Changing physician behavior through involvement and collaboration.

During a seminar several years ago, a participant asked if I could offer a tool that would help him manage physician relations at his hospital. Seeing this question as an opportunity for a class dialogue, I asked participants, “What is the first image that comes to mind when you hear the word ‘tool’?” The majority replied “hammer.” A few shouted, “gun” or “machine gun.” One even bellowed “chain saw!” These responses confirm that physician-relations issues provoke not only practical but also desperate ideas from healthcare executives. Many of the criteria on which their performance is judged (e.g., revenue, expense, and clinical outcomes) depend on the involvement of physicians over whom they have influence but lack control. What can leaders do to better exercise their influence and, in that process, change physicians’ behavior? In this column, I present strategies for involving and collaborating with physicians—the most important first step in changing behavior. Specifically, I discuss a bottom-up approach, finding the “win” with small projects, healthy competition, physician champions, positive deviance, and helping independent and employed physicians.