Is your health care organization concerned about physician engagement? If it lacks a compact to align and engage physicians, it's missing a great opportunity.
“What’s a compact?”, you may ask. Great question! A compact is a document that codifies what are usually unwritten reciprocal agreements between two or more parties. Unlike formal contracts, compacts are based on organizational values. They specify, for each value, how each party can expect the other to act in order to honor that value.
You may recall that conflicting values are one of the drivers of burnout. Values statements minimize the risk of values conflict, but in this VUCA world (of volatility, uncertainty, complexity, and ambiguity) naming a value without explaining what it means adds to the risk of values conflicts and the potential to worsen burnout.
Sound vague? Let’s get more specific. Most healthcare organizations have a stated set of values, things like quality, service, integrity, financial stewardship, etc. These values provide guidelines for how the organization will honor its vision and mission statements. It's important to state the values to help stakeholders know what is important in the organization. But if the values are vague and open to individual interpretation, they can add to the drivers of burnout.
Similarly, some organizations have a statement of expected behaviors describing how individuals should act to honor the values. If there is not a concomitant statement regarding the organization's role in supporting individuals as they work to honor the values, it can feel top down and heavy handed, again increasing the drivers of burnout.
How do we accomplish both goals - identify our values, and reduce the risk of burnout? This is the benefit of a compact. It adds clarity to each value. It states specific expectations for how each party will honor each value. These expectations are reciprocal. For each value there is a statement that says the hospital can expect the physician to do “X”, in return the physician can expect the hospital to do “Y”.
For example, this takes the vaguely stated value of “quality”, and provides specific actions/behaviors:
Physicians will maintain current clinical competence, and collaborate with other members of the patient care team to follow accepted quality guidelines.
The hospital will provide a clinical environment - staffing, equipment, supplies, and physical plant - that supports quality care.
Talk to physicians and they will tell you that the world of today is not what we signed up for when we went to medical school. We thought we had a reciprocal agreement with society:
We would work hard during much of our early adulthood, gaining the knowledge and skills required of a competent physician
Society would honor our competence with generous compensation and professional respect
That unwritten compact is no longer honored. And thus, physicians feel a lack of fairness (another driver of burnout).
A similar challenge arises as physicians move from independent practice to being employed by hospitals or medical groups. They are often enticed by promises that they can join the group, be relieved of day-to-day management responsibilities, and the group will allow them to practice as though nothing else has changed. This is unrealistic, and sets up many acquisitions for challenges, if not downright failure.
A compact can be a great benefit in managing a group. When shared with recruits in the hiring or acquisition process, it clarifies expectations for the new physicians. When shared among the current physicians, it provides guidelines for making difficult decisions, regarding group strategy and individual performance.
Beyond the benefit of the compact itself is the process of developing the compact, done collaboratively by group leaders reaching out to all physicians, hearing their thoughts and feelings about the values and how they apply in real life situations. The discussions themselves engage physicians across the entire group in what it means to be a member of the organization.
Often this is the first-time fellow group members have thought collectively about such issues. Physicians become engaged and aligned. The group is almost always much stronger as a result, providing a solid foundation upon which the group build successfully.