Physician Engagement Around the World

In a recent survey by HealthLeaders Media, physician engagement was identified as the predominant challenge that hospitals and health systems face when working with physicians, ahead of other important factors such as governance, data management, revenue cycle, and employment agreements (Thomas, 2013).  A subsequent and related profile of health care organizations that successfully address physician engagement issues notes that, "High levels of physician engagement are vital to healthcare leaders who wish to avoid conflict within their organizations" (Commins, 2014).

But what is physician engagement?  And is it truly something that health care administrators today should be paying attention to or reflecting upon?  To answer these questions, Amer Kaissi (Trinity University) conducted a review of peer-reviewed studies and gray literature reports on physician engagement, identifying many ways the construct has been defined and measured across international settings.  In his article published in the most recent issue of International Journal of Health Services, Dr. Kaissi provides a history of the division between physician and management cultures in the United States, Canada, and the United Kingdom, he summarizes varied approaches to define the construct, and he lists the identified determinants, levels, measures, applications, and outcomes of physician engagement.  The article also identifies numerous conceptual models and frameworks of physician engagement, and it identifies best practices on enhancing physician engagement that have been discovered and described in national and international studies.

Ultimately, Kaissi ties physician engagement to notions of both active involvement and commitment exhibited by physicians towards the health care organizations they work with as well as processes and conditions created by such organizations to foster and support relationships with physicians.  Building from past studies and the varied best practices previously identified, Kaissi develops an integrative framework that health care organizations may apply to enhance physician engagement.  He proposes that three strategies must be part of organizations' effective physician engagement efforts: 1) "developing clear and efficient communication channels" with physicians; 2) "building trust, understanding, and respect" with physicians; and, 3) "identifying and developing physician leaders that can help engage the rest of the physicians in the organization" (p. 584).  Specific tactics are provided for each of these three strategies, such as developing communication plans, emphasizing information sharing, being involved in physician orientation programs, inviting physicians to "have a seat at the table," establishing clear expectations and responsibilities, and providing ample support and recognition for physician leaders (pp. 584-585).  Kaissi concludes by identifying opportunities for future research and calling for the prioritization of improved relations between physicians and health care organization managers, explaining that "enhancing physician engagement...will have far-reaching and positive effects on the clinical, service, and financial outcomes of any health care organization" (p. 589).

What are your thoughts?  How does your organization address physician engagement, and in what ways have you found physician engagement efforts to be either successful or challenging?  We'd love to hear from you in the comments section!

Articles Citation

Kaissi, A. (2014). "Enhancing physician engagement: An international perspective." International Journal of Health Services, 44 (3), 567-592.

Works Cited
Commins, J. (2014, February 13). "Addressing physician engagement." HealthLeaders Magazine, 17 (1).  Retrieved from: http://www.healthleadersmedia.com/content/MAG-300794/Addressing-Physician-Engagement

Thomas, J.R. (2013). "Physician Alignment in the New Shared Risk Environment."  HealthLeaders Media Intelligence Report: September 2013.  Retrieved from: http://content.hcpro.com/pdf/content/295631.pdf

Executive Compensation in Health Care

It's a topic that has repeatedly received attention from the press, the public, and politicians: executive compensation in health care.  Just in the past month, Modern Healthcare published results of its annual executive compensation survey, noting the criticism some hospital and healthcare system executives face for falling under the top 1 percent of wage earners in this country (Landen, 2014).  In the face of such criticism, hospitals and health care systems have continually worked to justify the levels of compensation determined for their leaders, prompting health care management scholars to examine what factors ultimately determine an executive's compensation in health care organizations.

A recent article published in the July-September issue of Health Care Management Review addresses this "hot-button" issue, examining the empirical evidence to date for health care executive pay determinants.  The study's authors, Patrick D. Shay (Trinity University) and Kenneth R. White (University of Virginia), conducted a systematic review of the health care management literature, finding 21 studies spanning 1991 to 2012 that have provided empirical results through regression-based analysis of what factors are directly related to health care executive compensation.  The results of their review reveal that studies have produced inconsistent and, at times, conflicting findings regarding what factors are most closely associated with CEO pay in health care.  No single determinant was consistently identified across each of the studies as a significant determinant of health care executive compensation.  However, of the factors that were more commonly highlighted as key determinants, the most frequently identified and predominant determinant of healthcare executive pay was organizational size.  Firm financial performance was also a statistically significant determinant in seven studies, but in eight other studies financial performance either produced mixed or insignificant results as a determinant.  Other factors identified in some of the studies as significant determinants included job difficulty, market characteristics, organizational ownership, hospital type, and human capital attributes.  Executive demographics, board attributes, and nonfinancial performance measures were identified as the determinants that, for the most part, yielded either mixed or insignificant relationships to executive pay.

