COVID-19 - Physician-Hospital Alignment More Important Than Ever?

Success will Require a New Level of “Alignment”

While there is much attention being paid to physician leadership, we don’t talk about “physician-hospital alignment” as much as we used to.  Ten years-ago our strategic consulting work often included “alignment” projects.  Hospital administrators wanted deliberate plans to ensure that key groups of physicians were aligned with the hospital’s goals.  We wanted structures and processes in place to ensure that we were all working toward those goals, to everyone’s mutual benefit.

When’s the last time you saw an article about physician-hospital alignment?  I actually had an administrator say to me “alignment isn’t an issue anymore now that all of the physicians work for the hospital.”  First, in many hospitals, there are still independent groups that play a key role in delivering care. Second, employment does NOT guarantee that a physician’s goals and efforts are aligned with the organization’s.

See: Innovative Approaches to HRO, Coming out of COVID-19

[In our post-COVID-19 world] . . .we need to position leaders (physician and hospital) to be successful and this starts by making sure they are aligned – working toward a shared vision with a collaborative strategic plan.

I raise this issue now because as we work to define our post-COVID-19 world, we need both administrators and physicians that think and act differently for organizations to survive and thrive. We need to position leaders (physician and hospital) to be successful and this starts by making sure they are aligned – working toward a shared vision with a collaborative strategic plan.

Where Change Happens

Strategic vision can be crafted in the boardroom, at retreats, and any number of places where leaders can discuss and plan. However, that is not where change in healthcare happens. Change occurs at those thousands of interactions that occur daily. The decisions made and the action executed are where change happens. That change can either be aligned with the strategy of the organization or not.

"Physicians control the micro-culture by setting the tone, by reinforcing behaviors, by how they communicate."

Change in the micro-culture is controlled, primarily, by two groups - physicians and nurses. Physicians control the micro-culture by setting the tone, by reinforcing behaviors, by how they communicate. The physician only actually executes a small part of the change. They are like an architect, a coach, or a maestro. Without the nurses and the other members of the health care team there would be no building, no games won, or any music played. 

What Does Hospital-Physician Partnership Look Like?

Physicians, in general, either do not understand the power they possess or do not know how to use that power effectively. Hospital leaders in general don't engage physicians early in the change dialogue. They will typically bring the idea to the physicians after it is all wrapped up and expect the medical staff to act as if they have been given a gift.

"Physicians, in general, either do not understand the power they possess or do not know how to use that power effectively. Hospital leaders in general don't engage physicians early in the change dialogue."

How do we help hospital leaders engage more effectively with the medical staff - when is the time, how are purposes of the two groups aligned, how do we respect the autonomy of the physician, and how do we provide sufficient early mastery of the change we are proposing?  Also how do we recruit champions and how do we identify and manage resistors in the medical staff?

Physicians need to know how use their power in the micro-culture effectively. They need to understand how the change will improve patient outcomes and how it will improve their efficiency. They need the team-building, teaching, motivation, and communication skills to be a leader of a high performance, high reliability team. They need to have some basic performance improvement skills and understand change management.

Physicians Need to be Effective Change Leaders

We build these concepts into both our Department Transformation and High Reliability DNA™ programs.  While these programs are built on a foundation of sound strategy, practical operational concepts, and HRO principles, they lean heavily on the idea of hospital-physician partnership, leadership, communication and relationships.

Physicians Will Need Different Leadership Styles Coming Out of Covid-19

These become even more important in times of change.  Change management is a process that needs to be well thought-out and managed with a basic understanding of change management theory.  Change management is all about alignment and communication.  This takes work and cannot be left to chance.  It requires specific focus.  Most administrators get some of this training.  Few physicians do. 

Alignment - Assume Nothing

Now more than ever, change is going to be forced onto health care and we need innovative solutions that can be trialed by nimble organizations. Those organizations need to build front line teams and empower these teamsto find those solutions.

We need both administrators and physicians that think and act differently for organizations to survive. We need to be positioned to prepare leaders (physician and hospital) to be successful in an even more rapidly changing environment.

"Cohesion doesn’t happen without the foundational work of ensuring alignment of vision, goals and strategy."

Do NOT assume that everyone is clear on the new strategic plan or how you are going to achieve the goals.  Do the work to ensure the goals are clear.  Administrators:  Engage physicians from day-one.  Partner with them.  Physician Leaders:  Bring your clinical expertise to the table.  Ask questions. Advocate for patients and for the medical staff, but learn how to lead in times of change, in complex organizations, and to collaborate on innovative solutions.  Never assume alignment. Cohesion is a pre-requisite for team success.  Cohesion doesn’t happen without the foundational work of ensuring alignment of vision, goals and strategy.

Marty Scott, MD, MBA, is the Vice President, HRO Consulting.