The Secrets to Physician Buy-in
By
Christina Dempsey, Senior Vice President, Clinical and Operational Consulting Services
Monday, November 01, 2010
In my work with hospitals on transformational change, the one question I hear most often is, “How do you get physicians to buy in?” It's a question with no easy answers, but there is one simple fact: finding a positive solution to this issue is essential to everyone's future. With the advent of value-based purchasing and bundled reimbursement, hospitals, physicians and other providers must align themselves or perish. They won't be able to provide services at the level that will be required if they don't.
So, with that in mind, here are some physician buy-in strategies that work:
Answer the WIIFM question. While hospitals and doctors are in the business of providing care, there is and will continue to be some element of “what's in it for me” – the WIIFM question. Until you can articulate an answer to that question to physicians, you will be pushing the boulder uphill. However, when you can muster the data to show the docs how a transformation will benefit them, they will be much more likely to join strategic partnerships with you. Take, for example, the transformational change necessary to move surgeons off of one blocked day on the surgery schedule to another to ensure that the flow of patients to the inpatient units is smooth. To make sustainable improvement, the surgeons must know not only why this is important to the hospital but why it will make things better for them, too. The key to this are data. Having data that show docs that when they work on one day they have to round in multiple locations, wait to do their cases, get calls in the middle of the night from nurses who don't know how to take care of a particular kind of patient, and have unhappy patients goes a long way to demonstrating the need for change. So does showing them data that support what would happen if they moved their block to another day: placing patients on one or two units so less rounding and fewer phone calls, better access to the OR and ability to grow their practice and volume, and improved patient satisfaction (not to mention shorter lengths of stay and improved outcomes). That takes care of WIIFM!
Test it. Whether they are surgeons, hospitalists, ED physicians or staff, there is always reluctance to buy in when it sounds or looks like an edict from above. There are still trust issues between docs and administration. One way to move past that obstacle is to use trials or pilot projects. It’s also a good way to make sure something is going to work before making it a policy or long-term change. Trying something for 30 days, even changing block surgery schedules, is much easier to stomach for a physician and to sell for a hospital administrator than making a change that has no “out clause.” Using the same example, asking a surgeon to change his block for 30 days to make sure it works the way the data say that it will is much less stressful for the surgeon and his office than if it will be in place until the next time the block is revised, which may be three, six or even 12 months away. Once the surgeon has trialed it and has seen what it really means for their practice, it's much easier to make it permanent and to expand it to other surgeons.
Find a champion. When trying to implement and sustain transformational change, don’t try to go it alone. A physician champion is invaluable in these endeavors. Finding one credible and passionate physician who understands the data, understands the need and the benefit, and is willing to support the project will provide you with the ally necessary to move the project forward with the other physicians. In many of the hospitals that have had success in transformational change, it was as much a physician project as it was a hospital project. In fact, when the physicians do buy in, they can often sustain the improvement even when hospital leadership changes.
The other ally to employ in transformational change is the medical practice office manager. One hospital I worked with was even getting physicians to the table to begin the work. It had a breakfast for the office managers and explained the project to them and what it would mean not only for the hospital and the physicians, but what it would mean to the office practice as well. Hospital leaders further encouraged the office managers to get their physicians involved so that their input could be included. This hospital now has 11 physicians attending the project meetings. Don’t underestimate the influence of the office and hospital staff on your physicians. Remember to include them in assessment, planning, implementation and evaluation of success in any large project.
Celebrate success and admit failure. Not every project is going to be a resounding success. Sometimes you have to admit you went down the wrong road; ask directions and change course. There’s nothing wrong with that. More importantly, when you’ve made decisions based on data and involved your physician and staff stakeholders, admitting that things didn’t work out the way they were supposed to can actually improve trust.
On the other hand, when the project is successful shout it from the rooftops and give credit to those who helped make it a success. Speak at conferences, write articles, have parties and give prizes. Success breeds success and people understand that their contributions are noticed and appreciated (and don’t forget the office staff if they helped you get there).
Remember everyone is in it together. Patients are counting on us to get this right. Government is demanding that we get it right. As we go further down the road toward pay-for-performance and bundled reimbursement, going it alone is no longer a viable option. When the hospital does better, the physicians will do better and when the physicians do better, the hospital will too. It hasn’t always been that way, but it is now. Alignment is the key.