Doctors, the central players to healthcare transformation

Despite major advances in medicine and technology, healthcare regularly fails to live up to patient expectations in providing high-quality care with clinical effectiveness and customer-centric patient journeys. The urgent need to transform care delivery is well embraced around the world, but the journey is notoriously difficult and requires discipline, resilience, bold and sustained commitment, and patience.

Twenty-two years ago, John Kotter pegged the failure rate for organisational transformation at 70%, but it has not changed much since then. Significant change takes a long time to implement – between five and seven years on average. Transformation is also challenging because most people are reluctant to alter their habits. What worked in the past is good enough; without a dire threat, employees will keep doing what they have always done. When an organisation has a succession of leaders, resistance to change is even more vital. A legacy of disappointment and distrust creates an environment where employees automatically condemn the next transformation champion to failure, assuming they are “just like all the others”. Calls for sacrifice and self-discipline are met with cynicism, scepticism, and knee-jerk resistance. To the typical change-averse employee, all plans look alike. The leader must show employees precisely how their plan differs from the predecessors’.

In the healthcare setting, doctors must be central players in sweeping changes, and any change strategy that doctors do not embrace is destined for failure. Generally, doctors are anxious about the “transformation plans” and mourn about actual or anticipated losses of autonomy, respect, and income. To alleviate the stated concerns, the leader needs to engage with doctors and run persuasion campaigns so they can accept the new organisational structures, ways of working payment models, and performance goals.

To help healthcare leaders engage physicians in the pursuit of more significant goals, Toby Cosgrove MD, the CEO of Cleveland Clinic, recommended a framework based on the writings of the economist and sociologist Max Weber, who described four motivations that drive social action (that is, action in response to others’ behaviour). The factors were further elaborated by Nikola Biller-Andorno and Thomas H Lee in “Ethical Physician Incentives – From Carrots and Sticks to Shared Purpose” New England Journal of Medicine, March 2013.

Adapted for health care professionals, the four motivational levers below can be used by a leader to earn doctors’ buy-in and bring about the change the system so urgently needs.

1.     Engage in a noble shared purpose – appeal to the satisfaction of pursuing a common organisational goal, for example day appointments

2.     Satisfy self-interest – provide financial or other rewards for achieving targets, for example, 10-20% of compensation against clinical and financial performance goals designed to improve team collaboration

3.     Earn respect – leverage peer pressure to encourage desired outcomes, for example, making the patients’ ratings of physicians public

4.     Embrace tradition – create standards to align behaviours and make adherence a requirement for community membership, for example, appearance and etiquette, and when paged, respond immediately

Transformation is a journey to learn, discover, and adapt. Jeffrey Immelt, CEO of General Electric, very nicely summarised this: “We’re on a 40-step journey. Today, we’re on step 22. I don’t know exactly what step 32 looks like yet. But we’re going to explore that together. And we will do whatever it takes to be successful. We’re going to win.”