This is Part 1 of Hospital News’ 3 Part Series on effective working relationships between hospitals and physicians

Effective working relationships between hospitals and physicians: Themes from the literature

The Ontario health care system is in a period of significant transformational change. In order to continue driving the shared objective of a high-performing, integrated and sustainable health care system, a positive relationship between hospitals and physicians at all levels is critical. The enhancement of the partnership between hospitals and physicians will result in greater levels of satisfaction and engagement on the part of physicians working within robust and high-performing hospitals, which will improve both patient care and patient safety.

The importance of these relationships and their impact on the sector prompted the Ontario Hospital Association (OHA) to identify hospital-physician relations as one of its three areas of thought leadership. Working collaboratively with other health system stakeholders such as the Ontario Medical Association (OMA), the OHA has set objectives that will:

• o Identify cultural and structural barriers to the improvement of relationships;
• o Develop strategies to champion innovative models to engage physicians in hospital leadership; and
• o Improve hospital-physician alignment to enhance patient care and patient safety.

Currently, there is limited data regarding the current status of hospital-physician relationships in Canada. To better understand the issue, the OHA conducted a comprehensive review of the literature which explored:

o   Attitudes of physicians and hospital management towards a better alignment of purposes;

o   Factors affecting hospital-physician relationships; and

o   Strategies to enhance the alignment between physicians and hospital management.

The literature review canvassed Canadian, American and international research. While the nature of the legal relationship between physicians and hospitals varies across jurisdictions (i.e., employer-employee, independent contractor, or other models), the research highlights consistent themes that influence the working relationship between physicians and hospital management. The research also provides some insight into successful strategies for enhancing physician engagement; however, local solutions may need to be tailored to individual circumstances and working environments.

Additional research focused within Ontario will be helpful to better understand the strategies that hospital management and physicians are currently using to foster effective relationships. To this end, the OHA has been conducting member surveys and informational interviews with selected physician leaders and hospital management to determine the current state of hospital-physician relationships in Ontario, and to ascertain barriers and relevant best practices from a provincial perspective.

Following the review, seven considerations for leaders to reflect upon to successfully foster and maintain positive relationships emerged:

1. Supporting a culture of trust, respect and collaboration.

The foundation for building constructive and collaborative relationships is to create a culture of trust and respect among hospital boards, administrative leaders and physicians. To do that, it is important to understand and address the underlying characteristics and values important to physicians, (autonomy, time restrictions, and different styles of decision-making). Ultimately, there must be a shared commitment that promotes management’s understanding of what physicians require to provide quality patient care, and physicians’ understanding of hospital governance, management and government/legislative requirements

2. Creating shared purpose and values among hospital boards, administration and physicians.

Creating a shared purpose (mission, vision and values) with active participation by all stakeholders promotes ownership of a common agenda for all stakeholders and helps to ensure that work is driven by a shared platform of consensus and commitment to common objectives.  Roles, responsibilities and accountabilities should be clearly articulated and mutually respected.

3. Communicating effectively.

Effective communication among hospital boards, management and physicians is critical in creating a culture of trust.  Given that physicians value evidence-based data, investing in information technology can provide physicians with meaningful data to facilitate their understanding of and involvement in hospital issues.  Equally important is the need to provide timely opportunities to openly discuss sensitive issues.

4. Providing support and education to develop management skills for physicians.

An environment that identifies and supports physician leaders, and provides opportunities for individual and collective leadership growth, should be developed.  Physicians taking on leadership roles benefit from training in key areas such as change management, finance and leadership development.

5. Enhancing organizational structures and processes to support and encourage clinical leadership.

It is essential to create administrative structures and collaborative approaches to problem-solving that facilitate more effective engagement of physicians in all aspects of hospital operations.  Administrative decision-making should be evidence-based, impact-sensitive, outcome-oriented, fair, transparent, and timely.

6. Encouraging and empowering physicians to take leadership roles in the design, implementation and evaluation of a broad range of hospital and system initiatives.

Relationships are enhanced where physicians participate in decision-making at all levels of the organization, and are provided with meaningful opportunities to participate in the design, implementation and evaluation of hospital initiatives.

7. Setting clear and measurable objectives, as well as performance expectations.

Goal-setting with annual objectives and performance reviews should be developed for physicians participating in management, in a process similar to the evaluation of hospital leaders. In setting such goals, it is imperative to outline role descriptions, responsibilities, expectations, and lines of accountability.

Conclusion

While there are opportunities for further research with respect to organizational strategies used to achieve alignment between hospitals and physicians, a number of conclusions can be drawn from this literature review. Though many structural and cultural aspects of an organization contribute to creating an effective working relationship between hospitals and physicians, this article highlights the key themes prevalent in the research, regardless of hospital size, type and geographic location. The information gleaned from the OHA’s member surveys and informational interviews should provide additional insight to how organizations can be more successful in achieving alignment.

The hospital-physician relationship will benefit from further exploration, and lessons may be learned from other sectors that have successfully transformed organizational cultures in an effort to improve quality, patient experience, performance, and staff engagement. The OHA will continue to work with key stakeholders to gather leading practices in this area and share them with physicians and hospital management across the province.

Stay tuned for the next article in this series, coming in the February issue: Part 2: A Practical Approach to Enhancing the Relationship.

This article was submitted by The Ontario Hospital Association.