Physician executives influencing other.

We asked ACRE members via flashmail on July 74, 7999 how they influence physicians without resorting to positional authority Their strategies include:

* Show physicians meaningful, comparative data

* Help physicians see that the change is good for them and/or their patients

* Include physicians in the decision-making process

* Demonstrate why the new practice is better

* Provide a clinical context

* Offer financial incentives-money recognition, or time off are powerful motivators

* Get physician buy-in

* Understand what's important to physicians

Here's a sampling of the many responses we received:

Provide meaningful data

The best tool is comparative, meaningful data. Physicians are competitive, want to excel, and respond well to numerical comparison. Ultimately, they are reasonable about compliance, but need concrete visual cues to measure where they or their department stand. I try to reduce a requirement to a data representation and feed it back to them and they seem to do the rest. This, of course, works only for those requirements that lend themselves to measurement.

For other matters, I put the requirement in the context of our mission, vision, or values statement. Always. Anything I "ask" them to do must relate back to this as the bedrock for any expected behavior or job requirement. This keeps us on the same sheet of music.

John R. Aguilar, MD, CAPT

Chief of Medical Staff

Tripler Army Medical Center 

Tripler AMC, Hawaii

[e-mail]

Apply pressure

It is difficult to get physicians to change unless specific pressure is placed on them, and even then it is frustrating. The areas that seem to be effective in creating change are:

1. Monetary carrots and sticks--Profit-sharing for achieving goals, for example, "You will receive a bonus if you achieve this goal, like a 10 percent improvement in the number of patients with diabetes who have HbA1c's done."

2. Comparative data--You are 23rd out of 27 physicians when it comes to giving beta-blockers post MI. Physicians are very competitive--they want to be number one.

3. Data--Articles showing that the benefit of X is greater than Y, academic drug detailing.

4. Patient pressure-Notify patients to request something from their physician, such as reminders to get mammograms for women and immunizations for kids.

Victor G. Ettinger, MD

Medical Director

[e-mail]

Help physicians see it's good for them

Physicians may change their attitudes and behaviors if they think doing so will

1. Help their patients

2. Improve their quality of life

3. Improve their income

4. Enhance their knowledge base or practice patterns in direct comparison to their peers

5. Help the organization or is for a common good or principle (for those who can see the big picture)

Alan C. Nelsen, MD

Medical Director

Preferred Physicians Medical Group

Norfolk, Virginia 

[e-mail]

Include physicians in the process

One way to get MD's to do something they really do not want to be bothered with is to make sure they feel included in the process and have a decision-making role. This not only ensures the project's success, but often generates new and useful ideas.

Frederick S. Sherman, MD

Director of Perinatal Cardiology 

Magee Women's Hospital, University of Pittsburgh

Pittsburgh, Pennsylvania 

[e-mail]

Demonstrate why it's better

At Copic, the medical liability insurer for 75 percent of the practicing physicians In Colorado, we have been using risk management guidelines since 1986. Agreeing to follow them is part of the application and renewal process for 4,500 physicians. The guidelines have been instrumental in helping to control claims and costs and they have been enthusiastically accepted.

We demonstrate the usefulness of the guidelines, based on evidence from our claim files, risk management analysis, defense attorney assessments, and expert physician review. Educational seminars, averaging 200 per year, are supplemented with practice-based examples and "tools" to enhance the Implementation process. Office-based practices are surveyed every two years to determine the rate of guidelines adherence, assist with implementation problems, and obtain feedback. This information is added to the guideline development process.

The keys to influencing physician behavior are providing:

1. Evidence-based information, specifically focused on improving patient care or practice efficiency;

2. Information as close to the practice environment as possible with useful implementation tools;

3. Continuous practice based surveys in a consultation mode, not compliance audits with real or implied penalties.

George Thomasson, MD

Principal Risk Management Consultant

Copic

Castle Rock, Colorado 

[e-mail]

Provide a clinical context

Frame the issue in a context that the physicians can relate to, which usually means using examples that model clinical decision-making. If there is a concern about completing medical records properly, approach it from the viewpoint of the clinician needing timely information to provide good care to patients. I've used the example of being the physician who is taking care of another physician's patient, checking the chart and finding poor notes. With this level of information, you feel hamstrung. And, of course, you would not want to do this to your partners, would you? Another example is with charting. The patient is on the line and wants information about tests or what you discussed at the appointment two weeks ago--timeliness of the physician entry is critical to good communication among partners, patients and nursing staff. They find this hard to disagree with. I've also used group planning processes for setting practice goals and discussing the key financial indicators and referral patterns--group work, g roup buy-in!

Barb Supanich, RSM, MD

Michigan State University 

Associate Professor

Associate Chair/Clinical Services

East Lansing, Michigan 

[e-mail]

Get physician buy-in

Physicians need buy-in. Involve them in the decision process and allow them to take ownership. More often then not they come to the same conclusions you did or can better articulate why your way may not be correct. Keep the physicians well informed. I'm in a group of four. We meet and discuss issues weekly. This also allows the physicians to hear different viewpoints. Sometimes the peer pressure can convince them to change their way of thinking. Basically it's by consensus. It's time consuming. but in the long run it's the most effective way to influence physicians.

Another way is, of course, to offer incentives. Money, recognition, or time off are powerful motivators.

Scott R. Baker, MD

Medical Director

Fairfield Medical Associates

Lancaster, Ohio 

[e-mail]

Show physicians the data

We show the docs benchmarking data, community statistics, and hospital department figures with or without names attached. We produce monthly or quarterly reports about similar information. The doc or docs soon see that others are performing better and they often change their habits to come in line with what others are doing.

David Goldberg, DO

Senior Vice President of Medical Affairs

Grandview Hospital and Medical Center

Dayton, Ohio 

[e-mail]