Build a Culture of Physician Accountability in your Medical Practice

A Culture of Accountability ||

Former New York City Mayor Ed Koch gained many fans among the voting public when news cameras caught him shaking New Yorkers' hands and greeting them with, "I'm Ed Koch. How am I doin'?" That warm gesture and short phrase characterized him as a public servant who felt account­able to ordinary citizens — in spite of his powerful position. A physician should do the same thing.

As a physician, you can garner similar goodwill by recognizing your individual account­ability to your group and your partners by submitting to an annual performance evaluation. Even better, follow­ing a carefully designed performance-review plan pro­vides you with plenty of feedback to help you grow and improve both personally and professionally.

Laying the Groundwork

Medical practices find implementing a physician-review system is well worth the significant effort required to design and manage it. First, identify and find the best ways to conduct performance reviews for you and your colleagues. This will be different for each practice but you should identify those issues, both clinical and non-clinical, that you want evaluated. The result should be an evaluation form that is accepted by yourself if you are a solo practice or your colleagues if you are a group practice. If a group practice, develop physician buy-in throughout the practice.

Intelligent physicians respond best to concrete in­formation, so focus on iden­tifying objective performance measures as well as objec­tive feedback from co-workers. To be thorough and fair, the annual review could rely on information from many sources, such as the following:

• Patient satisfaction surveys for physicians with direct patient contact
• Peer satisfaction surveys for physicians with­out direct patient contact (radiology, pathology)
• Supervisor review (evaluation by the physician's department chairperson)
• Peer review (evaluation by other physicians within the practice or department if applicable)
• Interdepartmental review (evaluation by chair­persons in other departments)
• "360° feedback"
  • physicians evaluate their department chairpersons
  • non-physician staffers evaluate physicians within their departments
• Chart reviews (by peers, based on criteria like proper documentation/coding, appropriate and necessary testing and treatment plans)
• Physician production data
  • appointment availability (days’ wait for new and follow-up visits)
  • gross production (charges, compared to in-house colleagues’ and peer group (ex. Using MGMA data)
  • patient visits (total, compared to in-house colleagues’ and per group)

Customer" Service

I think patient satisfac­tion is a vital component of any evaluation. Your patient questionnaire should ask about waiting times, conve­nience, courtesy, thoroughness, telephone experiences and impressions of the physician's technical and com­munication skills. The evaluation report shows how the individual physician's score in each area compares to those of other physicians within the clinic — both of the same specialty and overall.

For physicians with little or no patient contact (radi­ologists and pathologists), you can develop your own "physician satisfaction survey" asking clinic doctors about their interactions with the individual specialist.

Co-Worker Feedback

Everyone's opinion in a medical practice should count.  Besides each physician, even support staffers should fill out an evaluation questionnaire. I suggest each form consists of no more than 7-8 questions with numbers to circle indicating ratings from poor to above average.

Demonstrating Physician Priorities

Remember brevity encourages participation — make sure it doesn't take long to fill out any questionnaire. All questions should clearly demonstrate what your medical practice sees as the top priority for its physicians' professional conduct. Many questions should emphasize:

• excellent patient service
• being available
• being approachable
• effective communicating
• accuracy and timeliness in reporting
• participating in department/clinic responsibilities
• being a team player
• accurate charting and excellent medical care
• productivity

It Takes Effort

Compiling, analyzing and reporting on this much data for large medical requires a lot of work. But for any size medical practice, the effort is worth it. Just improving patient sat­isfaction scores as a result of this process can really enhance the quality and perception of any practice. Satisfying patients should become a fundamental objec­tive, and accountability should become a way of life. As a result of the ongoing evaluation process, phy­sicians will understand practice expectations better than ever, and each member starts every year with clearly stated goals to work on.

Additional Resources on Building Culture

• Medical Practice Management Consultant for Physicians