Latest / Becker’s Healthcare Podcast / Healthcare Upside / Down: Advancing Physician Alignment and Leadership with Beth Graefe and Dr. Andy Anderson

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Healthcare Upside / Down: Advancing Physician Alignment and Leadership with Beth Graefe and Dr. Andy Anderson · Becker’s Healthcare Podcast

0:00
Welcome to Health Care Upside Down, a podcast
0:02
by Becker's Healthcare and ECG Management Consultants in
0:05
which we'll explore the upsides and downsides of
0:07
health care and the industry's most current trends.
0:09
I'm Molly Gamble, and today, I'm thrilled to
0:11
be joined by two guests, doctor Andy Anderson,
0:14
doctor Anderson is chief medical and quality officer
0:16
with RWJBarnabas
0:18
Health, and Beth Griffey, principal with ECG Management
0:22
Consultants.
0:23
Beth, doctor Anderson, welcome. Just thanks for being
0:25
my our guest today. We're looking forward to
0:27
the conversation that's gonna unfold.
0:29
Thank you. Well, I've introduced each of you
0:32
there just by your your name and your
0:33
title, but I imagine there's a lot more
0:35
to your story. So maybe, doctor Anderson, I
0:37
can turn to you first. You can tell
0:38
us a bit more about yourself, your role,
0:40
and RWJBarnabas.
0:43
Great. I'm a a physician. I'm a general
0:45
internist. I've worked as a hospitalist and a
0:47
primary care physician and
0:50
serve as the chief medical and quality officer
0:52
at RWJBarnabas,
0:53
the largest health system in New Jersey. We're
0:55
a comprehensive system with hospitals, medical group,
0:59
ambulatory
1:00
sites,
1:01
across New Jersey
1:03
that serve about 6,000,000
1:05
people.
1:06
And, you know, we're very focused on quality
1:08
safety patient experience,
1:10
and very focused on our partnership with Rutgers,
1:13
which is part of our academic mission
1:15
regarding research and medical education for future physicians.
1:20
6,000,000 people at some serious scale. Thank you
1:22
so much, doctor Anderson. Beth, let's turn to
1:24
you. Say more about you.
1:26
Sir, Beth Griffey. I'm a principal with ECG
1:30
Management Consultants,
1:32
and the focus of my entire career has
1:34
been partnering with physicians,
1:37
to uncover opportunities that improve both quality and
1:40
financial performance in health care.
1:43
This work has spanned roles on the payer
1:45
side as well as within health systems ranging
1:49
from large academic medical centers to rural hospitals.
1:53
My doctoral and ongoing research
1:55
explores how physicians think about their payment models,
1:58
predominantly
1:59
pay for performance,
2:01
and the influence that has on their clinical
2:04
decision making. It's been a fascinating career,
2:07
continually forces me to rethink
2:10
how
2:11
we can engage physicians
2:13
for,
2:14
the future of care delivery.
2:16
Mhmm. Excellent.
2:17
Well, Beth and doctor Anderson, I think between
2:19
your perspectives and your longevity, it sounds like
2:22
you've understood, like, physician and and hospital and
2:24
health system alignment is is not necessarily a
2:26
new topic, but it continues to evolve. And
2:28
I think what we're hearing from health systems
2:30
at Becker's is that systems now just feel
2:33
some really renewed pressure to
2:35
achieve multiple objectives in parallel. So I I
2:38
thought we could start here as health systems
2:39
are working to improve their margins. They're also
2:42
working to maintain care quality and care access.
2:46
What have you seen as some of the
2:47
most effective ways organizations are collaborating with their
2:50
physicians to do these things all at the
2:52
same time,
2:53
strengthening service line performance when it comes to
2:56
things like cost containment, patient reported outcomes,
2:59
value based care metrics.
3:01
There are a lot of plates spinning, doctor
3:02
Anderson. I'm I'm gonna turn to you first
3:05
here. What what have you seen as most
3:07
essential
3:08
to ensuring that, again, these objectives are being
3:11
hit in parallel and at the same time
3:13
and nothing's being traded off or compromised?
3:16
It's a great question. And, you know, the
3:18
simple answer is a lot of communication, a
3:21
lot of transparency,
3:22
and a lot of engagement of physicians and
3:25
decision making. You know, as much as as
3:28
we can,
3:29
we need to listen to the the physician's
3:32
ideas,
3:33
their
3:34
opportunities that they present for innovation,
3:37
and, you know, opportunities to improve
3:40
care pathways, care quality,
3:42
patient outcomes.
