High performance begins with physicians and staff who are engaged, satisfied, and productive — and perceive themselves capable of delivering effective care. This capability stems from intentional design of the workplace, from strategic incentives to sensible workflows to improvement resources. Our research has identified five attributes, shared by high performers, that enable physicians and staff to perform at their best.
Sustainable physician job design
Thoughtfully designed workflows, training, and automation take administrative work off of physicians' plates and allow nurse practitioners and medical assistants to perform at the top of their licenses, doing most pre- and post-care review. At DTC Family Health and Walk-In, exam templates for 10 to 15 common diagnoses enable medical assistants to determine the needs of each patient, from vaccinations to prescription refills and sample collections. Their MAs then meet those needs before the provider even enters the exam room. That means physicians and nurse practitioners can then take time to engage more deeply with patients in the moment of care. And that level of interaction not only improves patient outcomes, but returns the "joy of medicine" to the provider.
Radical transparency around performance data
Many physicians balk at the idea of having performance data shared publicly. Yet keeping data confidential can prevent providers from improving. High performers say one key is to take advantage of physicians' inherent competitiveness with their peers. At Farmington Family Practice, unblinded data is posted for all physicians and staff to see. Clinicians compare their numbers and learn from each other informally in the hallways. They have even started a football pool based on quality measures, which has proved more effective at improving metrics than other formal initiatives. At Martin's Point Health Care, every physician meets one-on-one with a physician leader to review the results and highlight areas of strength and weakness. Whether the process is formal or informal, high performers focus on the data, not the doctor, presenting metrics as guideposts for next steps.
Autonomy against clearly defined performance goals
At top performing networks, quality measures are closely monitored, with a clear definition of who is performing well and who is falling short. These hard thresholds have clear support actions tied to them, such as physician retraining or increased team staffing. In many cases, standards are developed by a quality committee with the input of physicians. High performers also set clear standards for staff, who are often expected to follow pre-set workflows. These defined workflows make it clear to everyone when steps have been missed — and the organizations give employees the tools they need to find and cover any gaps. Beebe Health credits clear processes for non-physician staff as a large part of its success in quality reporting.
Performance improvement resources
If physicians and staff are going to be held accountable for individual and team quality metrics, there must be a formal system to help them get to the next level of performance. High performers put in place well-defined processes and robust training programs for non-physician staff, so doctors can confidently offload administrative work. To facilitate continuous quality improvement, Beebe Health's workflow includes clinical optimization specialists and subject matter experts who train physicians, customize workflow templates, and help physicians perform at their best.
Top performing organizations align physician and staff compensation with quality and financial goals. Tying employee compensation to specific targets, which vary depending on roles, signals an organization's values and alsigns clinicians, staff and management. At Austin Area Obstetrics, Gynecology, and Fertility, new targets are set each quarter for everyone — from the front desk staff to physicians — and meeting those targets means quarterly bonuses for individual high performers. The bonus system has not only helped the group excel in quality measures, but has increased operational efficiency to the point of doubling the group's profitability in three years.
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