1. Physician Engagement…It Takes a Village
Physician engagement is critical to any healthcare organization. According to the
AMGA/Cejka Search Study, turnover costs are estimated at $1 million per physician
when active recruitment, bonuses, start-up, lost revenue, and internal costs for
interviewing and onboarding are considered. This does not include the possibility of
permanent market share loss; frequently, patients leave with their physicians. Losing
physicians can put the financial wellbeing of any healthcare organization at risk ;1
however, the cost of engagement reflected by turnover can be crippling to a small
healthcare organization. How can physician engagement be increased while
decreasing turnover? How can leadership learn to work better with physicians? Give
respect, ask for input, and communicate, communicate, communicate.
Adena Health System, located in Southeastern Ohio, employs 160 physicians in its
medical group. Before 2010, little thought was given to physician engagement. An
employee engagement survey, administered through Gallup, was measured and
reported annually. Action plans were implemented in areas where scores fell below a
certain grand mean; plans included increased mentoring opportunities for leadership.
Scores were expected to increase; however, efforts within our organization ended at
the staff level. Very little attention was given to the physicians, who Adena began
employing in 1998. Typically, if a physician left the health system, they were labeled
as “not the right fit”. It was a simple way of masking a growing problem—physician
engagement.
The 2010 physician engagement survey results showed us that 33% of our medical
group was “Actively Disengaged”, which meant they didn’t hesitate to refer to
physicians outside of Adena and were antagonistic toward Adena and administration.
Our “Fully Engaged” physicians (those who were very loyal and emotionally attached
to Adena) measured at 14%, or approximately 22 physicians. Although these survey
results were not bad, our attrition rate continued to grow. In 2010, we lost 16
physicians—more than 10% of our medical group. In 2012, we hit an all-time high,
losing 28 physicians in one year.
Understanding the Real Costs of Recruiting and Retaining Physicians, Lori Schutte, Recruiting1
Physicians Today, Volume 20, No. 3, May/June 2012

2. The 2012 survey reflected that 41% of our physician group was “Actively Disengaged”,
while our “Fully Engaged” group dropped to 8%. The results were alarming, but made
sense in context—we lost 28 physicians that “weren’t the right fit “during the year. In
order to determine the root cause of the physician disengagement trend, the
Physician Human Resources Director, Chief Learning Officer, and the lead physician
over engagement visited 28 practices and interviewed 98 physicians. After the survey
results were presented and explained, the dialogue began.
Through this process, we discovered many contributing factors to overall physician
disengagement. Physicians felt they had no input in regard to decisions being made
by administration; when decisions were made, very little context was given, and the
reasoning behind the decisions was not shared. Many physicians simply felt
disrespected by administration and by peers. The departure of 28 physicians within
a one-year period left several with a looming sense of fear—if they were unsure of
why a peer left, they often believed the move was involuntary—many suspected they
would be next.
Clearly, communication was lacking. Additional reasons for disengagement given
during the interviews are outlined below:
Adena Physician Separation Rate
2005-2013
0.00%
20.00%
2005 2006 2007 2008 2009 2010 2011 2012 2013
2.86%
7.50%
5.04%
7.63% 8.27%
10.49%
15.17%
18.92%
8.00%

3. The results of the interview process allowed us to create a focused plan of action.
1. Create a Goal
Our first action item was to establish a goal and subsequently develop a plan
around physician attrition. For 2013, we set the goal at no more than 10%
attrition. We had to have something outside of the Gallup score by which to
measure our work; we measured and tracked our work throughout the year by
utilizing an A3 annual planning tool.

4. 2. Use Peer Support
Our second action item was to create a Provider Engagement Steering
Committee. This committee was comprised of staff-level physicians and one
leader. In addition, a Nurse Practitioner and CRNA were added in order to
represent our Advanced Practice Provider group. Meetings were held monthly.
Topics for discussion included the physician frustrations voiced in the
interviews, initiatives to assist with engagement, and a re-evaluation of the
physician evaluation tool. An anonymous email account was established for
physicians to send their concerns, which were then addressed through the
committee.
3. Leadership
Physician leadership became a new focus for us. In 2008, prior to our focused
approach to engagement, a structure for physician practices and subsequent
hierarchy was established. We asked various physicians to become medical
directors, division chairs and practice leads without giving them the tools
necessary for successful leadership. In response to our 2012 survey results,
standard operating procedures (SOP’s) were created for:

5. ▪ Physician leadership expectations
▪ Role clarity between the physician leader and administrative dyad
partner
▪ Communication
▪ The evaluation process
4. Communication Expectations
The interviews made it clear that we were not soliciting enough input, we were
not taking opinions into consideration, and we were doing more telling than
listening. Expectations were defined for meeting frequency for our physician
leaders; this included individual meetings with other leaders and monthly
division meetings with all division physicians and advanced practice providers.
5. Mentor the New Physicians
Newly-hired physicians were given mentors; to qualify as a mentor, a physician
needed experience within the Adena medical group, a reputation for being
actively engaged and productive, and higher service excellence scores.
Mentors were expected to reach out their new peers and offer assistance with
questions; additional support was given through the Provider Engagement
Steering Committee.
6. Utilize EQ (Emotional Intelligence)
A physician “at risk” list was established and kept highly confidential.
Physicians were added to the list for a variety of reasons. Many were identified
as possibly being unhappy because of living away from home/family. Others
were viewed as being anxious about compensation. Some were added for being
actively disengaged. Physicians on the list were identified by their physician
leaders, administrative directors or other leaders within the organization.
When a physician was identified, the Chief Learning Officer, a certified
Emotional Intelligence (EQ) coach, began working with that individual to assess
the need or potential gap. Through EQ coaching and behavior changes,
physicians were saved who would have been lost to the system otherwise.
By saving one physician at a time, Adena only lost 12 physicians in 2013. Although 12
is still too many, , we hit our goal of less than 10%; in fact, our attrition rate fell to 5%
in 2013 (a rate we hadn’t achieved since 2007). Our hard work also made us eligible
for the Gallup Great Workplace Award, which we won for our efforts in 2013.

6. Lessons Learned:
1. Focus on leadership and the development of physician leaders. They are
trained to diagnose and treat patients, not to lead.
2. Insist that physician issues have physician input. Decisions made solely by
administration will fail without the right input.
3. Stay connected with physicians in your organization. We all have issues, and
physicians are no different.
4. Communication is critical – it cannot be emphasized enough.
5. Transparency about performance is important. Success is dependent upon the
physicians. The more they know, the better.
6. Physician engagement has to be a focus for the entire leadership team,
particularly in the C-Suite. If the organization has an incentive for leadership,
ensure that engagement is a goal for all.
7. Success, at any level, begins with engagement. Without engaged physicians,
advanced practice providers, leaders, and employees, all other work is for
naught.
8. It takes a village. Depending upon the circumstances, it should be “all hands
on deck”. Issues addressed included communication between physician division
chairs and physicians, poor office space, difficulty with staff, and assistance
needed with Information Technology. Because we, as a system, declared
engagement a priority, we acted on each one.
We still have a long way to go to reduce our physician attrition rate. The “at risk” list
is still active, and we still utilize group efforts when it comes to saving a member of
our medical group. Within the next two years, engagement will be pulled through the
organization instead of being pushed. Engagement can never be optional.
Gail Games
Chief Learning Officer
Adena Health System
September, 2014