3:44
Physicians,
3:45
you know, go into medicine with the purpose
3:47
of healing and and helping others. And
3:50
having physicians be at the table as decisions
3:53
are made is extremely engaging for physicians and
3:56
can provide valuable insights.
3:58
The other big
3:59
point in my mind is is data transparency
4:02
and really seeing how
4:04
each physician's doing it as an individual and
4:06
seeing how the health system's doing
4:08
as a conglomerate,
4:09
making sure that the outcomes are very transparent
4:12
in terms of the data points, around those
4:14
outcomes.
4:15
Beth, I'll turn to you here. It sounds
4:17
like doctor Anderson, your communication transparency, physicians having
4:21
even more seats at the table when it
4:23
comes to decision making. It sounds like it's
4:24
of increasing importance. What else have you seen
4:27
from your perspective? What what differentiates organizations that
4:30
are seeing measurable success from from those that
4:33
are maybe falling short or continuing to struggle?
4:35
Yeah. For sure. There are some clear differentiators
4:39
in this space and outcomes and cost when
4:41
physicians are engaged, and I'll echo some of
4:43
what doctor Anderson said. But my research, along
4:46
with practical experience and other research,
4:50
show some very common themes. Things like
4:53
treating physician engagement
4:55
as a discipline, being very purposeful
4:59
in clearly defining roles,
5:01
with primary
5:03
empowered physicians,
5:05
holding physicians accountable to what they can control
5:09
and what matters to them. So it's not
5:12
a, hey. You're an orthopedic surgeon, but you're
5:14
on and you you have episodic
5:17
transactions with patients, but you're responsible for patients'
5:20
BMI. That doesn't resonate. That that that doesn't
5:23
connect. So how do we hold physicians accountable
5:26
to what they can control and what matters
5:28
to them? That's a very common theme.
5:31
Building trust through transparency, like you said, doctor
5:34
Anderson, data matters. Good, credible data matters.
5:38
And then how is success measured? That matters
5:41
as well.
5:43
And then making sure that
5:45
we are grounded in common goals,
5:48
one common strategic direction,
5:51
and using physicians to influence their peers. That's
5:55
very often overlooked. It's what my research and
5:59
others definitely show that
6:02
the number one influencer of a physician's medical
6:05
decision making is their peers, and so how
6:07
do you best use that?
6:09
So when these factors are present, we definitely
6:12
see change that is
6:14
beyond what others can do, and then the
6:17
the opportunity is just limitless.
6:19
If I could tag on to the importance
6:22
of physicians leading physicians, you know, completely agree
6:25
with that. We've done a lot of work
6:26
in our service lines on
6:28
on cost and and physician preference items, things
6:32
in orthopedics or cardiovascular
6:34
or neurosurgery.
6:36
And having physician leaders lead the conversation
6:39
or present the data
6:41
makes all the difference. And, you know, the
6:43
other part of that is physicians are competitive
6:45
by nature. And when you show them data
6:47
and you show them, you know, how much
6:49
things are costing or how they look compared
6:51
to other health systems,
6:52
they naturally want to do better. They want
6:54
to perform better. And it really spurs on
6:57
that sort of competitiveness within
6:59
physicians. But back to physicians leading physicians, that's
7:03
just critical. And so I agree with those
7:06
comments.
7:07
Yeah.
7:08
And, Beth, I was just gonna add on
7:09
as well. Your opening remark about this is
7:12
a constant discipline versus a episodic
7:15
exercise. I remember early early years ago, we
7:17
had, at Becker, as a channel for physician
7:20
system alignment.
7:22
And we've since, like, base basically baked that
7:24
into so much of our other content and
7:26
news and thought leadership. So I think to
7:28
to your point, it doesn't need to be
7:29
a a stand alone or something that sits
7:31
on top of the organization. It truly is
7:33
just part of how it hums.
7:35
Let's talk about burnout a little bit. Doctor
7:37
Anderson, it looks like by many measures, burnout
7:40
is in some ways improving. You're hearing about
7:43
less
7:44
time
7:45
charting at home,
7:47
less hours spent on pajama time. But all
7:49
in all, this isn't a problem you solve
7:51
once. It's gonna be a condition that systems
7:53
need to manage continuously.
7:55
With it remaining a concern,
7:57
how is that shaping the way
8:00
our WJBarnabas
8:01
is really approaching
8:03
physician engagement,
8:04
thinking about support, leadership development? Can you talk
8:07
a bit about this?
