In this episode of the AMA STEPS Forward® podcast, author Paul DeChant, MD, MBA, discusses improving physician–administrator relationships and enhancing engagement. To learn more on this topic, review the related toolkit.
- Paul DeChant, MD, MBA, author
- Jill Jin, MD, MPH, senior physician advisor, AMA
Speaker: Hello and welcome to the AMA STEPS Forward® podcast series. We'll hear from health care leaders nationwide about real world solutions to the challenges that practices are confronting today, solutions that help put the joy back into medicine. AMA STEPS Forward® program is open access and free to all at stepsforward.org.
Dr. Jin: Hello, my name is Jill Jin and I am a senior physician advisor at the AMA. I also work as a practicing physician at Northwestern in Chicago, where I've been for about seven years. Today I am speaking with Dr. Paul DeChant, who is the author of the STEPS Forward® module "Building Bridges Between Practicing Physicians and Administrators." Paul, thank you so much for being with me today. And can you give a quick introduction of yourself? Tell us about your background and why you were motivated to write this module.
Dr. DeChant: Yeah, great one. It's good to see you, Jill. I spent 25 years practicing family medicine and during that time had progressive management roles in large health systems as well. I ultimately became CEO of a 300-physician group and over the course of five years, transformed that group around a theme of returning joy to patient care. We got great recognition as one of the top performing groups in the state of California, as well as moved our physician satisfaction up to the 87th percentile. And then for the last five years I've been coaching health system leaders around the country in how to pursue those similar goals.
My passion around burnout comes from my own experience, being frustrated and trying to provide great patient care and my desire to create practice processes where we as physicians can spend most of our time focused on our patients because the flow of the visit is supported by all the administrative needs that we deal with these days.
Dr. Jin: Got it. So, it sounds like you have been both on the front lines as a family medicine physician and in more recent years as a leader in the field. So why is this relationship between the two so important and why is there a disconnect as well?
Dr. DeChant: It used to be most medical groups were led by physicians, but as they got larger and we needed more complex business management we found more folks who didn't have clinical training, but had business administrative training. And without a strong focus on keeping the two of us connected, the business people can get wrapped up in strategy and finance and supply chain and other issues like that, that we as doctors don't necessarily think about all that much. And then we get frustrated because we're in kind of in two different worlds, speaking two different languages. But there's great opportunity when we come together to actually bridge those barriers and create something much better in the process.
Dr. Jin: So, Paul, it sounds like you have been both a practicing physician on the front lines, as well as a CEO and leader in the field. What motivated you to write this module?
Dr. DeChant: You know, Jill, there's a lot of things, but I think the biggest concern I have is that relationships between physicians and leaders are so broken in so many health care organizations these days. Doctors are really angry at leaders and leaders are really frustrated with physicians. We've both been put into these positions that feel as though we're being asked to do the impossible by the other, or the leaders feel like the physicians just aren't listening. You know, "We need more revenue coming in—why can't these doctors just work harder?" Meanwhile, the doctors are working so hard because the workflows just don't work and we have to work so hard just to do the work we used to do. And why can't those administrators understand this? And and it ends up being a really dysfunctional relationship. And there's so much opportunity to fix them by following some of the steps that are in this module.
Dr. Jin: And in order to bridge those barriers, you provide us with four excellent steps in the module. So, the steps are: one, to assess the status of the relationship; two, open communication channels; three, educate physicians and administrators in each other's roles; and four, most importantly, build trust. Can you give us a brief overview of what each of those steps covers?
Dr. DeChant: First of all, assessing the relationship, surveys are important. There's burnout surveys, engagement surveys, provider satisfaction surveys—each of them can provide valuable information if people participate and you dig into them deeply and understand them. There's also warning signs. When we see doctors leaving, we see high turnover rates, that tells us that something's not going right when we hear more complaints coming from patients, staff or other physicians; that can also be a sign. So there's both formal and informal ways to assess that.
Opening up communication channels. We can create a forum between the CEO and frontline physicians that can be an informal meeting over breakfast or dinner. We can create other more formal processes as well. Many places do town hall meetings. There's communication, written communications and CEO updates—different approaches like that that can make a difference.
