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Five dynamic tensions in contemporary medical staffs part 4: Appreciation and continuous performance improvement

Medical Staff Leader Connection, August 5, 2008

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As we noted at the start of this series, the five dynamic tensions in contemporary medical staffs are:

1. Collegiality and excellence
2. Freedom and commitment
3. Appropriate independence and mutual accountability
4. Appreciation and continuous performance improvement
5. Stability and change

Hospitals are constantly promoting continuous performance improvement measures in an effort to achieve better patient outcomes. But in doing so, they often fail to appreciate the excellent care physicians are providing already. Think about physicians who attend patients in the middle of the night and those who deal with angry patients or families who threaten to sue them. Who is saying thank you in your hospital? 

If physicians only hear about how they can improve, without hearing appreciation for the hard work and excellent care they already provide, you won’t have a healthy balance between appreciation and continuous performance improvement.

While there is no doubt that hospitals are embracing continuous performance improvement measures, physicians have often resisted such measures when they feel forced to change how they take care of patients. One of the reasons physicians resist is because they believe they already provide high quality care. Therefore, a medical staff culture that wants to embrace continuous performance improvement must also express appreciation for the quality of care, personal commitment, and sacrifices already provided by the physicians on the medical staff.  When physicians feel appreciated, they are far more likely to accept constructive feedback and improve the care they provide over time. 

The take-away message is that the answer to an effective medical staff is neither appreciation nor continuous performance improvement, but both. How do we capture the best of both and manage this dynamic tension? 

Next time, we will look at the fifth polarity, stability and change.

William K. Cors, MD, MMM, CMSL
Vice President Medical Staff Services
The Greeley Company

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