The external market pressures facing healthcare providers today are well documented. Payors are increasingly steering patients toward lower-cost sites of care, growing consumer demands require organizations to see patients when and where patients choose, and nontraditional market entrants have the capital and scale to ensure both things happen. This competition for market share and patient loyalty is forcing provider organizations to continually assess their capability to provide high-quality, consumer-focused care. Each market is unique in its payor landscape, competition, and patient population. However, the initiatives to reduce costs, improve access, and enhance population health capabilities are worthwhile strategies in every market. A transformation of the physician enterprise is often required to achieve these goals. Due to operational, technological, and political complexities, many organizations struggle to implement and sustain the changes needed to realize the desired results. Yet, when executed well, a physician enterprise transformation can position the organization for success—sometimes through unanticipated outcomes. Our experience suggests that the following results are often achievable through a thoughtful and deliberate transformation effort.
Common Definition of Success
The importance of defining and communicating the transformation pathway from the outset cannot be overstated; but more significant is the consistent definition of success that is understood by all stakeholders. Administrative and physician leaders must thoughtfully create a common vision of success, define how it will be measured, and then consistently communicate that definition to all stakeholders. Different stakeholders have different interpretations of the same language. Practice administrators, finance, IT, physicians, and other clinical staff may construe the vision through their own professional lenses, but defining success via predetermined targets offers clarity. When stakeholders are measuring with the same yardstick, the organization works collaboratively toward success, and it is clear when the desired outcomes have been achieved.
Governance Infrastructure for Continuous Improvement
An organizational transformation of any type requires the right governance infrastructure, membership, and decision-making rights to set the objectives and drive change. Many organizations have governance structures in place to manage the complexities of running large healthcare companies. Organizations that have previously undertaken a transformation effort may have established a dedicated transformation steering committee and associated advisory groups. In either situation, planning a physician enterprise transformation provides the opportunity to develop, rethink, or retool the governance infrastructure. Many organizations struggle to find the right balance between inclusiveness and rapid decision-making. Each organization and its people are different, and there is no one-size-fits-all structure. A high-functioning governance infrastructure is often created through trial and error, and like a muscle, strengthens over time. Putting in the effort to create the right governance for your physician enterprise transformation will pay dividends when change is hard and tough decisions must be made and communicated. Change in healthcare is constant, and the right infrastructure will endure the defined transformation process, sustain the achieved improvements, and support a culture of continuous development.
Enhanced Communications and Organizational Learning
In large-scale transformation efforts, organizations sometimes miss the chance to design an internal communication strategy that is effective, lasting, and bidirectional. A successful communication strategy involves more than determining the messaging media or creating stakeholder matrices. It should also address how members of leadership talk (the words they use with staff) and act (how they conduct themselves with staff). A communication strategy is about people. People drive the transformation effort when direction is provided clearly, consistently, and often. Communication should be an ingrained component of the governance and committee structures and include a feedback loop from staff straight to the most senior executive. This feedback loop is important for two reasons. The first is that the top-down, bottom-up approach works only when physicians and frontline staff are bought in to execute the desired change. Buy-in occurs more readily when staff can express concerns, request help, and communicate successes to the top of the organization. The second is that the transformation process is a learning opportunity for physician enterprise leaders. By encouraging feedback, leadership can learn things about the organization that would never otherwise surface. When these new opportunities are then acted upon, not only is the transformation process more impactful, but a culture of learning and engagement is often instilled. Frequently, as an unintended benefit of undergoing a transformation effort, the organization learns more about itself, reengages its workforce, and enhances morale.
Improved Access and Financial Position
The specific objectives of a physician enterprise transformation may vary, but common goals include improved market share, better margins, and improved experiences for physicians, staff, and consumers. A complete transformational effort is required in today’s healthcare environment due to the increasingly convenient site-of-care options and lower-cost alternatives available to the consumer. Incremental improvement efforts are not sufficient. Historically, these efforts have included expanding a clinic’s hours of operation, adjusting a physician’s scheduling template to accommodate more new patients, or cross-training frontline staff to create cost efficiencies. Each of these initiatives has its own merit and can improve a medical group’s operations, but a holistic transformation that coordinates sharing of best known practices, appropriate levels of standardization, and technology and process optimization across the enterprise can offer a better patient care experience, which is the result of the enterprise’s ability to provide more accessible, convenient, and efficient care—an improvement for the patient and the bottom line.
Heightened Transparency and Accountability
Developing the right governance and committee structure, communication plan, and measurable targets has compounding and lasting effects past the initial transformation effort. Administrative and physician leaders then communicate with staff using a common language, regularly publish progress to stated goals, and clearly identify the persons accountable for results. This may be a culture shift for some organizations, but it occurs in an organic fashion anchored by the “why” developed and communicated at the outset. There is rigor inherent in each of the transformation pathways described above. The organizational cadence of change that ensues simply becomes business as usual, with stakeholders understanding their role in the transformation process and culture of continuous improvement. Implementing and sustaining change requires strong leadership, but undertaking a transformation also strengthens leaders’ capabilities.
High-Performance Physician Enterprise
A high-performing physician enterprise is an asset to the community, health system, and other partners. The results possible from a well-executed transformation are becoming increasingly imperative because of relentless cost pressures and consumer demands as well as record high levels of physician burnout. This type of undertaking allows the organization to clarify its vision and set a new direction. It is not only a financial and operational change but also cultural shift. Change is not just a process, it is also a competency to continually develop—and one that will be valuable in the ever-changing healthcare environment.