8:09
Absolutely. And it is a a focus for
8:11
us, and I like to think of it
8:12
as as wellness and and promoting, you know,
8:15
wellness and avoiding, you know, burnout.
8:18
Certainly with
8:19
COVID, with all the stressors over the past,
8:22
you know, decade in health care, it's it's
8:24
created stress points on physicians. And part of
8:26
what we're trying to do is make it
8:27
easier
8:28
for physicians to to practice and easier for
8:31
them to do what they love to do.
8:33
Part of that always goes back to the
8:35
electronic medical record and making that easier to
8:37
use, you know, creating less noise there, creating
8:40
shortcuts.
8:41
Part of that's
8:42
coming with AI tools, things like documentation
8:45
that's created for physicians to review, ambient voice
8:48
technology, for example, or creating a discharge summary
8:51
or drafting a note in response to a
8:53
patient inquiry. Those types of things save time
8:56
for physicians,
8:57
and really
8:59
give them more time to do things they
9:00
love to do and less time spending
9:03
time doing things they don't like to do,
9:04
like documenting, for example. So if we can
9:07
create documentation tools for physicians, that saves them
9:09
time and and really creates
9:11
a more of a wellness, you know, type
9:13
environment. We're also targeting our physicians with wellness
9:16
committees
9:17
who often can find low hanging fruit, things
9:19
that could be improved in the work environment
9:21
that can be fixed relatively quickly. And we're
9:23
trying to do those things, you know, as
9:25
much as we can to make it easier
9:26
for physicians to practice.
9:29
And and, Beth, I'll turn to you here.
9:30
And thanks for highlighting those those ways you're
9:32
thinking about this, doctor Anderson. I think to
9:34
hear those tools are saving time
9:36
is is a really positive development, but the
9:39
a lot of work remains,
9:41
to free up physicians for what they are
9:43
are meant to do, which is treat patients.
9:45
And, Beth, speaking of that, you see a
9:47
lot of physicians at times when it comes
9:49
to leadership roles.
9:50
They see it almost as a compromise between
9:52
treating patients and moving into, you know, the
9:55
other side, if you will.
9:57
How have you seen strategies for systems to
9:59
really engage positions in leadership roles to build
10:02
strong pipelines and deep benches with leadership?
10:05
Are they doing anything differently in how they
10:07
structure compensation,
10:09
best practices that you would share? Because this
10:11
continues to be something comes up time and
10:12
time again where systems are creating more leaders
10:15
and a a bigger leadership pipeline, but a
10:18
lot of physicians can see some trade offs
10:20
that cause reluctance.
10:21
Mhmm. Yeah. Absolutely. I mean, we are seeing
10:24
such a variety
10:25
of comp design right now, which, of course,
10:28
ECG has been studying for decades. But we
10:32
are seeing some shifting from pure transactional
10:36
comp models, the RVU based model,
10:40
to more fixed dollar comp with some minimum
10:43
work standards,
10:44
but allowing physicians
10:46
time
10:47
to contribute in different ways. And so whether
10:50
that be
10:51
some salary
10:53
with
10:54
a day to contribute to leadership
10:57
or sit on a supply chain cost control
11:00
committee or whatever that might be. We're seeing
11:02
a shift there,
11:04
but definitely a resounding,
11:07
theme is that we are seeing physicians being
11:10
elevated more as leaders,
11:13
because going back to doctor Anderson's point, you
11:16
know, we see that that peer influence makes
11:18
such a difference. And
11:20
so, you know, how do you elevate a
11:22
physician as a leader? Whether it's through a
11:23
comp model or some other, you know,
11:26
career progression,
11:29
it makes a difference in just overall recognition
11:32
that physicians
11:33
have control
11:35
of a great deal of what obviously occurs
11:38
in medicine. 80 to 90% of cost and
11:40
utilization decisions are based on physician,
11:44
physician decisions. So
11:46
that we are seeing physicians elevated to leadership
11:49
roles
11:50
beyond what we ever have in the past,
11:52
but you just have to be, again, purposeful
11:54
in how you do that. I I don't
11:56
think everybody
11:57
is necessarily trained and equipped to be great
12:00
leaders, and so how do we best support
12:02
positions
12:03
in that in that journey? And there's a
12:05
way to go about that that makes,
12:08
makes it more successful than just sticking somebody
12:11
in the role. But
12:13
it can be a whole through a whole
12:14
variety of comp models, leadership training,
12:18
peer mentoring, those kinds of things. We're seeing
12:20
all of that right now.
