Integrated Delivery Systems
When physicians align: Practical steps
improve clinical quality, patient
outcomes, physician satisfaction
By Cristina Arredondo, MHA, MBA, FACMPE, FACHE, regional director, CHRISTUS Santa Rosa Medical Group,
San Antonio, [email protected]
ACMPE Fellow
D
eclining reimbursement, healthcare
reform, demographic changes, staff
shortages and service demands have intensified the need to leverage scarce resources
through the alignment of hospitals and
physicians in more efficient, effective
ways. Despite growing enthusiasm for integration, information about implementing
and evaluating integration-related initiatives is not easily accessible. There is little
guidance for medical group administrators
and decision-makers on what strategies
improve clinical quality, patient outcomes
and physician satisfaction.
Improvements in these areas should
bring physicians and hospitals together,
yet several things get in the way of successful integration, such as confusion
over common goals. For example, hospital clinical leadership is an area where
improvement is possible. Overall, administrators who employ active listening
skills, encourage trust, promote transparency and focus on developing new
physician roles will smooth the way to
successful integration.
“We have got to partner and work
together to make the system better, make
patients safer, lower costs and retain the
economic viability of both sides,” says
Chris Van Gorder, FACHE, president and
chief executive officer of Scripps Health,
San Diego.
The term “active listening” refers to a
technique or way of paying attention to
people that can make them feel like you
are hearing them. It involves making it
clear that you understand what someone
is saying. Active listening includes certain
skills, attitudes and behaviors, including
pausing, managing silence, not assuming
p a g e 2 • MGMA Connexion Supplement • October 2012
something that is not discussed and asking
for clarification. Following up with a brief
summary after a conversation to ensure
that each person has a clear understanding
of the discussion is a good practice.
Ask “Did I explain this correctly to you?”
rather than “Did you understand what I
said?” The first question places the obligation on the sender to ensure effective
communication instead of focusing on
whether the receiver got the message.
Encourage all participants in your
organization to learn and employ active
listening skills and attitudes to ensure
that they listen to what others say and
that they are sensitive about what others
need from their relationship with hospital
groups or other physician groups. Several
resources (including Toastmasters1) help
leaders learn the art of speaking, listening
and thinking.
Establishing and sustaining a culture
of trust and transparency are important
elements for successful alignment between
hospitals and physicians. Both parties
must earn and nurture trust through open
communication; mutual respect; and clear
roles, expectations and responsibilities. A
culture of trust and transparency provides
a foundation for enhanced performance.
Hospitals can improve trust by sharing
information and data openly and regularly.
This includes good, bad and uncomfortable information that impacts better
patient care and community service.
People earn trust by doing what they
say, saying what they mean and following through on promises that benefit the
hospital and community.
Once an issue that needs your immediate attention has been identified, move on
©2012 MGMA-ACMPE. All rights reserved.
“We have got to partner and work together to make the system better,
make patients safer, lower costs and retain the economic viability of
both sides.” —
­­ Chris Van Gorder, FACHE, President and CEO, Scripps Health
to prompt implementation of a solution.
Lack of prompt implementation results in
physician distrust. This can be a problem
for some hospitals as large systems may
require several steps of approval before
implementation can proceed.
Create new physician roles
Many leaders have focused their attention
on implementing business models from
other industries and high-profile companies, such as the airline industry and
Disneyland. Instead of an external focus,
organizations should turn their attention
to creating physician roles.
For example, co-management agreements offer physicians an opportunity to
participate in clinical and administrative
oversight of hospital services. Physicians
typically get compensated with a fixed
fee based on services related to improving
quality and a variable fee based on quality
outcomes. This is accomplished through
the use of combined physician and
hospital-personnel committees, which
meet at regularly scheduled intervals to
address specific assigned tasks and metrics. Accountable care organizations and
medical home projects are good examples
of new initiatives in which physicians can
take leadership roles — such as chief of
physician relations, chief of integration
and medical informatics and chief health
informatics officer — that are vital to the
organization’s success.
©2012 MGMA-ACMPE. All rights reserved.
By providing a broad range of alternatives to physician leadership roles, a
healthcare system allows more physicians
to participate in key decision-making
processes. Healthcare systems that cultivate and increase physician participation
report increased physician satisfaction and
improvement in clinical quality indicators.
One example is the Scripps Health Foundation2, which was created by Scripps Health
to provide physician services.
Develop a clear, defined statement about
why alignment is important to your organization. Share this statement with your
leaders, and develop strategies and activities that align with this statement. Some
experts say that integrated health systems
provide superior performance in terms of
quality and safety as a result of effective
communication and standardized practices. Hospitals and physicians must learn
to act more interdependently rather than
independently because they depend on
each other for success.
With a few practical steps, such as active
listening, prompt implementation and a
focus on developing new physician roles,
medical group administrators can improve
clinical quality, patient outcomes and
physician satisfaction.
Notes:
1. Toastmasters International, toastmaster.org.
2. Scripps Health Foundation, scripps.org/about-us.
Learn more in the
alignment and integration
strategies session “A7:
Partners in Healthcare:
Physician Integration
Strategies” on Oct. 22.
For more information about
the MGMA 2012 Annual
Conference, Oct. 21-24, visit
mgma.com/mgma121012S.
MGMA Connexion Supplement • October 2012 • p a g e 3