Medical Staff Development – Discipline of Safety

Physicians require discipline to participate on a quality medical staff. There is the discipline of personal integrity, the discipline of good interpersonal relationships, the discipline of professional development and the discipline of safety. The medical staff, through the person(s) of its officer(s) requires the same menu of disciplines. If there is a place to re-establish lost discipline, it is in the area of safety. Here is a point on which the hospital, physicians and public agree. A hospitalization should be safe. For all of that, physicians, even respected physicians try to reclaim their lost autonomy by ignoring hospital safety protocols. Just think how difficult it is to achieve compliance on the simple safety procedure of washing hands between patients. Medical science has only known about the benefits of hand washing for over 100 years. There is a problem with discipline. When the medical staff officers fail to enforce, they fail an important integrity test.

Christmas at Work

Most of us would say that Christmas is over now and that we can get back to normal if we can only survive New Years. The truth is that there are twelve days of Christmas and this is only number three. So, I thought I would indulge in a little reflection on the significance of Christmas at work in the hospital. The emphasis on gifts at Christmas diverts from the essential Christmas message, that God lives with us and among us. How do we see God working in our hospitals? Do we think about the idea from time to time? Does that kind of reflection change the way we interact with patients? What would it be like in your hospital if that awareness of God’s presence were a primary objective?

Medical Staff Development – Leadership style

Physician leaders are a key element in medical staff development. Physicians also need some management skills to lead effectively. Yet, leadership and management are different and often confused. To lead physicians effectively eludes many physicians who have been cast in the role of leader. The problem is quite simple. Physicians practice a directive style of leadership. You might call it a prescriptive style. We rehearse it daily: “Take this medicine. Do these exercises. Return in two weeks.” Unfortunately, physicians do not themselves respond to a prescriptive-directive leadership style. The beginning of effective physician leadership is to learn the most effective style. The leadership training we offer at Physician Formation Consulting emphasizes the most effective style. Visit www.PhysicianFormation.com

Medical Staff Development - The Right Relationship

Dr. William Cors recommends that one of the keys to good medical staff development is having the right relationship between the hospital and the physicians. He begins to describe different models of hospital-physician relationships: joint ventures, gain-sharing, or employing physicians. None of these is the right fit for every medical staff, but starting at this level reduces the hospital-medical staff relationship to a formula for dividing the pie. Adding a few rounds of golf and periodic social events serves to smooth the negotiations, but it is still about the pie. Why not gather around the mission flag? Why not collaborate to build the mission plan first? Most would respond: “Because it can’t be done with a disparate group of physicians.” Why not? Because we have simply chosen not to invest the time and effort in the spiritual formation of physicians. We have not invested because, for the most part, we don’t understand how to promote the spiritual formation of physicians.

Appreciative Disposition

Dear Readers,

I apologize for the interruption in posts to this blog. I thought you might want a little pause in the commentary on Medical Staff Development. So here are some other thoughts:

People naturally have certain dispositions in their personality, but dispositions can be strengthened or suppressed by intentional spiritual training. Our mission team speaks often of having and developing an “appreciative disposition,” and it is an important disposition to develop. An appreciative disposition signifies a propensity to find the good in events and situations. It fosters an accepting attitude toward people. It does not signify that all people, situations, or beliefs are good. It signifies rather a faith that God will use people and situations for ultimate good. Out of this disposition flows a capacity for forgiveness, reconciliation, charity, peace, gentleness, joy, and patience. Can we hope for a better description of a healing environment? Can we not hope that our hospitals will be dominated by people with appreciative dispositions? To that end, invest heavily in the spiritual formation of the team and the physician champion who will succeed you. How can we promote the influence of physicians with appreciative dispositions?

Medical Staff Development - physician profile

The joint commission promotes a profile of six competencies for physicians on staff.

http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/03MAR2009/090310HHN_Online_Johnson&domain=HHNMAG

Interestingly, alignment on the hospital mission is not a core competency. Its hard to imagine someone working effectively in automobile manufacture who was incompetent to contribute in some way to the construction of the automobile. Why should it be acceptable that physicians aren't aligned? The Joint Commission's competencies are the competencies of cure, but patients want to be healed. Why aren't healing competencies thought to be important for physicians? Maybe its time to rethink our expectations for physicians.

