New models of health care delivery hold promise for improving the quality of care and reducing costs. But their success depends on physicians altering their behavior and functioning within a larger organization. In accountable care organizations (ACOs), for example, if providers from across a spectrum of care—primary care doctors, specialists, and hospitals—succeed in delivering quality care while reducing costs, they share in the savings. But physicians can be resistant to organizational change, seeing it as a threat to their professional autonomy. Commonwealth Fund–supported researchers set out to identify the most promising strategies for engaging doctors in change.
What the Study Found
Researchers from the Brookings–Dartmouth ACO Collaborative analyzed physician engagement strategies used by four nascent but well-regarded ACOs of different size and structure: Monarch Healthcare, Tucson Medical Center, Norton Healthcare, and HealthCare Partners. The authors found that physician engagement strategies varied dramatically by site. Despite the absence of a best practice, the four organizations agreed it was important to first determine how physicians viewed themselves—as a number of individual practitioners, as part of a professional group, or as team members working toward a larger goal—before choosing an engagement strategy.
ACOs and other integrated models of care must pay attention to group dynamics when trying to engage physicians in change. Independent practices might respond best to the notion that an ACO is physician-driven while salaried doctors might embrace a shared-purpose strategy. The authors conclude that appropriate engagement strategies depend on first determining the social identity of the target groups.