Healthcare executives cannot let their guard down on physician satisfaction even during an unprecedented event like the COVID-19 pandemic. Even in areas that have been less devastated by COVID-19, healthcare executives may wonder how to best preserve their valued relationships with physicians as they cope with the ramifications of the global emergency.
Whether hospital operations are business as usual or upended because of a crisis, it’s imperative that healthcare executives stay focused on physician satisfaction, engagement and well-being, according to experts. “Caring about professional well-being is the way that organizations are going to best achieve the other outcomes that they are working toward, including safety, patient satisfaction, quality of care and the financial stability of the organization,” says Christine A. Sinsky, MD, a general internist and vice president of professional satisfaction at the American Medical Association.
As affiliations between physician practices and health systems continue, focusing on physician satisfaction and engagement may help executives address financial challenges and staff shortages that threaten patient care and their organizations’ sustainability, according to a 2017 study, “Executive Leadership and Physician Well-Being,” published in Mayo Clinic Proceedings.
Following are strategies for improving physician satisfaction, even during challenging times.
1. Create a culture that respects physicians and their well-being.
Prior to the pandemic, only half of physicians said they had a positive relationship with administrators, according to a 2019 survey of more than 5,000 physicians from multiple specialties by the American Academy of Family Physicians and the staffing company CompHealth. In the same study, only 31% of physicians reported that their organizations prioritized physician well-being. At the time of this writing, no large surveys of physician satisfaction with hospital leaders had been completed during the COVID-19 crisis.
To improve physician relationships, healthcare executives should create the kind of workplace in which all leaders make physician satisfaction and well-being a priority, experts say. Rather than being reactive to physician concerns, leaders should adopt a more proactive—even strategic—approach. “The CEO has to create a supportive culture for physicians, not just keep them from getting upset,” says Thomas H. Lee, MD, CMO, Press Ganey.
In its “Joy in Medicine” resources, the AMA refers to the ideal workplace environment as having a “culture of wellness,” which values self-care, personal and professional growth, and compassion. In organizations with such cultures, leaders have shared accountability for physician wellness. They include physician satisfaction as part of their strategic plan. They also may make a portion of top executives’ annual compensation dependent on the well-being, satisfaction or engagement scores of their physician workforce, Sinsky says.
In organizations that have embraced this kind of culture, leaders and physicians also share the same values and work in concert to deliver safe, coordinated and empathic care, Lee says. When leaders and physicians are aligned this way, organizations tend to have lower turnover and better health outcomes, including fewer readmissions and a shorter length of stay, he adds. (That said, he thinks it is a mistake to use financial incentives to align physicians to the organization’s quality improvement goals. “It can send the wrong message by suggesting that there’s a threshold and if physicians just get there, that’s good enough,” he says.)
The AAFP/CompHealth survey also found that only one-third of physicians felt appreciated for their work, suggesting that even during normal operations, many healthcare executives may miss opportunities to show their respect and gratitude to the medical staff.
For some physicians, working with an organization that has a culture that respects its professional staff is just as important as compensation, says Clif Knight, MD, FAAFP, senior vice president of education, AAFP. “Sometimes, compensation becomes a proxy if physicians don’t feel appreciated or respected, and they focus on how much they get paid,” he says. “But if physicians feel appreciated and respected by the organization, that goes a long way in helping them feel a sense of satisfaction and connection to the organization.”
2. Reduce the inefficiencies that irk physicians.
According to the AAFP/Comp Health study, clerical duties and administrative issues are the top tasks that hinder physician happiness at work.
“The physician workforce in this country is not working at full power,” AMA’s Sinsky says. “Physicians are working extensively, but we are misusing a lot of those hours on work that does not require a medical school education.” She believes that in most organizations, physicians could save three to four hours per day by redistributing clerical and lower-level clinical tasks to other members of the patient care team. Strategically delegating tasks also would decrease the amount of work that physicians need to do at home after normal business hours—what Sinsky refers to as “pajama time”—that is a major contributor to burnout and dissatisfaction.
EHRs are another major source of physician dissatisfaction. Sinsky co-authored a March 2020 study, “The Association Between Perceived Electronic Health Record Usability and Professional Burnout Among US Physicians,” published in Mayo Clinic Proceedings, that found a strong dose-response relationship between EHR usability and physician burnout. In terms of usability, EHRs ranked below common technologies like Excel spreadsheets and global positioning systems, according to physicians surveyed.
