Baldrige as a Framework to Improve Physician Engagement

In 2016, what issues will keep the C-suite in health care organizations up at night? One common thread among those issues will most certainly relate to their own workforce, namely, physicians.

A recent Becker's Hospital Review article, the "5 Top Concerns Shared by CEOs and CMOs in 2016," looked at the top issues expected to occupy most of CEOs' and CMOs'  time and attention for the foreseeable future, and compared the issues ranked most important by both groups. Several of the issues were the same and related directly to physicians:

• Physician alignment and integration
• Disengagement, morale, turnover (all staff)
• Physician engagement and satisfaction

"Physician engagement has consistently been a strategic priority for progressive provider organizations . . . but recently, we have seen it emerge the top strategic priority in the shift to population health," said Chas Roades, chief research officer at The Advisory Board Company, who was quoted in another Becker's Hospital Review Article "CEO Survey: Physician Engagement Ranked Greatest Opportunity for Performance Improvement."

"Our research underscores that physician engagement is imperative to an organization's successful transition to value-based care models. Driving fundamental and sustainable changes to providers' business models is impossible without buy-in from the clinicians on the frontlines of patient care," added Roades.

The Baldrige Excellence Framework provides a structure to address physician engagement, as well as collaboration with and integration of physicians across a system, from leadership to operations. Feedback to Baldrige Award applicants often specifically points out opportunities for improving physician engagement by ensuring that medical staff members are integrated in decision making and given opportunities to provide input into strategy and new initiatives--without overburdening them with meetings. The questions within the framework and its Criteria can lead to suggestions on how to engage medical staff to collaboratively address challenges and actively engage physicians in care transformation to reduce variation, thereby increasing quality, improving patient safety, and decreasing costs.

For example, physicians are considered part of the workforce of a health care organization (note 5.1), and 5.1 considers the question, "How do you build an effective and supportive workforce environment?" The Core Values and Concepts of the Baldrige framework include "Valuing People," which covers an engaged workforce and internal partnerships, often with and among physicians and other caregivers. Physicians are also specifically addressed in the Core Value and Concept of "Organizational Learning and Agility."

"The path to progress," writes Mo Kasti, CEO of the Physician Leadership Institute, "lies in the overlap, beginning with physician alignment and integration, or integrated leadership."

In Baldrige, leadership has always been integrated; for health care organizations with separate administrative/operational and health care provider leaders, the term “senior leaders” refers to both sets of leaders and the relationship between them.

In addition to the award application summaries of Baldrige Award recipients, among the Baldrige community, several examples offer best practices to engage physicians:

• Baldrige Award recipient North Mississippi Medical Center's Physician Leadership Institute (see also "A Physician Hothouse for Innovation")
• Johns Hopkins Community Physicians' communications plan to better connect and engage physicians and staff members
• The ICARE culture of Baldrige Award recipient St. David's HealthCare, including its Institute for Learning and Academy for Clinical Excellence
• The "remarkable" values and coaching plans at Baldrige Award recipient Hill Country Memorial

In yet another article relating to physicians, "Studer Group: More than Half of Physicians Feel Leaders Don't Do Enough to Combat Burnout," a recent survey showed that physicians report the top factors contributing to burnout as psychological stressors, such as too much change too fast and feelings of disconnection from patients and community, and the healthcare environment and practical hurdles, like staffing and patient access.

"According to the survey, physicians would like leadership to give them a greater say in operational decisions, more leadership opportunities and access to resources and education on burnout," writes the article's author Emily Rappleye. "Physicians also felt having adequate post-call recovery time and vacation time, realistic scheduling and an appropriate balance of quality over productivity would help prevent feelings of burnout, according to the survey."

All of these suggestions, including incremental change in which physicians have input, are considerations in the Baldrige framework.

 How have you seen the Baldrige framework help encourage physician engagement?