Engaging the Front Lines: Clinician—Executive Partnership in the Pursuit of Value-Based Care

Abstract

Purpose: As health delivery organizations prepare to shift from volume-based to value-based reimbursement, executives will need to effectively translate institution-level incentives into actionable change on the front-lines of care delivery. We sought to determine if an opportunity exists for health system leaders to leverage the collective knowledge of front-line clinicians in navigating this transition, and to ascertain which communication practices best enable senior managers and front-line clinicians to work in tandem to deliver higher-value care. Methods: Following a literature review to ascertain best practices for intra-hierarchical communication among, we developed a semi-structured interview questionnaire in order to understand how such practices could be translated to the challenge of clinician engagement. We interviewed executives, mid-level managers, and hospitalist physicians at a leading academic medical center. Interviews were transcribed verbatim and analyzed for common themes. Results: Four themes were identified: 1) front-line input is valued by executives and is willingly offered by clinicians, but organizations often lack reliable channels of communication; 2) effective front-line engagement strategies must fit into existing clinician workflow; 3) call-out systems only succeed if accompanied by closed-loop communication and organizational capacity to respond; 4) previously successful safety programs may serve as a template for value initiatives. Conclusions: Front-line providers are well-positioned to detect current drivers of low-value care, presenting an opportunity for partnership with managers who seek their input. To translate institutional incentives into delivery of high-quality high-value care—and to actively engage their clinicians in the improvement process—health care executives will need effective, well-defined lines of communication with their front-line care providers, a value-oriented institutional culture that encourages front-line engagement, and capacity to incorporate learnings from front-line feedback into the institutional strategic planning process.