Many EHRs include redundancies that can make the day-to-day practice of medicine maddening. For example, Sinsky found that it took 32 clicks in her own EHR to order and record giving a patient a flu shot.
Some healthcare organizations are actively working to address such issues. For example, leaders at Hawaii Pacific Health in Honolulu implemented a “Getting Rid of Stupid Stuff” program, in which employees submit their ideas to reduce inefficient documentation practices. Their early successes were described in a November 2018 article in The New England Journal of Medicine.
Leaders can also consider technology investments like larger monitors, which reduce physicians’ cognitive workload because they can see more information on a single screen. Using badge logins, rather than requiring usernames and passwords, also helps save time and eases the burden of technology, according to Sinsky.
3. Be an accessible and transparent leader.
Whether leaders are in the midst of a crisis or managing business as usual, they need to make themselves available to physicians, says AAFP’s Knight.
At Memorial Hospital in Jacksonville, Fla., Bradley (Brad) S. Talbert, FACHE, president and CEO, rounds frequently with his leadership team. “I want to be visible,” he says. “I want the physicians to see my face and the faces of our executive team and be able to interact, share ideas and collaborate.” He even provides physicians with his cell phone number and encourages them to reach out to him directly.
With most of the 800 providers on his medical staff still in private practice, Talbert acknowledges that their needs may be different from the hospital’s needs. “It’s important that we listen and have an open dialogue so we can try to find those common-ground areas on which to collaborate,” he says.
Even during difficult times like the pandemic, he aims to be as open as possible with his medical staff. “We want to be as transparent as we possibly can at all times because that ultimately builds trust,” he says, “and when you have trust, you can have really strong relationships.”
Talbert credits these relationships for helping improve physician engagement. In his hospital’s most recent survey, 85% of the medical staff identified as “highly engaged” or “very engaged.” Since he joined the organization in 2017, the hospital also has improved how many physicians believe the hospital is an excellent place to practice medicine, moving from the bottom 10th percentile to the 67th percentile nationally.
“We’re not satisfied with that number, but it’s a tremendous improvement,” he says.
4. Give physicians a voice in capital allocations for new services and technology.
Healthcare leaders can improve physician satisfaction by working collaboratively with their medical staff to shape the organization’s investments and capital strategies, Talbert says.
A few years ago, some surgeons on staff at Memorial Hospital were disappointed by the hospital’s lack of sustained investment in robotic surgery. Although it was one of the first hospitals in the area to offer robotic surgery, leaders had failed to continue investing in and promoting the technology.
After speaking with the surgeons, Talbert and his team invested in two new surgical robots and made expanding the program an organizational priority. Since then, the hospital has seen a rapid growth in robotic procedures, from about 15 cases per month to nearly 100 cases per month. “We’ve had numerous physicians join the medical staff to take advantage of that,” Talbert says. “It’s been a real strong success story for the physicians, for the hospital and, ultimately, the patients.”
5. Turn survey results into action.
“The redesign of healthcare delivery has been accelerating for a long time, and the pandemic just makes it that much more dramatic,” says Lee of Press Ganey. In times of rapid change, like the industry is currently experiencing, Lee believes healthcare executives should survey their physicians more frequently than once every two or three years.
While more frequent surveys can provide valuable insights, it’s important for leaders to remember that physicians suffer from survey fatigue, says AAFP’s Knight. “The most important thing about surveying physicians is that you have a plan for what you’re going to do with that information,” he says.
During normal operations, and especially in times of crisis, it is critical for healthcare executives to acknowledge and address physicians’ concerns if they want to build trust. Experts say doing this and following other physician satisfaction practices can drive better outcomes—particularly when organizations need it most.
Laura Hegwer is a freelance writer and editor based in Lake Bluff, Ill.
Resources to Improve Physician Satisfaction
Healthcare Executive Magazine
Sustaining Performance With Nudges
Helping Physicians During the COVID-19 Pandemic
Health Administration Press Books
Developing Physician Leaders for Successful Clinical Integration
Change Management Leadership
AAFP’s Physician Health First portal provides resources to help physicians boost their practice efficiency, build leadership skills, practice self-care and more.
AMA’s “Creating the Organizational Foundation for Joy in Medicine” module, co-authored by Christine A. Sinsky, MD, offers guidance on implementing a culture of wellness and efficiency.
AMA’s “Getting Rid of Stupid Stuff” module helps physicians reduce inefficient EHR tasks and regain control of their day.
The Institute for Healthcare Improvement’s “Framework for Improving Joy in Work” white paper provides ideas for improving clinician satisfaction and engagement.