Happy Thanksgiving

Have a wonderful holiday. Meet you here next week.

Medical Staff Development - The Right Number

Truth-telling sounds pretty elementary. Most health care providers are truthful people. The problem as I see it is that most health care providers are so busy that they fail to recognize truth about themselves. Their focus is often on doing more and more. Knowing the truth about their professional goals requires time to reflect and ask the important questions about what gives meaning to the professional life. Though it is simply one example of the issue, establishing life balance in high performance professionals will significantly alter the calculation of what is the right number of physicians to have on the medical staff. Do we take the time to stimulate reflection? Do we encourage our caregivers to ask these key questions? Are the caregivers regarded as the engine of business or the healthy, balanced human beings that we want our own physicians to be? Is this care for the caregiver too expensive? Does it take too much time? Is it just not on the radar screen?

Medical Staff Development

Dr.William Cors, of the Greeley Company, begins his analysis of medical staff development by calling for the right number of physicians. The concept of the right number sounds incredibly simple, but the right number is the wrong number if the specialty mix is out of balance or if there is a gap in the 24 hour coverage. Truth-telling is critical as administrators and staff physicians explain their goals to each other. Truth-telling is much more likely to happen when the conversation isn't viewed as a part of a continuing negotiation, rather when the parties are working from a common mission. This is particularly so when a faith-based hospital mission is what they have in common and what resonates deep with their own purpose.

Medical Staff Development

I recently read James Londis' book, "Faith-Based Caregivers". There he asserts that "A true revolution in Christian health-care would result in patients experiencing the person of Jesus in the care they receive at our hands. Anything less cannot claim to be an heir to Christ's healing ministry." Developing a medical staff to provide that level of care while honoring its cultural and religious diversity requires us to think carefully, deeply and critically about what Christ's healing ministry actually signifies. This kind of thinking comes out of dialogue. What opportunities have we provided in the hospital that encourage that dialogue? How do we move to the point that patients experience that kind of care if we have not begun the dialogue?

Medical Staff Development

There are some earlier posts that bear on the issue of medical staff development. See February posts on "Mission" and "Barriers to Collaboration". Also January's post entitled "Challenges" shows some of the forces working against an alignment of physicians. Physician compliance with the hospital is different than alignment. When alignment occurs at the physician's "heart" level, impassioned collaboration results. The question is how to form the physician's heart. Embedded in that question is how do we need to form our own hearts.

Medical Staff Development

Medical staff development plans are predominantly medical staff selection plans. Medical staff development involves a dedicated and thoughtful effort for the entire time that a physician is on the medical staff. It involves a change of administrative paradigm. It involves moving from the question: "What can this physician do to build this hospital's business?" to the question: "What can we do to help this physician be a fulfilled healer?"

Medical Staff Development

Competition by specialists with hospital services can create friction, derail collaboration and has already passed the point of mission alignment. Competition is bred into our culture. It strengthens us and pushes us to higher quality, but at the cost of fractured relationships and duplication of services. With health care financing at the point of significant belt-tightening, neither the hospital nor the specialists can afford the battle. Much of the drive to compete is the spin-off of a spiritual battle raging within the competitors, the classic rift between pride and humility. Medical staff development, at its best, will address that very fundamental rift. It will be ready to take the time and make the personal effort. In the end it will be rewarded with a cohesive medical staff.

