As more hospitals and health systems come to understand the importance of forming a partnership with their physicians, more physician advisory groups are springing up.
While such groups can be as varied as the organizations they serve, with schedules, membership, and functions reflecting very different agendas, their underlying purpose usually falls within a fairly limited range. Check out their charters and you’ll often find language indicating that they are meant to accomplish some combination of the following considered aims:
- provide a venue for regular two-way communication
- solicit direct input on important issues
- elicit timely feedback on organization actions or concerns
- anticipate and address physician concerns
- engage physicians in decision making on either a strategic or tactical level
On the other hand, there’s nothing like a crisis to make a physician advisory group suddenly seem like a great idea.
Six Months to Never
Back in 1988, referring physicians were so angry at the University of Michigan Health System that they were threatening to send their patients elsewhere if the situation didn’t change. The main problem, explains Josie Aguirre, UMHS’s director of physician and consumer communications, was the follow-up -- or, more precisely, the lack thereof.
“In response to a survey question about how quickly they received clinical reports on their patients, a common response was ‘six months to never.’”
And thus was born the Referring Physician Advisory Council. Each clinical chair nominates two physicians to serve two- to three-year terms, for a total of 35 members who serve two- or three-year terms.
“We look for diversity in terms of geography, gender, and specialty, so it’s a well-rounded group,” says Aguirre, who is herself one of two UMHS representatives on the committee. The health system’s chief of clinical affairs serves as the primary bridge to UMHS’s medical staff, chairing committee meetings, conveying concerns in both directions in between, and assuming responsibility for follow-up.
Not surprisingly, one of the group’s first recommendations was for the health system to address the communication issue, which UMHS quickly committed itself to doing.
Today, Aguirre explains. “the system distributes clinical reports by fax to our 15,000 major referrers within five days on average.”
And those reports are a lot shorter than they used to be. “Our discharge summaries often ran to five or six pages. We asked the council for advice on redesigning the format and during a focus group meeting they worked with our health information management team to create templates for our faculty.”
According to UMHS’s biennial survey of its referring physicians, the forum is serving its purpose of channeling and responding appropriately to their concerns; satisfaction rose from a low point of 29.9% in 1988 to a steady 82.2% today. (See graph.)
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The health system is likewise happy with the results of its investment in the relationship. “Opening up this two-way interaction is probably one of the best strategies we’ve ever put in place,” says Aguirre.
Lessons Learned
Aguirre lists four factors that she feels are responsible for the effectiveness of UMHS’s Referring Physician Advisory Council.
- Full-day meetings scheduled every other year. “Initially we met every year, but we felt we weren’t able to produce very good outcomes in that time frame. Realistically, it can take up to two years for our health system to develop strategies and programs to respond to some of the physicians’ concerns.”
- Meaningful, well-structured agendas. “These are working meetings and our members are not willing to travel if the agendas aren’t well-developed.”
- Skillful facilitation. “There’s often one person who just wants to complain about things that happened six, seven years ago. Our chief of clinical affairs does an excellent job of keeping the group focused on very specific issues that have occurred over the last 12-18 months – issues we can respond to.”
- The involvement of top leadership. “That’s what draws the members. They have lunch with the executive vice president for medical affairs, the director and CEO of the hospital and health centers, and the dean of the medical school.”
Advisory councils made up of a hospital’s own physicians are likely to meet more often and deal with a wider range of issues – from growth opportunities and technological investments to quality initiatives and facility planning – and veterans of such groups offer other tips for success:
- Meet monthly or more often at the start.
- Pay the members a nominal fee for attending.
- Make sure younger physicians are represented; they often have a different viewpoint than their older colleagues
Regardless of the mission, format, or make-up of the group, two rules apply: Make sure the process is transparent, and always always follow up.
No Issue off Limits
Another example of an advisory group formed to address a crisis is the Scripps Health Physician Leadership Cabinet (PLC). Following five votes of no-confidence by the system’s medical staffs and public criticism by physicians of the system’s strategic plan, Scripps brought in new executive leadership in 2000, which promptly made alignment with its physicians a top priority.
