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INSIDE THE PHYSICIAN MIND Finding Common Ground With Doctors AUTHOR: Joseph S. Bujak, M.D. PUBLISHER: Health Administration Press DATE OF PUBLICATION: 2008 127 pages

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FEATURES OF THE BOOK Inside the Physician Mind is most beneficial to healthcare organizations that are having a hard time communicating with and relating to both staff and non-staff physicians. The book contains notes and references at the end of each chapter, which is convenient for readers who want to look more deeply into the information addressed in a specific chapter.

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THE BIG IDEA Inside the Physician Mind provides an insider’s perspective to help healthcare administrators communicate, collaborate, and engage physicians in order to implement change initiatives.

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INTRODUCTION Many healthcare organizations struggle to communicate effectively with physicians, particularly when dealing with change implementation. Disruptive technologies, external change forces, evolving physician attitudes, and updated internal processes are increasing the tension on the already weak bond between healthcare administrators and physicians. Given the intensity of these changes, companies that cannot encourage their physicians to adapt to new circumstances without negative confrontations or miscommunications face a serious disadvantage.

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PHYSICIAN CULTURE It is common for physicians and healthcare administrators to clash on a regular basis. According to the author, this can be explained by significant differences in their working cultures. Outcome. Physicians focus on the outcome of situation rather than the means by which they achieve it. The healthcare industry culture, on the other hand, holds that the outcome is not important if the necessary staff members were not consulted during the process.

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PHYSICIAN CULTURE Goals. Physicians are driven by their personal visions and goals, and organizational mission statements will fail to motivate them if they cannot relate to them. If the organization can align its mission statement with the physician’s self-interest and medical vision, however, it can earn the physician’s support. Time. Physicians view time differently than healthcare administrators do. For example, “now” usually means “right at this moment,” while “now” to an administrator might mean “as soon as the paperwork is finished processing in a few weeks.”

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PHYSICIAN CULTURE Autonomy. Physicians are naturally more autonomous and individualistic; they do not collaborate often and they prefer to rely themselves. This can be attributed to their competitive nature, which embraces an “every man for himself” attitude. It is not uncommon for physicians to believe that they can do everything on their own, without practice and without outside help.

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THE PHYSICIAN’S RESPONSE TO OUTSIDE FORCES Technology has significantly impacted the medical field, particularly with regard to the role of physicians. In the past, physicians were the final decision makers for their patients, responsible for conveying expert knowledge of medicine to the patient. Since the advent of the Internet and the associated free flow of information, however, patients can visit their doctor armed with information about their symptoms or problems. Advances in diagnostic tools and equipment have also caused patients to have higher expectations for healthcare quality.

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THE PHYSICIAN’S RESPONSE TO OUTSIDE FORCES In addition, health insurance companies are proving difficult for physicians to reckon with. Insurance companies make a profit when they do not reimburse the physician, so it is often in their best interest to make physician reimbursement as difficult as possible, forcing the patient to foot the majority of the bill. When the patient is unable to pay the entire bill, the physician has essentially provided the service for free. Furthermore, malpractice lawsuits are forcing physicians to deal with increasing amounts of red tape and paperwork, and the high cost of malpractice insurance saps even more from a physician’s annual income.

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INFLUENCING PHYSICIAN BEHAVIOR For a healthcare organization to be successful, it must be able to adapt to advances in technology, which in many cases requires a change in organizational culture. Rather than being afraid of change, the organization must embrace it, and for this to occur effectively healthcare administrators need to be able to influence their physicians and gain their buy-in. There are several steps on the pathway to influence, as follows: Trust : Healthcare leaders must be willing consider the issue from the physicians’ perspective and understand their needs. Being able to convey this understanding demonstrates that the organization has the physicians’ interests in mind.

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INFLUENCING PHYSICIAN BEHAVIOR Encourage self-discovery : Healthcare leaders should ask leading questions that help the physician reach the answer the organization desires, such as the validity of a new diagnostic tool or medical technique. In this way, physicians are able to connect the dots on their own; they feel as though they solved the problem themselves; and they gain ownership over the outcome.

