GUNDERMAN: We should improve physician engagement

Several central Indiana hospitals have recently been stung by dreadful physician engagement scores. Patients and communities should take note, because low levels of engagement are associated with higher physician turnover, increased error rates, poorer rates of patient cooperation in treatment, and lower levels of patient satisfaction.

Definitions of engagement vary, but they generally include pride, loyalty and commitment. When engagement scores are low, physicians take little pride in the hospital, would not recommend it to a job-seeking colleague, and believe the hospital’s mission and vision are not in sync with the needs of patients.

To better understand the roots of poor physician engagement, I recently sat down for a conversation with a large group of students from the Indiana University Kelley Business of Medicine MBA program. Its students are practicing physicians from around the country who have realized that, to improve patient care, they need to become better leaders.

Challenged to explain declining physician engagement scores, the group pointed first to a lack of transparency. Many hospitals, they said, collect a great deal of information about the performance of their medical staff, but share little information in return. One physician described the situation in terms of a “one-way mirror.”

Another key problem, according to the group, is the fact that so many hospital administrators do not take care of patients. In contrast to physicians and nurses, whose work revolves around patients, hospital administrators typically have business backgrounds. Even health professionals who play leadership roles often “haven’t cared for patients in years.”

The group also pointed to the different standards by which physicians and hospital administrators are evaluated. The most important criteria of physician performance naturally revolve around patient care, while administrators are typically judged first on financial performance. This misalignment can frustrate both sides.

Said one participant, “For many occupants of the hospital C-suite, the central operating principle is, ‘No margin, no mission.’ This means that, no matter how noble the hospital’s mission statement, revenue must exceed costs or the hospital will close. In too many cases, though, ‘No margin, no mission’ gets transformed into, ‘The margin is the mission.’”

The group pointed to the growing bureaucratization of health care, driven in part by consolidation among health care organizations. As hospital systems grow, their decision-making tends to rely more on impersonal policies and procedures and less on relationships. Said one participant, “This is frustrating to health professionals whose careers are devoted to building trust.”

Another participant added, “To a hospital administrator, the corporation’s annual report might seem the most important thing, and the center of the universe might appear to be the hospital executive suite. But to health professionals, it is patients. When administrators put their own programs first, they inevitably seem out of touch with reality.”

The physician-MBAs offered a number of suggestions for improvement. One is for hospitals to start treating health professionals as partners in care. Another is to ensure that hospital boards are well populated with people who regularly care for patients. A third is to pair each administrator with a health professional who understands what day-to-day patient care is like.

Said one participant, “Physician engagement isn’t just about whether doctors happen to be happy or not. It’s about integrity. It does no good for the hospital to make lots of money and reward its executives handsomely if the people who care for patients distrust it. Improving engagement scores is ultimately about ensuring that health professionals believe in their work.”•

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Richard Gunderman is chancellor’s professor in medicine, liberal arts and philanthropy at Indiana University.