When physicians align: Practical steps improve clinical quality, patient outcomes, physician satisfaction

Declining reimbursement, healthcare reform, demographic changes, staff shortages and service demands have intensified the need to leverage scarce resources through the alignment of hospitals and physicians in more efficient, effective ways. Despite growing enthusiasm for integration, information about implementing and evaluating integration-related initiatives is not easily accessible. There is little guidance for medical group administrators and decision-makers on what strategies improve clinical quality, patient outcomes and physician satisfaction.

Improvements in these areas should bring physicians and hospitals together, yet several things get in the way of successful integration, such as confusion over common goals. For example, hospital clinical leadership is an area where improvement is possible. Overall, administrators who employ active listening skills, encourage trust, promote transparency and focus on developing new physician roles will smooth the way to successful integration.

“We have got to partner and work together to make the system better, make patients safer, lower costs and retain the economic viability of both sides,” says Chris Van Gorder, FACHE, president and chief executive officer of Scripps Health, San Diego.

The term “active listening” refers to a technique or way of paying attention to people that can make them feel like you are hearing them. It involves making it clear that you understand what someone is saying. Active listening includes certain skills, attitudes and behaviors, including pausing, managing silence, not assuming something that is not discussed and asking for clarification. Following up with a brief summary after a conversation to ensure that each person has a clear understanding of the discussion is a good practice.

Ask “Did I explain this correctly to you?” rather than “Did you understand what I said?” The first question places the obligation on the sender to ensure effective communication instead of focusing on whether the receiver got the message.

Encourage all participants in your organization to learn and employ active listening skills and attitudes to ensure that they listen to what others say and that they are sensitive about what others need from their relationship with hospital groups or other physician groups. Several resources (including Toastmasters) help leaders learn the art of speaking, listening and thinking.

Establishing and sustaining a culture of trust and transparency are important elements for successful alignment between hospitals and physicians. Both parties must earn and nurture trust through open communication; mutual respect; and clear roles, expectations and responsibilities. A culture of trust and transparency provides a foundation for enhanced performance. Hospitals can improve trust by sharing information and data openly and regularly. This includes good, bad and uncomfortable information that impacts better patient care and community service.

People earn trust by doing what they say, saying what they mean and following through on promises that benefit the hospital and community.

Once an issue that needs your immediate attention has been identified, move on to prompt implementation of a solution. Lack of prompt implementation results in physician distrust. This can be a problem for some hospitals as large systems may require several steps of approval before implementation can proceed.

Create new physician roles

Many leaders have focused their attention on implementing business models from other industries and high-profile companies, such as the airline industry and Disneyland. Instead of an external focus, organizations should turn their attention to creating physician roles.

For example, co-management agreements offer physicians an opportunity to participate in clinical and administrative oversight of hospital services. Physicians typically get compensated with a fixed fee based on services related to improving quality and a variable fee based on quality outcomes. This is accomplished through the use of combined physician and hospital-personnel committees, which meet at regularly scheduled intervals to address specific assigned tasks and metrics. Accountable care organizations and medical home projects are good examples of new initiatives in which physicians can take leadership roles — such as chief of physician relations, chief of integration and medical informatics and chief health informatics officer — that are vital to the organization’s success.

By providing a broad range of alternatives to physician leadership roles, a healthcare system allows more physicians to participate in key decision-making processes. Healthcare systems that cultivate and increase physician participation report increased physician satisfaction and improvement in clinical quality indicators. One example is the Scripps Health Foundation, which was created by Scripps Health to provide physician services.

Develop a clear, defined statement about why alignment is important to your organization. Share this statement with your leaders, and develop strategies and activities that align with this statement. Some experts say that integrated health systems provide superior performance in terms of quality and safety as a result of effective communication and standardized practices. Hospitals and physicians must learn to act more interdependently rather than independently because they depend on each other for success.

With a few practical steps, such as active listening, prompt implementation and a focus on developing new physician roles, medical group administrators can improve clinical quality, patient outcomes and physician satisfaction.