What the Doctor Ordered

A question for hospitals: How healthy are your relationships with your physicians? The wellbeing of your organization might rest on the answer.

Recent Gallup Organization studies of more than 6,000 physicians in the United States show that only 10% of physicians are fully engaged with their hospital, while 42% are actively disengaged. (See sidebar "How Engaged Are Your Physicians?") Although it's intuitive that physicians who are engaged with a hospital would prefer to practice there, this assumption is proven by several case studies that demonstrate a clear linkage between physician engagement and referral patterns. The result is better financial performance at the hospitals where these physicians practice.

Consider a recent study of a large community hospital. Seventeen percent of physicians who are actively disengaged with this hospital anticipate decreasing referrals to the hospital in the next year. They report they'll do so as a result of the hospital's poor management of customer relationships. In contrast, 26% of physicians who are "fully engaged" or "engaged" with this hospital anticipate increasing their referrals.

Physicians are among a healthcare organization's most important customers. They are unusual customers, as they neither receive nor pay for a hospital's services. But they do make careful choices about where they practice medicine and where they prefer to send their patients for care. Because physicians can create tremendous value for healthcare organizations by the revenue they generate through referrals, hospitals must regard them as critical customers -- and partners in the future success of any long-term strategy.

Consider this: In a study of a major healthcare system, hospitals that scored in the top quartile for physician loyalty had earnings per adjusted admission that were about $320 more than that of bottom-quartile hospitals. More significantly, hospitals that scored in the top quartile for physician engagement had earnings per adjusted patient day -- a key metric of efficiency and appropriate use of healthcare services during inpatient stays -- that were about $80 more than hospitals in the bottom quartile. (See sidebar "Physician Engagement and the Bottom Line.")

To improve these key financial metrics, it's essential for healthcare executives to understand the concepts of physician engagement -- not only how to measure it, but how to improve and sustain it.

Physicians are emotional beings

Let's start with the basics: All decisions are driven by two distinct thought patterns -- rational and emotional. Physicians use rational thinking all the time. A patient presents a doctor with a symptom or illness, and the doctor performs tests, gathers results, makes a diagnosis, and develops a treatment plan.

Given that physicians have had years of education and training in analytical hypothesis testing and rational medical science, one would assume that the best way to engage them would be to address their rational needs. However, after studying physician engagement for many years, Gallup has discovered that their decision making is more emotional than you'd think. Consider the following statistics:

• Forty-two percent of physicians are actively disengaged with hospitals and other healthcare entities, while only 10% are fully engaged. A review of the factors that affect physician engagement reveals that doctors' preferences and alliance to a particular hospital are strongly influenced by their emotional attachment to the organization's values and their level of confidence in its key leaders.
  
  
• As Gallup studied the specific components of physicians' engagement with their hospital, we determined that 24% feel what Gallup defines as "Pride" in their association with the organization, while only 7% have "Passion." (See sidebar "Levels of Physician Engagement.")
  
  
• Analyses demonstrate that overall physician engagement with healthcare organizations differs significantly when segmented by age group. The ratio of fully engaged to actively disengaged physicians under 45 is 1:5; in contrast, the same ratio for physicians over 55 is 1:2. And the most profoundly disengaged group is physicians ages 35-45; this ratio of fully engaged to actively disengaged physicians is almost 1:6.

"The new generation of physicians entering the healthcare industry is less engaged with their profession and with healthcare organizations," says Larry Mallory, Ph.D., senior consultant with the Gallup Healthcare Group. "This poses a challenge for healthcare leaders as the population of mature, more engaged physicians begins retiring. It will require a different kind of thinking and a different kind of relationship to engage the hearts and minds of younger physicians."

Creating and sustaining relationships

Since physicians are more emotionally driven than many people realize, healthcare leaders must build strong relationships with their medical staff based on trust, integrity, and personal values. Gallup's research has discovered that doctors want to align themselves with leaders who are truthful and candid, share common ethics, respect their input, and focus attention on what helps them be successful as a doctor. In essence, physicians choose to work closely with leaders who make them feel good about practicing medicine at their hospital.

What's more, building strong relationships with physicians will require individualized solutions and attention, not just general "free breakfast in the lounge" programs. Top-performing hospitals consistently deliver on even the simplest factors in physician engagement.

"Many hospital executives don't even know the names their doctors like to be called," says Rick Blizzard, D.B.A., principal consultant at the Gallup Healthcare Group. "If leaders want physicians to feel comfortable identifying with the hospital and that their values and the organization's align, it's important to sit down with each physician periodically to get to know him or her as a person -- not just as a referral source. Calling a doctor 'John' when he prefers to be called 'Dr. Smith' sends a clear message that you don't know him and haven't taken the time to appreciate his preferences."

Blizzard notes that at hospitals that rank highest in Gallup's database for physician engagement, doctors believe that the executives listen to them and deliver on their promises. These doctors have a personal relationship with the leadership team that goes beyond the hospital walls. These physicians know that the hospital's leaders are interested in helping them be successful both clinically and financially and trust them to fairly resolve issues that concern them. "Physicians are less concerned about business operations than they are about a personal connection," Blizzard says.

Dealing with conflicts

Resolving problems is another crucial factor in building physician engagement. According to Gallup research, only 15% of U.S. physicians believe that hospitals provide fair resolutions to problems. Again, an individualized approach is essential. Studies show that as conflicts with hospital policy or operations arise, physicians want to be involved in decisions that affect their patients and their medical practices. They want a partnership with healthcare leaders who will follow through on their promises, treat them with dignity, and resolve their problems fairly.

In general, best-practice healthcare organizations build physician engagement by:

• meeting one-on-one with all physicians at least once each year to ask questions like these: Are we, as leaders and employees, meeting your expectations and those of your patients? Do you have any concerns with our values or our goals? How can we help you provide higher quality care to your patients?
  
  
• hosting a retreat with executive management and physician leaders to encourage doctors' input on the hospital's strategic plans and operations
  
  
• requiring managers and leaders to participate in medical staff committees to listen for potential concerns and conflicts
  
  
• facilitating effective communication between doctors and key department managers (for example, between cardiologists and the manager of cardiac rehab) to ensure that they are working as a team and share a sense of trust
  
  
• including physicians in recognition activities and acknowledging their efforts to improve quality and efficiency or achieve strategic goals

"As a physician, it's not that important to me whether I like the executives, if we interact socially, or if my kids play with theirs. What really matters is whether I can trust the CEO and if I can rely on him to put the needs of the patients first," says John Tinker, M.D., chairman of the department of anesthesiology at the University of Nebraska Medical Center in Omaha, Nebraska.

"If an executive meets with me frequently, speaks honestly about problem areas that are of concern, and follows through on promises -- that is someone that I can trust and will keep sending my patients to," Tinker adds. "Open, honest communication is critical to sustaining strong relationships with physicians."

The bottom line: Physician relationships can either improve a hospital's health or be a prescription for disaster. As local markets become more and more competitive, healthcare leaders must create strong, emotionally based relationships with their medical staff to build a powerful network of engaged physicians. Getting to know each physician as a person, understanding his or her values, and individualizing the approach to managing each relationship and resolving conflicts are keys to success and are what separates successes from failures.

It's time to ask: What's the prognosis for your relationships with your physicians?