Restructuring the Healthcare Business Model

Part Three of Four

The previous discussions on structural changes within nursing are vital, but it is also imperative to look at the physician’s role in a healthcare organization. Despite nursing teams carrying more influence over a healthcare brand, hospitals cannot function by nursing and administration alone. A hospital’s revenue still comes through elective surgeries and admissions while patient care is still orchestrated through an MD’s orders. Physicians are paramount to the success of a hospital, yet few resources are given to partnering well and ensuring physicians are happy within the organization.

Physician empowerment and engagement need addressing to succeed in a healthcare world that is continually restructuring. Organizations need a strategy to energize physicians, nurses, and staff around a common goal of patient safety and quality care performed in a supportive culture that values their time and skills.

Below are four areas to help you improve your physician relationships.

  1. Physician Workflow Analysis 

The value proposition for physicians is efficiency and excellence in nursing care, which drive the patient’s experience and care outcomes. Rarely are the workflows of an MD’s time in the hospital evaluated, giving concrete data to problem solve and increase efficiency. Experience mapping and conducting a workflow analysis will show your organization where the logjams are and the processes that cause the most tension.

Most hospitals utilize surveys to engage physicians around their experience, yet rarely give physicians a platform for a feedback loop nor a place to engage in problem-solving. Surveys can be helpful, but if not combined with other strategies of trust, engagement, and empowerment, most survey participants are left feeling voiceless in a bureaucratic institution.

Solving the workflow barriers and instituting avenues of feedback loops will make your physicians, nurses, and patients happier.

2. Develop an onboarding and ongoing training program

Hospital systems invest in training nurses but rarely train physicians. A new nurse will often spend weeks onboarding while a new physician may only get a brief EMR training session and a facility tour after receiving an email stating they have been successfully credentialed. Though this process may require the minimum amount of time which is precious to physicians, it may also leave them to feel left out and disassociated from the organization. Worse yet they may develop practices and habits that detract from organizational goals. How can you create a more inviting and engaging onboarding program for your new physicians, welcoming them into the culture, vision, and values? How can you make them feel that they are a part of the team?

Additionally, are there opportunities for ongoing training and education? Physicians are trying to manage their outpatients, office, staff, and inpatients sometimes across several hospital systems, often without proper training in leadership skills and organizational management. It is not surprising that an MD’s and hospital’s priorities clash. There is neither time nor avenues of collaboration to work together towards a common goal.

Are there tools, training, communication avenues, or resources you can offer physicians to help them accomplish their priorities more efficiently while bringing you closer to your goals? Perhaps this will communicate to physicians that you understand the stress and time constraints they are under and that, rather than competing for their time, you are willing to help them work smarter, not harder.

 3. Involve the physician’s office staff 

Speaking of competing priorities, it is well known in most physician practices that it is the office staff who run the show and keep things afloat. Yet, very rarely do hospitals ever engage with them. Perhaps you have an MD who uses paper charts and doesn’t want to change to electronic records. Have you considered training his office staff in the new systems, not just the MD? Investing some time and relationship building in the people behind the physician, the ones who usually know everything about workflow and processes will go a long way in solving communication and efficiency problems.

4. Think outside the box about how to utilize scarce physician resources

Some physician specialists, Neurology, Infectious Disease, Psychiatry, and Intensivists/Pulmonologists, for example, are needed by hospitals but offer low reimbursements that require stipends to make up the revenue difference.  Additionally, high-paying specialties like GI, Anesthesia, General Surgery, and Urology that can function independently from the hospital are declining to take calls or provide inpatient services without substantial subsidies.

Call schedules are increasingly decoupled from medical staff bylaws as a requirement or constrained to only the Emergency Department leaving gaps in coverage for inpatient consults. The high rate of uninsured or underinsured complicates this as well. Partnering with physicians over these dynamics is key and developing strategies that don’t require ever-increasing subsidies is needed.

Perhaps it will involve a new way of utilizing consults. What if less expensive staff such as residents, Physician Assistants, or Nurse Practitioners round more frequently with patients, collaborating with an off-site physician specialist over a patient’s care? What if telemedicine and virtual consultations allow a physician to interact with hospitalized patients from the convenience of his own busy private practice office, cutting down on commutes or late-night visits? What if case managers worked more closely with physicians and their office staff to ensure that patients make it to their next level of care with a well-informed handoff?

Endeavor Management’s advisors have extensive industry experience in healthcare and utilize a collaborative approach to develop practical and world-class solutions. Our consultants bring a unique understanding of your direct challenges and have research-based strategies combined with sustainable implementations. Endeavor can help you analyze your physician’s relations strategy, workflows, and training, and then walk with your organization through developing long-lasting solutions that will impact your bottom line.


Diane Biery MD, MBA

Health Care Expert Advisor

Dr. Diane Biery is a physician-executive with more than 20 years’ experience in a variety of healthcare leadership roles transitioning to a consultant role to assist organizations to bring innovative solutions to industry challenges. She is committed to the equitable delivery of safe high-quality healthcare and is comfortable in fast paced, highly matrixed organizations.

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