reliability in agreements. Handshakes must be commitments that are
understood and acted upon.
5. Provide staff and infrastructure that help build physicians’ “engagement
Physician Engagement in Hospital quotient” (EQ). Make it easier for physicians to be more fully engaged
in group work via smarter and leaner reports (all board members call for
Governance Improves Performance this). Call fewer—but higher quality—meetings that have meaningful
by Jim Rice agendas, provide useful information, and promote open discussion.
Schedule some of the meetings around the physicians’ early patient care
Reviews of U.S. hospital boards over the past three years day (i.e., meet later in afternoon, after ofﬁce hours).
reinforce the conclusion that fulﬁlling a hospital’s mission
and maximizing its margin require more effective physician There is risk associated with active physician involvement in hospital board
collaboration and trust. But just when collaboration and work, however, the risks are much greater if they are not fully engaged. The
trust are needed most, hospital boards are ﬁnding these the ﬁve most common risk issues that arise as a result of increased physician
most difﬁcult to achieve. What factors frustrate or facilitate engagement are as follows:
this needed physician collaboration? What can be done to 1. As more physicians are tempted to participate in the ownership or
rekindle and nurture collaboration and engagement? operation of competing care facilities, conﬂicts of interest may arise.
Recent studies by The Governance Institute in San 2. Board members and managers may ﬁnd it time consuming to support
Diego acknowledge the growing importance of physician physician participation.
engagement in all aspects of hospital governance and the 3. Physicians may ask disarming questions about why and how strategic
common factors that frustrate this engagement. Physicians moves and investments are being made.
cite ﬁve key frustrations that reduce the effectiveness of their 4. Physicians may become more astute and assertive in their calls for
participation in hospital board work: additional capital spending.
1. Lack of meaningful and sincere invitation to participate. 5. Physician relations with staff and patients may unfairly leverage their
If physicians sense the board’s request to participate is impact on developing or executing hospital strategy.
only lip service, their enthusiasm and the quality of inter-
action are constrained.
2. Time constraints. Unfocused and unproductive processes
and meetings that are scheduled for the convenience of The Positive Circle of Physician Engagement
the non-physician board members demonstrate a lack of
understanding of the physicians’ time limitations. The pursuit of a higher physician engagement quotient
3. Lack of relevance to their practice. With technology and (EQ) in hospital governance processes can generate a
patient preferences changing, most physician specialties positive circle of results that improves the organization’s
do not need the hospital as their workshop in the same performance.
way they did 20 years ago.
4. Lack of preparation for governance processes and
decision-making roles. Physicians are rarely trained
in teamwork, medical economics, or policy making.
Resources are needed to optimize the physicians’ mean-
ingful participation in governance work.
5. Lack of compensation. It is more difﬁcult to ask for
volunteered engagement when it appears to beneﬁt the
hospital more than the physician’s practice of patients.
Five strategies have been found to be useful in optimizing
physician engagement and effectiveness:
1. Board leaders must demonstrate to their physician
colleagues that they can learn to listen, and listen
2. Remove obstacles to physician participation. One of
physicians’ most valued resources is their time. Strip away
unnecessary meetings, reports, processes, and activities.
Schedule meetings that speciﬁcally take into consideration
the physicians’ availability and convenience. Acknowledging these potential risks and adopting the strategies of openness
3. Adopt a culture of openness: open door, open communi- and engagement to minimize these risks will lead to enhanced hospital gover-
cation, and open books. Even with the threat of informa- nance and improved hospital performance. The movement toward involving
tion and insights leaking to competitors, err on the side of and engaging physicians is a positive step, but we must continue to move
transparency as a ﬁrst step toward building trust. Promote forward if we hope to strengthen our nation’s health sector performance.
this openness as a two-way street for physicians to also
share their plans relevant to the hospital’s well-being. Jim Rice is a principal in the LarsonAllen Health Care Group. Contact Jim at
4. Keep your word. Building trust requires consistency and firstname.lastname@example.org or 612/376-4571.
14 LarsonAllen EFFECT / Fall 2005