New role for hospitalists: managing other physicians
Good performance management starts with recruiting the right people and defining your group's goals
From the October ACP Observer, copyright © 2005 by the American College of Physicians.
By Paula S. Katz
As hospitalist groups continue to grow, a new challenge has emerged: Hospitalists are now being called upon to learn personnel management skills.
Knowing how to hire, supervise, motivate and even fire physician employees is becoming a key part of many hospitalists' jobs. And mastering these skills can make or break their real job of providing top-flight medical care and serving patients' needs, explained Russell L. Holman, ACP Member, national medical director with hospitalist company Cogent Healthcare in Burnsville, Minn.
At a session on managing physician performance at a recent Society of Hospital Medicine meeting, Dr. Holman laid out strategies and tips to help hospitalists who now must manage colleagues and employees.
Good performance management clearly starts with recruiting the right people, he said. But to do that, the group or program has to clearly define and explain its vision, values, goals and objectives.
"Unless you can answer those questions," said Dr. Holman, who is also assistant professor of medicine at the University of Minnesota based in Minneapolis. "You will not move on to the next step."
What to look for
In hiring the right person, hospitalists have to assess not only a candidate's clinical skills but his or her "organizational fit." That means personality style and personal and professional objectives.
"Bringing in the right people will solve 80%-90% of your management problems down the road," Dr. Holman said.
You then have to design the job responsibilities, work schedule, compensation, benefits and level of hospital support so a promising colleague can succeed, he said.
Benefits are critical for retention, he said, and setting clear expectations for the new employee is also key. All employees should have an updated job description and understand the group's culture. The group should also set between 10 and 12 specific, relevant and realistic behavioral expectations.
"You don't want to kill [physicians] with the number of expectations," he noted. Examples of doable expectations include being on time to meetings, having good interpersonal interactions with nurses or pharmacy staff, and complying with coding requirements.
Expectations can be used as performance measurements as long as they are timely (within the last quarter), objective and interpretable. Dr. Holman cautioned that performance measurements should quantify observable behavior or measurable outcomes, not judge behaviors.
You can, for instance, measure how often a physician was able to accept admissions between 3 p.m. and 6 p.m. Scoring low on that measure is not a value judgment, he said, but instead may signal someone's poor organizational skills.
Dr. Holman doesn't recommend tying dollars to every performance measure, but you can for some. If you set up your compensation system to reflect performance, he said you need to put enough money at stake—more than 20% of compensation—to drive behavior. To find that best balance, group leaders should include physicians in building the compensation system.
Give feedback
Effective feedback, which shouldn't occur just at raise time, is also key. Dr. Holman said the challenge is to keep the focus on the behavior, not on the person.
Feedback can happen both informally, such as in the hallway when you say something like, "I just observed you with a patient. This is what I noticed," and formally, during an annual performance review. Formal reviews should occur in a private, relaxed environment and the employee should see the review in advance.
Even following all these steps may not prevent problems. You may have made a mediocre hire who shows up late, doesn't come to group meetings or blows up at staff. But there are ways to effectively handle those situations, Dr. Holman said.
First, document objective and measurable behavior and share this documentation with the hospitalist in advance of a private meeting. During the meeting, be direct and succinct and focus on the behavior by listing specific examples. Don't apologize or editorialize.
Next, have the physician acknowledge that the behavior is unacceptable. This may require several meetings, Dr. Holman said. Document your discussions and offer options, such as training, resources or an amended schedule. Make sure the physician knows the consequences if problem behavior reoccurs.
The bottom line is that some situations cannot be resolved, including those where the physician displays conduct that is detrimental to patient and staff safety or to care quality, or is disruptive.
When firing is called for, Dr. Holman said the procedure should be short and direct. The process shouldn't take longer than 10 minutes and should be coordinated with the hospital's human resources department if possible.
While firing someone is always uncomfortable, "you, your organization and group will be better off," he said. And in many cases, physicians who are let go will themselves benefit, because now they can find a job better suited to their skills, personality and style.
Paula Katz is a freelance writer based in Vernon Hills, Ill., who specializes in health care writing.
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