Enhance physician engagement with clear physician-organization compacts that align goals, reduce burnout and foster collaboration for a better workplace and patient care.
Physician engagement is particularly challenging for medical groups, hospitals and health systems because of the high-stakes nature of caring for patients. The traditional physician-organization relationship is also outdated as physician burnout levels remain elevated and many organizations undergo major changes, such as mergers or acquisitions.
Rather than the traditional -- and often unspoken -- agreements between physicians and their employers, a more formal compact is needed, according to Jack Silversin, DMD, DrPH, and Mary Jane Kornacki, co-founders and partners at Jack Silversin Healthcare Consulting.
The duo, who have dedicated their decades-long careers to engaging physicians and other clinicians, have worked with many healthcare organizations employing from 10 to 300 doctors to craft and execute physician-organization compacts to boost physician engagement, alignment, satisfaction and retention. Silversin and Kornacki also recently partnered with AMGA Consulting to spread awareness and develop these compacts.
"Exploring the traditional, too-often unstated compact, and how it may and may not support evolving organizational needs, has proved to be a useful method to engage physicians and drive performance improvement. Now, more than ever, this work is vital to the success of health systems across the country," Silversin said.
Fred Horton, MHA, president of AMGA Consulting, added in an interview that developing these more formal, explicit compacts with healthcare organizations he's worked with "made a very fundamental difference in the way they operated moving forward."
In a time of increasingly complex change initiations within and beyond healthcare organizations, physician-organization compacts are needed to address major workforce challenges, particularly lagging physician engagement. Without these compacts, patient care might be at stake.
Why clinician compacts are so important now
There has always been tension between physicians and an organization's leadership. Physicians are trained to make the clinical decisions best for their patients, not necessarily to consider the cost of those decisions or how to document those decisions in an EHR system. However, these might be top priorities for leaders who are charged with managing the business side of healthcare. Put simply: Expectations traditionally differ between physicians and administrative leaders.
Additionally, the healthcare landscape is vastly different from even a decade ago. For example, less than half of physicians work in private practice, according to data from the American Medical Association. Physicians have increasingly moved to hospital-owned practices, medical groups and health systems, and these organizations themselves are also experiencing major transformations.
Healthcare has seen a rapid pace of merger and acquisition activity since at least 2012, with the number of deals among healthcare organizations remaining above 90 until the COVID-19 pandemic, when general economic activity slowed. The number of announced healthcare mergers and acquisitions has rebounded since then, with 72 deals announced just last year.
That's where a lot of the frustration, the feeling of being disrespected and burnout comes from. Compacts are important now to get people on the same page, to clarify expectations and ensure the expectations brought into the organization are still relevant and helpful.
Mary Jane KornackiPartner, Jack Silversin Healthcare Consulting
Furthermore, an increasing number of healthcare organizations are comprised of physicians of various ages, races and sexes, as well as different clinical backgrounds.
"Now all these people are being brought together, and they all have different expectations, yet they need to work effectively as a team," Silversin said.
Without overtly stating or agreeing upon expectations, organizations can struggle to achieve enterprise-wide goals, such as efficiency, cost reduction and care standardization. Patient care can also suffer from misalignment between clinicians and leadership.
"That's where a lot of the frustration, the feeling of being disrespected and burnout comes from," Kornacki stated. "Compacts are important now to get people on the same page, to clarify expectations and ensure the expectations brought into the organization are still relevant and helpful."
What is a physician-organization compact?
At its core, the physician-organization compact is nothing new; when physicians agree to work for a medical group, for example, there is usually an unwritten agreement between the two parties around expectations and alignment of goals. Kornacki identified this unwritten agreement as an implicit contract. However, the implicit contract "is a major source of slow change, failed attempts at change, and strained relationships," she wrote in her bookA New Compact: Aligning Physician-Organization Expectations to Transform Patient Care.
Explicit physician-organization compacts address the challenges of the unwritten agreement to accelerate change and foster alignment. These written compacts specify the organization's responsibilities and the physician's responsibilities.
