Encouraging Participation in Non-Clinical Activities

Professional Interactions – Best Practices Series
Encouraging Participation in Non-Clinical Activities

By Fred Corbus

This article first appeared in Round-up Magazine, official publication of the Maricopa County Medical Society.

In most health care settings, there are organizational and/or political expectations for participation in activities beyond direct patient care. Practices always need physician input. And the smaller the practice is, the more likely that input will be related to day-to-day operations. When the practice grows and employs a qualified administrator, the need for physician contribution changes, but it still continues.

THE NEED FOR PHYSICIAN INPUT

Small Practice

1. Hiring and firing decisions
2. Front and back office policies
3. Billing and contract decisions
4. Scheduling
5. Banking relations
6. Equipment purchase decisions
7. Space planning
8. Etc.

Medium Size Practice

1. Systems design
2. Legal issues
3. Compliance
4. Governance
5. Marketing
6. Capital expenditures
7. Compensation plans
8. Etc.

Large Practice

1. Physician performance
2. Liability issues
3. Clinical research
4. Medical community leadership
5. Publications
6. Educational leadership
7. Mergers and acquisitions
8. Etc.

Each practice has its own unique identifiable, highly advantageous list of non-clinical activities. While I recognize that the mission of a medical practice is to serve patients, I’ve seen many opportunities pass by a practice. Nobody has time to do these non-critical activities, and so the tendency is for nobody to do them. Yet, over the long haul, they often make a very important difference for political and economic reasons. They also offer the opportunity for:

1. Leadership
2. Professional growth and satisfaction
3. Understanding health care organizations and environments
4. Initiating patient care strategies beyond the physician’s own patient base
5. Maintaining or improving local, regional, and national reputation

As I work with physician groups on this issue, it’s amazing to me how many different opinions there are regarding the level of need for spending time on a given activity. In most cases, this is because each person has his or her own personal interest and/or different level of awareness of the opportunity and potential value of each activity. Developing an agreed-upon list that is the product of rich discussion is the first step. The second step is to encourage each physician’s involvement. Both of these steps are discussed in the two case studies below.

CASE STUDY #1

One of the practices I have worked with for may years has shown continued commitment for building and implementing a simple and yet complete package of Best Practices: Mission Statement, Goals, Governance Document, Internal Peer Review, and Code of Conduct. As the patient base grew, demand for patient care became excessive. During this time, only the founders remained committed to participating in non-clinical activities. As other MDs were recruited and credentialed, the workload eased and it became apparent that three or four of the remaining docs had not taken the opportunity to actively participate in activities beyond patient care.

Step 1
During one of the physician meetings, this issue was put on the table, giving me the opportunity to suggest the concept of developing a PARTICIPATION MATRIX. At the next meeting, I passed out examples of a matrix, and the group then developed a list of valuable non-clinical activities. By the following meeting, I had the list polished for their critique and buy-in. Table 1 (p. 21) shows a few of the categories and items from that matrix.

Step 2
In this case, because the practice is small and personal relationships are close as well as collegial, “encouragement” for participation comes in the form of a completed, filled-in matrix for formal group discussion every six months. These sessions provide a license for acknowledging the efforts for those physicians who are giving above and beyond, while at the same time applying appropriate pressure for everyone to participate. During these meetings, the entire group also talks about the appropriate amount of time worth devoting to each activity.

Table 1		Phys A	Phys B	Phys C	Phys D	Phys E	Phys F
Related Efforts:
1c.	Cardiovascular Liaison					X
1g.	Progress Notes Update				X
Hospital committees/Conferences
2a.	Department Committee		X
2b.	Patient Care Committee		X
2d.	Trauma Committee
2e.	Quality Council		X
2f.	Institutional Review Board		X		X
2g.	Ethics Committee					X
2k.	Pain Care Committee					X
2w.	ER Committee	X
2x.	Code Green Committee	X		X
Medical Education
3a.	Lectures (Physicians)					X
3b.	Lectures (Residents)		X		X	X	X
3d.	Curriculum Committee
3g.	Coordinator Medical Student Relationships		X
3i.	Resident Interviews	X	X
Research
6a.	Peer Reviewed Article – 1st Author
6b.	Peer Reviewed Article – Contributing		X			X
6c.	Funded (Grant) Research
6d.	Principal Investigator				X
6e.	Participant Clinical Trial				X
6f.	Poster Pres-Regional/Nat’l Conf
6g.	Oral Pres-Regional/Nat’l Conf

CASE STUDY #2

This second practice is a large, multi-site, primary care practice in the midst of building an effective Best Practices infrastructure: a Long Range Plan (Mission, Goals, Objectives, Action Pan s); a Board of Directors and Administration Governance Document; a Physician Compensation Model that addresses productivity; and the following PARTICIPATION MATRIX.

Step 1
In this case, the matrix was developed by the Board of Directors for review by all providers who critiqued and polished the form and also gave input to the Board on the relative value of each item on a scale of 1-4. The real and perceived needs of this practice are different from the first example, although many areas overlap. Their matrix includes 60 items, some of which I have included in Table 2 (p. 22).

Step 2
All physicians have an upfront understanding that each year:

1. Each person’s activity will be recorded on the matrix and made public their points will be totaled

2. Their total points will be divided into the total number of points for all physicians (resulting in the “percentage participation”)

3. Each person’s resulting percentage will determine their share of that year’s participation bonus

Identifying valuable, agreed upon, non-clinical activities is an exercise all by itself. Step 1 will accomplish this, and the examples that I have outlined in Step 2 should provide you with ideas on how to accomplish the “encouragement” part.

Legend: <4 = averages less than 4 hours per month; 4 = averages 4 hours per month; 8 = averages 8 hours per month; >8 = averages more than 8 hours per month

If you have any questions about this article, please feel free to give me a call.

The development of documents such as this is an investment of time, requiring meetings where participants listen and understand. Gaining a joyful environment within which to practice medicine makes it all worthwhile!

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