Medical Staff Development

A feature of most medical staff development plans includes an analysis of possible new clinical services. When medical staff development is focused on the bottom line, the choices of new services can provide some interesting and unusual options, a few of which prove profitable. That focus comes at a price. The remainder of the medical staff readily sees the motivation. Whether they articulate the observation or not, they certainly understand the administration's bottom line focus...and its implication that the mission, vision and values are important but take a back seat. Conclusion: The bottom line is important but belongs in the back seat. (Matthew 6:33)

Medical Staff Development

Integrating physicians into the mission of a hospital is the premier challenge in medical staff development. True integration involves more than the pledge-to-the-flag lip service that often substitutes for real commitment. True integration requires an alignment of the physician's passions. I think faith-based hospitals have an excellent opportunity here since their mission can resonate with physicians' own passions at a very deep level. It is so easy even in a faith based hospital to swing toward the business model of medicine. Our diversity provides further pressure away from faith-inspired medical healing. I favor dusting off those mission statements, having some thoughtful dialogue about what they really mean and breaking through some of the habits of the business model to achieve extraordinary physician integration.

Medical Staff Development

Since the 1980's hospitals have had medical staff development plans, some of which have been very controversial. One component of staff development involves the physician recruiting criteria. Most criteria revolve around issues in the medical market place. Ironically, the mission of most faith-based hospitals rarely includes a statement about earning a lot of money. Should not the criteria for physician recruitment also include the physician's commitment to the mission of the hospital? Should not faith-based hospitals recruit first for virtue then for economic qualities?

Building Spiritual Community

Just as there is on-the-job training, there is on-the-job spiritual formation. In preparation for ministry, all of those on our Seton Cove Spirituality Center team complete a course in spiritual formation (Epiphany Certification Program, 820 Crane Ave., Pittsburgh, PA 15216-3050.) Participants reflect on their person spiritual journeys, discovering landmark experiences along the way. The landmarks may have seemed ordinary during the experience, but reflecting, hearing and telling these stories helps participants discover their spiritual significance. When team members share an intensely introspective formation like this, it helps them become a spiritual community within the institution. That community reinforces important values and encourages an appreciative disposition.

Attitude of Acceptance

However, on closer examination John 3:18 is curiously worded. Condemnation is not contingent on believing that God has a Son, or that he is the one and only Son, or that the son is Jesus of Nazareth. It is contingent on believing in the “name” of the Son. In ancient times the “name” referred to a person’s character rather than to a spoken or written word. To “believe” was to have the mind-set that something was true. Today we use the word “believe” in significantly different ways. The statement, “I believe in the force of gravity,” signifies that the force of gravity is part of the speaker’s life paradigm. If this person jumped out of an airplane, he would not expect to go up. However, we also use the word “believe” as a statement of opinion or supposition such as in this contrasting statement: “I believe the Titanic will safely cross the ocean.” The two uses of the word “believe” confuse our perception of the scripture. Scripture uses “believe” to refer to a life paradigm. Consequently, this seemingly divisive sentence invites every human on the planet, including the physician champion, to adopt the charitable and self-sacrificing character of Jesus of Nazareth and make it a personal reality. Found in a charitable and self-sacrificing character is an accepting attitude toward people of other faith traditions. That this should be so is supported by the oft-quoted verses:
John 3:16-17 “For God so loved the world that he gave his one and only Son, that whoever believes in him shall not perish but have eternal life. For God did not send his Son into the world to condemn the world, but to save the world through him.”
Saving the world sounds like a very accepting attitude toward people. An accepting attitude is a matter of the heart and therefore a matter of personal spiritual formation.

Attitude of Acceptance

Among the most divisive texts in Christian scripture is this:
John 3:18 “Whoever believes in him (Jesus) is not condemned, but whoever does not believe stands condemned already because they have not believed in the name of God's one and only Son.”
Many Christians believe this means that God immediately and finally condemns those who do not accept central Christian tenets. This belief can block an accepting attitude, and it is a formidable barrier, especially for people from evangelical faith traditions.

How can health workers avoid these barriers in the workplace and remain true to their personal beliefs?

Praying with Patients

The question often arises: "Is it alright to pray with patients?" Dr. Jason Salagubang, from Florida Hospital Apopka, came up with an ingenious and inexpensive way to deal with that question in the hospital. On admission patients are asked if they want staff to pray for them. If they respond with "yes", they receive a purple bracelet with the words "Trust" "Belonging" and "Hope" imprinted. Any staff member then already knows the answer to the question "Is it alright?" A bookmark accompanies the gift and provides details:
Trust - as you come to know we really and truly care about you as a person.
Belonging - because while you are with us, you are family.
Hope - because we join with you, mind, body and spirit to affect a wonderful future.

