary by Indiana University's Dr. J. Matthew Neal, a member of the Physician Leadership Journal editorial board, on addressing engagement, as presented in an article by Dr. Marcia Nelson.
Strong leadership is needed to solve the issue of disengagement. A study at Enloe Medical Center demonstrates important initiatives to help facilities get back on course.
The report by Nelson illustrates a major concern for health care systems: physician engagement. This timely project was conducted to learn from physician leaders regarding their opinions on drivers of engagement. Multiple physician leaders representing 18 clinical departments were interviewed about three leadership domains (administration, physician group culture and leadership), and efforts to improve engagement resulted in an increase in overall engagement from the 44th to the 85th percentile over an eight-year period.
Why is this so relevant now? We are practicing in an era where physician disengagement is more prevalent than ever, and Nelson’s article illustrates many important initiatives to get back on course. Some of these include seeking physician input, being appreciative of physicians’ time, placing value on nonclinical activities (hospital committees), and making sure meetings are valuable. If we value revenue generation above all else, this does not reward our best physician leaders to devote time to committees.
The recent trend is for most physicians to become employees of an organization rather than “go it alone.” A wise colleague once told me: “If you treat people like employees, they will act like employees.” While technically employees, physicians are still responsible for generating the lion’s share of operating income of any health care organization; without them, revenue generation grinds to a halt. This does not mean they should not be held accountable, but they should be treated with respect for the services they provide and the unique skill sets they bring to the organization.
Engagement is present when doctors care about the health of their organizations and want to help solve the problem rather than be the problem. Therefore, it’s critically important to recognize when physician engagement is absent; some organizations don’t do this very well. We are teaching this concept in residencies via the Accreditation Council for Graduate Medical Education’s competency of systems-based practice: how our actions impact the health care system as a whole. Failure to recognize this problem leads to dissatisfaction, increased burnout, less productivity and attrition — all which make it difficult to sustain a proper physician work force.
Any organization’s sustainable strength and viability is directly proportional to the number, quality and dedication of its members. The lifeblood of the physician pipeline is therefore effective recruiting, another topic Nelson mentions prominently. Physician shortages lead to stress and increased burnout, and having more physicians on the call schedule increases physician engagement.
Recruiting physicians — especially to a rural health care system — isn’t easy. This task demands engagement of the recruiting team and doing homework beforehand to make sure the best candidates are selected, and that the visit is as perfect as it can be every time. This requires education and planning for the C-suite and the interview group, and engagement of the legal team to be sure contracts are issued in timely fashion to showcase the organization as one worthy of talented physicians.
Physician burnout and wellness are on everyones’ minds these days; the creation of flexible schedules can go a long way toward enhancing physician satisfaction, preventing burnout and improving retention. This organization created extended time-off periods (“sabbaticals”) for physicians to use for personal growth, additional training or service work outside the United States. Another essential topic visited in this article is the need to adapt practice models to various specialties (i.e., “one size does not fit all”), leading to increased satisfaction.
Physicians also dislike being taken for granted, and recognition is an important topic Nelson emphasizes to recognize excellent clinical care in the organization. Special events for physicians and their guests contributed to higher engagement in the study. In this organization, as in many others, contract issues were major drivers of disengagement. Correction of this involved engaging the senior leadership to keep promises to doctors and demonstrating their value.
As some physicians become more distant from the hospital-based medical staff, collegial relationships can suffer, leading to further disengagement. Nelson mentions the importance of creating off-campus social events for medical staff members to connect. Opportunities for intellectual and collegial enhancement, such as journal clubs can also be helpful.
Nelson also illustrates an important aspect of physician engagement: empowerment of physician leaders. While many executives still believe health care administration to be their exclusive domain, the organization cannot fully succeed without physicians on board, using their unique expertise and respect among their peers to enhance services for everyone. If the leaders aren’t engaged, it is hardly possible to expect the same of the medical staff.
Engaging your physician leaders is also key. Many physicians become frustrated when taking on a new leadership role. The worst thing we can do for a new physician leader is to give him or her a leadership position without providing some education on how to do it. Physicians are used to knowing answers; unfortunately, solutions in the leadership world are often less quantitative than in the clinical setting. Yet, physicians possess abilities uniquely suited for problem solving and innovation — when motivated and used optimally.
We also must create an environment where physician leadership can work together as a team; this can often be challenging considering how physicians think and how we select practitioners of the medical profession. Medical school admissions committees choose candidates based on high individual achievement (grades, Medical College Admission Test scores, letters of recommendation), and further success (obtaining of residency, board certification, etc.) is based on similar metrics. We should not be surprised, then, when the individuals we self-selected don’t have the skills necessary for optional functioning optimally in a team-based leadership environment. We must work hard to help bring our best leaders up to speed and recruiting our “best and brightest” into leadership positions. Only by achieving these goals can we derail the hurtling train of physician disengagement and get where we need to be.
Matthew Neal, MD, MBA, CPE, FACP, FACE, FAAPL, is a member of the Physician Leadership Journal editorial board. He is the executive medical director for academic affairs and chairman of the department of medicine for Indiana University Health Ball Memorial Hospital, and assistant dean for faculty affairs and professional development and a professor of clinical medicine for Indiana University School of Medicine.
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