7 Ways Hospital Administrators Can Improve Medical Staff Relations

Here are seven ways hospital executives can improve relationships with their medical staffs from Susan Reynolds, MD, PhD, president and CEO of the Los Angeles-based Institute for Medical Leadership.

1. Understand each other's needs. Listening is the most important leadership skill when hospitals and physicians are trying to align their interests. "And doctors are not always the best listeners," says Dr. Reynolds. "It's important to understand the other person's point of view before trying to be understood."

She says once administrators stop thinking about themselves and start thinking like doctors, it changes the tone of the dialogue between the two groups. Dr. Reynolds, who has coached more than 1,000 doctors and trained another 1,600 through her firm's Chief of Staff Boot Camps, says when administrators and doctors walk in each other's shoes, even for a few minutes, they come to better understand each other's specific needs and how they can better help each other to achieve success.

2. Talk inclusively. Medical staff physicians and hospital administrators need to use the transformational or participatory model of leadership to talk with each, rather than the autocratic style used in medical practice.

"Physicians are taught to give orders and their clinical team obeys the orders," says Dr. Reynolds. "However in a management setting, if physicians say, 'It's my way or the highway,' they may find it very difficult to persuade others to follow them. In transformational leadership, managers seek the opinions of people on their teams and make them feel included in solving problems."

3. Seek collaboration, rather than competition. "Fifty percent of a joint venture is better than zero percent of a physician-owned venture," Dr. Reynolds observes. "It used to be that hospitals wanted all the pie. If they gave up anything, it would only be a crumb or two, because they wanted control."

 But today, she says, physicians have more options and hospitals have more to lose. "Neither side wins when hospitals and doctors compete, and hospitals could drive doctors away into direct competition with them."

4. Align incentives. More hospitals are now employing physicians, she says. "Some of the happiest doctors I have found in my travels around the country are employed doctors. Many older physicians would fall on their swords before going to work for hospitals," Dr. Reynolds says. "But many younger physicians like being employed because it provides them with a better lifestyle and fewer administrative hassles. If a hospital pays them fairly and treats them well, relationships can be optimized."

She suggests that hospitals find creative mechanisms to incentivize doctors to participate in quality initiatives and other programs, such as participating bond transactions, which she says are financial tools relatively new to healthcare.

5. Help physicians adopt healthcare technology. The Stark III rule allows hospitals to help physicians purchase IT systems for their offices, which can facilitate e-prescribing, and provide better information for emergency room and hospital visits.

"Hospitals can finance up to 85 percent of the cost if the system meets certain criteria. Physicians really need this," Dr. Reynolds says. "Medicare is now paying more money to physicians who are providing quality data, and the only way to do this efficiently is through electronic health records. Now hospitals can legally assist physicians. Yet less than half the nation's hospitals have done this. Both sides will have to come closer together, even though over half the hospitals are losing money now because of investment losses in this tough economy. Obama's stimulus package includes $19 billion for healthcare IT, because the administration knows it will help physicians improve healthcare quality and patient safety."

6. Pay for emergency department on-call coverage. "Physicians are demanding pay for emergency department call now and many of their medical societies are passing resolutions recommending that call duty should be voluntary in order to pave the way for doctors to get paid," Dr. Reynolds says. "Doctors are increasingly refusing to take call and are no longer willing to work for free."

But Dr. Reynolds says if hospitals decide to pay, they should employ an equitable formula to pay fairly across all specialties. "You have to pass HHS' Inspector General's muster and establish fair market value. If you don't do it fairly across all specialties, you'll get chaos and have to undergo painfully negative annual negotiations."

7. Encourage Physician Leadership Development. Dr. Reynolds says the Joint Commission has recommended that hospitals develop physician-leadership development programs. "Such programs are good educational opportunities that help physicians understand hospital needs and align more closely with their hospitals on key issues," she says. "Hospitals are starting to do that and it's important. Some hospital medical staffs are dysfunctional, and their members have never been trained for leadership roles. Physicians appreciate the training because it offers them a forum to air their views and doctors always want to learn new things."

Dr. Reynolds (sreynolds@medleadership.com) is the president and CEO of The Institute for Medical Leadership (www.medleadership.com), based in Los Angeles, which provides leadership training and executive coaching to health care executives and physician leaders across the United States. She is a former emergency physician, CEO of an emergency medical center, White House advisor and executive search consultant who created a physician leadership training program for the American Medical Association prior to forming The Institute for Medical Leadership, as well as the Chief of Staff Boot Camp programs.

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