A Midwestern medical group seeking to strengthen the relationships between physicians and administrators created a physician compact.
When Wheaton Franciscan Medical Group (WFMG) — with more than 320 primary care and specialty physicians working at facilities in Illinois, Iowa and Wisconsin —set out to form a compact with physicians, some doctors were very skeptical.
WFMG was actually formed a few years ago by merging All Saints Medical Group and Covenant Medical Group. All Saints Medical Group was a multispecialty group with a 13-year evolution of physician leadership and partnership between physicians and hospital leadership to achieve strategic priorities.
Covenant Medical Group was a primary care-dominated organization that operated according to a separate strategic plan from its affiliated hospitals and had varying levels of integration between physicians and administrative leaders.
The main goal of creating this compact was to improve collaboration and communication for the medical group. Additionally, there was a secondary goal of identifying an operational, shared vision that supported the unified group.
We needed to improve physicians’ collaboration in achieving strategic goals of the medical group. We felt that the compact can be used by physicians and leadership to carry out crucial conversations that are inevitable at times to resolve the conflicts and facilitate much needed collaboration. We also felt that the compact will promote value-based behaviors among the physicians.
The compact is an informal understanding between the physicians and the medical group leadership as to what physicians expect to “give” to the group and what physicians expect to “get” from the group in return. It is a social contract and not a legal contract.
It does define the relationship in terms of behaviors that are central to the partnership between the physicians and the organization: A desire and commitment to support a common mission and vision of service and clinical excellence, financial viability and being the employer of choice.
When physicians join a group practice, there is an expectation of how the leadership and the practicing physicians will interact. The compact is an effort to clarify and codify those expectations. By putting the understandings into a document, that document can serve as a tool to facilitate discussion and conflict resolution.
It also demonstrates the group leaders’ willingness to engage in open discussion around the challenges of group practice in a dynamic environment that requires changing tactics to maintain a values-based strategic course.
Creating the Compact
To complete this task, a compact development team consisting of a facilitator and nine physicians from Southeast Wisconsin researched other high-performing medical groups. Some of the physicians on the team held formal leadership positions, but most did not.
One common element of these nationally recognized medical groups was a defined physician/leadership compact for the medical group. The team also reviewed references and examples from institutions with compacts in place.
The team found helpful criteria for framing compacts such as:
- Compacts need to have reciprocity with benefits to both leadership and physicians where both receive benefits and believe that the exchange is equitable.
- Compacts need to have a shared sense of strategic imperatives that balance individual autonomy with the medical group’s best interest.
- Compacts should be developed and supported for alignment within a changing environment of different cultures.
Work by the development team started in April 2007, and the first draft was completed around October. The development team had spirited discussions around which specific behavioral elements to include for the physicians and the leadership. This extensive discussion got very specific concerning word choice, meaning and precise intent of statements on the compact document.
In October 2007, the group reached consensus for the specific value-based behaviors for both the leadership and physician members of the medical group. The compact then was sent to three department chair councils and presented to physicians at the department meetings. The physicians were offered the opportunity to provide feedback and then their feedback was included in the final draft. It was important to assure that all medical group members felt they had a voice in the identification of defining compact content.
After the final draft compact content was developed, it was again shared with the department chair councils and with the WFMG leadership for final approval of content. After all approvals were obtained, the compact was then shared and approved by our medical group board of 14 practicing physicians and five health system senior leaders, two of whom are physicians with extensive experience in group practice.
The approved compact included value-based behaviors of both leadership and physicians with main headings of respect, integrity, development, excellence and stewardship.
Reactions to the Compact
Physician: “My initial thoughts were filled with skepticism, as I did not understand the purpose of it. However, after reading through it, I think it is a great outline of the commitment, expectations, and goals of the organization. If we see this organization as physician led, then the foundation needs to be laid down. The compact is a great place to start in addressing the mission and the goals of the organization. Also, the philosophy and expectations of the organization are spelled out to the physicians, staff and patients. The compact makes expectations crystal clear in my mind."
Operations leader: “I believe the compact provides a foundation for physicians and administration to build from at WFMG. It outlines the responsibilities of both parties which supports the mission vision and values as well as open communication. I also believe it is an important message for our patients and demonstrates being a physician-led organization. Most physicians have been supportive of the compact. A few have been supportive at compact signing but have been negative or made fun of the compact in private. I believe it is a very positive move that can differentiate us as a medical group to attract future physician recruits or acquisitions.”
Physician executive: “To me the compact is EPA (not an Environmental Protection Agency) but: My entitlement (E) to be a collaborative partner with the leadership and colleagues; Protection (P) from the fierce competitive market forces; and Autonomy (A) in my practice. This is a terrific tool that each medical group should have. This helps me open up a meaningful dialogue with other physicians and leaders in our organization.”
To promote physician buy-in, Wheaton Franciscan Medical Group made certain that proper communication occurred throughout the entire process. Letters explaining the compact and articles about the progress of the compact were shared with the physicians through the organizational newsletter and the intranet.
Physician input in development of the compact is very critical and was obtained through including non-leadership physicians in the development, refinement and approval processes. Proper approval process discussed above was followed.
Identifying why a compact is important and how it will benefit both parties as we align our behaviors behind one compact is essential as well. Support by the physician leaders is critical to demonstrating the importance of the physician compact.
During those signing ceremonies, the CEO (a physician) and/or the COO emphasize the purpose of the compact as a tool for communication and dialogue around mutual expectations, not as a legal contract whose terms might be breached by either party.
There were some physicians who chose not to sign the compact, which became an opportunity to open a dialogue around shared expectations for being within a group practice. Practicing medicine within the current environment requires that physicians support one another while practicing and adjusting to market, legislative and technological changes.
A compact helps all members have a set pathway toward achieving the vision for a unified medical group. It also helps the group align value-based behaviors, giving the members an opportunity to have frank dialogue. The compact provides protection in the current health care market while aligning the entire group in achieving the strategic goals of the organization.
Sanjeev Shukla, MD, MMM, FAAP, CPE, is regional medical director of the Wheaton Franciscan Medical Group in Milwaukee, Wisconsin.
Loren Meyer, MD, FAAP, CPE, is president and CEO of the Wheaton Franciscan Medical Group.
Denice Stingl is manager of organizational development at Wheaton Franciscan Healthcare.