Bridging the Administrator-Physician Divide

Healthcare is migrating into a business-environment. To successfully change, it is imperative that administrators and physicians work together.

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Test and measure, test and measure, and repeat. For an industry based on scientific principle, we sure don't apply this concept very well in terms of healthcare business. You hear a lot of ideas, ideologies and theories, but very little on testing. As you can tell, this is not going to be a sugar-coated TED talk. Let's get to it.

As a transplant to this industry, I have been fascinated by a divide that exists among decision-makers. This divide is not necessarily measurable; it has no ROI. Rather, it is a divide that results from a relationship, or rather, a lack of. The relationship I am referring to is that of healthcare's decision makers, the administrator and physician. I tested this by posting a simple observation on a LinkedIn group. My question was brief, yet precise:

I can't help but notice a fundamental disparity between key stakeholders to the decision-making in an organization, namely the administrator and physician. Why do you think there is such a large divide between the two and how do you bridge that gap?

Within 6 months, there were over 651 replies to this observation. I received an e-mail from LinkedIn explaining that they would have to close the message board since the discussion consumed the entire group for 6 months, not allowing other topics to be discussed. I instantly knew this test, a direct probe, had measured to be an industry-wide issue across all types of healthcare organizations.

In healthcare, we are often so consumed with the minutia that we often lose focus on bigger issues. I propose that we can deliver better care to our customers by teaching the business side of healthcare to all healthcare professionals, building trust, taking a teamwork approach, embracing change and driving peer-driven accountability. By implementing these suggestions, the divide between the administrator-physician relationship will disappear (or at least shrink), driving better outcomes for the patient.

This Divide - What is it, Anyway?
This divide is nothing novel. The culture of divide has been woven into healthcare's DNA for decades. So why is this culture prevalent? The responses from my test indicate that it is a misalignment of objectives. Both the administrator and the physician want to deliver services deemed both valuable and patient-centered. Yet, an inherent disconnect is the methodology of delivery. The Physician thinks that he or she is responsible for outcomes, solely, while, the administrator thinks he or she is responsible for cost containment, solely.

In recent years, a predominantly physician-managed industry has changed guards with business folk, the administrators. It should come as no surprise that the relationship has tensed as administrators have had to come to grips with tightening reimbursement, engaging in survival mode by closing service lines and turning patients away based upon insurance. All of this is perceived by the physician as the administrator saying, "Hey, physicians. Not only have you screwed up this system, but we're going to be telling you how to do it right, set baselines for 'best practices' and other terms we learned in business school and tell you how to care for your patients." Two very different disciplines and stances, yet if the two had more understanding of each other's situation, the less misaligned the core objective of delivering services deemed both valuable and patient-centered would be.

The Customer's Voice
So, where's the customer's voice in all of this? Customers of healthcare are voicing the need for cost-consciousness while delivering accessible and great care. While the three are juxtaposed, there is an opportunity to cater to this voice by addressing the administrator-physician divide.

As a customer of our healthcare system, I want to know that my physician is delivering the most advance, scientifically-backed, affordable care. For this to occur, the physician must pursue improved patient care and outcomes given the constraints of what they have: clinic infrastructure and staff proficiency. Administrators are tasked with trying to change practice care delivery into more cost effective paths. Both require each other. Imagine how much waste is created due to imbalances in this relationship.

What Can We Do?
Fear not, as correction is occurring. As reimbursement tightens, healthcare organizations must battle financial uncertainties and drive towards better quality. The system is evolving such that even the most adamant administrator and physicians must work together.

However, if we continue down this road of driving efficiencies without addressing the divide all while trying to inject the customers' voice, we are going to face increased resistance to change and frustration. So consider this checklist a test to solidify relationships of administrators and physicians in your practice:

1. Teach the business of healthcare to all healthcare professionals.
It is pivotal for us as an industry to realize that this is a business. To function like a business, we must first understand healthcare business' basic principles. This requires a shift at the most fundamental level, academia. We need to implement a practical primer that helps us shed existing solutions that are unpractical, time-prohibitive and times cost-prohibitive. I Will Change Healthcare (shameless plug) is aiming to do just that.

2. Trust.
It is pivotal for both administrators and physicians to trust and respect each other. Both share a common vision. Undermining each other makes the provider-administrator relationship toxic and leads to failure. Instead collaborate. Providers are expert collaborators. Teach administrator colleagues the art of collaborating.

3. Teamwork approach.
This requires an empathetic approach. It requires investment in people. A practice's team is a living, breathing organism. It requires nurturing, time and effort. This translates into people-investment of all individuals within the setting. "But my administrator/physician is not personable and this is not a trait that can be learned,"I often hear. A change of attitude for both administration and physicians is necessary. Fully understand the nature of your business. Know the guts of what you run. Take time out of pointless meetings or in downtime to foster relationships and increase understanding of the practice.

4. Embrace change.
The business world embraces change. Healthcare is migrating into a business-environment. Much like an organism, the healthiest organizations adapt and change.

5. Peer-driven accountability.
Here's a novel idea: why not hold each other accountable? I have come to find that each party holds the other accountable for the most part, yet cross-linking accountability is not as prevalent. We need to hold each other accountable and understand that laggards, whether they be administrator or provider, affect everyone's bottom-line.

Through peer-driven accountability, trust and teamwork we will be able to operate in an ever-changing environment. We need to identify and nurture our commonalities. We must recognize the need to understand that we are a business. As leaders we must teach this to those that emerge into this field as well as those that had entered when the environment was much different.

Neil Pithadia is founder and CEO of I Will Change Healthcare (www.iwillchangehealthcare.com), an open-source platform to discuss healthcare business issues aimed at existing and future healthcare professionals. He is also an administrator of an academic practice in Texas.

Articles Archives

One possible reason for the Divide is the realization by all that the results we all want, both personally and professionally, are constantly at risk. One day everything goes well and the next it does not, we often do not know how any of it happens and how to cause it to happen deliberately. There is one thing that seems certain, consistent good results are the product of how people operate, lead, interact, perceive benefit to themselves and what is important to them, and how they are treated, respected, made to feel they matter -- that they count. When these are in alignment the chances for success go up and when they are out of alignment chances drop.

Great article by the way.

Mike Fox,  PhysicianDecember 20, 2012


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