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This mini-case study is part of our Culture-in-Action Series.

“Satisfaction surveys” (sometimes referred to as “engagement surveys”) delivered to physicians affiliated with community health systems have become routine. Both employed and independent physicians are typically surveyed. And, while there is nothing wrong with evaluating physician satisfaction in multiple domains, senior leaders should not confuse an evaluation of “satisfaction” with a sufficient examination of physicians’ perspectives on their “belief system” as it relates to the culture of the organization.

Keystone Culture Group Case Vignette:

An Executive Medical Director for a community health system undertakes the effort to survey independent and employed physicians on multiple domains of “satisfaction” to determine opportunities for furthering “engagement” of physicians with the organization. The results were reported as “unremarkable”. In fact, aggregate results demonstrated that, on the main, levels of satisfaction, across the two groups, seemed “good”. Yet, when physicians were asked how likely they would be to refer a close friend or family member for care to the organization, the results were less than hoped for, by a large margin. The physician leader, along with other members of the senior leadership team, were perplexed. The result was an unexpected and concerning “disconnect”.

What is a plausible explanation for this apparent “disconnect”? In fact, this finding is not, necessarily, a disconnect at all. The mistake in the interpretation of results is the assumption of a necessary connection between one’s satisfaction with their work setting and performance within that setting, and their confidence in the whole of the organization’s ability to care for one who is closely related.

The human condition is very good at “compartmentalizations” as an essential coping mechanism. In other words, a person is readily capable of believing that the subset of the organization that “I live in”, or even control, performs at consistently high levels, but the performance or some or all of the other component parts are sub-par for various reason, making the reliability of the performance of the whole suspect and unreliable.

All individuals in organizations form “beliefs” pertaining to the culture of their organization, eliciting varying responses to our Keystone CulturePulse survey item; “I believe the culture of the organization is as good as it should be.” These belief systems influence perceptions of the quality and safety of the performance of the whole in organizations, especially as they relate to how vested a physician is in the “ownership” of the performance of the whole for any individual referral. Consequently, for physicians to, ostensibly, be satisfied at their place of work and yet be reticent to make a referral of someone with a close and valued relationship, is not inconsistent with being “satisfied” with their piece of the whole.

Users of “physician satisfaction surveys” need to be mindful of what is really being evaluated with the content of a labeled evaluation instrument, including results, interpretations and applications to leadership decision-making.

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