Physicians are critical to the success of all healthcare organizations. The days of physicians being separate entities practicing at the hospital as an independent contractor are fading away. Now, physicians are not only responsible for the high quality delivery of care, but they also impact the hospital’s financial performance in ways not considered a few years ago.
A single, fully-engaged surgeon at a major medical center may be responsible for over $100,000,000 in revenue from their surgeries alone. Ambulatory care physicians make key decisions about admitting and referring patients that, in turn, provide the key source of a hospital’s revenue. As we move more into the age of “Value-based Purchasing”, we also see a direct connection between a physician’s commitment to quality, ability to function in a team, practice of new concepts such as “Shared Decision-Making,” and generally being a good corporate citizen, to a hospital’s financial health.
Government and private payers are demonstrating their increased clout by reducing payments or even refusing to pay when standards of care are not met, or patients report less than appropriate attention to their needs.
At Strategic Programs, Inc., we have been assessing physician engagement and making the case that engaged physicians are more likely to deliver better care and live up to the values of their practice sites. Our research has certainly borne this out to be true.
We are starting to investigate best practice organizations and have identified some practices related to physician hiring that help ensure physician engagement by hiring for fit. The case study below relates the development of a behavioral interviewing process to include physicians:
This organization is a large, multi-site system in the Southeast. They have spent much time and effort building a set of predictive behaviors for use in hiring interviews to determine “hire for fit” for all job classifications. They want to enforce a culture of teamwork, which they define as “a desire to work closely with a variety of people towards the accomplishment of a shared goal in an environment of mutual respect, commitment and valuing of differences.” The organization has taken each of the desired behaviors and turned them into behavioral interview questions. They use the behavioral questions to determine if the candidate has demonstrated these desired behaviors in the past, as a predictor of future behavior. Credentials being equal, their hiring preference is weighted towards the candidate with a history of collaboration and team based work as opposed to the order-spouting, self-focused candidate.
They have developed a set of job interview guidelines for 10 different job categories. Each of the job categories have behavioral questions designed to determine whether the candidate has experience practicing desired behaviors tied to the organization’s values. They have also developed and implemented a training program to give all hiring managers the basics of behavioral interviewing, role play practice in class, and time to customize or add to the interview guidelines for their particular area. This organization has piloted this process with their security and environmental services departments. They are reporting less turnover, fewer disciplinary issues, and quicker enculturation for new hires.
The organization is also currently reforming their physician practice process. They have added employed physicians, enrolled a significant number of community physicians into their system-owned practice group, and are embarking on a process of defining physician behaviors aligned with their values for all future hiring and privilege granting processes. Ultimately, they want every physician practicing in their facilities to have a proven track record of not only being good medical practitioners, but good corporate citizens as well.
Next month, we will have a case study presentation of a large, Midwestern academic medical facility that has a values-based screening process for determining if a physician can practice at any level in their organization from student to staff.