Physician Alignment Today May Prevent Conflicts & Lawsuits Tomorrow

By Bill Bithoney & Karen Meador

Healthcare delivery has increasingly become a multidisciplinary team activity, but along with the closer working relationships between clinicians and non-clinician administrators has come evidence of greater tensions and public conflicts. Three incidents thus far this year show how taking more proactive clinician engagement steps could have helped providers avoid infighting and focus on care delivery improvements.

Physicians Strike a Blow Against Administrators: Tensions between university administrators and University of California campus health centers came to a head when the physicians launched a one-day strike over a contract dispute. The union sought clarity over financial resource allocation, objected to a unilateral pension fund change and was dissatisfied with oversight from non-clinical managers.

A National Spotlight on Dirty Laundry: A physician’s letter criticizing an “us-versus-them” relationship brought physician-administrator relations at a Connecticut hospital into the national spotlight. The letter, which said efforts to identify $35 million in cost reductions or new revenue had negatively impacted patients and staff, was circulated to 1,600 healthcare union members. Then the local newspaper published it.

No One Wins a Lawsuit but the Lawyers: Administrators at a Minnesota hospital changed medical staff bylaws – without medical staff input – to influence appointments, and they simultaneously changed medical staff’s ability to provide input on certain patient care matters. The chief of staff responded with a lawsuit. The dispute, which rose to the state Supreme Court, appears to have originated from independent physicians’ perception that the hospital was directing emergency room patients to hospital-employed physicians.

Cooperation – a Vaccine Against Dissent

From our experience as physicians, senior managers and advisors to multiple healthcare teams, we believe that the picket line, the courtrooms and the national exposure of internal conflicts could have been prevented.

In California, having more physicians in management and on committees could have improved communication from the highest levels of leadership to all clinicians, fostering a culture of mutual respect. Management, then, would have had an earlier understanding of physicians’ concerns and could have addressed them before they escalated. Having their views represented by physicians with similar experiences, and full disclosure on administrative rationales, should have helped physicians accept and even feel some ownership for the process and outcomes, even if not all concessions were met. Engaged physicians who feel ownership over decisions and have access to decision makers are less likely to resort to a strike as a means of communicating dissatisfaction.

The same theories apply in Connecticut. While physicians and staff may not agree with every business decision, hospitals can avert public conflict by including physicians in the decision-making  – not so they have a window into the process, but so they have a seat at the table and a stake in the decisions.

We don’t know the specific steps taken to avoid court in Minnesota, but efforts to facilitate good relationships among different physician groups almost certainly began too late, nor were policies and processes as equitable, transparent and effectively communicated as they could have been.

Bringing in a third party to guide transformation that may include cost-cutting or relationship changes can help unite administrators, clinicians and staff. External leaders can more objectively evaluate all the elements of referral, financial and control issues, and ensure that decision making processes are appropriately inclusive, transparent and effectively communicated, especially if the external team is representative of the internal team and includes financial, operational and clinical experts, including physicians.

Without collaboration, infighting and costly public fights can stall efforts to shift the care delivery paradigm to value and damage not just the balance sheet and reputations, but patient care itself.
Essential Elements of Physician Engagement and Alignment
✔ Shared purpose

✔  Mutual respect

✔  Open communication

✔  Clear understanding of roles and responsibilities

✔  Sense of fairness

✔  Physician representation among administration

✔  Physician inclusion in processes that may lead to change