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If healthcare is an orchestra

If healthcare is an orchestra, then providers play ‘first fiddle’

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Health systems can trim costs by millions of dollars a year — and improve patient outcomes — by reducing care variations. It starts with the diagnostic process, which makes provider engagement an essential component. So how can hospital administrators get that all-important provider buy-in? Through effective communications. These seven steps will help CEOs and CFOs communicate with providers in ways that matter to them.

Analogies of healthcare to sports teams or an orchestra are common. If healthcare is an orchestra, then providers are the concert master. Providers lead the activity in many ways. They initiate orders for diagnostic services and can set the tenor of the entire patient experience. Therefore, the engagement of providers is critical to ensure that care delivery is harmonized for patients and the rest of the healthcare team. But how do you effectively engage providers?

Don Goldmann, M.D., the chief medical and scientific officer at the Institute for Healthcare Improvement, has identified seven ways to engage clinicians/providers.1 Roughly translated, these seven are:

  1. Frame the issue correctly and avoid using language that has negative implications from the provider perspective
  2. Avoid using jargon or acronyms
  3. Relate the work/initiative to what matters to the provider
  4. Accommodate the provider’s schedule
  5. Be upfront about any fiscal agenda
  6. Provide relevant data
  7. Highlight how the effort is aligned with provider goals/desires

Efforts to reduce diagnostic variation critically rely upon provider engagement. Providers are in control of the diagnostic process, and hospitals need to engage them to reduce the diagnostic variation that leads to downstream costs for the hospital and potentially less desirable outcomes for patients. If we used Dr. Goldmann’s rules, what would that look like?

A problem statement that frames the issue in language the provider can relate to could look something like:

The incidence of hyponatremia in our hospitalized patients is currently 17%. This rate is similar to the national average. Patients who experience a hyponatremic event while in the hospital have higher morbidity and mortality and a longer length of stay. This contributes to poorer clinical and financial outcomes. What can we do to reduce the negative consequences of hyponatremic events in our hospital?

Such a statement helps focus the issue on what matters most to providers (i.e., clinical care). It also lays out the financial implications (Goldmann rule #5) and avoids jargon (Goldmann rule #2). But how do you address Goldmann rule #4 and meet providers where they “live”?

Accommodating providers’ schedules is a critical part of effectively engaging them. Face-to-face meetings are challenging to arrange and frequently get delayed as competing demands pull the provider in a different direction. Fortunately, many of the activities that support improving clinical and financial outcomes can be enabled through asynchronous conferencing, allowing providers to participate when and where they have the time to do so. Use of such tools enables better provider engagement.

Goldmann rule #6 can also be accommodated, particularly as it relates to the use of clinical laboratory services. Clinical laboratories contribute approximately 70% of the objective data upon which providers make diagnostic and treatment decisions. Data from the electronic medical record, laboratory information system, or billing system can be presented in such a way to illustrate relevant, local variation in ordering patterns. For example, variation in the use of clinical laboratory tests for the most common admitting diagnoses at a community hospital are illustrated in the following graph.


The red bars show the total number of unique tests used for each admitting diagnosis cohort, and the blue bars show the average number of unique tests per patient episode for that cohort. The dramatic difference noted in this simple bar chart immediately gets the attention of and engages providers to ask the question “Why?”

Goldmann rule #7 — show how the activity relates to provider goals — can be accommodated within the framework of the problem (in this example, showing how addressing hyponatremia can have a positive impact on clinical and financial outcomes). If patients have a shorter length of stay, they are more satisfied and the hospital is better off financially, given the transition to more bundled payment models of reimbursement. In addition, providers will have a more predictable care pathway to share with patients and families.

If the hospital is an orchestra, then providers play “first fiddle.” Engaging them to ensure that the hospital plays beautiful music is critically important.


1 “What Are Seven Ways to Engage Clinicians in Quality Improvement?” Institute for Healthcare Improvement Open School video, 06:50,




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