How to involve doctors in transforming the health system

All health systems need to streamline costs while solving a lot of complex problems and  improving health outcomes. We’re dealing then with difficult challenges that are almost impossible without the doctors’ involvement, and for this reason I found this article to be very relevant: "Engaging Doctors in the Health Care Revolution" by Thomas Lee and Toby Cosgrove, from Harvard Business Review, as they are seeking solutions from Max Weber and his 4 fundamental motivations for social actions.

Motivation 1. Look for noble targets

When managers and doctors meet up, they ought to discuss patients, quality and results, and if they really want to change the status quo, they should not wonder away from this script. The conversation, therefore, should never start with contracts and compensations, this topic ought to be reserved, if at all, for the end of the meeting, after the main topics. Managers ought to listen, assess the views and know how to create a process in which all parties should have the opportunity to add their personal touches to the final process. A basic script of 3 points that the authors extracted from Mayo Clinic should be kept in mind: a) at the time of sitting down for the discussion, everyone should be very clear that things can not continue as they are; change is needed, b) the transformative project that arises must be clearly focused on the patient, and c) this is a path on which all involved actors will walk together.

At this point, I believe I should add a suggestion: lose (or gain) 4 minutes watching this video that Cleveland Clinic has promoted for their professionals training programs: If we could see inside others' hearts: "If, as a professional you are able to get into the patients’ or peers’ shoes – they say-, then you are one of us, and you cant bet it will all go well."

Motivation 2: Look for intrinsic incentives

Doctors like to be valued and therefore, they accept the assessment if they perceive that the objectives are timely and consistent (from the perspective of value clinical practice) and to demonstrate the validity of these claims, the authors present two cases of success in involving doctors, one with economic incentives (Geisinger) and one without (Cleveland). That is, the involvement of doctors does not necessarily mean money, but consistency.

Motivation 3: Promote respect

Respect must be based on the value that each doctor provides for the patients, colleagues and the organization, in that particular order. For this reason, Lee and Cosgrove cite Utah Health Care, where a customized system (for each doctor) of quality indicators and results has been implemented and, gradually, the information has been openly generated and thus – according to Utah – it has been shown that this model encourages efficiency, clinical effectiveness and respect for the value of well done work.

Motivation 4: Promote a sense of belonging

Professionals like to identify with their institution and, beyond the corporate image, what should prevail is what is being conveyed so well by the Mayo Clinic: "Here we have a way of doing things", taking it for granted that doctors are more likely to get involved in organizations (whether primary care centres, hospitals or health centres) that provide a corporate way of relating to patients, a method of professional cooperation, a means to see the quality of care, etc. This is what is meant by “welcoming institutions” or "magnet hospitals".

According Max Weber’s postulates and the interpretation of Lee and Cosgrove, the issue of doctors’ involvement in the health system is very important for clinical management, self-esteem, respect and a sense of belonging to the institution of employment. Therefore, compensation models, organizational models and acquired rights, despite their importance, should come after having addressed the weberian motivations, if any progress is to be achieved.

Jordi Varela
Editor