In healthcare organizations patient trust in the physician-patient relationship is based on the idea that physicians have responsibility and control over medical decision making and that physicians prioritize the needs of patients over all other considerations (Carayon, 2007). In the past decade the issue of professionalism among physicians has been central focus of numerous national and international medical conferences and public initiatives by professional organizations (Carayon, 2007). All these efforts have been geared towards changing physician’s perception on healthcare organizations. The main area of concern by the regulators of changing physician perception on healthcare delivery system on physician’s primary dedication to patients had spawned a call for renewed commitment to the principles of the primacy of patient welfare, patient autonomy, and social welfare.
Carayon (2007) commented that “the need to change the perceptions of physicians has been motivated by perceived negative effects of the efforts by healthcare organizations to improve quality and decrease costs on the ability of physicians to serve as advocates for their patients” (p. 139). There is a need to reduce the perceived conflict between the goals of physicians as professionals and organizational management efforts which will help to explain why so many organizational attempts to change physician perception meet with failure (Carayon, 2007).
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In many healthcare organizations, research has shows that system improvement that decrease reliance on individual memory and attention, decrease error rates and improve the quality of care. Carayon (2007) noted that “the system approach to changing physician perception may not only be a more effective approach but may be better accepted by physicians that traditional organizational incentives to decrease costs and improve quality” (p. 139). This approach of changing physicians approach may be more reconcilable with the concept of physician professionalism because of its more indirect effects on physician behavior.
In order to change physicians perceptions on health care organizations Manion, Lorimer & Leander (1996) argued that three challenges must be met. First health care organizations must be well prepared through education and coaching to play their part. They must be ready to deal with the most volatile customer service situations. Secondly managers must steadfastly position physicians as the first line remedy for problem resolution. Manion, Lorimer & Leander (1996) says that managers traditionally have been rewarded for fighting fires and resolving crises, forgetting the bottom of a problem. The third challenge in changing the perception of physicians is no less daunting. Physicians should be rewarded for going straight to the top. They must learn to get the results they need directly through the other members in the organization. Manion, Lorimer & Leander (1996) indicated that physicians must have regular dialogue with their peers about mutual expectations and responsibilities not when problems arise but all the time.
Healthcare organizations must align the physician’s goals in the same direction. Manion, Lorimer & Leander (1996) says that healthcare organizations must take going directly to the teams the best way for physicians to get results. For example the nurse manger receiving a physician complaint understands completely a situation and arranges an immediate discussion with the physician. This approach accomplishes several objectives. Firstly it redirects problem resolution to the team and it avoids giving the physician the perception that the manager is blowing them off or just does not want to be involved (Manion, Lorimer & Leander, 1996). By consistently handling these situations in this manner gradually changes behaviors because it becomes in physicians own self interest to seek out the team.
In healthcare organizations, Lewin’s change model permits us to view change as a series of forces working in different directions. Borkowski (2009) says that for implementation to take place there must be an increase in the strength of the force for change that is driving forces, the strength and position of opposing forces must as well be reduced or removed. Borkowski (2009) researched that physicians’ non-acceptance of Clinical Practice Guidelines (CPGs) into their medical practice illustrates the application of Lewin’s Force Field Analysis in the change process. In healthcare organizations CPGs are seen as important tools to reduce variances of medical services received by patients and to improve quality of care by establishing best practices. However, CPGs have been remarkably unsuccessful in influencing physician perception and practice patterns. Borkowski (2009) indicated that “the driving forces for perception change and implementation of CPGs represented knowledge and attitudinal change and were viewed positively by physicians” (p. 378). On the other hand, restraining forces represented changes being imposed by some external force that were viewed by physicians with resentment and negativity.
Lewin provides us with a three-step process for implementing planned change in a healthcare organization. The first step is unfreezing were by physicians involved in perpetuating resistance acquire an understanding of variances that exist between current practices and behavior and desired activities and behavior. Borkowski (2009) established that “unfreezing may occur when managers effectively communicate the need to change driving forces such as mortality or morbidity rates, hospital readmission data, and best practices benchmarks to physicians” (p. 378). The second step is change. Borkowski (2009) says that on the basis of new objectives in the healthcare organization, a series of revised policies, procedures, and operating practices is implemented. In this step it is important that physicians understand the reasons for change and participate in the design of new approaches. Physician’s involvement in the change design followed by appropriate training and reorientation, presents each worker with the opportunity to buy into the new approaches (Borkowski, 2009).
The third step in Lewin change model entails refreezing. Borkowski (2009) says that “changes are implemented and monitored and they are adjusted where necessary”. New healthcare organizational goals are reinforces by subsequent changes in daily activities. Continuous monitoring ensures successful operating practices (Borkowski, 2009). Audit and feedback of physician’s perception and practice patterns are the most common reinforcements used by mangers in healthcare organizations (Borkowski, 2009).
Marquis’ & Huston (2008) say that “during this last phase, physicians should assist in stabilizing the system so that it becomes integrated into the status quo” (p. 169). For refreezing to occur, the change agent must be supportive and reinforce the individual adaptive efforts of those affected by the change (Marquis’ & Huston, 2008). In healthcare organizations refreezing does not eliminate the possibility of further improvement to the change. The physicians should measure the impact of change and allow it to be part refreezing because without measurement, the capacity to achieve administrative and clinical outcomes remains an intuitive undertaking (Marquis’ & Huston, 2008).
In conclusion, Marquis’ & Huston says that many forces are driving change in contemporary healthcare costs, declining reimbursement, workforce shortages, increasing technology, information availability and a growing elderly population. These dynamic forces have led to changes in physician perceptions due to destabilization in some healthcare organizations to such an extent that they threaten viability. In this context Marquis’ & Huston (2008) says that the reality today is that healthcare organizations should continually institute change to upgrade their structure, promote greater quality and change the physician perceptions as well as keep them in the organization. To change physician perceptions, healthcare organizations should undergo dynamic changes directed at organizational restructuring and quality improvement. Change and quality improvement efforts that incorporate system redesign may be more successful in changing physician perception and maintaining physician job satisfaction in a healthcare organization.