Broken Promises Injure Physician Engagement

by Rick Blizzard, D.B.A.
Health and Healthcare Editor

Communication is one step toward healing

Only 10% of physicians at the 50th percentile of Gallup's 2005 physician engagement database -- those who represent "average" ratings -- give scores that indicate they are fully engaged with their healthcare organizations. One of the sore spots is physicians' perceptions that their organization delivers on its promises -- fewer than one in eight physicians strongly agree with this statement, making it the second-lowest scoring item of the items Gallup uses to measure physician engagement.

How are healthcare organizations failing to deliver on their promises to physicians?

To attract physicians, healthcare organizations must differentiate themselves from their competitors. How? Emphasizing mission isn't enough, as most organizations have the same basic mission -- to improve the health status of the community. Promising physicians that their patients will receive high-quality care and services is not enough either, as every healthcare organization pledges to do things right and avoid medical errors. To truly separate themselves from the pack, healthcare organizations need something more.

The Kano Model of Quality

Healthcare organizations must develop a unique "brand promise" for the physician practice experience. The Kano Model of Quality, which originated with Japanese researcher Noritaki Kano, provides some guidelines for how to do this.


The first question is -- what do physicians assume will be characteristic of a high-quality healthcare organization? "No medical errors" is one assumption, which relates specifically to operational processes.

Even more importantly, physicians have assumptions about the people and the nature of relationships within the organization. Physicians expect to have access to the CEO when they have a problem, and they expect to have input regarding key decisions. They may also expect a certain level of friendliness and familiarity -- for example, they may look for nurses to greet them by name when they enter a nursing unit.

The absence of these assumed attributes will lead to dissatisfaction among physicians.


The middle section of the Kano pyramid represents things that physicians ask for, but don't necessarily expect without asking. A "STAT" lab test is one example -- if the physician perceives the test to be conducted accurately and reasonably promptly, he or she tends to be satisfied as to the level of respect and professionalism the organization exhibits.


The key to the uppermost level of the pyramid, delighting physicians, is providing positive surprises -- going above and beyond what is expected or even requested. For instance, a hospital emergency department could call a physician's office to let her know that one of her patients has left the emergency department and has been recommended to schedule an appointment. Better yet, someone from the ED could call with the patient standing by to schedule an appointment before the patient even leaves the ER.

It's important to remember that when healthcare organizations regularly provide positive surprises for their physicians, the physicians begin to expect them. Hospitals can never stop improving, because the bar is always rising. Some hospital administrators might run screaming from this proposition, but good leaders recognize it as a way to guarantee a culture of ongoing quality improvement and competitiveness.

Bottom Line

On the road to improving physician engagement, the steps are simple and logical:

  • Explicitly define your organization's brand promise, and be sure that promise differentiates you from other organizations.
  • Communicate this brand promise to your staff. Educate staff members about physician expectations and hold them accountable for fulfilling these expectations.
  • Communicate the brand promise to all physicians. The brand promise is an affirmation of what the organization is going to do to meet expectations, and it also helps physicians to shape their own expectations of the organization.
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