By Apeksha Desai, MD, Agathos Medical Advisor
Photo by Harvard Business Review
Traditionally, healthcare has been organized around independent practitioners with high emphasis on physician autonomy and respect. In the changing healthcare climate, this emphasis has slowly been shifting to larger physician groups and hospital employment of physicians, where the patient is at the center of all decisions made.
According to Medscape’s 2015 Physician Compensation Report, 63% of physicians are now employed by larger entities, “likely because it eliminates many legal hurdles associated with hospital-physician relationships.” The radical change has caused deep-seated anxiety among some physician groups as the fear of anticipated loss of autonomy, status, and income looms on the horizon.
This anxiety is wearing at the link between practitioners and healthcare improvement, making it more important than ever before for healthcare innovation to appeal to physicians. A 2016 survey by Merritt Hawkins shows that 50 percent of physicians reported frequent or constant feelings of professional burnout (defined as physical and emotional exhaustion due to prolonged stress), largely due to job dissatisfaction from constantly changing requirements and regulations that physicians perceive as having no control over. Recent healthcare developments like the push towards EHR shows that no healthcare strategy is likely to be successful without full cooperation and buy-in from physician groups, as physician groups are at the frontlines of patient-focused care. In fact, hospitalist-driven approaches to creating better patient-focused care have saved individual hospitals millions of dollars in yearly expenses while providing dramatically improved patient experiences.
This need for full cooperation has been noticed by other healthcare professionals. A few years ago, The New England Journal of Medicine published a study on the psychology behind incentives for physician engagement and developed these framework conditions for a physician-friendly workspace:
Using tradition and perceived culture is one route to creating social pressure and instituting behavior change. Leaders should not underestimate the importance of aligning incentives to goals and the societal context of peer pressure. For instance, my workplace Kaiser Permanente has the reputation of providing high quality care at affordable costs and putting patients at the center of everything we do. Moreover, physicians are salaried with no incentive to under or over prescribe treatments and tests. This attracts a specific kind of physician and eventually creates the culture of the organization.
While the above approach certainly works, the most effective route to culture change is to appeal to a sense of shared purpose or intrinsic motivation. The Harvard Business Review sums up this sentiment in a call to action for physician leaders: “Leaders should use data to demonstrate how proposed changes can improve efficiency and patient outcomes and use vignettes about patients’ struggles and triumphs to get physicians thinking about what kind of care makes them ashamed or proud.” Traditional incentives like pay-for-performance also work better in an environment where physicians are motivated intrinsically by a shared purpose and the culture and climate of the organization works to support it. These tools work best when they are combined and used synergistically. As we ask physicians to engage more with the metrics, we need them to come up with the most meaningful things to measure. When incentives align with a shared purpose, that is when we can expect the most engagement.
As we all know it, culture trumps strategy any day. The primary goal for today’s healthcare leaders is to create a culture and climate that supports and encourages innovation in healthcare and supports physicians in their intrinsically motivated goals to provide high quality, accessible, cost effective care to their patients.