Physicians must see key barriers removed before reaching their maximum productivity.


Like many professionals, physicians are fundamentally oriented toward optimizing productivity. In order to support productivity initiatives in key physician practices, healthcare executives need to drive performance through effective leadership, incisive data and analytics and financial arrangements. They also should identify the main barriers to productivity and evaluate trade-offs created by eliminating those barriers.

Depending on the medical setting and the goals of the organization, productivity will be measured differently. It might be measured by the outcomes versus cost in a value-based primary care practice, whereas in a primarily fee-for-service setting, it might focus on the number of patient encounters per day.

Before engaging these elements to promote productivity, hospitals and other providers should review the perennial barriers to physician performance.

3 common productivity barriers

Barriers to productivity can range from the minor, such as small design problems within the facilities, to the systemic, such as inefficient document feedback, laboratory bottlenecks and slow-loading electronic health records (EHRs). 

Issues with documentation. Charts should accurately document patient care, which translates to hospitals getting paid for the work being done. Simply addressing variances in clinical documentation leads to improved communication within the healthcare team and smoother transitions for patients between one care team and the next.

Problems with the lab. A data-driven assessment of typical laboratory turnaround times and the outliers, including their causes, can uncover any consistent inefficiencies. Removing these barriers requires data to identify the issues and getting staff insight into how to fix them.

Challenges with the EHR. In terms of clinical time wasted, EHR systems often are the biggest culprits. One of the quickest ways to improve clinical productivity is to update the hardware on which the EHR is running.

To drive performance further, hospitals or departments should get into the plan, do, study, act cycle. Starting with a careful assessment of the current workflow, the process includes devising a comprehensive way to measure productivity and then implementing an incentive system that promotes responsible, achievable change.

Selecting the right leaders

As with any organizational initiative, leadership is crucial for successfully increasing physician productivity. In this case, a physician is best suited to serve as one of the initiative’s leaders. Representatives from affected services such as nursing should participate in decision-making and communication to anticipate unintended consequences during implementation and to improve adoption by the entire care team. From an operations perspective, when a physician leader is paired with a business leader, the resulting dyad can be very effective due to shared goals, metrics for success and accountability.

Choosing a physician leader is a critical decision; the physician should have a natural emotional intelligence but also may need training in performance management techniques. Physician leaders should model the desired behavior and be able to manage and coach others toward the model.

Measuring productivity

Different medical units will select different ways to measure productivity. No matter the unit, though, there should be no fewer than three metrics chosen, and their logic should be transparent. Leaders should strive to provide accessible data on current performance against all metrics as timely and as close to the point of care as possible.

In the emergency department (ED), one important productivity metric is left without being seen (LWBS). EDs with a high LWBS rate will want to identify the reasons behind this poor score. The typical source is an overly long wait time before the patient sees a physician. Data establishing this issue, and pinpointing where the delay originates, should be used to inform any efforts to fix the problem.

Consider the following example: A large health system in South Florida with between 35,000 and 40,000 annual visits in their ED had a walkout rate (people who came to the ED but left without being seen by a clinician) of 12%. By identifying the barriers in play and then responding with what is often called a provider-in-triage, the health system got the walkout rate to under 2% in 90 days. The consequent increase in patient volume essentially raised the productivity of the system’s providers, as the organization was able to see more patients without additional staff. The new triage process led to increased patient satisfaction levels and a better reputation for the health system overall. These improvements contributed to a patient volume that exceeded the difference in the original LWBS rate.

Improvements this dramatic typically will require a substantial intervention. Other metrics like patient satisfaction may respond to simpler efforts, such as better tools for assessing patient experience or provider-specific education. For example, if there’s a very productive physician whose patient satisfaction scores are low, individual training about eye contact, using the right kind of language and keeping patients and families informed may be the best course of action. If a large enough trend is identified based on patient feedback, the provider may be encouraged to create an action plan for improvement or be congratulated for exceptional work.

Ensuring incentive alignment

Designing an incentive program will depend on the nature and culture of the group, and the group’s overall objectives. Will the program be for individual performance, group-based or a mix? And will it be framed as a “carrot” or a “stick”? For example, suppose the prevailing market rate is $250 per hour, and the group is concerned about timely medical attention to patients seeking emergency care, as expressed by the average daily “walk-away rate,” or the LWBS metric. Options to consider in this case might be offering the full $250 an hour with a $20 financial downside for not meeting established patient-care objectives, or offering $230 per hour with an opportunity to earn an additional $20 per hour, up to $250, for meeting established patient-care objectives.

Another strategy is setting a threshold of performance before any bonuses are paid out. In any case, aligning the incentives to the goals is first step.Ensuring the overall and individual formulas are easy to understand also is imperative.

Outcomes and benefits

If a productivity initiative encompasses the right tools, metrics and incentives as well as addresses physicians’ and other clinicians’ concerns about workflow barriers, benefits should include increased professional satisfaction, reduced turnover and improved overall hospital culture.

From a hospital’s perspective, greater physician productivity directly affects the hospital’s ROI via increased patient volume. Well-designed productivity programs also should lead to second-order effects like enhanced reputation and quality, which spur further increases in volume and satisfaction. 


Lisa Fry is chief growth officer at Schumacher Clinical Partners, Atlanta.

Stephen Nichols, MD, is executive vice president and chief medical officer, Division 1, at Schumacher Clinical Partners, Lafayette, La.

Publication Date: Wednesday, May 01, 2019