Best Hospitals Nurture the Emotions of Engagement

Second in a two-part series

Tension between physicians and hospitals is nothing new, but according to a report in the American Medical News, a weak economy, compounded with an intense public focus on quality of care issues, has further frayed the relationship -- and more and more disputes are ending up before a judge.

Gallup research indicates that a key problem between hospitals and physicians is the perception among physicians that hospitals do not deliver on what they promise (see "Physician Engagement is Built, not Bought," in Related Items). However, some hospitals are doing a better job than others are of building good relationships with their physicians. To determine what separates average hospitals from great hospitals when it comes to engaging physicians, Gallup compared hospitals in its database scoring in the 50^th percentile for physician engagement to those scoring in the 90^th percentile.

What Sets Best-Practice Hospitals Apart?

A physician's level of emotional attachment to the hospital where he or she works can be divided into four basic levels:

To determine what most differentiates "best-practice" hospitals from the rest, Gallup researchers analyzed the responses of over 7,000 physicians to its eight emotional attachment questions (two questions for each level), and determined the differences in scores (namely, deviations) on each question between 50^th percentile hospitals and 90^th percentile hospitals.

It seems logical to assume that physicians at best-practice hospitals would score higher on the levels at the top of the emotional attachment hierarchy -- which are represented by the items that are often the most difficult to get agreement on -- than physicians at average hospitals. Gallup's data validates this assumption. Best-practice hospitals score substantially higher than average hospitals on all "Pride" and "Passion," attributes, suggesting that emotion is really the key differentiator.

Success on the Pride measures occurs when physicians define themselves as proud members of their hospital. "Passion" is the strongest emotional connection between the physician and the hospital. Doctors feel Passion when they see a perfect fit between their needs and the hospital. They view the hospital as irreplaceable.

All levels of the hierarchy tap into emotions, however Pride and Passion are often the most difficult to achieve. In order to achieve these feelings of Pride and Passion in their doctors, hospitals must align expectations between the medical staff and the hospital's mission. These emotional elements are almost impossible to standardize because they come about through the quality of physicians' interpersonal relationships -- with the board, management, and staff.

Relationship Breakdowns Destroy Pride and Passion

So the establishment of a climate that inspires Pride and Passion takes place one situation, one interaction at a time. A single case of relationship mismanagement can shatter the trust and respect that underpin these emotions. Take, for example, the controversy generated by some hospitals' use of screening policies as way to control emergency room use by the poor and uninsured populations.

Hospital executives view this as a fiduciary responsibility that better positions their facilities to achieve the healthcare mission. And physicians would certainly expect their hospitals to maintain financial viability over the long term. But physicians have also taken an oath to serve all patients, regardless of their ability to pay, a principle that is also part of the AMA Code of Ethics.

Turning patients away generates a clash of ethics and expectations, and creates a crucial moment in physicians' relationships with their hospitals. Once a solution is implemented, will emergency department physicians still be proud to practice at these facilities? Will they feel they are perfect places for them to practice? Will they view their emergency departments as irreplaceable? Will they feel it is a hospital they can trust?

Hospitals and physicians must find common ground on unpopular decisions, and the best become adept at doing so. Such facilities stress open communication between the administrative and medical staffs, and make every effort to involve the medical staff in important planning and implementation of decisions. In doing so, they view tough decisions as opportunities to establish Confidence, Integrity, Pride, and Passion among all employees.

Bottom Line

Physician engagement and loyalty to the hospital can't be bought with new equipment or technology. It can't be acquired through the development of new policies and procedures. Absence of these things may cause physicians to treat their patients elsewhere, but they alone will not produce long-term bonding.

Engagement is an emotional condition, based on interactions with people at all levels within the hospital. Hospitals in which physicians believe they are well-treated are well on their way to having engaged medical staffs. Hospitals with doctors who don't feel this way have failed to differentiate themselves and are vulnerable to physician turnover. Strong negative emotions among physicians toward their hospitals could lead to hostile relationships, and hospitals with such problems can be next in line for medical staff lawsuits.