Organizational Strategies to Engage Physicians in Management of Healthcare Resources

Background

Recognition of the unsustainable growth of healthcare expenditures has led to increasing calls to better manage healthcare costs. Physicians' clinical decisions are a major driver of these costs. The Physician Charter on Medical Professionalism, authored in 2002 by the ABIM Foundation, ACP Foundation and European Federation of Internal Medicine, includes among its principles and commitments a call for physicians to work for social justice and the “just distribution of finite resources.” However, there is evidence that a number of barriers exist to engaging physicians in managing medical resources. Many physicians feel that cost decisions are beyond their professional purview; and that consideration of costs to society undermines their commitment to an individual patient's welfare.

Methodology

We conducted exploratory, semi-structured screening interviews with representatives of 30 healthcare organizations to understand how they advance values aligned with the Physician Charter, including physicians' commitment to social justice and the management of healthcare resources. We selected a purposeful sample of ten of these organizations, representing diverse geographic and structural characteristics for hour-long, in-depth interviews. For each of the ten organizations, we interviewed one leader, and where possible (N=9/10), conducted a separate interview with a second organizational leader. The interviews were audiotaped and transcribed. Following grounded theory methodology, staff analyzed the transcripts for themes using an iterative coding process.

Results

Data analysis revealed that organizational leaders implemented a number of strategies to engage physicians in managing resources, including a clear articulation of an organizational responsibility to use resources wisely; recruitment of physicians interested in collaborative group practice; engagement of physicians, staff, and patients in shared decision-making; leadership support of evidence-based medicine; and empowerment of clinicians and staff to identify areas of cost-savings. Additionally, national recognition of quality and efficiency, through programs such as the Malcolm Baldridge Quality Award, served as a source of pride for physicians. Finally, organizational leaders drew a clear connection between wise management of resources and local community benefit, and demonstrated this benefit through the provision of community-based, free or low-cost care. This linkage was particularly strong in geographic areas with high rates of unemployment and poverty.

Conclusions

Healthcare organizations have undertaken a variety of strategies to engage physicians in managing resources. However, further research is needed to understand the relative effectiveness of these strategies, particularly across different medical specialties and organizational structures, in order to better target efforts to engage physicians in managing finite healthcare resources maximum societal benefit.