“What matters is living by [the physician compact] and sticking to it over time. That’s how the culture is changed.”
– Dr. Joyce Lammert
Getting at the intrinsic motivators
The Value of a Physician Compact
Virginia Mason has proven that a physician compact — now more than a decade old — can serve as the rock-solid foundation upon which Virginia Mason’s improvement work is built. The relationship between physicians and provider organizations is often uneasy. Tension, challenges and conflict too often mark the back and forth.
When Gary S. Kaplan, MD, became Virginia Mason’s chief executive officer in 2000, he believed real progress could come only with a clear understanding of what was expected from doctors and what doctors could expect from the organization. He asked Joyce Lammert, MD, to work with her colleagues throughout the medical center to reach a compact.
“Being very clear about what it means for a physician to be a citizen of Virginia Mason is really the crux of it,” says Dr. Lammert. “It’s about all those things that motivate people that don’t have anything to do with money — the intrinsic motivators. Everybody wants to feel like they’re part of something that matters, something bigger than themselves. And with our mission of transforming health care and putting patients at the top — that’s huge.”
So what would Dr. Lammert suggest for organizations contemplating the compact process?
“I think the No. 1 question you have to ask is do you really want to do it,” she says, “because most people want to get a compact and then they’re done. ‘Okay, we did the compact thing and now we can go on to more important things.’ So I think the No. 1 thing is do you really want to change?”
Honest conversations with doctors are essential to creating a meaningful compact, says Dr. Lammert. She vividly recalls from a decade ago the sense of loss felt by many doctors who had been trained to believe that they would always be autonomous and in charge. Yet the new world increasingly defines health care as a team endeavor.
As Dr. Lammert stated in the book Transforming Health Care: Virginia Mason Medical Center’s Pursuit of the Perfect Patient Experience, “You go through college and medical school and training and all those years and all that hard work and you think you’re going to get one thing and you get something else. There was an expectation of autonomy — that’s a really big thing with doctors, calling the shots on how you practice and what you do. It’s gone from doctor-knows-best to 21st century medicine where it’s patient-centered, collaborative, team medicine — all about working together.”
She cautions that the compact process requires countless conversations — many of them difficult and sometimes emotional.
“It is not something done easily or quickly,” she emphasizes. “Nor is the piece of paper itself particularly powerful. What matters is living by it and sticking to it over time. That’s how the culture is changed.”
How would a physician compact go over in your organization?