The Medical Staff - A Gap in Organization Strategic Planning?
As part of a project to understand her physician engagement challenges, a CEO shared the recently created, comprehensive, and ambitious, five-year strategic plan. She wanted me to understand why it was so important to have the medical staff on-board.
No surprise, one of the pillars of the plan was entitled “people." It included strategies to attract and retain top talent, and to help employees find career success and satisfaction. The organization recognized, rightfully, that people are very much at the heart of the services/products being delivered.
There was also a separate section of the plan, written by the Chief Nursing Officer. This outlined plans to build and support a world-class nursing organization. I asked the CEO why there was nothing in the “people” pillar section about the medical staff, and no separate “physician” section, that paralleled the CNO’s document. The answer? “Physicians are covered by everything we talk about in the People pillar, just like everyone else.”
I asked the CEO why there was nothing in the “people” pillar section about the medical staff, and no separate “physician” section, that paralleled the CNO’s document. The answer? “Physicians are covered by everything we talk about in the People pillar, just like everyone else.”
Physicians as a Unique (and Neglected) Workforce
The medical staff, historically, was made up of independent physicians. They weren’t employees, so their success of failure wasn’t the organization’s issue.
This has changed. Most health systems do, indeed employ large number of physicians. In many respects, they are treated as employees. As an industry, though, healthcare has failed to recognize the challenges facing this unique workforce that we’ve created - or given much thought to how we can support their success.
(Imagine for a moment that the leaders of Google, as they were designing Google, forgot to consider how to attract, retain, and support the success of software programmers . . .)
To the CEO’s point – Yes, physicians are employees and yes, we should value ALL employees, and expect all employees to meet certain performance expectations.
This can be true – AND we can still recognize that physicians are a unique, invaluable part of the organization. If nursing is unique enough to warrant its own section in that strategic plan, surely ensuring physician success warrants similar attention?
Physician Success Supports Organizational Success
A decade ago, many healthcare organizations focused on “physician alignment” – efforts to encourage independent physicians to collaborate with the hospital to improve care quality, increase profitability, and grow volume.
It often seems, now, hospitals assume that employment equates to alignment. “They are employed. We don’t need to work hard to meet their needs, or keep them closely aligned with us.”
"It often seems, now, hospitals assume that employment equates to alignment."
No group has a greater influence over quality of care, finding innovative solutions, creating better care continuums, and controlling costs. It would seem worth understanding how to best engage physicians in these efforts, and how to provide the support, tools, and resources necessary for physicians to have successful, satisfying careers.
See the HMS Article: Engaging Physicians to Lead
This is, especially, important because the dynamics of the profession have changed drastically, and quickly. Physician education and training does NOT prepare them for the work world they enter. This contributes to frustration, declining career satisfaction, and increasing burnout.
Creating Success in Physician-Centric Organizations
Any organization that relies on physician success, needs to create a situation where physicians feel like partners in all of these efforts, and feel like the organization appreciates the challenges of practicing medicine, today – and wants them to succeed. (This goes far beyond the important work of improving physician emotional wellness – but will support that work.)
Below is a model, looking at four categories, that might help us to re-think how to integrate physician, and organizational, success. This can apply to a department, a hospital, or a physician group. (In my case, the approach grew out of work with individual departments.)
The Strategic Plan -
Like any group, physicians need a vision around which they can rally – a vision that will motivate the work. Consider:
Is there a recent, comprehensive plan in place, and are physicians aware of it? (Saying “We have a plan and they can go look at it any time they like,” is NOT sufficient. Yes, I’ve heard this response from a Department Chair when his people said they weren’t clear on the vision.)
Were physician leaders actively engaged in developing the plan?
Is the plan realistic? Do people have the tools and resources to execute it?
Is it aligned with the goals of the physicians in a way that will motivate them?
Culture
Does the medical staff understand, and share the vision? You don’t need 100% agreement, but I often discover that an entire group of Department leaders never bought into the vision. Good luck making it a reality.
Has anyone done the work to define and communicate what the organization needs from physicians, including clear behavior expectations?
Has there been work to ensure a culture of trust, psychological safety, and productive relationships and communication? Without these, the work to create the plan is a waste of time. If these don’t exist – get help, now.
Effective Leadership
Are there clear physician leadership roles and expectations? (It’s unfair to complain about a lack of physician leadership if you’ve never defined what’s expected.)
Do physician leaders function as a team, or in silos?
Do physician, and administrative, leaders function collaboratively?
Are you supporting physician leader success by providing honest, productive feedback, and developmental resources? Leadership is a practice – that is distinct from the practice of medicine.
Physician Success –
You invest a great deal in recruiting physicians. What are you investing in their success? Most executives, and even nurses, have some sort of developmental plan. Too often, we leave physician success to…the physician.
Do you define clear performance expectations?
Do physicians have individual goals, and plans?
Do you provide adequate resources to support their success at all points in their career?
Do physicians feel like valued partners?
Does your compensation plan align with your goals?
Do you identify physicians who are struggling and get them help – BEFORE you tag them as “disruptive”?
"Too often, we leave physician success to…the physician."
Let's Go Beyond Physician "Wellness"
Everyone in the organization is important. Front line staff are important and have unique needs. Administrative staff are important and have unique needs. The same is true of nursing. The same is true of physicians.
Calling out the unique role of physicians, and the unique challenges they face, does not diminish the importance of these other groups. It merely recognizes the reality that healthcare has, very much, evolved around the growth and development of the nursing and medical professions. They are central to the services being provided.
Preventing, and addressing physician burnout, is a great start - but if we acknowledge that physicians play a central role in organizational success, let's build the work around supporting that success.
To learn more about a unique approach to physician leadership development, visit Activ8 Health, and Rali.
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