Executive Leaders Key to Physician Engagement with New Healthcare Structures

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In a recent article published in the Harvard Business Review, Thomas H. Lee and Toby Cosgrove examine the new challenges confronting healthcare leaders when faced with motivating physicians to react positively to newly emerging innovations in healthcare. According to Lee and Cosgrove, in order to meet the ever-evolving needs of healthcare, systems must move from an organizational structure built around individual physicians to a team-focused approach that centers on patients. Doctors must also contend with new organizational schemes, methods of working, payment models, and performance goals, and to earn support from their physicians and bring about change in the healthcare system, industry leaders must employ several key motivational levers.

Many organizations attempt to appease their doctors by giving them leadership positions and creating financial incentives based on performance. To get physicians on board with new processes and procedures, however, hospital systems must focus on providing a solid foundation on which their teams can build. "Just employing physicians and providing them with a compensation package with bonus incentives will not achieve the level of quality outcomes as a high-performing organization," says Robert Kuramoto, MD, a managing partner at Quick Leonard Kieffer. "A culture of collaborative patient-centric care must be developed and continuously grown to face healthcare's challenges. The appropriate executive leadership and experience is needed to make this transformation, and many hospital-owned physician groups will not be successful because this culture of shared purpose and teamwork has not been realized."

According to "Engaging Doctors in the Health Care Revolution," there are four motivations that drive social action: shared purpose, self-interest, respect and tradition. These motivations will be paramount in creating a positive atmosphere in which new systems in healthcare can be implemented. So how can these motivations be applied in your organization? In their article, Lee and Cosgrove provide a framework adapted from Max Weber's typology of social action. In this structure, healthcare leaders must appeal to the satisfaction of pursuing a common organizational goal in order to engage in a honorable shared purpose, provide financial or other rewards for achieving targets to satisfy the self-interest of their physicians, leverage peer pressure to encourage desired performance in order to garner respect, and create standards to align behaviors and make adherence a requirement for community membership to encourage support of tradition.

Many healthcare organizations are already utilizing the tools described by Lee and Cosgrove, with the most successful adopting all four. Hospitals like Ascension Health in St. Louis, Missouri and Brigham and Women's Hospital in Boston, Massachusetts have used all four motivational levers to reinforce the concept of putting patients first and boosting ratings of patient experience. At Ascension, administration used these levers to help their doctors adjust to a new "full disclosure" policy, while clinicians at Brigham and Women's Hospital used the motivational tools to improve the care patients receive in the emergency departments. Although these initiatives were met with resistance by staff at first, both hospitals were able to get their physicians to comply and attained successful outcomes.

"It is important to recognize that healthcare reform is changing how physicians individually have been successful both clinically and professionally," Dr. Kuramoto states. "On the other hand, many of these clinicians have given extraordinary time and care to their patients beyond any remuneration. The common denominator of hospitals and physicians is delivering high-quality and compassionate care, so it is important for both to start there and build on these principles."

In addition to their article in Harvard Business Review, Lee and Cosgrove have produced a webinar that details the framework for driving physician engagement and highlights examples where these motivational practices are used by some of the top health systems in the nation.

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