That third step, educating clinicians and leaders about each other's world. A great way for administrators to learn about the physician world is have the administrator shadow physicians while they're working. And while it can feel a little funny at first, it's incredibly powerful when particularly a non-clinician administrator spends time following a clinician. And I found even for myself as a CEO, once I stopped practicing, it was so valuable for me to shadow different specialties and realize that the challenges in each vary, and if we're going to create a great workplace for everyone we have to be very cognizant of what those individual challenges are.
Also, for physicians to understand leaders, developing leadership training for physicians. This can be somewhat informal, but organizations that bring in external physician leadership education can make a big difference particularly if we pair physicians with non-physicians in both that leadership training, as well as in some administrative roles. Oftentimes we see dyads in leadership roles where a physician and the non-physician partner are in charge of a clinic or a department or a division, and as they work together, that builds amazing trust when we're actually working together and solving problems together.
A great way to help build trust is to develop what are called organizational compacts. Every organization has mission, vision and values, and you can see these values written up on a wall somewhere. And they’re always good, but they're oftentimes not very meaningful to practicing clinicians, and can get lost in the rush of all the changes, challenges that we're dealing with.
A compact is a meaningful process of taking each of those values and having initially a leadership team spend a good day or so thinking through each value. When we say that is a value, we talk about how to honor that value and oftentimes we'll see organizations where they've got a value and then a statement of how everyone's expected to honor the value. The compact, one that's done well, will even take that a step further and talk about not just what's expected for each of us to do, to honor the value, but what's expected for the organization to enable everyone to honor that value more effectively.
So if our value is quality and one of the steps to honor that value is to close care gaps at every visit, the organizational responsibility to empower that is to make sure we have the tools we need in order to do that effectively. Whether it's working as a team, having a registry, a number of other factors that make it so that we're actually able to do that without adding a significant extra burden that the poor docs out there just slugging away on their own, trying to make sure that every A1C has been done and all the eye exams are done and you name it, that we really build teams and systems that enable those things.
And for every single value, it should be a reciprocal agreement. And those reciprocal agreements, while they can get drafted initially by a leadership team, they have to get vetted as broadly as possible throughout the organization. And that can take six months or a year through different department meetings or other places actually putting that draft out there, getting feedback from all the frontline clinicians, what makes sense in this, what doesn't, how can we improve it, pulling all of that back together, and then coming out with one document that everyone's had a chance to have some input on. Not that every single person's thoughts get into that full document, but that everything's been heard and we have a chance to come up with a much broader, accepted and developed document that is reciprocal. It's here's the value; here's how we honor it; here's how we have the organization make sure people have the capacity to honor it well.
Dr. Jin: Are there any final pearls of wisdom that you can offer to our readers?
Dr. DeChant: So, if you're a leader, make the time in your schedule proactively to shadow clinicians and start that process gradually, first with people who know you and trust you, and as your reputation builds to somebody to shadow as well, you can spread that.
If you're a physician, invite a leader to shadow you. There's a whole process around how to shadow effectively that we go into some in the module. Oftentimes physicians feel like someone's coming to shadow them, they're stupid, and they're trying to find something wrong with them. No, it's the opportunity to help the leaders understand the challenges you face. So, if you're a leader, shadow; if you're a frontline clinician, invite a leader to shadow.
Dr. Jin: Very well said. Thank you, Paul, so much for being with us today and for taking the time to write this module that will be so useful for both aspiring clinician leaders as well as administrators and anyone looking to improve their practice and the trust and transparency in their relationships. For me personally, it was such a useful module to read as a clinician. And it kind of makes me appreciate my administrators a little bit more, to be honest. So, thank you again for taking the time for contributing your expertise and wisdom.
Speaker: Thank you for listening to this episode from the AMA STEPS Forward® podcast series. AMA's STEPS Forward® program is open access and free to all at stepsforward.org. STEPS Forward® can help put the joy back into medicine by offering real world solutions to the challenges that your practice is confronting today. We look forward to you joining us next time on the AMA's STEPS Forward® podcast series, stepsforward.org.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.