February 2016: Role of the Physician Leader and the Psychology of Integrating Physicians with a Health System

One certainty of the U.S. health system is more consolidation; mergers, acquisitions, partnerships and other integrating transactions. An increasing proportion of these transactions will include physicians; physicians coming directly from training and those who have practiced for years; those who decided “independence is no longer for me (us)”. 

Integrating transactions can take a number of forms with various terms and conditions applied, including varying compensation plans. The point of this installment of Physician Leader Coach is the need for physician leaders to be “at the table” from the beginning to manage the “psychology” of the process; enhancing the odds of success with the relationship building with physicians joining health system.

Regardless of whether the integrating event is an employment agreement or practice asset acquisition followed by employment, the senior physician leader of the organization should be engaged at the beginning of the process to understand the terms and conditions of the arrangement and to prepare the new physician(s) for their relationships with the health system. The “checklist” to follow stems from experience with the “on-boarding” of physicians with integrated health systems. The guidance is provided as a checklist for messaging. 

1. The mission, vision, values of the organization and their application to ALL who serve patients and other customers of the organization. The message here is “these matter”. 
2. “You” are now part of an organization with a singular purpose and unifying strategy. To join our organization will cause accommodation to our strategic vision for our organization. While we will respect your autonomy and judgment as a practicing health care professional. This is not a “private practice” eco-system; meaning, we expect collaboration and respect of colleagues and what we stand for.
3. While you may hold, maintain and nurture a primary relationship with patients, patients are not “your property”. All of us have an obligation and responsibility for their care as well as the experience we deliver. 
4. All work within a structure, this structure is designed to provide for an environment of respect, fair treatment and mutual support. The structure (and related policies, procedures, related rules and processes) are, by definition, a “bureaucracy”. Our goal is to minimize its intrusion on your freedoms of professionalism and job satisfaction. 
5. What may be “most efficient for you", may, in fact, impede the efficiency and productivity of the whole? Leadership and management is sensitive to your need to be productive, efficient and proficient in your practice. The goal is to balance your needs with those of the medical practice and the organization overall. 
6. All practicing professionals are subject to review by peers. Our philosophy of peer review is intended to be constructive and supportive. We believe all practicing professional can improve. The delivery of high-quality, cost effective care is a journey not an outcome. We encourage you to embrace the process. 
7. There are multiple ways for you to contribute to the ongoing progress of our mission, including ways to lodge concerns and complaints and, when necessary, there is a pathway to “the top” of the organization to make your message heard. Our goal is for you to be heard through appropriate channels. 
8. With the goal of best care for patients every time, we encourage you to use the resources of the organization, including referrals to other providers within the organization unless, in your professional judgment, patients are not well-served by utilizing resources within the organization, and to the extent that you believe it to be the case, you exercise your responsibility to inform medical leaders of your views with the supporting evidence. 
9. All members of the organization are expected to be good stewards of organizational resources. Good stewardship does not translate to “the health system just trying to save money”. The messages you convey, to colleagues, staff, patients and their families are important. As a licensed, healthcare professional in the organization you hold a respected position of influence and responsibility as a role model. 
10. The organization is making a long-term commitment to your professional development and growth as a member of the organization. You are not seen simply as a “producer of revenue”. You are, as are others, the heart and soul of the organization. 
11. Medical leadership expects to engage you with honesty, integrity and “straight talk”. We expect the same from you. 
12. We invest in the development of the staff that support you. We expect them to perform at high levels. They are with us for the same reasons as you. While they may be assigned to you, working to serve the patients you serve, they should not be considered “your employees”. This may, at times, cause concern and confusion since staff are partners in our mission, vision and display of common values. 

1-12 above is offered as a framework for establishing a healthy and productive start to a relationship. Experience shows that, often times, too little attention is paid to the psychology of the relationship. 

Experience also shows that medical leaders who take their responsibilities seriously with this process provide a solid foundation from which a productive relationship can begin. Much more often than not, physicians coming on-board will respect the intention and spirit of the process as much as the messages delivered. 

If the organizational structure includes clinical division or departments, the leaders of these units can participate with senior health system physician leaders in messaging the process. 

Non-physician leaders and divisional or departmental managers should know and understand the process so as to be supportive; especially as they participate in the early phases of relationship development with physicians new to the organization.