You'd have thought by now we would have addressed everything worth tweaking, overhauling or trashing in our drive to change healthcare. Yet so powerful are the forces of tradition and culture that we continue to struggle with a critical element of the healthcare equation: the relationship between physicians and healthcare organizations.
Executive leadership continues to seek more-effective ways to gain physician support and improve cost-effectiveness in their organizations. Physicians look for more-effective ways to influence the organization and improve patient services.
These differences may lead to open conflict. As one physician puts it, "The thing that concerns me the most is the loss of professional autonomy and the sense of professionalism, because (the concern for patients) is what got us up in the middle of the night."
So how should today's hospitals and healthcare systems address these issues? They need to change the physician-organization relationship by addressing three critical issues.
1. Rethink the relationship and culture, acknowledging different perspectives. Like it or not, physicians and system executives are never going to agree on a number of issues. They have different constituents and different goals. So what?
Redefine the relationship around what both sides agree on: the need for a mutual sense of professionalism and support so that both sides achieve their goals.
This is not, as many healthcare executives believe, simply an issue of control. Nor is it, as many physicians worry, about sacrificing quality of care to reduce costs and increase revenues. Instead it encompasses issues of autonomy, contribution, influence and professional behavior-and requires an environment in which high-quality healthcare is also cost-effective and aligned with appropriate economic incentives.
Changing the doctor-executive relationship usually requires a revised culture that encompasses shared values and expectations and new behaviors. Just how important an organization's culture is can be seen in Fortune's annual report on the world's most admired companies. We've found that one of the key differences between the best and the rest is culture: Those at the top of the list have consensus around their top cultural values and live by those values.
2. Expand the "emotional intelligence" of both partners. No offense, but both partners in many physician-organization relationships lack some behaviors and emotions that are critical for success.
Yes, they both have high IQs and exceptional skills, and when they work within their own areas of expertise, they are highly successful. But when they must interact with another part of the organization, they need the additional emotional competencies of self-awareness, self-control and empathy to deal with conflicts and clashing viewpoints.
If you're a skeptic who believes "emotional intelligence" is so much psychobabble, consider our studies and those by Daniel Goleman, a writer and the chief executive officer of Emotional Intelligence Services in Sudbury, Mass.
* EI is twice as important in creating outstanding performance as is the combination of technical skill and IQ.
* Divisions or business units led by highly emotionally intelligent senior managers typically outperform their counterparts who lack EI.
* EI counts for more than 85% of what sets star performers apart from average ones in top leadership positions.
Although much of this research focuses on the corporate world, the findings apply to healthcare. Goleman makes that point in his Working with Emotional Intelligence (Bantam Books, October 1998): "Medicine is a field newly awakened to the benefits of empathy, in part for some compelling economic reasons. In a day of heightened competition for patient loyalty, those physicians who are better at recognizing emotions in their patients are more successful in treating them than their less sensitive colleagues."
3. Reinforce the new behaviors, culture and relationship. To sustain new relationships and behaviors, back them up with appropriate rewards. To create this critical performance-linked relationship, more healthcare organizations have begun developing both physician and executive compensation plans that incorporate incentives to help align behavior-thus performance-with market needs.
According to our studies, 70% of physicians participate in some sort of annual incentive program, compared with 59% two years ago. By comparison, more than 80% of system executives are now eligible for such incentives.
Whatever form rewards take, they should focus in part on developing the new behaviors needed for success. Such "pay programs" send a powerful message about the value in satisfaction, access, and cost and care management that both physicians and executives bring to patients.
Healthcare organizations should be no different from well-run companies in other industries, which select and motivate executive leadership and top talent. They don't limit these individuals' power and autonomy; they capitalize on their competencies, provide them with resources, focus them on what is important and give them the leeway to effectively use their experience and expertise to improve performance. In return, they economically reward them based on that performance.
By developing and rewarding new behaviors and cultures, healthcare organizations can create environments that, as a physician leader once noted, "allow us to provide the highest quality care, the greatest satisfaction and the greatest technical skill-all at a lower cost."
Isn't that the outcome every doctor and organization wants?
Sally Berger is president of Sally Berger & Associates, a Chicago-based healthcare consulting firm.
Gordon Hawthorne is a senior healthcare consultant with the Hay Group in Dallas.