By Ted A James, MD, MHCM, FACS
January 9, 2020
“Doctors must be central players in the sweeping changes transforming health care. Indeed, any change strategy they do not embrace is doomed.” – Thomas Lee, MD
THE IMPORTANCE OF PHYSICIAN ENGAGEMENT
I was recently invited to participate in the National Academy of Medicine Emerging Leaders Forum, where the group explored the most pressing challenges in health care and sought to develop new ways of thinking that could lead to change. One takeaway from the meeting was that today’s ever-shifting landscape of patient needs, regulatory environment, and downward cost pressures requires physician leadership to meet the changing demands of health care.
Leadership defines the future, and engaging physicians in efforts to lead change is a critical factor in the future success of health care. Multiple studies across a variety of care domains and clinical settings demonstrate that engaged physicians drive quality improvement, which supports the rationale of increasing the number of clinicians in leadership positions in health care organizations.1,2
In truth, we need every member of the health care team to be actively involved in leading change; however, if we neglect physician engagement, these efforts will achieve only limited results at best. Beyond physician satisfaction, alignment, or cooperation with hospital systems, engaged physician champions serve as a motivating force for quality improvement initiatives and inspiring colleagues. Engaged physicians provide the fundamental insight and leadership necessary for health care transformation efforts to succeed.1-3
CURRENT STATUS OF PHYSICIAN ENGAGEMENT
The problem is that many physicians are not at all engaged. Recent national surveys assessing the degree of physician engagement (i.e., level of commitment and involvement in the hospital mission) found that approximately 3 in 5 employed physicians are disengaged.4-6 Physicians have the lowest engagement across the health care workforce, followed closely by nurses.7 Few physicians felt a sense of pride or passion about working at their health care organizations. This lack of engagement was particularly true for younger physicians.
I have no doubt that the high rate of physician burnout is a contributing factor. Physician burnout is a pervasive problem in today’s health care environment and carries significant professional and personal consequences. It is challenging, if not impossible, for a physician to be fully engaged when burdened by the effects of burnout.
Physicians may also feel that they lack the ability to effect change, isolated from administrative leaders, and overwhelmed by the extent of change required in the system. Fortunately, experience has shown that an effective physician engagement strategy can help to resolve these issues and dramatically improve professional fulfillment, quality of care, patient experience, and health system performance.
HOW TO CREATE PHYSICIAN ENGAGEMENT
“The single most important quality a hospital organization and its physicians must possess if they are to succeed in building a lasting relationship is mutual trust.” – Herman Williams, MD, MBA
Engaged physicians have a strong sense of ownership and connection with their health care organizations. This type of relationship does not happen by accident. It requires a deliberate intent to partner with physicians in achieving shared goals.
It starts by having a well-defined physician engagement strategy that includes mechanisms for soliciting physician input into decisions that affect their clinical practice. Physicians must have a voice at the table where their opinions are heard. Transparency and effective communication between physicians and system administrators will go a long way in establishing a culture of teamwork and respect. An engaging organization is one that is grounded in integrity and holds to the highest standards of ethical conduct.
Equally important is ensuring that physicians have the necessary resources (e.g., staffing, equipment, access, etc.) to provide high-quality care to their patients. Ultimately, the goal is for physicians to work collaboratively with administrators on solutions to identified problems as well as opportunities for improvement. To this end, we should encourage more physician involvement with hospital administration and seek out opportunities for physician leadership development and professional growth.
OUR SHARED RESPONSIBILITY & THE LEADERS STANCE
“By not accepting personal responsibility for our circumstances, we greatly reduce our power to change them.” – Steve Maraboli
Engagement is a two-way street that requires a sense of shared responsibility. As physicians, we have to own our role in shaping the conditions that impact us. We are good at pointing out problems, but do not always look to ourselves to find solutions. If we want to see changes, we have to be the ones to bring about change.
In the book, Extreme Ownership8, leaders are encouraged to take ownership of everything in their domain. With this mindset, instead of blaming others for problems, you set out to learn what needs to be done to create success. Practicing extreme ownership requires you to accept that there are no bad teams, only bad leaders. And since we all share the responsibility of leadership, the onus of improvement starts within.
“Everyone is a leader because everyone influences someone.” – John C. Maxwell
Even without a leadership title, physicians have a great deal of agency in transforming culture and promoting change. The Institute for Healthcare Improvement teaches the importance of health care professionals taking the “leadership stance.” The leadership stance is a positive, can-do attitude toward problem-solving. It is the understanding that you can lead without a formal position of authority within an organization or group.
Leadership is an action, not a title. Leaders do not ignore problems or just complain about them; they work with others on figuring out solutions. You can start with the areas over which you hold influence. Your sphere of influence may be in the clinic, operating room, patient bedside, or simply your next interaction with a team member. By supporting your team, advocating for changes that improve the care of your patients, and setting an example with your actions and words, you start to create an impact and will inspire others to follow.
CALL TO ACTION
Engaging physicians in leading change is a proven strategy for improving health care. At its foundation, it is a healthy relationship built on trust and mutual support. Addressing issues surrounding burnout, ease of practice, and opportunities for quality improvement are important drivers of physician engagement. However, it is also about physicians embracing ownership. Transforming health care is a priority, and we need to recognize our role as agents of change.
As a first step, simply commit to leaving things better than how you found them. This philosophy can apply to your patients, practice, hospital, or community. Think about an area where you can influence change and then dedicate yourself to making a meaningful impact. In doing so, we pave the way forward for the future of health care and society.
REFERENCES
- Goodall AH. Physician-leaders and hospital performance: is there an association? Soc Sci & Med, 2011.
- Stoller JK et al. Why the best hospitals are managed by doctors. Harv Bus Rev, 2016.
- Bodenheimer T, Sinsky CA. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med, 2014.
- Advisory Board Company. Medical Staff Engagement Benchmark Report, 2014.
- Blizzard R. Physician Engagement Is Built, Not Bought. Gallup, 2004.
- Kamins, C. What Too Many Hospitals Are Overlooking. Gallup, Business Journal, 2015.
- Health Care Workforce Special Report: The State of Engagement, Press Ganey, 2019.
- Willink, Jocko, Extreme ownership: how U.S. Navy SEALs lead and win, New York: St. Martin’s Press, 2017.
Dr. Ted James is a medical director and vice chair at BIDMC/Harvard Medical School. He is an alumnus of the Harvard Health Care Management program and is involved internationally in leadership development and health care transformation. He also teaches through the HMS Office of Executive Education.
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Dr. James blogs about health care transformation. To see more of his posts, click on his name in the tags below.
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