Answers
As a consultant, I specialize in hospital-physician relations at the strategic level. I call it "translation".
Too often mutually beneficial endeavors are not pursued, or if pursued have unattended consequences, as both parties are in the same business sector but have VERY different business structures and goals.
One example: hospitals, whether for-profit or not-for-profit, use an Accrual Accounting basis. Physicians, whether employed or private practice management systems, use a Cash Accounting basis. This creates very significant challenges to "translate".
Also, most deals need to have the not-for-profit entity as a majority owner (51 %+) to maintain the hospital’s overall IRS not-for-profit status, but most physicians see the required 51% as a means of control.
Further, suppose a hospital and a four-physician private group enter into a joint venture to provide an urgent care center in an underserved community. The venture costs $2M and quickly fails. At 51%, the hospital loses $1,020,000, but all of the hospital executives take home their same salary. At 49%, the docs each take home -$245,000 less, probably more than each of their full year's salary. ($980,000/4). Not acceptable.
Administrators manage/make decisions/conduct and attend meetings - this is how they earn their salaries. Physicians have to provide patient-related care to produce revenue. When physicians attend a meeting they are making $0, and some specialists' fixed overhead approaches $500/hr. So, for a one hour meeting, physicians have to work two hours to "break even".
Bottom line: to improve Hospital-Physician relations their financial incentives MUST be aligned; Gainsharing Programs for Quality Improvement are the most significant means to achieve this, which by definition means significant improvement in quality for patients and lower costs.
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The ultimate responsibility of these complex, multi-layered relationships falls onto the hospital chief executive officer, chief operating officer, and other key members at the top of the leadership team. Successful relationships allow the hospital to move forward with everything from expansion to quality improvement; failure can mean organizational chaos and potential career-limiting opportunities for leaders.
I think a lot of opportunities are overlooked to improve physician hospital relations. First of all I think this is a cultural problem in the health care industry. Administrators and clinicians seem to have trouble with their relations and communication in many areas of the health care industry. I think there are a couple reasons for this. First of all there is the culture of hiding mistakes due to litigation concerns and so there is a reluctancy to have open communication between these groups. Secondly there is the problem of communication style and goals. Many administrators don't learn how to communicate effectively, and this is true of medical personnel as well. The style that is taught to these groups is entirely different (When it is taught at all). Clinicians for example are taught to communicate with a patient and to discuss medical matters, administrators are taught to discuss administrative things. I think that creating a liaison of sorts that can translate and discuss both types of topics in langauge understood by the other party is a great start.
Another issue that is secondary to cultural misunderstandings is the issue of time, as someone else brought up often time there isn't a lot of time available for these groups to communicate and email is a fantastic way of being misunderstood (or can go unread for days). I would suggest having meetings after business hours when clinicans don't have to worry about losing any income due to their meeting requirements.
Yet another issue that I think is very much a bone of contention if I can use that phrase, is that neither group fully understands what the other does and has unrealistic expectations. For example, a relative of mine works at a hospital where the new CEO sent out an email to all department heads asking them to come up with suggestions of what their department can do to minimize hospital stays. For a physician this may be unrealistic because a physician can't unilaterally cut the time a patient stays in the hospital, a physician needs to take into account the patient's condition before a discharge. Administrators expecting otherwise will find themselves disappointed. As I read this email from my relative's new boss I commented that he won't last long in this position, course the man doesn't come from a health information technology and probably doesn't understand the nuances of this industry.
I would suggest having some times, maybe during the lunch hour where administrators and physicians can get together and discuss what they do and what their goals are. This could be a time to air frustrations to each other and come up with some creative solutions.
Change is often implemented by administrators (or physicians for that matter) with no respect for any other group affected. I think it would be best if people expressed what the change is and why it is being made as well as what the benefit is for the other party. I think the change should also be realistic, one shouldn't expect things that are just not possible of the other party. A great example would be to say "We are changing to a 3 day 12 hour shift schedule versus the standard 5 day 8 hour time frame. We realize this might be causing you anxiety, however we feel it is in the best interest of everyone. Your benefit in this is that you will work close to the same amount of hours in less days and will have more time to be off. Our benefit is we save money from lost productivity when staff has to be off." This is a better approach than just we are changing to a 3 day schedule deal with it. Also it is very realistic to expect someone to go to a 3 day vs. a 5 day. Expecting a physician to become an administrator might be unrealistic as very often they don't have the time or want to make the time to acquire the skills set or perform administrative duties.
I think there are lots of untapped opportunities to improve relations.
Often times, I use focus groups which comprise a cross section of the key players. I think this can model collaborative relationships and continue the process of mutual understanding...Dr J
You just might get some real insight from a new book on that subject by Marlena Fiol and Ed O'Connor. They are on the faculty of the health administration program at Colorado University. I heard them speak on their experience and work with physicians and hospitals at a Lunch and Learn meeting of the CU Alumni Association.
I don't know the exact title but you could google them for it by name or subject.
Hope that helps.
In my experience as a physician liaison it was the one-on-one conversations that helped me understand what the particular opportunity or misperception was for that moment. Just like any large group of people, there are many moving parts. However, I believe if you ask your physicians what can make a deal happen, they will tell you as long as you've built a solid, respectful relationship.
I’m wish I had a one size fits all answer, but it’s just too complex of an issue.
Good luck!
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