Fostering Physician Collaboration

Physicians rarely see eye-to-eye with their organization’s executive staff, but an environment of collaboration can soothe conflicts, according to Paul Weygandt, MD, JD, MPH, MBA.

As physician who has worked in hospital management, Weygandt, vice president of physician service at J.A. Thomas & Associates, has the unique perspective of understanding both sides. At the Healthcare Financial Management Association’s national meeting in Las Vegas, he held a session on how chief financial officers (CFOs) can improve physician alignment and engagement.

In the past, CFOs and physicians worked in separate silos, but that is changing dramatically, according to Weygandt. CFOs are paying more attention to quality because their future salary depends on it, and physician leaders are working more closely with CFOs to acquire the resources they need.

“That whole role has changed, where the CFO has to be much more collaborative with the CMO, with the chief nursing office, with the CIO, and it truly is a more collaborative management model,” he said.

Unfortunately, physicians and the executive staff don’t always work well together, and that’s mostly because they received vastly different training. Weygandt, who both went to medical school and business school, experienced firsthand the different ways these 2 groups are trained.

When a physician is confronted with a problem, he or she develops a presumptive diagnosis, and if it turns out to be wrong, the physician moves on to the next most likely diagnosis. In business school, people are taught to assemble all the information, analyze it, and work toward the one, right solution. The physician approach shows constant progress, while the business approach can take months to come up with the answer.

In order to soothe some of the conflict when physicians are looking for CFOs to help with a problem, it is up to the executive to keep the physician in the loop as they move forward.

“I found it very valuable to look at things from different perspectives and realize that there isn’t as much conflict between CFOs and physicians as we used to perceive,” Weygandt explained. “It’s that we have different ways of thinking about problems. They’re both very principled, but we need to work collaboratively to come up with good solutions.”

Weygandt also recommends creating an executive medical committee and including those members in any discussions early on when it comes to any changes. If people on the medical side are included in the executive process and endorse a concept, then it becomes easier to get the rest of the medical staff on board.

“The worst thing you can do is come up with a new initiative, like a clinical documentation program, and then tell the medical staff they must adopt it or adapt to it,” he said.

Another critical aspect for CFOs looking to engage and align physicians is recognizing the important of physician workflow and how valuable a physician’s time is. Weygandt pointed out that physicians are not only working more hours than a decade or more ago, but they’re earning less per hour. As new systems are considered, the CFO needs to considered how it will impact the physician.

He pointed specifically at ICD-10. While some hospitals Weygandt has spoken with expect their medical staff to complete 30 hours of ICD-10 instruction, he does not think it is realistic because no physician has the time to spend 30 hours of ICD-10 education. The hospital system needs to be aware of how much time physicians can actually devote and how they will learn best, and the best way to do that is by involving physicians in the decision-making process.

“The secret for success for CFOs as we move into this new accountable care era is going to be collaboration with their physician,” Weygandt said. “Not only with their physician leadership, but the entire medical staff.”