I agree that both physicians and hospital leaders feel that they are working in a state of siege and that the confluence of declining reimbursement amid rising expenses, complex regulations, and heightened consumer expectations make conflict inevitable. Occasionally the tensions between patient survival and organizational survival can make us forget that we agree on the “who” (patients) and “why” (to make a difference in patients’ lives) as we go through the iterative journey of the “how,” as I described in my blog post Collaborative Indifference.

I think that it is unfortunate that our differences of opinion are inaccurately linked to 98,000 patient deaths per year and offer four keys to physicians and hospitals working more interdependently to improve care for their communities.

1) Use transparency to build trust

Trust is a card house that takes years to build and only a puff of suspicion to blow to pieces. We frequently personalize differences in training, outlook, and values with inflammatory statements like, “He lied to me.” However, participating in interdisciplinary projects that benefit patients can bring vital sunshine to processes that previously were cloudy. Transparency can be a bridge to building vital trust and mutual respect.

The patient safety movement offers multiple examples, such as the work of the Pittsburgh Regional Healthcare Initiative which was among the first regional initiatives to decrease central-line infections, hospital readmissions, and medication errors. As Dr. Richard Shannon, Chair of Medicine at Allegheny General Hospital, said:

“I believe that if we eliminated medical errors, there would be no malpractice…, but the work begins with us. The work begins at the patient’s bedside. The work begins with the people that provide the care. The work begins by listening to what they know about how to make things better, not the historical top-down approach.” (Cohn et. al. “Taking a Proactive, Collaborative Approach to Malpractice Issues,” in Collaborate for Success! Breakthrough Strategies for Engaging Physicians, Nurses, and Hospital Executives, http://healthcarecollaboration.com/books/).

2) Cultivate physician champions

Physician champions are outstanding clinicians who have earned the respect of their peers by caring for patients in a consistent and reliable fashion, delivering great clinical outcomes. They are the people we turn to when we need medical care. They are also seasoned professionals looking to leverage their knowledge and experience to improve care for their community. (http://healthcarecollaboration.com/collaborative-champions/)

Possible roles for physician champions include:

• Presenting and discussing clinical data with fellow physicians
• Minimizing physician-hospital battles
• Creating a safe environment for learning
• Helping to build transparency and trust, as discussed above

3) Respect one another’s time

Showing respect for one another’s time goes beyond punctuality. It includes closing the loop on issues that are brought up, even if they are outside of our usual and customary duties but involve patients’ well-being. Keeping such activities on a dashboard reminds busy professionals of commitments yet to be delivered.

The way physicians deal with implementation issues is the way that they learned in residency with a “scut list” that describes the task, person (not committee) responsible, and the timeline. Long-term projects are OK if the steps are chunked into 2-3 week action items. Outcomes are physicians’ daily currency, and we are suspicious of process because we have had no formal training in process measures in medical school, residency, or fellowship.

4) Make time to celebrate successes

Gathering people together who contributed to a project’s success makes it easier to work together the next time. Informal communication at such events may prevent the next crisis from happening. These celebrations provide a way to publicly acknowledge people who went beyond their job descriptions to improve patient care and thus help build the culture to support recruitment and retention of outstanding healthcare professionals.

What activities have you found helpful in improving physician-hospital relations? Please send them to me at ken.cohn@healthcarecollaboration.com, and I will include them in my next quarterly ezine.

©2008 Kenneth H. Cohn, M.D., MBA, FACS