12:22
And I love leadership training. It's a message
12:24
that we're investing in you, and we wanna
12:26
make you a better leader. And there's also
12:28
a ton of communication that typically goes into
12:31
those types of settings so that the leader,
12:33
the physician
12:34
has a deeper understanding of the the goals
12:37
of the health system and the key,
12:39
work areas in the health system.
12:41
The other
12:42
point that that I thought of a moment
12:45
ago I wanna mention is is recognition. Just,
12:47
you know,
12:48
letting physicians know they've done a good job.
12:51
And some of that can be done through
12:53
physician of the month, for example. We do
12:55
that typically at all of our sites. A
12:57
physician is recognized typically through patients or family
13:00
comments, and and they're they're honored. You know,
13:03
they are publicly honored as, the physician of
13:05
the month because of of the work, and
13:07
and that recognition helps reinforce
13:09
the importance of what they're doing and it
13:11
makes them feel better and more engaged at
13:13
their workplace.
13:14
Imagine too, doctor Anderson, going back to the
13:16
the peer effect, I think, for the peers
13:18
to see physicians highlighted for certain reasons, I
13:21
imagine that's really instrumental too to building the
13:23
culture you want. Absolutely.
13:26
Yeah. Well, the other thing I I think
13:28
health systems are facing, margin pressures, patient population
13:31
demands, and and workforce expectations that continue to
13:35
take different shapes.
13:36
This is gonna be a a serious phase
13:39
where operational strength and clinical excellence, they were
13:41
always intertwined, but now even more so.
13:44
And given that reality, the question for both
13:47
of you here, as you look ahead, where
13:49
do you see the next big opportunities for
13:51
alignment between physicians and health system leaders?
13:54
You've all both of you have highlighted some
13:56
best practices. But when it comes to this
13:59
next era, when the margins pressure continues to
14:02
tighten, patient population
14:04
acuity volumes increase, and then we've got a
14:06
workforce to continue to be mindful of,
14:09
What do you think this will look like
14:10
for physicians and leaders to really advance
14:13
both financial sustainability and then also the clinical
14:16
performance? Doctor Anderson, can I turn to you
14:18
for a look ahead?
14:20
Yeah. We're finding that
14:22
there are best practices
14:24
in our health system, and what we've not
14:26
done well historically is share them. And you
14:29
can do that through hospitals. You could do
14:31
that through service lines. And then,
14:33
typically, you really could have the physician who's
14:36
performing that best practice teach the other physicians
14:39
what they're doing. So that's highly engaging for
14:42
that person to be able to sort of
14:44
showcase what they're doing. It also enables us
14:47
to to do things more efficiently and effectively
14:48
across all of our sites when we do
14:48
do it the best possible way. So
14:50
effectively across all of our sites when we
14:52
do do it the best possible way. So
14:53
some of that translates into things to the
14:55
electronic health record, you know, things there, or
14:57
it could translate into our care pathway. It
15:00
could translate into
15:01
a readmission program and how we're providing access
15:04
for patients to follow-up with us.
15:06
It could translate into how we're identifying opportunities
15:09
to improve,
15:10
patients not getting surgical site infections,
15:13
mortality
15:14
review processes. There's so many opportunities for us
15:17
to allow our physicians to really share their
15:19
best practices and and and hardwire them and
15:23
standardize them across our health system. And that,
15:25
again, is gonna save dollars, and it's gonna
15:27
result in better outcomes.
15:30
Sounds like building a bigger tent for more
15:33
leaders to have voices and and play a
15:35
role in education is gonna be increasingly important.
15:38
Very true. I mean, the other point just
15:40
to say, maybe it's obvious, but historically, I
15:42
think we tended to work in silos more
15:44
so than we should have. And really transparency
15:46
again and and really sharing and learning from
15:49
each other is the biggest opportunity.
15:52
Thank you so much, doctor Anderson. Beth, I'll
15:54
turn to you here. What else do you
15:55
see,
15:56
taking on renewed importance or becoming more effective
15:59
models for this hospital physician administrator alignment
16:03
in this next era
16:04
that the pressures are only gonna increase from
16:06
here.
16:07
Love what doctor Anderson said, and I wholeheartedly
16:10
agree. I think
16:13
what we're going to see and are seeing
16:14
is that health systems are taking a more
16:17
holistic
16:18
look
16:19
at performance. It's not one dimensional any longer.
