Janury 22, 2007

A Doctored Approach
By Laura Gater
For The Record
Vol. 19 No. 2 P. 22

Hospitals are beginning to realize the benefits of meeting physician needs to grow patient volumes, increase patient satisfaction, and improve bottom-line results.

A recent Press Ganey Associates survey indicates that what matters most to patients also matters to physicians; namely, the hospital’s delivery of care. The survey, which compiled the opinions of more than 15,600 physicians at 169 U.S. hospitals, found that the issues of most concern were overall quality of care, ease of patient care, the administration’s ability to deal with changes, how quickly physicians get patients’ clinical information, and physicians’ overall confidence in administration.

According to the survey, which also ranked physician satisfaction by specialty, radiation oncologists are the most satisfied, followed by hospitalists, oral surgeons, podiatrists, and pathologists.

What’s It Mean to Hospitals?
“Physician satisfaction is crucial to both patient satisfaction and employee satisfaction,” explains Jay Kaplan, MD, FACEP, medical director of the Studer Group and director of service excellence at the California Emergency Physicians Medical Group. “If physicians are happy, they can create an environment in which staff are also happy. Physicians, employees, and patient satisfaction are all intimately interdependent. Some recent studies have pointed out that, in general, physicians are not a happy group. I think what physicians want is C.A.R.E.—Care, Appreciation, Response to their issues and needs, and Efficiency of practice.”

Matthew Mulherin, director of corporate communications at Press Ganey Associates, finds the survey results “very refreshing” in that patients and physicians share the same mindset regarding what’s most important: quality of care. He says the most successful hospitals have found incredible value in engaging physicians in decision making.

For physicians to deliver the best medical care, they have to practice in an environment where the entire team is committed to providing exceptional care and service to patients, according to Stephen C. Beeson, author of Practicing Excellence: A Physician’s Manual to Exceptional Health Care. It’s difficult for physicians to focus on treating patients if there are operational or clinical barriers to delivering care to patients. Focusing physicians on organizational excellence is tough when staffing shortages are commonplace, lab turnaround is slow, and operational support is not in place.

Conversely, when healthcare organizations commit to practicing excellence to support physicians to provide the best care to patients, physicians can quickly align with the healthcare team’s aspirations. Physicians want to be the best, and the goal is to provide exceptional, compassionate care and earn the respect of their peers, Beeson says. In an age of physician burnout and frustration, the process of physician engagement and alignment to organizational excellence can be challenging. It often requires tactical measures to get physicians on board.

“If physician satisfaction is high within a facility or organization, one will see physician loyalty to that institution. When physicians are fulfilled in a work environment, their willingness to align with the platform of the organization and its code of conduct in service and clinical excellence is incrementally greater,” explains Beeson. “When physician satisfaction is high, physicians treat patients and staff better and improve the performance of their clinical unit, as well as improve patient satisfaction. It is difficult, if not impossible, to provide great care to patients on the back of a burned-out, frustrated physician. Patients see physician burnout and staff feel it as clear as day.”

The Impact of Physician Satisfaction on Hospital Finances
Physicians are the bloodlines of the hospital because they produce revenue, says Mulherin. Hospitals can’t afford to ignore their concerns because physicians can choose to send their business (patients) elsewhere if they are dissatisfied. Thus, most hospital administrators consider physician relations to be high priority, if not the top one.
“The bottom line is that hospitals need to compete for physicians. The definition of satisfy is ‘to meet an obligation.’ Hospitals have to go beyond that in order to attract physicians. They need to astonish them,” explains Kaplan. “The healthcare environment is very competitive. We know that the major reason why patients choose one facility over another is on the recommendation of their doctor. Given declining healthcare revenue, hospitals need to be very competitive.”

Physicians are not looking for lavish, expensive things from hospitals, but rather, they are concerned with ways to improve patient care and to be listened to in the improvement process. Physicians want to be more efficient and streamline their patient care processes, the second item indicated by the Press Ganey survey. In doing so, they can increase patient satisfaction, which in turn impacts the hospital’s reputation and revenue.
“Physician satisfaction and patient satisfaction have a linear relationship. They both drive each other,” says Mulherin. “In fact, employee satisfaction has a similar relationship to both patient and physician satisfaction. Hospitals focusing on all three are usually the ones that are able to create an optimal service culture.”

Sharp Coronado (Calif.) Hospital uses the information it obtains through surveys to directly engage its physicians and ensure they feel Sharp is the best place for them to bring their patients and that patients believe Sharp is the best place to receive care, according to Susan Stone, chief nursing officer and chief operating officer.

Communication Tools
Hospitals employ various strategies to give physicians a sounding board to voice their opinions about hospital conditions. Kaplan recommends creating “physician preference cards,” which contain three questions: How do you like to be contacted? (eg, by phone, pager, e-mail, text message, etc]; What is your preferred time for rounds?; and Is there one thing we can do that will help you enhance your practice or further enjoy your practice at our hospital?