Having asked for a formal board and gotten instead an advisory group, those physicians were skeptical of PLC at first. But even though it has no formal authority, the cabinet has “tremendous power and influence,” according to Chris Van Gorder, FACHE, president and CEO of Scripps Health. Today “physicians proactively take issues to their chiefs of staff for presentation to the PLC ‘because that’s where things get heard.’”
And no issue is off limits. Early on, for example, the PLC took up ED call reimbursement. The physicians had put a high number on the table, at the same time the system was planning to implement a raise in nurses’ pay. A task force was formed to share financial information with physicians, Van Gorder explains, and the system pledged to accept whatever amount the physicians then recommended. To accommodate the nurses, the physicians returned with a lower number.
Indeed, in the eight years of its operation, 100% of the PLC’s recommendations have been accepted.
Van Gorder and the system’s CM0, A. Brent Eastman, M.D., FACS, co-chair the group, which includes the elected chief of staff and chief of staff-elect from each hospital, along with a rotating chief nurse executive. System executives from areas such as finance and IT attend monthly meetings as guests as appropriate and there is a Q&A at every meeting, but physicians set the agenda and physicians maintain the majority vote.
And it is the physicians Scripps credits in large part when asked about the system’s financial turnaround, from losses of $10 million when the PLC was formed to an operating margin of $100 million in 2007.
Sending a Stronger Message
Sometimes an advisory council is asked to play a very specific role. Such is the case with Lancaster General Hospital’s new physician advisory group on government affairs, which is designed to amplify the efforts of the hospital and the county medical society to stay ahead of the curve on state and federal policy issues of vital mutual interest.
Jo Ann R. Lawer, Lancaster General’s director of government affairs, explains that she and the hospital’s director of physician relations are permanent members of the group, along with the executive director of the medical society. Of the five physicians appointed to terms on the committee, one spot is reserved for the society’s president.
At its first meeting this past spring, says Lawer, the group tackled one of the toughest issues facing Pennsylvania’s healthcare community: the proposal by the Governor to use some of the money from the state’s medical liability subsidy program to fund a universal healthcare initiative -- as a first step in phasing out the subsidy program.
On behalf of its physicians, “Lancaster General wrote letters, held meetings, and provided testimony about the impact of the Mcare subsidy on the ability of physicians to maintain their practices here – and on our ability to recruit new physicians.
“But we also helped the medical society with their initiatives. They had a legislative action day and we helped them get the word out and make the necessary connections. We conferred with them and they conferred with us and, as a result, I think we made the message stronger.”
Alas, it was not strong enough. “We were hoping until the day they signed the final budget agreement that we could find a way to get the Governor to change his position,” says Lawer, but he did not. Undaunted, the advisory group has put the issue at the top of its agenda for its next meeting, still hoping to influence the legislature before it adjourns for the year.
Meeting at least twice a year, the group is also expected to channel information to and from the hospital’s larger physician community, including its medical staff and employed physicians, who will be able to access regular email alerts on government affairs.
“There are so many challenges,” says Lawer. “We can’t do everything. But this group can help us set some priorities and identify issues where there is sufficient consensus for us to take serious action.”
What’s in a Name?
By its very nature, says James Reinertsen, MD, president of The Reinertsen Group, an advisory group is not in the business of making decisions. It gives advice.
At their worst, physician advisory groups can be a form of patronization; they meet when they’re told to meet and they don’t control the agenda. “There there, we gave you a voice, now go back and practice medicine and we’ll run the hospital.”
At their best, they can help steer the organization – the budget, the strategic plan, the capital plan. “And if crises come up, they’re part of the team that manages the response. They’re right in the thick of things.”
It’s how you use the group that’s important, Reinertsen says. But sometimes what you call it can be a tip-off.
“I know one group that’s called the Clinical Board of Governors. Now there’s a title that’s got some weight to it. They consider everything of strategic significance to the organization before it goes to the board; they really have a say.”