Second in a two-part series
The first part of this series discussed Gallup research indicating that physicians' engagement levels as "customers" of the hospitals where they practice is low, compared to engagement levels of customers in other industries (see "Can Hospitals Inspire Lasting Loyalty in Doctors?" in Related Items). So how can hospitals improve their relationships with the physicians on whom their success depends?
Physician engagement is not simply a function of the objective performance of a hospital and its staff; it's also a function of a physician's emotional attachment and the specific expectations that he or she has for the hospital.
The Role of Expectations
A physician's level of engagement is based upon evaluations of his or her experiences with the hospital and its staff members. Key factors include the physician's perceived quality of the nursing staff, ease of communication with hospital administration, and scheduling/turnaround time in the operating room. These factors contribute to the degree to which physicians trust the hospital; how fairly they feel the hospital treats them; whether they feel the hospital delivers on its promises; and their overall satisfaction with the hospital.
Physicians evaluate their experiences at a hospital through the filter of their personal expectations. For example, when a physician arrives at a nursing unit for rounds, three sets of expectations come into play:
- the self-perceived role of the physician, as defined by the medical profession (namely, their medical education training, the structure of managed care, and so on)
- the self-perceived role of the physician as a member of the hospital's medical staff
- the physician's expectations for the unit nurse
As they work together, the physician will naturally evaluate the nurse's performance, which in turn will lead to increased or decreased physician engagement. But the physician's expectations of the nurse are not the only factor. The physician-nurse relationship is also influenced by the nurse's expectations for the physician and what the nurse perceives his or her role to be when interacting with the physician.
Two key relationships exist, which will affect both physician engagement and nurse engagement:
- the alignment of the physician's self-defined role with the nurse's expectations for the physician's role
- the alignment of the nurse's self-defined role with the physician's expectations for the nurse's role
Aligning expectations is a crucial step in improving physicians' engagement with their hospitals. To promote such alignment, hospitals should take the following steps:
- Identify key "physician contact" staff members (those who interact with physicians the most -- for example, nurses).
- Define physician expectations for the roles of each member in this group. (How? Ask the physicians directly.)
- Define the expectations physician-contact staff members have for the physician's role.
- Evaluate the gaps between these sets of expectations.
- Have the physicians and staff groups work together to close these expectation gaps and reach consensus.
- Define mutually agreed-upon standards of performance.