Engaging Physicians to Lead Change in Health Care

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


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


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.


“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.


“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.


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.

Learn more about developing your leadership skills through Harvard Medical School’s Office for External Education


  1. Goodall AH. Physician-leaders and hospital performance: is there an association? Soc Sci & Med, 2011.
  2. Stoller JK et al. Why the best hospitals are managed by doctors. Harv Bus Rev, 2016.
  3. Bodenheimer T, Sinsky CA. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med, 2014.
  4. Advisory Board Company. Medical Staff Engagement Benchmark Report, 2014.
  5. Blizzard R. Physician Engagement Is Built, Not Bought. Gallup, 2004.
  6. Kamins, C. What Too Many Hospitals Are Overlooking. Gallup, Business Journal, 2015.
  7. Health Care Workforce Special Report: The State of Engagement, Press Ganey, 2019.
  8. Willink, Jocko, Extreme ownership: how U.S. Navy SEALs lead and win, New York: St. Martin’s Press, 2017.

Head shot of Dr. Ted James.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.

Follow Dr. James: LinkedIn / Twitter

Dr. James blogs about health care transformation. To see more of his posts, click on his name in the tags below.


The Role for Health Coaching in Primary Care

By Monique Tello, MD, MPH
July 25, 2019

It’s remarkable to me that while overweight and obesity are major epidemic medical problems resulting in many clinical complications, and we have solid scientific evidence showing us safe, effective interventions that actually help people to lose weight, we are not yet incorporating these methods into primary care. What’s our problem?

Want to know more about what works for weight loss? I’ll tell you: behavioral change support, in the form of a health coach. Continue reading “The Role for Health Coaching in Primary Care”

Emotional Intelligence for Physician Leaders

By Ted A James, MD, MHCM
June 13, 2019

“By teaching people to tune into their emotions with intelligence and expand their circles of caring, we can transform organizations from the inside out and make a positive difference in our world.”   –Daniel Goleman

The Hard Impact of Soft Skills

Have you ever regretted saying the wrong thing in the heat of the moment, or wished that you could quickly diffuse a tense situation, or could get a better sense of how others viewed you? Many of the challenges of health care stem from working in a highly complex, emotionally demanding environment. The ability to manage yourself and your relationships with others is an invaluable skill that physicians and other health care leaders must possess in order to be successful. Continue reading “Emotional Intelligence for Physician Leaders”

Primary Cares Initiative Tests Value-Based Pay—Will It Work for You?

By Krishnan Narasimhan M.D.
May 8, 2019

The road from fee-for-service payments to value-based care has been a bumpy one for the entire health system. Current models have not found the most effective way to pay and incentivize primary care.

At an April 22, 2019 event in Washington, DC, the US Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) announced new payment models that aim to transform primary care through value-based options. This Primary Cares Initiative 1 will also test financial risk and performance-based payments for primary care physicians. The voluntary initiative includes five new payment models under two paths—Primary Care First (PCF) and Direct Contracting (DC). These models will be rolled out in 20 states starting in 2020. Continue reading “Primary Cares Initiative Tests Value-Based Pay—Will It Work for You?”

Best Practices for Engaging Physicians in Health Technology

By Ted James, MD, MHCM
March 28, 2019

Advances in health technology allow health care professionals and organizations to meet ever-increasing demands for performance improvement—or at least that should be the case. The problem is that the adoption of technology in health care is a slow process with many hurdles. Wearables, predictive analytics, remote medicine, EHRs, digital health, AI, diagnostic algorithms, self-care apps, and next-generation clinical decision-support all have the potential to improve patient care; however, fundamental issues with usability and implementation need to be addressed for physicians to engage with these health innovations. Continue reading “Best Practices for Engaging Physicians in Health Technology”

The Physician Side of the Medicare-For-All Debate

By Krishnan Narasimhan M.D.
February 28, 2019

As the 2020 presidential campaign is getting into high gear with a host of candidates, health care continues to take center stage. Specifically, the Medicare-for-all proposals from Democratic candidates and members of Congress have become a key issue. These proposals could represent the biggest access change in health policy since the Affordable Care Act.

It pays for physicians to understand and be engaged in health policy as it will dictate their practice life, their patient’s health, and the future of health care. However, unraveling competing proposals is not always easy. Let’s take a deeper look. Continue reading “The Physician Side of the Medicare-For-All Debate”