Doctors are facing more complex demands. How can medical institutions support them — and boost their profits in the process?
For more than 2,000 years, the Hippocratic oath has been the basis for the ethical conduct of every physician. But the pledge is not static; in 2017, the World Medical Association proposed changes to the modern version of the oath. Chief among the revisions were the requirements that doctors must take care of their own health and well-being, respect their colleagues and students, and share their medical knowledge “for the benefit of the patient and the advancement of health care.”
If one looks at how hospital physicians’ workloads have changed over time, this new wording of the Declaration of Geneva is by no means surprising. But the changes are motivated by more than the constantly growing share of administrative activities with which physicians must contend. These edits also target areas of deficiency that are common in the institutions where physicians serve.
Fostering a Culture of Health
The division of labor in any complex organization requires employees to coordinate with their colleagues, make decisions together and work as a team. But medical students are rarely afforded the opportunity to systematically learn forms of cooperation or train their leadership skills. Instead, medical education focuses on how to make therapeutic decisions based on medical rationality. It does not prepare doctors to make complex managerial decisions in the context of micropolitical power games within a strongly hierarchical organization such as a clinic.
Only by building a healthy, supportive environment for both physicians and patients, health care organizations can provide truly excellent care.
These educational shortcomings ultimately create dysfunction for health care organizations, and they raise stress and dissatisfaction for medical professionals. But what is the impact on patients?
The new oath suggests that the role of the physician is so central to medicine that comprehensive and skilled patient care can only happen when doctors safeguard their own health and cooperation. If this is true, must not health care organizations take the next logical step? Only by building a healthy, supportive environment for both physicians and patients can health care organizations provide truly excellent care. It is an ethical imperative—and, in our view, also a shrewd business strategy.
Hospitals and other health institutions must ask themselves: What framework of working conditions must we create in order to provide patients with optimal care? What structures and work processes are needed to create those conditions? What kind of culture must be created to foster healthy cooperation between doctors, nursing staff and administration?
Diversifying Relationships with Patients
Let’s look at a real-world example from an institution that is taking innovative measures on this front: The Fricktal Health Center (Gesundheitszentrum Fricktal) near Basel, Switzerland.
A recent visit to the gynecological clinic within the Fricktal demonstrated that providing the best possible health care for patients requires medical organizations to examine how they can make improvements internally while also developing a strategic focus on market positioning. Health care organizations must dedicate time and money to understanding the market, developing strategy, improving organizational structures and boosting staff members’ leadership skills.
Making the community the provider of choice.
Dr. Maik Hauschild, who runs the clinic, started building the department from scratch in 2011. His primary interest was to build an interdisciplinary breast care center providing cutting-edge therapy for cancer patients, but he instituted a requirement that the clinic hires only attending physicians specialized in at least one alternative therapy. This was done with an eye toward strategic positioning: The center offers many treatment options and approaches intended to increase the community’s appreciation, with the goal of making it the provider of choice in an area where patients can select from a number of options. Despite it not being a profitable undertaking, the clinic began offering labor and delivery services, with the intent of making the clinic an integral part of families’ lives through all stages of the life cycle, including periods of sickness and of health.
In addition, the Fricktal hired an external consultant to help obtain certification for the breast care center from both the German and Swiss cancer societies—an investment that has quickly paid off from a marketing point of view.
Implementing Structures to Prioritize Patient Care
The growth of an organization inevitably creates an increased workload and, in growing health centers, doctors can often be caught in an endless cycle of insufficient supply and increasing demand. As the number of daily patient visits grows, so does doctors’ workload; eventually growing centers can hire additional doctors, but there is always a lag between the need for additional support and the arrival of new staff.
In a moment when many hospitals are seeking to downsize administrative functions, leaving medical residents overburdened with secondary duties, the Fricktal is instead seeking to establish structures that free doctors from this administrative work and leave them more time to focus on patients. Breast care nurses and a ward secretary have been hired on each floor to alleviate doctors’ administrative workloads. This, in turn, enables further growth as it allows flexibility to spend time with new patients.
Setting Clear Communication Rules
In addition, administrators have made an investment in time spent on structured communication. In the 48 hours before each tumor board meeting, participants come together in three preparatory meetings designed to ensure open communication and thoughtful deliberations. It is an extraordinary commitment for a team operating in a setting with so much inherent schedule uncertainty: Surgeries run long; patients require urgent visits, and yet they still manage to prioritize these meetings. As a result of this extensive preparation, the tumor board meetings themselves are less impacted by interpersonal micropolitics, and they run quickly and efficiently. Discussions of patient treatment are reasoned and focus primarily on the needs of the individuals under the doctors’ care. As a result, there is a sense of accomplishment and shared takeaways that smooth the flow of collaboration, reduce interdepartmental friction and ultimately improve quality of care.
Center administrators also work to foster a culture of self-reporting and openness when it comes to errors. All doctors and nurses are encouraged to anonymously report themselves if a mistake has been made or might have happened. While it would be relatively easy in such a small hospital to track who was responsible for these errors, administrators and managers instead understand that it is not in their interest to do so. They use the data to examine and improve the processes that may have led to the mistakes.
Viewing Optimization as an Investment
All too often, optimization is a euphemism for penny-pinching. But at the Fricktal, hospital leaders seek to optimize processes and structures with a primary focus on patient experiences and outcomes. These organizational innovations keep the focus on patients while also supporting doctors and, as a result, health outcomes and personal satisfaction rise.
It is the kind of profit that today’s doctors—hoping to live by even the most ambitious tenets of the updated Hippocratic oath—can get behind.