What Are The Key Attributes Of Physician Alignment?

Thursday, August 17, 2017 | Larry Sobal

What Are The Key Attributes Of Physician Alignment?



A few months ago I blogged about why we still struggle with physician alignment. That blog post, along with one on addressing TCG (trust, consensus, grit) deficiency in leadership teams, seemed to hit a nerve; they generated the most responses I’ve had since I started this weekly blog almost two years ago. This week, I want to talk about a related topic and ask for your help.  

I’ve noted many times that we are in an era of health care that is unprecedented with the level of challenges and amount of change taking place. Regardless of your opinion on the pace and type of change, it’s hard to argue that there has ever been a greater need for hospitals and their physician partners to collaborate and innovate together.

Hospital and health system executives recognize that they cannot be successful in accomplishing meaningful clinical transformation without high levels of physician alignment and engagement. At the same time, physicians may view industry pressures, such as bundled payments, the Two Midnight Rule, and readmission reductions, as unreasonable affronts to their traditional autonomy and clinical judgement. As I work with organizations around the country to master effective methods of planning, innovating, implementing, solving conflicts, and producing meaningful and measurable improvements, I have noticed that the number of organizations working in this way is more the exception than the rule.

The reason that synergy doesn’t seem to happen to everyone’s satisfaction has been described in a number of ways, but most commonly I hear “we just can’t seem to get in alignment with each other.” So here’s where I need your help. MedAxiom has been contracted by a large organization to conduct research around the attributes that best correlate with successful hospital and physician alignment. I think that’s going to be pretty interesting, especially to look at whether the attributes are identified consistently by both physicians and hospital executives.

Hospital and health system executives recognize that they cannot be successful in accomplishing meaningful clinical transformation without high levels of physician alignment and engagement.


In preparation for this project, I have been doing both formal and informal research, such as having conversations when on site with my consulting clients and asking them what they think are the key drivers of successful hospital and physician alignment. Curiously, I can find no surveys of physicians related to what they want out of the alignment process. It would seem then, and this is my experience, that the alignment process is mostly a hospital-centric process. 

One thing I quickly learned is that “alignment,” or better said, “misalignment,” is not just limited to physicians and hospitals. There can be just as much consternation about the lack of alignment between physicians and medical groups, particularly those large multi-specialty employed medical groups that are cropping up all over. Other areas that seem to be struggling for alignment with physicians include ACOs (or other forms of Clinically Integrated Networks), provider-owned health plans, and even among physicians themselves, either within their practice or with other practices or specialties.

So back to my request for help. If we define alignment as “a state of agreement or cooperation among persons, groups, nations, etc., with a common cause or viewpoint,” what are the attributes that are most likely to create this state of bliss? Here are some of the more frequent attributes I have heard thus far (in no particular order):

  • Trust
  • Communication
  • Transparency of information
  • Consistency in relationships (i.e., same people working together over time)
  • Shared vision
  • Candor
  • Decisiveness
  • Focus on the patient above organizational or individual agendas
  • Bias toward action
  • An economic model that delivers a win/win
  • Shared risk and reward
  • Discipline
  • Courage

In addition, some of my more interesting conversations have been around whether or not there can be different degrees of alignment versus alignment being an “all or nothing” situation. One person described alignment as “either you are all in or not,” while another described alignment as fitting into a “range of maturity levels” from absent to fully aligned (and everything in between). 

What I would like you to do is answer two questions by commenting on this blog post.

Question #1 – If you were to assign 100 weighting points to different attributes of alignment, how you would allocate them?  Example, you might say Trust gets 50 points, Shared Vision gets 25 and Focus on the patient gets 25, etc. You can assign as many or as little points as you want, but the total needs to be 100.

Question #2 – Do you think that alignment is: a) an “all in or not” scenario or b) has different levels or degrees?

This will help shape our upcoming research and I will share those research results in a future blog post. Thank you in advance for your help.


Illustration: Lee Sauer


Larry SobalLarry Sobal is Executive Vice President and a Senior Consultant at MedAxiom. He has a 35-year background as a senior executive in medical group leadership, hospital leadership and health insurance. Larry consults, writes and presents on topics relevant to transforming physician practices and health systems. His weekly blog post comes out on Thursdays and can be accessed at www.medaxiom.com.


About the Author
Larry Sobal

Larry Sobal, MBA, MHA, is CEO of a yet-to-be-named cardiology practice which is transitioning from employment to an independent physician group effective January 1, 2019. He has a 37-year background as a senior executive in physician practices, consulting, medical group leadership, hospital leadership and health insurance.

To contact, email: larry.sobal@gmail.com

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