Shay and White point to the inconsistent methods and findings across the review's studies as evidence that "the question of what factors determine health care executive compensation remains unsettled according to the extant empirical literature" (p. 264).  They acknowledge that the professional literature on health care executive compensation has identified organizational performance as a "relatively small consideration for boards when compensating executives" (p. 266; Bjork, 2012), perhaps in contrast to public expectations or assumptions.  In an age in which the public increasingly expects executive pay to be tied to firm performance, and as the industry increasingly embraces a "pay for performance" mentality, the study authors suggest health care organizations would benefit to more clearly incorporate performance measures - including financial as well as nonfinancial measures - as a contributing determinant of executive compensation.  They also call for "critical consideration as to what factors comprise the truly necessary and concrete determinants of pay," particularly in the event of declining organizational performance, as well as how to effectively communicate the varied determinants of pay to stakeholders and community members.  Shay and White note that, given the consistent public interest as well as continued media attention (e.g., Bartlett, 2014; Evans, 2014; Rosenthal, 2014), this subject is not likely to fade away soon, and further empirically-based studies are needed to shed light on the determinants of health care executive compensation.

What do you think about this subject?  Do you have any related questions or perspectives to share?  We'd love to hear your thoughts in the comments section.

Article Citation
Shay, P.D., & White, K.R. (2014). "Executive compensation in health care: A systematic review." Health Care Management Review, 39 (3), 255-267.

Works Cited
Bartlett, J. (2014, August 18). "Partners HealthCare, Lahey, Tufts executives see double-digit pay raises." Boston Business Journal.  Retrieved from: http://www.bizjournals.com/boston/blog/health-care/2014/08/partners-healthcare-executives-see-double-digit.html?page=all

Bjork, D.A. (2012). Healthcare executive compensation: A guide for leaders and trustees. Chicago, IL: Health Administration Press.

Evans, M. (2014, April 26). "Bonuses still tied to better financials: Use of CEO pay incentives for quality is uneven across for-profit hospital systems." Modern Healthcare.  Retrieved from: http://www.modernhealthcare.com/article/20140426/MAGAZINE/304269985

Landen, R. (2014, August 9). "Hospital executives see slower growth in compensation." Modern Healthcare. Retrieved from: http://www.modernhealthcare.com/article/20140809/MAGAZINE/308099980

Rosenthal, E. (2014, May 17). "Medicine's top earners are not the M.D.s." The New York Times. Retrieved from: http://www.nytimes.com/2014/05/18/sunday-review/doctors-salaries-are-not-the-big-cost.html?_r=0

Out of the Tower

The Murchison Tower at Trinity University

Here at Trinity University, the tower carries multiple meanings.  Those who have visited or passed by our campus have no doubt seen the iconic Murchison Tower that has become a San Antonio landmark and now serves as the University's official logo.  More generally, the term "ivory tower" has long been associated with academia, becoming a perjorative expression relating to intellectuals and institutions that foster academic elitism and engage in scholarly research without practical application.

This blog, "The Trinity Healthcare Digest," has been created with the intent of bringing the latest research in healthcare management "out of the tower" and into the hands of practicing health care administrators who can engage in study findings, relate the findings to their own experiences, foster a dialogue about how to advance the discipline of health care administration, and ultimately improve the health services patients receive.  In an industry as complex and dynamic as health care, we recognize that it is a considerable challenge to keep up with all of the changes that are taking place as we continually gain new understanding about health care and the provision of health services.  Textbooks on the subject of health care administration that were written just a few years ago are already falling behind current knowledge in some regards, and staying informed and up-to-date on the state of health care administration requires constant and vigilant effort.  At the same time, we recognize that too often health services research falls short in dissemination and application.  For many health care administrators, accessing relevant studies from a range of scholarly journals that speak to the issues and problems they face daily is a difficult, laborious, or frustrating exercise.  We also appreciate the difficulty administrators face in finding the time to read and reflect upon the latest studies.

Therefore, we are starting this blog as a means to highlight high-quality, recently published healthcare management and health services research in a form that will be easily digested by practicing health care administrators.  Each week, we aim to provide a citation and summary of a recent study  from a peer-reviewed journal relating to healthcare management or health services organization.  We encourage you to share your own thoughts and comments on these research briefings, and please also let us know what research topics, subjects, or questions you'd like to read about.  Finally, please share the link for our blog with others in the health care administration profession...let's bring the latest knowledge about health care administration "out of the tower" and bring others into the conversation as we work to make health care work better.