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Physician relations: now more than ever.

The pressures facing physicians today come in many forms. Declining reimbursement (with news of more to come in 2008) has physicians searching for alternative sources of income--a search that often leads to ventures that can cannibalize existing hospital services.

Specialty hospitals and their perceived and real threat to the viability of the community hospitals are perhaps the most visible manifestation of that pressure, but office installations of nuclear scanners, CT scanners and MRI's are even more prevalent.

Physicians rail against increasing governmental interference in their day-to-day practices. Pay-for-performance along with its necessary technology accommodations looms on the horizon for physicians' offices, to say nothing of the federal push for electronic health records and patient safety measures.

Hospitals struggling to comply with pay for performance and meeting standards of The Joint Commission often request assistance from their medical staffs that can leave harried physicians feeling pulled in two directions at once.

Add in malpractice threats, paying for call and other controversial issues and the relationships between hospitals and their medical staffs certainly are taking a beating.

My belief is that now, more than ever, health care leaders must attend to the fragile and threatened relationship between doctors and health care facility administrators. The predicament for administrators is how to accomplish that. Or if they are already striving to improve physician relations, how can those efforts be made more effective?

In my role for the last nine years as head of physician relations for a large investor-owned hospital corporation, I have found that improving physician/hospital relations is not that complicated. In fact, it is very doable, even in the most acrimonious situation.

Good physician relations simply require some basic concepts mixed with an uncomplicated structure, and seasoned with a modicum of discipline.

Knowing the differences

Before a hospital team can approach physician relations, it is important to understand the differences between administrators and physicians. Both groups want the same thing--quality health care administered in a financially sound institution.

The rub lies in how each group approaches and overcomes obstacles to achieving that goal. A simple way of understanding these differences is depicted in Chart 1.

From this contrast, it is no wonder hospital administrators often find themselves at loggerheads with doctors. The trick is how to proactively engage physicians to head off conflict or to deal effectively with it once it occurs.

[ILLUSTRATION OMITTED]

If you ask the average lay person on the street what motivates physicians, "money" would likely be a frequent response. But if you ask physicians what motivates them, they would tell you that their top hot buttons are respect for what they do and some sense of control over their work environment.

A good physician relations program will provide both for physicians. Let's look at how it can work.

Basic concepts

The most obvious element to physician relations is talking to doctors, and to do this effectively you will have to meet with them. Within the context of such a meeting, there are four basic concepts that will drive any physician relations program:

1. Deciding what to talk about

2. Listening

3. Processing

4. Responding

Sounds simple, but let's look at each one more closely.

Deciding what to talk about is easy. Talk about what the physicians want to talk about. They may be aggravated that the gate to the physician parking lot doesn't work half the time, or they may be upset about the quality of nursing care in the ICU.

The point is that good physician relations starts with hearing what is bothering the doctors. Within the framework of the meeting, there will be plenty of time to talk about what is bothering you.

Listening, as we have all been taught, is more than sitting in a room with someone who is talking. It involves actively hearing, not only what words are being spoken, but also "hearing" the unspoken clues of facial expression and body language, while at the same time resisting the temptation to formulate a quick answer.

Physicians and hospital administrators are among the brightest professionals in the country. All bright people have had the experience of partially listening to another person, jumping ahead to conclude their thoughts, and beginning the process of an answer.

I maintain that physicians are more interested in being heard than in getting a quick answer. So focus on hearing them out, even if you know where they are headed, and even if you have "heard all this before."

Cutting off a physician before she feels she has been fully heard will always have a negative impact on your relations with her.

Processing what you have heard does not have to be immediate unless you are in the middle of a true emergency of some sort. In fact, not responding immediately can be beneficial, particularly if the exchange has been heated.

It is much better to let all sides cool off and then present a clearheaded evaluation of the issue. I have found a delayed response allows effective processing and is especially helpful if the topic under discussion has financial implications for the institution. So go ahead and take time to research, evaluate and prepare a response.

Physicians are trained to put some thought behind their treatment decisions; they will respect the same approach from you.

Responding is the next step and is as important as listening and processing--perhaps even more important, especially if the answer you have to deliver is "no." Saying "yes" to physicians is easy. But an effective physician relations program makes it easier to say no.

No one always gets everything he wants. Physicians will accept a "no" answer provided you have done the previous steps of listening and processing. Physicians are trained to think logically, so feel free to answer them that way.

If you cannot agree to their requests due to legal, financial, strategic, or ethical reasons, by all means tell them so, and tell them what those reasons are. More often than not, they will be glad to revisit the topic to see if there are other acceptable ways of accomplishing the goal.

Uncomplicated structure

The basic concepts will go absolutely nowhere without an equally simple structure and some modest discipline. The decisions about structure should include how to meet, when to meet, how often to meet, and with whom.

Clearly the best way to hear what physicians have to say is to meet them face-to-face. Dialogue can only occur with sequential meetings, so it is best to meet on a standard schedule and no less frequently than every 4-6 weeks. An agreed upon meeting schedule ensures that things don't "fall through the cracks" as they so often do with busy doctors and busy administrators.

