“Quite frankly, the big issue going forward is going to be physician engagement in terms of being able to drive all the changes that need to be made in healthcare,” Cosgrove said in the interview. “If you don't have physician engagement, I don't see how you possibly are going to take costs out, how you're going to get more continuity of care. Physician engagement is really a critical issue.”
Cosgrove (ranked 10th on Modern Healthcare's 2014 list of the 50 Most Influential Physician Executives and Leaders and 16th on the 2013 list of the 100 Most Influential People in Healthcare), said it has been a struggle to get physicians—particularly older ones—to buy into the concept that standardization improves quality.
“I think that you have a lot of anger in the physician community right now, or denial,” he said. “They can't believe their whole world is changing. It's essentially Kübler-Ross' degrees of mourning. They have been in denial, and now there's anger and eventually there will be mourning. Then we'll get acceptance.”
The Harvard Business Review column is co-authored by Dr. Thomas Lee, chief medical officer for Press Ganey. He and Cosgrove write that the new concept of physician engagement goes beyond the traditional arrangement where doctors show loyalty to a hospital by referring most of their patients to the institution.
Instead, Cosgrove and Lee write, the goal should now be to have a partnership that strives “for full collaboration in relentless improvement.”
“Many organizations hope that they can win over physicians by combining good intentions with a few broad interventions, such as putting doctors in leadership roles and creating financial incentives for desired behavior,” Cosgrove and Lee write.
Leaders, they write, will more effectively tap into physician motivation if they engage in a noble shared purpose, satisfy self-interests, earn respect and embrace tradition.
It would be interesting to see Cosgrove adapt those strategies to change culture at the VA.
Follow Andis Robeznieks on Twitter: @MHARobeznieks