If you want to improve “physician engagement”, engage….physicians. We can start this by dropping the phrase “physician engagement”. It tends to be used as a way of framing all of what is wrong in healthcare. So often I hear people declare that if we only had more physician engagement we would be able to cut costs, improve quality, etc. This is a distraction. It puts everyone on the quest to improve something that is difficult to define. The vast majority of the quality, patient safety and cost improvement initiatives I’ve been involved in over the last decade were improved through better system design. Don’t misunderstand, physician input and cooperation are important for any healthcare system design work. As a general rule, though, physician engagement seemed to follow good system design, not precede it. Unfortunately, everyone expects it to happen before any change, not after, and this becomes a barrier to the very change we wish to see.
By stating the issue is dependent on “physician engagement” we, not only make this a precondition on any solution, but we also imply that the issue or problem is being caused solely by physicians. Healthcare is a complex system and singling out physicians as the sole source of the problems in healthcare is too simplistic. In many of the studies I’ve participated and/or published, we inevitably discovered processes that either were not under the direct control of physicians, or barriers existed in the system that prevented those improvement processes from occurring despite physicians best intentions.
As an old friend of mine used to say, when we point a finger at someone, we have three fingers pointing back at ourselves. If we want to engage physicians, lets’ quit pointing a finger at them and start understanding how we can work with them to improve the system. Physicians wake up every morning wanting to do good. They are highly motivated, intelligent and already engaged in the care of patients. To suggest they are not engaged (enough), and that their lack of engagement is somehow the cause of all that is bad with healthcare is wrong. Imagine what that does to physician morale. Let’s start by framing the discussion differently and working with, not against, those who are already engaged and working to improve patient care.
Too often, physicians see “physician engagement” strategies as just another way for the system to get them to do what the system management would like them to do. This is usually interpreted as, how can we get physicians to help improve the healthcare system’s bottom line. There is nothing wrong with a healthcare system improving their bottom line, however this may not necessarily be at the top of a physician’s wish list. For physicians, the top of that list tends to be populated with things like improving patient outcomes, optimizing physician work-flows, having a greater say in their work environment, and obtaining access to risk-adjusted data about their clinical practice. Some of the best professional experiences I’ve had began by incorporating this wish list into an initiative. When physicians see a system’s leadership that cares about what is on the top of their list, “physician engagement” on the rest of the list will certainly follow.
