A Local Solution for Hospital-Physician Relationships

Abstract

I COMMEND THE feature authors on their thoughtfulness and diligence researching and writing about this critical link to provide excellent healthcare. Many of the concepts they present are universal and can be applied to all healthcare systems, but just as all healthcare is local, so are the tactics for solutions. We use our own frame of reference to filter what we see and hear. I have been a physician a private practice, an employed physician, chief medical officer, and CEO at the same hospital-physician integrated delivery system, the same town. There is no other hospital for over 25 miles. We have no specialty hospitals, ambulatory care centers, or joint ventures, but we do have critical needs recruiting and retaining quality physicians so we focus resources these areas. Each position I've held offers a very different view, and from each perspective the path to improving patient care is also very different. For example, 95 percent of our physicians are employed by or contracted with the system; many of my fellow physicians the upper Midwest find themselves a very different situation. The high percentage of physicians employed by the system by no means indicates that our physicians are any closer to achieving consensus with administration, and we must be intentional about aligning our organizational goals with those of the doctors. The same skills of communication, aligning strategies and goals, and decision making are needed our situation as are needed organizations with fewer employed physicians. SEEING THE BIG PICTURE I agree that administrators and physicians look at the world very different lights. The two professionals come from different viewpoints when considering, for example, the amount of time required to make a decision, the value of meetings, or how a message should be communicated. The skills that make an excellent physician-such as autonomy, efficient use of time, and the ability to make decisions rapidly on often incomplete or unknown information-are foreign to administrators who seek data, analysis, and a broad range of input before a decision is made. From physicians I hear over and over how long the organization takes to make decisions. The physician disdain for meetings as a waste of valuable time creates dissension, because decisions are formulated and made at the committee level. When administration does not engage the physician properly, or when physicians do not become engaged, decisions appear to be made without physician input. When such a decision is then implemented, physicians have no buy in and often even defy the decision. The methods suggested the feature articles will certainly aid these relationships. If physicians can be convinced to step back and see the big picture, better discussions will result. Recently one of our rural physicians complained to our CFO that we were delaying our decision on his building expansion. The CFO took the time to explain all of our capital projects that dwarfed the size of the expansion of his office and explained our process of prioritizing capital expenditures. He also explained the process of the business plan and return on investment. Once the physician better understood his project respect to other decisions he became much more patient. THE VALUE OF GOOD PHYSICIAN LEADERSHIP I could not agree more with the authors on the value of effective physician leadership. Physicians often have disdain for administrators who have never practiced medicine or taken call for patients. If physicians are asked for input, they prefer to explain clinical opinions to leaders who understand clinical medicine. Physicians also want to be educated by other physicians when implementing a new process. They certainly do not wish to be corrected or counseled by a nonclinician. Three of our top five executives are physicians, and we find that this helps the organization's relationship with physicians, but having such representation leadership is not a panacea. …