When everyone is moving forward together, success takes care of itself. The question is, how is success defined? At hospitals and health systems, there are various clinical practices and administrative personnel that collectively drive the success of the hospital. All too often, these various service lines operate in silos, with little interdisciplinary communication and even less engagement with the overall vision of the hospital and health system. These silos contribute to poor clinician satisfaction and patient experience, inefficiencies, and ultimately poor patient outcomes and financial outcomes for hospitals and health systems. In my experience improving performance at various hospital-based physician practices and hospital-system clinics, aligning physician practice goals with hospital and health system goals is one of the most influential ways to secure a sustainable future for your hospital, fulfilling career for your clinicians, and positive outcomes for your patients.
The Power of Alignment
Consider the concept of alignment outside of healthcare and its power becomes clear. For example, a rowing team must row in the same direction at the same pace to be most powerful and effective. Likewise, at a hospital, when all stakeholders understand the overall vision and goals of the hospital, have a voice in the process of achieving those goals, and are incentivized to help achieve them, alignment happens.
In order for a hospital to thrive, leadership and clinician teams must move in tandem and operate in agreement. Uniting around shared challenges and objectives, opening communication channels, and nurturing a collaborative approach to organizational improvement builds trust. This trust builds a foundation to surface ineffective processes, break down operational and interpersonal barriers, and give everyone the chance to feel heard and understood. This part of the journey is not glamorous, but it is deeply necessary.
When all hospital service lines are aligned with the hospital’s overall vision and objectives, the result is high-quality patient care. Physicians are more engaged, patient health outcomes improve, patients are more satisfied, community perception flourishes, and even organization bottom line improves. In this post, I outline strategies to get there. My post primarily focuses on the emergency department, but the concepts and strategies are generally applicable across all specialties.
1. Give Everyone a Voice
Take time to hear all stakeholder perspectives
I believe alignment starts with one simple question: “what is one thing I can do to make your life easier?” This requires interfacing with the human beings that make up the team you want to align with. This could be the emergency department, the operating room, or an outpatient clinic. Envision this as data collection. Walk through the practice. Notice the environment and the energy. Ask each one staff members that crucial question. Take note of the dynamics between nurses and physicians. Watch how patients are being attended to.
The observations you make and feedback you receive are what will ignite and inspire the performance improvement initiatives you design. The individuals you meet and perspectives you hear will inform who comprises the interdisciplinary teams that will lead these projects. This is your starting point.
It is imperative that this process of data collection is not performative. If you, as the leader of an organization, are going to take your own and others’ time to glean the information, you must do something with it.
Create accountability, make measurable goals, and always (I mean always) close the loop with physicians, nurses, and other front line staff who have shared feedback with you. Even if you cannot execute on something now – or ever – follow up and tell the individual why. Demonstrate that you listened. Show that your teams that they can depend on the hospital and those at its helm to care about them, use their input, and take their thoughts seriously.
- Ask all staff, “What is one thing I can do to make your life easier?”
- Design performance improvement projects with front line staff
- Increase interdisciplinary meetings among program leaders
- Ask team members to hold you and each other accountable
- Close the loop
2. Create a Problem Solving Culture
Empower your teams
One key reason that closing that feedback loop and exhibiting accountability is important is that it reinforces this alignment as a permanent solution rather than a quick fix. Your goal is to not be a firehose; to not simply come in and snuff out the obvious crises just to leave things charred and susceptible to more damage. Your goal is to create a sustainable, problem-solving culture that is equipped to stay beyond extinguishing; to clean up, repair, and restore.
Defining and living core values: Embody the culture you want to see and practice the core values you preach.
Investing in your teams: Not all things can be solved with money, but financially investing physicians via culture-focused training, education and peer review, meaningful support systems, and more proves that it is not all talk.
Hiring intentionally: Whenever possible, go beyond simply filling a role with a warm body and instead only select candidates who are on board with the goals, initiatives, and culture you are striving toward.
Setting up guardrails then giving trust: Clear parameters and guidelines are critical to ensuring patient safety, but once they are set up, give your ED staff latitude to flex creativity in decision-making, devise innovative solutions to clinical and operational issues, and showcase organizational core values in their own unique ways. The culture naturally becomes more collaborative when providers and staff are empowered to come up with a creative solution to a problem in real time.
- Define and live core values
- Invest in leadership training and development
- Prioritize hiring a culture-focused medical director and team
- Focus on positive communication, and respect at every interaction
- Focus on improving doctor-nurse communication
- Encourage creativity
3. Put Incentives in Place
Incentivize your team’s efforts
An alignment strategy I have seen work time and time again in a variety of practice environments is creating thoughtful, contractually shared incentive plans for providers who achieve shared objectives. These incentives are based on clearly stated goals and vision statements. This approach is only effective if the providers and frontline staff not only know what the goal is (for example, improving throughput) but why it is important goal (it impacts patient care quality, reimbursements, etc.).
These incentives can feel transactional, but when they are supported by robust communication about the “why” behind the goals and mutual investment (by the hospital and the physician group) in interdisciplinary efforts to achieve the incentivized goals, they can be a powerful, meaningful motivation for our provider teams.
- Clearly document and communicate shared goal
- Create shared incentives
- Create space for education and peer review
- Encourage interdisciplinary process improvement efforts
Well-Aligned Teams deliver a Strong ROI
Below are a few high-level examples of the alignment strategies outline above working well to drive care quality, efficiency, patient satisfaction, provider satisfaction, and financial wins for the hospital and provider group.
EXAMPLE 1: LEVEL 3 TRAUMA CENTER, VOLUME: 40,000
The ineffective leadership, broken communication patterns, and dwindling trust that pervaded this organization made it difficult to attract and keep dedicated clinicians. Through our efforts to catalyze change in clinical leadership, align teams around shared goals, and overhaul communication expectations, the hospital was able to:
- Reduce length of stay 6%
- Build staff from 60% to 100% recruited
- Drop left without being seen metrics from 2.3% to 1.2%
EXAMPLE 2: RURAL ED, VOLUME: 17,500
This site struggled with abysmal efficiency metrics and high levels of tension between nurses and physicians. Burnout was rampant and staff engagement was low, leading to continual conflict and poor patient satisfaction. Our team worked with the emergency department to initiate real, lasting changes to culture and behavior, resulting in:
- A shared vision of organizational goals
- Renewed relationships and trust between clinical leaders and their teams
- Decreased left without being seen metrics from 4% to 0.85%
- Reduced length of stay by 28%
- Reduced transfer rate from 9% to 6%
If you take away anything from this….
This process of aligning and culture-building will not be perfectly smooth – transformation rarely is smooth. The important thing is to work on creating a place people want to come to work and work together. In my experience, when performance improvement projects bear fruit, it is because people felt aligned behind the goal of the project, they saw the fruit of their labor, and they felt they had an impact on making their team more effective.
This effort begins with giving everyone a voice, acting on their feedback, breaking down silos, empowering your team to problem solve creatively, and putting financial incentives in place to reward these efforts. The result is better patient care, happier providers, and a better bottom line for your facility.
Perhaps you begin by uniting your hospital leaders and physicians around the common goal of advancing patient care. Perhaps you explore what has been done to align at your organization in the past to figure out what went wrong and what could be replicated. Maybe you source support from a reliable, committed partner who can drive performance improvement forward. The important thing is to start.
Interested in learning more?
My (virtual) door is always open. Please feel free to contact me at firstname.lastname@example.org.