How do we improve the trust gap between private practices and a health system to create a team of teams approach to prioritize the care of all of our patients?
Problem to be solved: There is a significant trust gap between our private medical practices and our health system. This historic tension has interfered with the tremendous potential to develop a strong, team-based approach to improve care for our patients together. As we move forward in healthcare with patient-centered care and population health, our patients are asking for and expecting consistent clinical information sharing, communication, and care coordination across care venues and between private practices and the health system. One barrier to this information sharing is of course the presence of separate electronic records systems that lack interoperability, but before we attempt to address the IT barriers to effective care coordination, we need to improve our team trust. The shared value proposition that all these teams have in common is the collective goal of improving the care and wellbeing of all of our patients.
As we design new models of care coordination in our hybrid environment of private practice physicians and health system employed physicians working together, we need new and creative approaches to improve trust and collaboration. What are the strategies that others have used to help rebuild and maintain trust in this type of scenario?
We have engaged private practice physicians in almost all aspects of strategic planning, program development, quality improvement, care standardization, and other health system initiatives. By actively engaging them within the health system beyond just direct patient care we have created a shared vision and a common framework for practice and care delivery as well as aligned incentives and outcomes. This degree of transparency has gone a long way to developing trust and enabling a shared value proposition. Our patients and the larger community we serve are better for it. We still have work to do around EMR integration and more fluid communication, but have come a long way from the “we versus they” mentality.
I have worked in both environments as a private practice physician and an “employed” physician. The biggest barrier to trust for the physicians is usually money (sad but true). The physicians only see the the money or wRVUs that directly impact their income and not what the health system finances looks like. From their perspective the health system is always trying to make more money at the expense of the physicians doing more work and seeing less return with declining reimbursement. Personally, I think complete financial transparency is the starting point of improving physician trust in our current fee-for-service environment. While physicians often loathe EMR integration, I have never had a conversation with my physician colleagues about that being a factor of trust with the health system.