Doctrinal Concerns

An accepting attitude toward people of other faiths incites some devout persons to fear doctrinal erosion. However, an accepting attitude does not imply doctrinal compromise from either the hospital or the physician champion. A close alliance is required between foundational doctrines for the physician champion and the hospital. They need to be compatible because this is the direction of spiritual growth that the physician champion will be fostering in the medical staff. Spiritual compatibility, however, is not synonymous with theological unity, nor is theological unity even a goal.

Religious Language

Religious language can impede spiritual conversations in the workplace. An approach to this language problem relates to the practice of using religious jargon as shorthand for a more detailed concept. One strategy is to put such expressions in the “longhand” form. For example,using the expression of “being under the blood of Jesus,” would probably border on being offensive to a Hindu. Instead restate the concept in longhand form: “In my Christian faith, I see how I have behaved contrary to God’s will and how that has separated me from God. I believe that Jesus sacrificed his life to reconcile me to God.” This style of conversation is understandable and does not ordinarily alienate those of another faith. Rather I think it improves their understanding.

What language examples have you experienced that impede or promote spiritual dialogue?

Endorsing a Candidate

Most important for a candidate is God’s endorsement. I cannot predict how that endorsement might appear. Some would interpret the candidate’s popularity or their ability to recruit physicians as hallmarks of endorsement. I wonder.

How do you discern God's endorsement?

Language of faith

Focus not on a particular religious tradition, rather on spirituality. So, the spirituality that gives meaning and purpose to the physician champion may require an investment of time and prayer to become responsive to the needs of this ministry. That spirituality must allow dialogue with people from a wide variety of faith traditions and with those not having any faith tradition. This capacity is partly embedded in an accepting attitude toward people of other faith traditions, but it also requires a break from some of the language of faith traditions. In fact, our language can be one of the greatest barriers to interfaith dialogue. For example, a Christian who speaks of “being under the blood of Jesus,” will likely close the door to further spiritual conversation with a Hindu. Van Kaam used a new vernacular that he called a “meta-language” to mediate between the jargons of different faith traditions.

What language works well for you? What language seems to impede spiritual conversations?

Finding a Physician Champion

Among physicians, some self-identify as being interested in spiritual matters. Look for people who work with missions and relief. Physicians who are gone on long mission trips will not likely have the energy or time to devote to being the physician champion, but they often have passion and a charitable heart. They can be important contributors to this ministry. Watch the medical staff leaders, especially the ones who offer prayer or reflection as a part of their leadership. As they cycle off of their leadership roles, they might be interested in this aspect of ministry, and they will have a rich network of contacts that includes other staff physicians. However, they may also bring social baggage to the role from previous staff disciplinary actions or political conflicts. Ideally, the physician champion should be approachable by sinner and saint alike. You may find candidates among the academic physicians who train medical students and residents. Just as you would evaluate a medical staff leader, look for the hallmarks of spirituality integrated into their practice and their teaching. Look for joy expressed in the practice of medicine, for good relationships with the nursing staff, good reports from patients, and a balanced attitude toward charity care. That balance is struck between two extremes: 1) Physicians who are totally committed to charity care will have trouble relating to physicians who refuse charity patients and focus on the bottom line. 2) Physicians who resist charity care will require a greater investment in spiritual formation before they can become effective as a physician champion.

What have been some of the characteristics of physicians that have been influential in your professional life?

Finding a Physician Champion

Where will you find a physician champion? Begin with the active medical staff. Physicians will not relate as well to a retired physician champion, or to one coming from outside the medical staff. So, focus on the active physicians. Effectiveness increases the more that the physician champion is regarded as “one of us”.

Have you experienced "outside" physicians that have been effective championing initiatives on the medical staff? How did they do it? What made them effective?

