Enhancing Physician Engagement

One of the keys to being a successful chief medical officer is engaging your medical staff. In 2022, a Press Ganey Provider Engagement Survey showed that the physicians at Providence Holy Cross Medical Center, where Rex Hoffman, MD, MBA, is chief medical officer and executive director of operations, were highly engaged. These results were the culmination of many small steps that have been initiated in the past 4½ years. Hoffman shares the keys to the system’s success.

When you were a brand new CMO, how did you get your medical staff engaged?

Simple…I listened and spent most of my time developing relationships. I made sure to focus on all of the physicians, not just the popular physicians or major influencers. Not surprisingly, some relationships were easier to forge than others; however, focusing my efforts on really learning what was important to each of them and genuinely trying to help them be successful at the hospital allowed me to overcome any initial barriers.

And it was imperative that I gain their trust, which sometimes meant that I had to confess I did not know something. But I always made it a priority to get back to them with an answer in a timely manner.

Over the past three years, I have often found myself counseling other chief medical officers as they get onboarded and acclimated to their new role. My message to them is clear: Focus on building relationships with your medical staff. And whatever you hear about a particular physician, forget it — you need to develop your own perception of them. You never know what may have led to them having a certain reputation. You need to start with a clean slate.

Now that you have been in the role a few years, do you do anything differently?

I still focus on building relationships; however, now, since I have relationships with most of the physicians on the medical staff, I spend a lot of time enhancing those relationships. The worst thing one can do is take a relationship for granted. It is essential to continually nourish it. This may mean something as simple as checking in on them during a particularly difficult week, asking about their family or last vacation, or going out and spending time with them outside of work.

Even as a chief medical officer who has been in the role for a few years now, I still prioritize meeting new physicians. In fact, a couple of years ago, I made it a point to have a 15-minute meeting with every new member of the medical staff during their orientation. This allowed me to get to know them and help set them up for success at our hospital. Oftentimes, I would connect them with another member of the medical staff who shared similar interests, either professionally or personally.

During COVID, was it easier to get physicians engaged or more difficult?

This was a mixed bag. COVID affected physicians differently. Some became less engaged and were seen at the hospital less frequently and, in some cases, it resulted in early retirement. For others, it led to them being more engaged. One thing was certain during COVID: We needed all hands on deck to help navigate the craziness that took place.

As the leader of the COVID clinical task force, I reached out to many physicians asking for their help in interpreting different studies and treatment regimens as we sought to take the best care of our patients. Although the task force only included 20 physicians, I sought out the input from many more. By the end of the COVID pandemic, I would venture to say that our medical staff was closer than ever before because of many of the relationships that were forged as we were all fighting the same foe: COVID!

Can you provide some examples of how you got a doctor more engaged?

During my first year as chief medical officer, I attended a meeting of the sepsis workgroup. Leading the meeting was a senior leader of our medical staff who had been in this role for a few years. Seated at the table were several other physicians, including one junior member of the medical staff who appeared to be very enthusiastic about the topic.

As the meeting wore on, it was clear that the physician leading the meeting didn’t show any vigor. Instead, he seemed to be running the meeting just because he had to. When I left this meeting, an epiphany came to me: What if we made the enthusiastic junior member the chair and had the current senior physician leader be the vice chair? As vice chair, he could mentor the more junior leader until he got up to speed.

I pitched this idea to both physicians, and they loved it. The rest is history. With this change came more engaging meetings, and our sepsis team has achieved success that they never thought was possible.

A second example revolves around a senior physician leader who was looking to get more involved. This particular physician shared with me that he was trying to decide if he wanted to become a chief medical officer. Upon hearing this, I reflected on which committees would be important for him to understand if he were to become a chief medical officer.

Subsequently, I arranged for him to be on the Credentials Committee, the Utilization Management Committee, and the Readmissions Committee. Because he was well-liked and an effective leader on his own, he made his way to becoming chair of a department and, ultimately, to the Medical Executive Committee.

Whether he becomes a chief medical officer someday will be up to him, but if that is the path he chooses, he will have been exposed to some of the important committees that will prepare him for this role.

We often hear about doctors feeling burned out. Is this happening at your hospital, and what, if anything, are you doing to get your physicians more engaged?

Physician burnout has been a big focus of mine, dating back to 2019. In 2019, I established a Physician Wellness Leadership Council made up of 12 physicians, each representing a different specialty. My intention with this group was to listen and then act upon what I heard. That year, I heard a lot, and through this group, we developed a list of 13 things that doctors should not be called about between 11 pm to 6 am, a one-page sheet on how to de-stress, and an easily accessible list of resources available to physicians to combat burnout. Each of these was a big physician satisfier.

Unfortunately, during COVID, other things led to increased physician burnout which required different solutions. At the height of COVID, there was an immense amount of physical and emotional stress. To combat this, we arranged for a stress trauma session during which we had a certified stress trauma nurse come do a sensing and therapeutic session with our physicians. This was extremely well received and appreciated.

Last year, we used the Mayo Well Being Index to better understand which departments were experiencing a lot of stress. With this information, we were able to focus our efforts on those departments that needed our help the most. Sometimes it was simply listening to these physicians; in other cases, it resulted in us changing their workflow, which was causing them to feel overwhelmed. After we were able to intervene, we had these same departments retake the Mayo Well Being Index, and much to our delight, their distress had gone down significantly.

Today, physicians at Providence Holy Cross feel well cared for and are very engaged. In addition to being engaged, they are aligned with the hospital and administration. A testament to this is that each year we have significantly more physicians joining our medical staff than are leaving, and it is not infrequent that I get asked by another chief medical officer, “What is your secret sauce?”