16:22
So
16:23
how do we reconstruct our ability to evaluate
16:27
everything from
16:28
physician productivity
16:30
plus
16:31
cost per case, plus
16:33
quality and outcomes, plus
16:35
patient access and satisfaction,
16:37
plus managed care contracting, plus the demand for
16:40
for care in the future. You have to
16:42
take all of those into consideration,
16:45
to understand
16:46
best practice, I think. And so
16:49
we can't just focus on one of those
16:51
areas in a physician's contribution to one of
16:53
those, but how one might impact the other.
16:56
And I I think it's really requiring us
16:59
to rethink
17:01
about what partnership looks like. And so partnership
17:04
with physicians, partnerships with our suppliers, partnerships with
17:07
others outside
17:09
the whole system.
17:10
But those foundational themes still apply that we
17:13
talked about, you know, right off the bat,
17:15
which are,
17:16
you know, treating physician engagement as a purposeful
17:19
discipline and clearly outlining roles,
17:22
holding physicians accountable to what matters to them,
17:25
trust and data and transparency, all the things
17:27
we've just talked about. That is a foundation,
17:30
then you can take a holistic look at
17:32
performance.
17:33
If we look at one of these performance
17:35
factors independently,
17:38
then we're gonna miss the opportunity to have
17:40
a physician influence so much more
17:43
than what we think is possible. So I
17:45
I think it's just that holistic
17:47
perspective of
17:49
pulling one lever affects so many others.
17:53
Mhmm. Collectively, what we heard here was
17:55
greater importance and need for physician led education
17:58
and teaching moments,
17:59
from those physicians who have proven best practices.
18:02
Doctor Anderson, you highlighted a number of them,
18:04
whether it's care pathways,
18:07
readmission programs.
18:09
Beth, to your point, more holistic assessments of
18:11
performance, productivity plus cost per case, plus quality,
18:14
plus outcomes, patient satisfaction, and more,
18:17
ensuring that one performance factor does not overwhelm
18:20
or compromise the others, fewer silos, and then
18:23
rethinking what partnership looks like. I think that's
18:25
gonna be one that will probably take a
18:26
few different iterations at health systems over the
18:29
next several years.
18:30
This has been a a really helpful grounding
18:33
conversation, but also looking ahead, doctor Anderson, Beth,
18:36
is is there anything we didn't touch on
18:37
or any final thoughts that you'd like to
18:39
leave our listeners with?
18:41
One thing I did mention perhaps enough is
18:44
the health care is a team sport. And
18:45
and part of what we have found is
18:48
when you have physicians
18:49
collaborating with nurses,
18:51
collaborating with quality leaders, working together as a
18:53
team,
18:54
everyone benefits and everyone's engaged and better ideas
18:57
flow out of those relationships. And that translates
19:00
even down to
19:01
the bedside. If we can get our physicians
19:04
and our bedside nurses to spend
19:06
more time talking to each other, it's gonna
19:08
create more efficiency and more engagement, and it's
19:10
better for the patient.
19:12
Yeah. And I would just leave with I
19:13
mean, I would say most physicians that I
19:16
interact with genuinely want
19:19
to be successful wherever they practice, and they
19:21
want that organization to be successful. I don't
19:24
find very many physicians
19:26
are opposed to the organization they work for
19:29
to not thrive. And so but there's a
19:32
way to structure
19:34
what that engagement looks like
19:36
so they can be successful in the things
19:38
that they have control over,
19:40
and they genuinely want to see
19:43
what those outcomes look like and adjust if
19:46
things aren't working,
19:47
but they are engaged partners. They're willing partners.
19:50
We just have to make it as easy
19:52
as possible for them to contribute
19:55
while practicing, right, and having a life and
19:57
having work life balance, all of those things
19:59
that matter. But I find physicians genuinely
20:02
want
20:03
to have a a an organization successful where
20:06
they work, and so how best do we
20:07
unlock it? That's the question.
20:10
The team sport and to your point, Beth,
20:12
you assuming good intent
20:14
is critical and underpins all of this.
20:17
So I wanna thank you, doctor Anderson and
20:19
Beth listeners. Again, this is doctor Andy Anderson,
20:21
chief medical and quality officer with RWJBarnabas
20:25
Health, and Beth Griffey, principal of ECG Management
20:27
Consultants.
20:29
Thanks for listening to this episode of Healthcare
20:30
Upside Down, and thank you to our podcast
20:32
sponsor, ECG Management Consultants.
20:35
Listeners, you can tune in to more podcasts
20:36
from Becker's Healthcare by visiting our podcast page
20:39
at beckershospitalreview.com.
20:41
Thank you.