Physician Champion Skills

The physician champion needs organizational skills to coordinate programs, create presentations and manage a database. I use an Excel™ spreadsheet to keep track of activities. A physician champion needs leadership skills. I believe that the menu of leadership styles that physicians commonly practice are inadequate for this role but a physician champion can learn a servant leadership style that is very effective.

What leadership characteristics appeal to you in your professional life?

Selecting a Physician Champion

Does a candidate profess faith? This is a critical question in a faith-based institution, and a valuable question in a private or public institution. Does that person appear to live by principles of faith? The confluence of these two responses is another critical integrity test. Of course, everyone makes mistakes, but the candidate’s “compass heading” is the issue. Is the candidate’s life going in the right direction? Is there evidence that this person is attempting to be faithful? Are his or her decisions consistent with scriptural teaching? Selecting the wrong champion at this point could destroy the effectiveness of any physician champion within an institution for several years, while other physicians forget the bad experiences. Discernment is critical. Plan to pray several times one-on-one with your candidate, especially during times of discernment and particularly with this decision in mind. Stay open to God’s direction. Clarity will come.

What are your thoughts on expressions of faith in a faith-based hospital?

Faith-Based vs. Other Hospitals

Faith-based, private and public hospitals share an interplay of personal and institutional purposes, but there are some significant differences. They become apparent when you try to help physicians align on the hospital mission. Private and public institutions can publicly appeal to humanitarian and financial motives in their medical staff, but generally use faith-centered motivations in private conversations. In faith-based hospitals, the physician champion can emphasize publicly faith-centered motives for physicians, and secondarily appropriate humanitarian and financial motives. The strength of the faith dimension can be powerful, especially when it is visible in the institution.

How do hospitals that are not faith-based express spirituality on the medical staff?

Crisis as Opportunity

When I served in the role of physician champion, I heard the laments. Downsizing began to dismantle cooperation and detracted from a healthy sense of meaning and purpose. Nevertheless, downsizing was an excellent opportunity for the physician champion to listen, help individual physicians find context, re-establish meaning and renew dialogue with administrators. The result is that institutional values are revitalized.

What complaints do you hear? How can you use them to renew a sense of purpose?

Cost of Mission and Values Breaches

When physicians perceive lapses in our adherence to the mission, vision and values, they become angry or discouraged. This is especially so when lapses occur at a high level. A few years ago our hospital downsized, for example. The physicians who were employed by the hospital retained their jobs but experienced significant staff cutbacks. A number of them lamented the loss of good people, good workers and good friends. Our hospital emphasizes core values and among those values are integrity and reverence for people. These physicians had trouble reconciling the labor cuts with our stated values. These physicians felt that honest employees who had given their best deserved an institution that took care of its loyal employees. They questioned whether the hospital revered employees by suddenly marching them off of their work station and discharging them. Whether their perceptions were accurate or not, the result was that many of these physicians became discouraged, disillusioned, and lost morale. They resented the administrative moves.

What strategies do you use to reduce discord between physicians and administrators?

Lived Mission

Physicians contribute to the actual, lived institutional mission. What they contribute influences how closely the actual, lived mission approximates the stated mission. What physicians contribute is a strong influence indeed. The role of programs in physician spirituality is to help physicians find meaning in the work they do and see it in the context of the hospital mission. These programs can work on a number of levels such as personal reflection, leadership development, collegial mentoring, and service opportunities. Many details of how we have approached these levels constitute much of the remainder of what appears in this forum, but there is a commonality for each program. Each one links to the mission, vision and values of our hospital.

How do you see physicians contributing to the mission of the hospital?

Mission as Spirituality

Institutional mission gives an institution its purpose, its reason for being. In a sense, a hospital or institution has its own spirituality, and it can be summarized in a mission statement. Of course, just as in the life of an individual, what we claim as our institutional goal is often not what we actually do. An actual, lived institutional mission emerges from the collective spirituality of its members. The concept of collective spirituality transcends the differences in departmental purposes. Understandably the purposes of the marketing, food services and surgery departments are very different, although they serve the overarching institutional purpose of curing disease and healing the spirit. Yet, collective spirituality refers to the collection of all of the people’s individual spiritualities who work within or are served by the institution.