Time of day is also important. My experience is that evening meetings are best. Physicians usually have about an hour in the early morning or at noon before they begin to feel the pull of their patient responsibilities. Once they start looking at their watches, the meeting is over.

In the evening, after they have completed their patient care responsibilities for the day, you will be much more likely to get them to sit down in a relaxed atmosphere and talk to you about what is bothering them.

At first blush, you may think physicians will be reluctant to give up an evening for yet another meeting. Some won't. But if your physician relations program offers physicians an opportunity to participate in decisions that will affect how their patients are cared for in your institution and how they go through their work processes, they will give you the time.

This is even more true once they realize that your response to their concerns is changing things for the better within the facility. My experience is that if you create this type of meeting, you will eventually get requests from physicians who want to participate in the group.

When was the last time a physician on your medical staff asked for another committee assignment? It happens in our organization all the time.

It is also best to meet away from the hospital in a more collegial, or even social setting. This sets the atmosphere of a relaxed exchange of ideas apart from the usual roles as physician/administrator.

Whom should you talk to? This is a key decision that will impact the effectiveness of your program. After trial and error, I am convinced that a formal physician relations program cannot be carried out within the context of the executive committee of the medical staff. They are just too busy.

The MEC has a full agenda with no time for brainstorming through physician issues. A good group for this purpose must also be of a manageable size. You can't talk to your entire medical staff in a group setting effectively, nor do you need to. Select eight to 12 physicians who are key opinion leaders among your medical staff. They may or may not be the elected officers of the medical staff, and they may not necessarily be your closest allies on the medical staff.

Target the physicians who are sought out by their colleagues in the physicians' lounge when there is an important decision facing the medical staff. Moreover, they don't all have to be tried-and-true loyal supporters of your facility. Splitters can often tell you why they refer patients to your competitor across town. If you can solve some of the splitters' issues with your facility, you will likely move business.

Discipline

Once you have embraced the concepts of physician relations and put a structure in place that works for you, the secret to ongoing success is discipline. I mentioned how busy clinicians and administrators are. It is all too easy to forgo talking with one another for more pressing patient or hospital needs.

However, having just enough discipline to mutually agree to meet, to meet regularly, and to discuss identified topics will ensure success. As in all human relations, continuing to talk can solve even difficult disagreements.

Other pointers

* Name your group. This helps give them an identity.

* Talk with the group about confidentiality, particularly if you will be discussing key strategic issues for your facility.

* Include one or two members of your MEC in your physician relations group for purposes of cross-communication between the two groups.

* Be sure your board is aware of the discussions taking place within the group.

* Stay away from topics such as credentialing, peer review and disciplinary actions that are within the purview of the medical executive committee or other standing committees of the medical staff.

* Don't hold the meeting if the CEO of the facility cannot attend. Doctors want to talk directly with the captain of the ship, not with representatives of the team, no matter how respected they are.

* Let the physicians set the agenda. Let them run the meeting. Make it "their meeting," not yours. You can always bring issues to the table that you need help with at the end of the meeting.

Word of warning

Based on your organization's culture, what I am about to say may be the most difficult thing for a management team to embrace. It is certainly the most important thing I can say to you about starting a physician relations program.

If the senior management team of your organization does not have the interests of physicians at heart, does not understand the importance of physicians as customers of the delivery system, and is not committed to helping solve physicians' issues in a creative and collaborative fashion, you will fail.

If your management team does not adhere to these simple tenets of concept, structure and discipline, if you are simply interested in window dressing, or if you really don't enjoy sitting in a room with (sometimes angry) physicians, then please don't attempt this program. You will make the doctors angry and your relationships with them will be worse off than before.

On the other hand, the rewards of an effective physician relations program are great. Trust and communication are improved. Problems come to light and are solved earlier when they require less time and resources.

Physician loyalty to you and to your institution is enhanced. And an organization that is focused on patient care and physician workflow from the physicians' point of view will attract admissions.

In short, good physician relations will make your life easier, and it will be good for your bottom line.

Robert Rowntree, MD, FACP, is president of RJR Consulting, LLC in Dallas, Texas. He can be reached at rjr@rjrmdconsulting.com

[ILLUSTRATION OMITTED]

Robert Rowntree, MD, FACP
Chart 1

Clinicians Managers

Doers Planners and designers
1:1 Interaction 1:N Interaction
Reactive Proactive
Deciders Delegators
Value autonomy Value collaboration
Independent Interdependent
Patient advocate Organization advocate
Identify with profession Identify with organization
Gratification immediate Gratification delayed
COPYRIGHT 2007 American College of Physician Executives
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2007, Gale Group. All rights reserved.

Article Details
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Title Annotation:Searching for Satisfaction
Author:Rowntree, Robert
Publication:Physician Executive
Article Type:Author abstract
Date:Sep 1, 2007
Words:2129
Previous Article:'Can't get no (physician) satisfaction?'.
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