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INFLUENCING PHYSICIAN BEHAVIOR Know the players : When it comes to an individual’s willingness to accept change, there are several types of physicians. From most-willing to least-willing, there are proactive leaders, reactive followers, “uncertains,” skeptics, and cynics. The key for healthcare organizations is to get the proactive leaders on board; once they adapt to the change, it is only a matter of time before others follow suit. Put it together : Organizational leaders should focus on the parts of the change that already exist within the organization. They should then explain how well the change is doing in those areas to make the proposed change less intimidating.

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ALIGNING PHYSICIANS WITH HEALTHCARE ORGANIZATIONS <ul><li>Due to the rapidly changing healthcare environment, hospitals and other healthcare organizations can no longer view themselves as the physician’s sole place of employment. For example, ambulatory surgery centers now allow doctors to perform surgeries outside the hospital setting. </li></ul><ul><li>When faced with this situation, healthcare organizations have three options: </li></ul><ul><li>They can become more efficient and simplify their processes to better attract physicians. </li></ul><ul><li>They can decide to compete directly with them. </li></ul><ul><li>They can attempt to collaborate in some way. </li></ul>

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BARRIERS TO IMPROVING SAFETY AND QUALITY The aging Baby Boomer generation, combined with an increase in chronic diseases, has resulted in a significant demand for general internist physicians. However, many younger physicians are rejecting this career path in favor of becoming specialists. According to Bujak, this is because third-party payers (such as insurance companies) tend to consider specialists as more legitimate and reimburse them accordingly. In addition, contemporary specialists make more money than in the past because they can work at both hospitals and ambulatory surgery centers.

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BARRIERS TO IMPROVING SAFETY AND QUALITY Integration and systemization is essential to improving an organization’s efficiency and communications, thereby helping to prevent medical errors that can result from miscommunication. However, the physician culture’s desire for autonomy and individual accountability can inhibit potentially productive collaborations, integration, and systemization. Patient care relies heavily on individual proficiency, memory, and vigilance, and it is common for physicians to look no further than their own skills when working.

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USING PHYSICIANS TO IMPROVE SAFETY AND QUALITY Improving patient safety requires changing the physician culture, which will no doubt take time. To launch the change process, healthcare administrators should learn to focus more on prevention and less on punishment. They should also be able to understand the difference between errors, mishaps, violations, and sabotage.

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USING PHYSICIANS TO IMPROVE SAFETY AND QUALITY <ul><li>An error occurs when an individual makes a mistake when following an identified process. </li></ul><ul><li>A mishap results when an individual is distracted from the identified process and then forgets where he or she was in the process. </li></ul><ul><li>A violation is a conscious decision to ignore stated procedures. </li></ul><ul><li>Sabotage is a conscious decision to ignore stated procedures solely to cause disruption. </li></ul>

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DISTRUST BETWEEN PHYSICIANS AND ORGANIZATIONS Healthcare administrators cannot hope to influence physicians unless a foundation of trust exists between the two parties. Given their divergent perspectives, however, administrators and physicians often find it difficult to understand where the other is coming from, which can easily foster sentiments of distrust. Physicians, for example, tend to have a very narrow vision, seeing the effects of a situation only on themselves and their patients, and they have extremely short time-frame expectations. Healthcare administrators tend to have a broader, system-based perspective and maintain long-term time frame expectations.

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HEALTHCARE ORGANIZATIONS AS CHANGE LEADERS In order to successfully change their company’s culture, healthcare administrators must first identify its mission and purpose. When the culture of the entire healthcare industry is changing, it is critical for the organization to have an identifiable core value system that guides staff decision making. Administrators then need to position the organization in a way that will increase its ability to stay ahead of medical trends. They can do so by developing and implementing an innovative business development program.

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HEALTHCARE ORGANIZATIONS AS CHANGE LEADERS Organizational leaders must prioritize their change initiatives; more than one change initiative occurring at the same time risks overwhelming the staff and physicians. The most necessary changes should be implemented first. The change agents should understand that one of the first responses to any type of change is ridicule, but as long as they stay positive about the change, they will eventually gain buy-in from proactive leaders. The rest of the organization will soon follow. Company leaders must also establish metrics by which they can measure the success of the change initiative.

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