How significant is the mission statement in your institution?

Power of Mission Statement

To understand the power of the mission statement we need to consider two important concepts and how they relate to the institutional mission. When people hear the word “spirituality” most will immediately and exclusively associate it with the word “religion.” This work require a persistent and steady message that “spirituality” and “religion” are different. “Religion” in this context is an institutionalized system of attitudes, beliefs, and practices relating to the worship of God or the supernatural. There are at least thirty general definitions of “spirituality.” For this work, one definition serves me best: “Spirituality is that which gives a person meaning and purpose in life.

What understanding of spirituality serves you best?

Clear Mission

Making a mission assessment is not as straightforward as you might imagine. Realize that the people in positions of leadership may not be the thought leaders within the institution. So, there are two classes of leaders to consider, the thought leaders and the positional leaders. The views of both classes of leader are important to your work. Get a clear articulation of the goals of the hospital leaders. This is a time for integrity and truth-telling because the power and the joy of your work will hang on these overriding goals. When the mission statement is in alignment with the leaders’ stated goals, the mission statement becomes a powerful tool in your hands.

Where do you find the "thought leaders" in your hospital?

Barriers to Collaboration

The relationship between hospitals and their physicians is critical to the goal of real healing. Many features of modern practice strain those relationships. Some physicians are employed by their hospitals and have the strains of employee-employer relationships. Others are employed by independent practices which often compete for business against the very hospitals that court their cooperation.

Where have you seen the stresses in the physician-hospital relationship impair healing?

Physician Champion's Faith Tradition

Physicians often registered surprise and perhaps a bit of relief when they discovered that I was a Methodist working in a Roman Catholic hospital. I can only imagine what concerns they might have harbored. I suspect that they feared that they would be required to accept Catholic doctrine or be pressed to convert to Catholicism. When I mentioned my Methodist faith tradition, it probably did more to dispel those fears that all of my teaching on the differences between religion and spirituality.

What kinds of fears do you imagine (or hear) from physicians on your staff?

Find a Successor

Almost no one starts a new job by trying to find a successor. Most people start by organizing their files and defending against any potential successors. However, the practice will clarify your role, define desirable characteristics for this role, highlight ideas for your personal development and that of your successor, and provide ample time to recruit and mentor protégés who may be successors. Your protégé can assist with activities, and you will enjoy mutual encouragement.

What prevents you from developing a successor right now?

Finding a Physician Champion

As you consider possible medical staff members, look for important characteristics. Your candidates should demonstrate personal integrity. Confirm your impression of their personal integrity with other physicians, partners, nurses, patients and sometimes the grapevine. Physicians who are medical staff leaders would seem to be a good choice and often are. Remember that medical staff leaders have generally been politically active. Leaders may compromise to make deals and put “spin” on reports. This is not to say that politically active physicians are unacceptable, but be circumspect. Ask yourself, do they have the respect of the medical staff? Have they alienated segments of the medical staff during political battles? Can they build respect and trust? Are they empathetic with the members of the medical staff? Can they meet the expectations and needs of their sponsors and supervisors?

Where to Start

Start your project with the goal in mind. The hospital has a mission that is theoretically its overriding goal. Keep in mind that the institution may not be doing what it says it’s supposed to do. Among the reasons for this non-alignment are that the mission statement may not match the thinking of principle leaders. The mission statement may have been designed by a committee years before and relegated to an unused box of documents. There may be a disparity between the stated mission and the way the institution is functioning. The stated mission may be on target while the institution is off course. The stated mission may never have been properly designed or both the action and mission could be inappropriate. All too often the mission has drifted from the enlivening purposes of the founders.

What goal are you trying to achieve?

Forum's Purpose

I hope that this Forum provides a starting point on this battleground and an approach for attending to the medical staff, aligning physicians on the institutional mission and fostering a spiritually nourishing environment. I shall try to write to that physician in the hospital who will lead the work; I will call that person a physician champion. However, I also want to write for hospital administrators, nursing staff, hospital chaplains, and health policy planners. I shall try to keep the concepts consistent with Christian theology. Nevertheless, I want to honor people from all faith traditions. As I worked for ten years with physicians at St. Vincent Hospital in Indianapolis, I tested these concepts repeatedly. They are generally well received. Finally, these ideas are not doctrine, a cookbook or the only possibility. It is simply one place to start. I know that there are many other directions to take and I hope that readers will share those with an interested and concerned community.

