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A physician joins your practice, told that in two or three years, if he or she performs well and both parties think there is a good match, the owners will consider whether or not to let him or her buy into the practice. But two or three years is a long way off. How can you make sure that physician will be motivated enough to work hard, work smart, and do what it takes to make the practice a success?
"We’re just starting to face this issue as we grow," says Karen Buck, executive director at the Centre for Health Care Medical Associates in San Diego. Her practice has 35 physicians, 27 of whom are owners.
Buck says she has worked hard to get staff both physicians and other non-owners to take an active role in growing the business regardless of whether they have a financial stake in it. "They need a sense of ownership, even if they don’t actually own the business."
The best way to do this is to teach them how to effect change and influence the voting owners. "That means participation and inclusion," she says.
Buck’s practice includes non-owning physicians in meetings and provides them with financial data. "We don’t give them salary information, but all other financial records are at their disposal," she says. "Money is always a good way to motivate people."
Along those lines, the staff physicians see their income increase if they perform up to certain parameters both in terms of quality and quantity of care starting in their second year on the partner track.
While Buck is feeling her way through the motivational maze, Kaiser Permanente has made an art form out of getting physicians to meet organizational goals even if the structure of the organization is different from a private practice in which the owners reap the monetary rewards of success.
David Shearn, MD, director of physician education and development at Kaiser Permanente of Northern California in Oakland, says there are five basic steps he takes to ensure physicians are willing to do what it takes to meet Kaiser’s goals.
1. Listen to resistance.
"If you have a desired behavior or a goal you want to achieve and some of the physicians are reluctant, then you have to ask yourself why," he says. While most organizations are focused on quality care and the changes they institute are in the interest of meeting that goal, physicians are wary of change because they read about and hear of those organizations whose focus is cost.
"Remember that if a change is obviously in the best interest of patient care, then most physicians will go along with it," says Shearn. "In fact, most will jump over each other to do it."
Even if one physician is the only holdout, Shearn adds, you owe it to the practice to try to find out why.
2. Build consensus from within.
Physicians respond to leadership from within. If you have a physician whose behavior needs to change, Shearn says direction and counseling should come from other physicians, not from an administrator. "Change which is led by physicians works much better and much faster than change inspired from outside the community."
3. Define expectations clearly.
Kaiser had a long history of tolerating wide variations in performance, Shearn says. That has recently changed, and the organization has set targets for its physicians in a wide range of areas. "But it only works if you provide feedback to the physicians and follow through on any consequences you say will arise from not meeting goals," he says.
The feedback is particularly important, he adds, noting that physicians are by nature competitive. "If you give them information on their performance relative to the group, it can be a powerful motivator," Shearn says.
4. Use peer pressure.
Peer pressure can also work to motivate your staff, he says. "That is especially true for the outliers if you have a team setting where one’s destiny is linked to other members of the team."
5. Don’t misuse money.
Shearn says money can be a great motivator for some people, but he cautions against relying too heavily on it. "The message that comes through is that it is the most important thing, when we know that money is not the key motivator to most people. But you can use your compensation model to signal what you think is important as an organization."
Monetary rewards can even warp motivation, he adds, because it takes the internal desire to meet goals away and replaces it with an external source.
Most doctors, whether they are owners or not are motivated by wanting to do a good job, Shearn says. "It may get buried among other things, but it never gets completely lost. You just have to find a way to play on that."
Karen Buck, Executive Director, Centre for Health Care Medical Associates, San Diego. Telephone: (619) 618-5810.
David Shearn, MD, Director of Physician Education and Development, Kaiser Permanente of Northern California, Oakland. Telephone: (510) 987-4514.