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July 12, 2016

Most doctors aren't engaged in their work. Here are 3 ways to change that.

Daily Briefing

Editor's note: This story was updated on December 4, 2017.

Engaging doctors in cost and quality improvements continues to be a top priority as organizations navigate tremendous change and uncertainty—but leaders often don't know where to start, says Advisory Board expert Taylor Hurst, who shares three key opportunities for organizations to increase engagement.

Infographic: How to navigate the physician engagement challenge

Why physician engagement matters

Employed doctors who are engaged in their work are 26 percent more productive than their unengaged peers, according to Gallup, which translates to an average of $460,000 in patient revenue per physician per year. Other research has shown that physician engagement is negatively correlated with medical errors and positively correlated with patient satisfaction.

But what is engagement, really? It's more than satisfaction with one's job: It's the degree to which employees emotionally connect with their organization and are committed to its goals. Leaders generally have a sense for whether or not their physicians are engaged—but they often aren't sure of the root causes of disengagement or how to fix them.

And disengagement is surprisingly common. An Advisory Board survey of more than 55,000 employed physicians found that just 46 percent of physicians working at the cohort's highest performers were engaged, along with just one-third of physicians at the median-performing hospitals and health care systems.

The 3 keys to engaging physicians

While engagement is clearly a challenge for many organizations, investing time and resources in physician engagement also presents a tremendous opportunity to reduce clinical variation, increase quality, reduce turnover, and more, says Hurst, a consultant with the Physician Executive Council.

According to an Advisory Board survey analysis, maximizing engagement is, in large part, about investing in three big opportunities:

1. Give physicians real authority to lead.

Doctors want to influence strategy and improve patient care, not just have a fancy title, Hurst says. "Physicians are more inclined to take on a leadership role if it allows them to have a meaningful impact," she adds.

Too often, hospital higher-ups do not extend sufficient authority and autonomy to physician roles out of concern that physicians don't have the right experience or training to lead.

The best way to overcome this barrier is fairly intuitive, Hurst adds: Give physician leaders the same leadership support generally guaranteed for administrative leaders. Start by ensuring they have well-scoped roles that place them at "top of license" for maximum impact. Give them access to support staff and tools to help with the nuts and bolts of project management. And finally, create fair, clear goals to hold them accountable.

Providing structure and support in the beginning will enable leaders to be confident and capable later on. Then, your promising leaders will be able to have a greater impact with their limited time, which will make them more likely to continue to participate in initiatives, Hurst says.

2. Keep communication lines open.

According to an Advisory Board survey, most physicians feel uninformed about their organization's strategy. It's difficult for workers to feel engaged when they're in the dark. This can be extremely frustrating for hospital executives, who feel they spend a lot of time talking to physicians.

The problem is that organizations too often take a transactional approach to communication, which leads physicians to tune out messages.

For instance, hospitals make a lot of asks of their physicians, from adopting a new care protocol to getting a flu shot. While it's important to make such requests, it's also critical to explain the rationale and the impacts the asks will have on physicians and patients. Otherwise, physicians may feel that a lot is being asked of them for no good reason.

Hurst suggests two main fixes. First, communication must be a two-way street. Most hospitals can do much more to create opportunities for structured dialogue with physicians.

Second, leaders should more carefully consider how messages are framed. Organizations should consider the physician WIFM—the "what's in it for me"—and craft messages with that perspective in mind.

This ensures physicians understand their role within an organization's strategy, why they matter to their organization, and how the strategy benefits them.

3. Involve physicians in strategic decision-making.

Disengagement can often come down to a lack of trust. "One of the reasons we struggle with engagement is, quite frankly, many physicians often do not trust hospital administration," Hurst says.

But physicians by and large do trust other physicians. So to build support for your organizational goals, it's important to integrate doctors into strategic decision-making. Physicians are more likely to feel engaged with a strategic plan when they know their voices and interests were heard during the decision-making process.

"When you engage physicians in your most critical decisions, you become a better strategic partner," Hurst says. "It's a virtuous cycle."

At Virginia-based Johnston Memorial Hospital in 2012, engagement scores among the clinical staff were low, in part because physicians had no structure for regularly interacting with the administration.

To rectify the problem, the CMO created ways for hospital executives to regularly solicit input from physicians, including an advisory council of physicians who provide input on high-level, strategic issues. The advisory council works as a conduit between physicians and the administration, helping all physicians feel represented during important decisions.

The program has yielded gains: In just one year, the response rate to the hospital's internal engagement survey doubled, participation in internal leadership programs increased, length of stay decreased, and operating income improved.

Navigating the physician engagement challenge


Strong physician engagement impacts a host of health system priorities, including physician retention, patient experience, care quality, and organizational costs. But many physician executives feel lost when navigating the multitude of potential tactics to improve engagement among both employed and independent physicians.

Use the three steps in this infographic to help scope your physician engagement strategy.

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