"So, when we say compact, we're talking about a deliberate process to clarify, codify, write down and agree on certain expectations that are reasonable to have and that work toward a shared vision," Kornacki explained. "And it's not just expectations du jour; it's about agreeing to do something, whether it's very simply to improve the care of our patients and the community or into the Leapfrog Group's top 100 hospitals."
The worst thing we can do as executives inside healthcare is not be transparent with what the true expectations are and what the true requirements are.
Fred Horton, MHAPresident, AMGA Consulting
"Whatever the goal or the vision is, that's where we start the conversation around expectations," she continued. "What do physicians agree to do to get to that point? What do managers agree to do to support the physicians to get to that point?"
These physician-organization compacts typically have one side that lists all the ways the physicians or clinicians plan to achieve a goal while the other side lists how the organization at large or leadership plans to contribute.
For example, the Wheaton Franciscan Medical Group once developed a physician compact for its value-based providers. The compact had five categories -- Respect, Integrity, Development, Excellence and Stewardship -- and under each category were the physician's responsibilities and the leadership's responsibilities. Under the Respect category, for example, leadership was responsible for five actions, such as "actively listen, communicate, share ideas, and support physicians" and "support physician wellness." While, under the same category, physicians had five actions, including "actively support organizational and group goals" and "encourage patient and family involvement in care and treatment decisions."
Writing these responsibilities down allows physicians to hold their leadership accountable and vice versa, enabling trust and respect across an organization. Providers at Wheaton Franciscan Medical Group also found that compacts had to have reciprocity with benefits, a shared sense of strategic imperatives that balance physician autonomy and the organization's best interest, and alignment within a changing environment.
Horton also warned that expectations need to be realistic.
"It's for the administrative team and it's for the physicians as it relates to how challenging healthcare is today and what it takes as far as performance in order to create a sustainable environment," he explained. "The worst thing we can do as executives inside healthcare is not be transparent with what the true expectations are and what the true requirements are."
How to start developing a physician-organization compact
Physician-organization compacts define the actions both sides need to take to serve a mission or achieve a goal. However, developing a compact really starts at the top, according to Kornacki.
"The first thing is that, at the C-suite level, there's a willingness to look at one's own responsibility for the situation as it exists," she explained. Deep introspection on behalf of leadership is key to starting the conversation about what needs to be done enterprise-wide to achieve goals and foster trust, satisfaction and work-life balance.
A leadership-first approach to compact development also addresses the tension between those who run the business and those who deliver patient care. Starting with leadership shows clinicians that the business side of the organization is genuinely engaging in dialogues to improve the workplace and bolster patient care.
"As far as what goes into the compact, this is one of those times when the journey is absolutely as important as the destination," Kornacki added. "It's about how we get people involved and engaged depending on how many doctors we have and how many sites we have. How do we introduce the idea? How do we get people to be constructive and engage with us?"
As leadership raises these questions to clinicians, though, the journey may experience some bumps. For example, if clinicians have a pressing issue with compensation, then dialogue around responsibilities is not likely to be constructive. Similarly, leadership may have to address situations that have left clinicians feeling disrespected.
"So, there may be pre-work because there has to be a vulnerability and introspection at the top," Kornacki said.
When clinicians and leadership can meet on a common ground, what goes into the compact is really tailored to the organization and its employees. However, a modern physician-organization compact, Kornacki asserted, moves away from a physician's "unfettered autonomy" toward more collaboration with leadership and other clinicians while still preserving a physician's ability to practice medicine as they deem appropriate.
"A phrase I like to use is: Be on the team, not above it," Kornacki stated. "Doctors obviously call the clinical shots, but it's about coming together to work."
After all, the physician-organization compact is meant to bring everyone within a healthcare organization on the same page to advance the mission.
"It really creates a team environment, and that's definitely what we need today with the amount of integration and dependency physicians have on one another for patient care within a medical group," Horton said.
Jacqueline LaPointe is a graduate of Brandeis University and King's College London. She has been writing about healthcare finance and revenue cycle management since 2016.
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