Building Shared Vision with Physicians

A major barrier to success under value based purchasing is lack of a shared vision with physicians. Given the investment made in physician employment, this issue is particularly acute with your employed physician network.

Without a shared vision, the likelihood that your employed network will be an asset going forward is reduced. Your physicians will continue to act as they always have, forming a confederation of practices rather than a united group. You likely understand the need to transform the mentality of your physician group to match market changes; how to get started is often elusive.

Physicians frequently have a good understanding of how a practice group needs to evolve in order to thrive. They understand how to better serve patients. They understand how variability in care represents an opportunity to improve. They understand why physician leadership is crucial to meeting health system and patient needs. But, frustration sets in when doctors do not have a a way to focus this insight and influence group direction.

A strong, shared group vision, established in conjunction with physician leaders, will help propel movement in a common direction. It will facilitate development of a strong group culture. The vision can also help ensure the organizational culture aligns with the requirements for enterprise success.

Many clients ask us how to approach this issue. Our advice is to assemble a group of formal and informal leaders, who are tasked with defining what the group will look like in 10-15 years. In doing so, we encourage the physicians to describe a group, with which they will be proud to be associated.

From that description, develop a narrative that documents common aspirations in some level of detail. A recent client's version yielded a 3.5 page statement outlining the end to which the group would aspire.

That vision length sometimes causes concerns and may feel bureaucratic or overwhelming. However, it allows the group to document nearly everything that is crucial to long term performance. It also creates a forum in which all physicians can understand the detailed intent behind the vision…leaving less to the imagination. In our experience, this has been critical to getting doctors pulling in the same direction.

As you might imagine, developing such a document is an iterative process. We start with interviews of involved physicians, executives, and practice managers in which we focus on group aspirations, as well as perceived problems. This gives us a baseline of understanding and allows us to educate everyone on the opinions of their peers. We review the hospital and system strategy for elements that translate to the physician group. We review group and health system data to benchmark performance and define strengths and weaknesses. Finally, we tap our experience to define success factors from other groups.

From that foundation, we create an initial draft vision that is reviewed with physician and administrative leaders. And edited …and edited …and edited again. This process focuses on content, presentation, and clarity rather than wordsmithing. Invariably, the physicians identify something that is near to their hearts and reflects a sense of service to their patients that we did not fully capture. Typically, the points of interest and emphasis changes with each version as the leadership group internalizes the content.

This process is also effective in increasing their sense of ownership. To promote that level of ownership, we recommend presenting the draft vision statement to the entire physician group, with physician leaders conducting the discussion. Inevitably, the front line physicians add further insights generating greater ownership.

From the final vision statement, the core strategies the group must follow to achieve the vision becomes clear. We find it helpful to extract those strategies and discuss them with the physicians as well. This makes the process more tangible as the physicians see how specific actions tie to the vision.

Finally, we recommend a semi-annual vision review be a part of an ongoing management control system. The vision review should keep these two questions in mind:

1. Has a change in the market occurred that generates new insights or changes the way we see our vision?
2. Are we prioritizing the correct strategies?

Using this approach, the vision becomes a guidepost to maintain focus and drive change while simultaneously accomplishing the task of engaging physicians in that change.