Teaching Physicians that Practicing Excellence is the Right Way to Practice

In 2002, Stephen Beeson, MD, a board-certified family medicine physician practicing with Sharp Rees-Stealy Medical Group in San Diego, was asked to serve as coach for the group’s Sharp Experience, an organizational commitment to service and operational excellence. He began compiling a war chest of material related to training and coaching physicians, and before long he had a substantial curriculum involving different elements of physician performance. Beeson thought, “I could write a book on this,” and so he did—Practicing Excellence: A Physician’s Manual to Exceptional Health Care (Fire Starter Publishing, 2006).

Beeson, who is also medical director for the Studer Group, a healthcare coaching firm, recently shared his thoughts on the importance and value of changing physician behavior to drive organizational performance.

Why did you write this book on changing physician behavior?

Over the course of years I realized that, first of all, nobody was doing it very well, and secondly, there was very little literature available in terms of what it is that gets physicians to change behavior. The book is tactical, it’s specific, and it’s designed for the frontline physician … what do I do in this era when performance reigns and patients will make choices based on their experience with me? How do I ensure my viability going forward? It’s by a physician for physicians. This is brass tacks in terms of how to actually do this stuff.

What’s the starting point for bringing about this change?

The classic paradigm of organizational change when it comes to healthcare has been that physicians are brought on board after the house is in order. Quite frankly, that doesn’t work as well, because the biggest players in the healthcare system are the physicians. They are the leaders of the healthcare team, and your ability to create cultural transformation in the absence of those of greatest influence is really compromised. When your physicians are in that place, that’s a tremendous accelerator for your ability to create culture change. So, our tactical change is early engagement of the physician, and allow physicians to lead in partnership and have a voice at the table in creating change within healthcare organizations.

How difficult is it for physicians to make this behavioral change?

What we find is that there are different categories of physicians. There are some physicians you coach; you tell them how to get this done, and they adopt it. They’re already almost there. They believe in their hearts it’s the right thing to do, and they were just sort of born that way. Those physicians are easy. It’s the other category of physicians who stand on the sidelines and say, “Show me the evidence that makes this different, and show me what’s in it for me.” And what we do for those physicians is show them the tactical behavior of the reconstruction of the patient encounter. But it’s not just about patient satisfaction and smile school, it’s about deriving better outcomes. It’s about deriving compliance. It’s about reducing your malpractice risk, and growing market share, and growing a reputation in the community. It’s about being a successful, better physician. And when you position it like that, and you couple that to the evidence-based tactics that work, physicians understand it.

Is there a second step in the process?

Yes. You have to create some accountability, because all behavioral change must be met with accountability. And we have physician scorecards where we have performance measures of how physicians greet patients, how they greet staff, how they greet each other, productivity, quality—all reflected in specific performance measures. And then you begin to pay physicians by virtue of performance, and not just productivity. If you’re really interested in transforming a culture and imbedding behaviors on a consistent basis, you have to pay doctors to do it. There are a variety of forces that create physician behavioral change, and money is one of them.

Do physicians need to improve their listening skills where patients are concerned?

Absolutely. The time it takes for physicians to express empathy is almost zero. And that’s one of the tactics that we train: to recognize the pain and suffering and discomfort that patients come in with. And not only is that the right, humane, and compassionate thing to do, but it builds patient-physician trust and loyalty. And trust is the requisite for the effectiveness of a physician. If you want to be a great physician, you can learn all you want, but if a patient doesn’t trust you, forget about it. They’re not going to do what you say. So, these are all tactics by which the great, more effective physicians operate.

Are you seeing a change in physician behavior?

Oh sure, there are changes occurring everywhere in healthcare systems for a variety of reasons. Most of it is because were are now in a regulated environment where Medicare and others are going to pay by virtue of performance. So, now we’re really interested in performance improvement, and that’s why the urgency. So, we like to say that change is happening all over the place, but a lot of it is in response to the performance, transparent accountability environment that healthcare is now evolving into.

Ed Rabinowitz is a veteran healthcare reporter and writer. He welcomes comments at edwardr@ptd.net.