I have been working with rural and community hospitals for more than 22 years and in that time, I have witnessed a mind-boggling amount of change. From the Balanced Budget Amendment to the advent of Critical Access and Certificate of Need to HIPAA to ARRA, HITECH and now MACRA and MIPS, the regulatory and reimbursement changes have come without mercy. At the same time, the impact of technology in both care delivery and care management has been nothing short of revolutionary. In the past 22 years however, the one constant that I have observed is that physician satisfaction is not only a pillar to the well-being of the community, it’s THE basis for continued financial stability at the local community hospital.
The 2016 Merritt Hawkins Physician Inpatient / Outpatient Revenue Survey points out the following.
- The average net annual revenue generated by primary care physicians on behalf of their affiliated hospital was $1,402,268.
- The average net annual revenue generated by specialist physicians on behalf of their affiliated hospital was $1,607,750
What is a happy doctor worth? A lot.
The loss of a “good doctor” in a rural community can be devastating and often it can take years to fill the void. Additionally, according to a report released by the American Medical Association in 2014, each physician contributes an average of $2.2M in economic output and supports an average of 13.84 jobs, totaling $1.1M in wages and benefits. Every dollar applied to physician services supports an additional $1.62 in other business activity.
What does this have to do with IT? More than you might think.
In a 2015 Medscape Physician Lifestyle Report, 46% of all physicians surveyed said they were burned-out, and “increased computerization of the practice” was cited as the fourth most common contributor. In the same report, 70% of physicians said that EHR technology decreased their face-to-face time with patients and 57% said that it detracted from their ability to see patients.
The answer might seem simple – just remove the information technology. However, even if that were possible, further study would indicate that isn’t necessarily what physicians want or expect. Most physicians actually would say that they see promise in Health IT adoption, but they just oppose many of the ways technology is being implemented and imposed upon them.
How can we turn physician satisfaction with IT around?
Steven Covey provides us with a time-tested path for this in his book “The 7-Habits of Highly Effective People” (I believe the Franklin-Covey organization has actually added an 8th habit now). Habit 5 is the key here though – “Seek first to understand, then to be understood.” Often in the community healthcare setting, I see a significant communication gap between physicians and the IT operation, usually causing some physician angst.
The first step in improving physicians’ attitudes toward all things IT, is for the physician to believe that their problems are completely understood. This cannot simply be solved by placing a clinical informaticist / analyst in the middle of the conversation as a “buffer” between IT and the doctors. In many cases, all this does is mask the problem and create more gaps in communication and understanding. Don’t get me wrong, this is an important role, but you cannot just throw a person into a particular job description and expect to fix issues that are systemic. For instance, what if one of the primary frustrations of the physicians is frequent downtime or systems slowness? Adding a layer between the technical folks who can solve the network performance issues and the doctor will not speed up understanding. (It also doesn’t help keep the budget in check)
How do we begin to create understanding, or even better, move from understanding to happy physicians?
The answers are simple, but the execution can be hard.
- A quality IT plan: It starts with a quality IT plan that is framed around the things that are most important to the organization. That plan MUST be informed by physician needs and wants that come directly from listening to physicians and walking in their shoes. This takes quality leadership that can balance the delicate communications and understanding that come between physician and technical staff.
- A resource plan and operational model: Once the IT plan is properly aligned with the organization’s objectives, then a resource plan and operational model should be developed to support that plan. You can’t skip this step, even though many try to. This is where the rubber meets the road and plans fail. The right resources, in the right amounts, assigned to the right tasks not only streamline effectiveness of IT, they streamline communication, which is critical for continuing Habit 5. The habit of seeking first to understand is a continual effort, not a “once every three years” sort of thing. Which leads me to the third leg of the stool.
- Standards and best practices: You must create standards and best practices that maintain performance and continuous improvement efforts. Without this, you might mask the problems for a time, but you will never fully arrive at physician confidence and happiness.
As I mentioned before, the solution statements here are pretty straightforward, but it can be a real challenge to execute well. At ICE, we have made this our life’s work. Let us help! If you do, I’m pretty sure your physicians will thank you for it.