Physicians appreciate the opportunity to be involved in decision-making committees and groups, as well as patient satisfaction groups and exploratory groups, says Mulherin. Ongoing dialogue is also important, he says, because it lets physicians know that hospitals are interested in obtaining their input on topics related to their satisfaction and that of their patients.

Get Happy
The most common strategies deployed by healthcare facilities to attract physicians include everything from providing overnight call rooms to improving technology and providing parking spaces close to the building.

“Physicians want quality care for their patients, efficiency for their practice, and appreciation,” says Kaplan. “Some hospitals have formed a physician satisfaction team, and physician satisfaction is a regular agenda item at department staff meetings. The team informs physicians about specific issues that come up on patient satisfaction surveys and lists issues and actions to get physicians’ attention and show the team’s actions and the results.”

Implementing new technology can help physicians make better use of their time, improve patient safety, order patient medication, and provide almost instant access to test results. Hospitals have not overlooked this aspect.

Recently, Sharp Coronado Hospital instituted an electronic medical record (EMR) system, which has increased physician satisfaction, according to Stone. Following an initial training period with the EMR software, physicians now have speedy access to patient information when they need it. Stone says that while no system is perfect and software issues do occur, the facility continues to improve the system with help from physician feedback.

In general, the implementation of new HIT is a huge factor in physician satisfaction. Older physicians who did not grow up with computers often have a difficult time when a hospital transitions to an EMR, acknowledges Kaplan, but they realize the technology’s benefits to both themselves and their patients. Kaplan cites the notification of drug interactions on sophisticated EMR programs and the use of computerized physician order entry as examples of new technology that physicians appreciate.

“Information technology is a significant tool in driving clinical care, as well as the physician work experience,” says Beeson. “Many healthcare systems offer remote access for physicians, allowing them to access all clinical information to be managed from a remote site. As a physician on call, the ability to access an entire medical record, history, problem list, and diagnostic studies on a patient in the [emergency department] is simply better care. Organizations that support physicians to utilize health information technology to take better care of patients will foster loyalty to that institution.”

Eye on the Goals
Healthcare organizations have long struggled with the issue of aligning physicians with their organizational goals. Coaxing, prodding, and cajoling usually don’t work. Physicians come to realize that in some places, their opinions don’t matter; changes won’t be made no matter how much they beg and argue.

Kaplan points out the difference between engagement and alignment. Engagement, he says, is getting physicians interested and focused on issues, then following up on those issues. Alignment is convincing physicians to practice certain behaviors and follow specific procedures.

“You first have to engage them before alignment,” says Kaplan. “Alignment is asking physicians to create a great climate for patient care and for staff, too.”

Conversely, marginal and disruptive physician behavior creates a negative environment for staff, he adds, and these physicians should be involved in engagement and alignment whenever possible.

“Ask your physicians to do three things which will improve organizational goals as well as atmosphere. One, treat your colleagues as customers. Two, say ‘thank you’ more often. And three, adhere to behavior standards and have your colleagues do the same,” says Kaplan.

In some healthcare organizations, physicians help set and reach organizational goals and make changes in the overall healthcare process. In other words, they believe their opinions matter.

Healthcare organizations that are able to change their culture so they create the best place for employees to work, the best place for physicians to practice medicine, and the best place for patients to receive care are those that can harvest the leadership of passionate, committed physicians, according to Beeson.

“Aligning physicians should be a core strategy for any healthcare organization interested in raising the bar. The physician is perceived as the leader in healthcare and the prospect of changing a healthcare system without the input, leadership, and example of the leader of the healthcare team can be difficult, if not impossible,” says Beeson. “When physicians get on board and lead others to becoming the best, everyone else will follow. There is no greater influence on what staff does than the example set by physicians. Those hospitals that rank the highest in patient satisfaction seem to be the ones that rank the highest in physician satisfaction. It appears we best serve ourselves by our dedication to others.”

Stone explains a tactic that worked for Sharp Coronado one year ago, when its physician satisfaction survey ranking dropped to the 84th percentile, down 14 points from the previous year. The executive team took advantage of Sharp’s internal workout and cap processes (Six Sigma tools) to prioritize specific areas of interest to physicians. The team also assigned a physician liaison to work with hospital executives. Physicians are updated monthly on the team’s progress via a newsletter created just for this purpose. She says this process has “significantly improved” physician satisfaction because the physicians believe they have an active partnership with executives in addressing key issues.

Conclusion
The Press Ganey survey and others like it can be a valuable tool for hospitals that take the information seriously and attempt to involve physicians in addressing problem areas or those with which they are dissatisfied. For the most part, it’s beneficial to involve physicians in organizational problem solving, goal planning, and other proactive measures.

— Laura Gater’s medical and business trade articles have been published in Healthcare Traveler, Radiology Today, Corrections Forum, Credit Union BUSINESS, and other national and online publications.