That is the wrong question.
The better question is, “Physician, what is the value agenda and how can we help you achieve it?”
Question A and Question B separate organizations between those who have, or will have, strong physician leadership, engagement, and alignment and those who do not and will not. If you want strong physician leaders, engaged physicians, and/or aligned physicians, ask Question B, not Question A.
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Question A: How can we engage physicians in our value agenda?
Question B: Physician, what is the value agenda and how can we help you achieve it?
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The interactions that ensue in pursuit of Question A are in the end mere manipulation. If physicians agree to engage in a value agenda designed without them at the table, they have done so out of altruism or personal appeal.
Work generated as a result of trying to answer question A is double-taxed. When physician time, ability, goodwill, and/or professionalism is given, it is almost always uncompensated. As physicians give those valuable resources, they also lose revenue because they are out of the clinic. An independent physician told me once,
“I am the only one around the table who’s not getting paid for being here.”
Even if the doctor is employed by an enlightened organization who compensates their physicians for time contributed toward improvement efforts, it is very rare that their salary is not directly tied to productivity.
Some physicians will give to the cause without hesitation, but most will not. It is hard to build a culture of continuous improvement wherein providers are deeply embedded and invested in the efforts unless you have at least a critical mass of physicians rolling up their sleeves to join in. You will not get to that critical mass by asking and acting on Question A.
Another fatal flaw that arises from asking Question A is the continual need for and subsequent ask for more. So the organization is required to repeatedly draw from the “same well.” The performance improvement pressures are real and compelling. Not much can be done without physicians. However, even the noblest grow weary of repeatedly donating their efforts because, in a Question A world, it is not their agenda. It is ours.
The end of Question A is disengagement and disenfranchisement. The very thing that we need the most, aligned, engaged, and strong physician leadership, is destroyed by our repeated appeal to professional altruism. For many of us, it just takes a quick survey of the last few Medical Staff Presidents of Chiefs of Staff to confirm those statements. The damage is real and long-lasting. Those physicians are some of the most embittered and recalcitrant physicians on our medical staffs, and we created them.
The last point to be made about Question A is that it belies a genuine commitment to physician leadership. Leaders set the agenda. Those that are asking Question A are not interested in relinquishing the agenda setting to someone else. They hope for ‘buy-in’ or endorsement, not leadership, and there’s a big difference between them. They look for physician placeholders, not physician leaders. They are often flummoxed by a lack of physician participation when clearly what we are asking from them is, “what’s best for patients.” What physicians ask from us is to be invited to the table from the beginning, to be listened to, and to be asked Question B.
It is the better question. We’ll explore the reasons for that in the next blog.
Photographs: Google via Creative Commons.