Do you have any suggestions about the format?

Barriers to Collaboration

Physician Formation emphasizes the good news. Every physician resistance is a teaching opportunity. Opportunities abound. Physicians are passionate people. They do amazing work, and most physicians entered the profession with high idealism and compassion. Physicians who choose to work in faith-based hospitals often do so precisely because they possess very admirable personal qualities. These are powerful qualities and more than adequate to counter the daunting barriers.

Have you noticed any differences between physicians working in a faith-based hospital compared to those in a non-faith based hospital?

Barriers to Collaboration

Ironically, issues of faith are often the greatest barriers to physician formation. The prevailing attitude in the United States is that faith and its expressions have no role in the work place. Perhaps this attitude derives from a mistaken interpretation of the constitutional separation of church and state. Others feel that expressions of faith are imperative, but may not express themselves appropriately. Some physicians, like other hospital workers, have preconceptions about spirituality that arise from their faith traditions. Others have no faith tradition or possibly exhibit antagonism toward God, faith or a particular faith tradition.

Where does faith get in the way for you?

Barriers to Collaboration

Physicians themselves create barriers to a healing collaboration with the hospital. Foremost they are incredibly busy. The demands of practice administrators, the electronic medical record, and the growing detail of required documentation insures that physicians will be busier yet. Physician lives are not generally very well balanced. Rest, recreation, and family relationships fall victim to the demands of the practice.

What is the state of "life-balance" for the physicians you know personally? If their lives are out of balance, why is it so? What should be done?

Physician Practice Environment

Other features of the medical practice landscape thwart the goal of real healing. Physicians are under intense scrutiny by peer review, bed utilization review, and practice guideline compliance monitors. Patients have increased access to medical information and misinformation from the internet. Physician incomes have been falling for several years. The collective message physicians hear is: “Non-physicians do not trust you, do not believe that you know as much as you should and that you are not worth what you are paid.” The collective message is not very positive. It is difficult for a physician to bring healing to the bedside when they experience this level of devaluation.

Is this message true?

Hospital - Physician Relationships

The relationship between hospitals and their physicians is critical to the goal of real healing. Many features of modern practice strain those relationships. Some physicians are employed by their hospitals and have the strains of employee-employer relationships. Others are employed by independent practices which often compete for business against the very hospitals that court their cooperation.

What do you think is the role of business competition between hospitals and physicians as both seek to heal patients, body, mind and soul?

Mission

Having physicians want to be within the mission of the hospital is critically important. Physicians make virtually all of the major decisions regarding the health care of individual patients. Those are decisions that alter treatment outcomes and institutional bottom lines. Physicians carry real authority to the hospital staff, the patients and their families. Because of the power of their authority they have the potential to deliver real healing. Physicians are trained to deliver cure and palliation but not particularly trained to deliver real healing.Patients want to be cured, but they long for real healing whether they can articulate that longing or not.

What do you see as the authority of physicians?

Challenges

Because of a growing appetite for spirituality in health care, there are many publications that address the spiritual needs of individual health care providers. However, few spiritually depleted physicians are motivated to read them. Physicians who are spiritually depleted are at higher risk of abusing staff and patients. They have trouble providing spiritual healing for their patients and fail to align their personal and practice goals with the hospital, straining their relationships with the hospital administration.

How can we foster a healthy spiritual formation for our hospital medical staff?

Welcome

Welcome to the Physician Formation Forum. This service is provided by Physician Formation Consulting as a place to ask and answer your questions as you work to:

1. Help physicians fulfill their hospital’s mission.

2. Help physicians live their core values.

3. Support physicians in their journey toward meaning, purpose and spiritual wholeness.

4. Invite physicians to connect deeply with their professional calling.