Want to Retain Practitioners and Improve Patient Safety? Align Practice Culture

Turnover is expensive. Between lost revenue and the total costs of hiring a replacement, one physician’s departure can cost a hospital hundreds of thousands of dollars.¹ This affects both individual healthcare systems and our society overall: The American Medical Association estimates that nearly $1 billion in excess patient costs can be attributed to physician turnover.²

Turnover also deals a blow to continuity of care: Researchers at the Mayo Clinic, in studying primary care, have affirmed that greater continuity of care is associated with “better patient outcomes, including diagnostic accuracy, patient satisfaction, fewer emergency department visits, hospital readmissions, better care coordination, improved end-of-life care, reduced mortality and lower costs.”²

Better patient outcomes promote decreased liability risk and lower litigation costs, bringing us full circle to where human well-being and financial well-being intersect. How do we reduce practitioner turnover? Put another way: How do we retain practitioners?

Culture Is Crucial to Practitioner Retention

When new practitioners and seasoned solo practice physicians join large groups, cultural conflicts can arise, and that can threaten retention. I experienced this firsthand when I served as the President and Chief Medical Officer of ProMedica Physicians, a fantastic healthcare network of specialized hospitals, facilities, researchers, physicians, and advanced practice clinicians in Ohio and Michigan.

Through training new-hire physicians on practice culture, ProMedica achieved a 98 percent retention rate. We accomplished this by developing a three-part approach:

1. Providing a thorough orientation.
2. Encouraging participation in a one-year practitioner academy.
3. Gathering a group to discuss transformative issues.

Our process was one that other healthcare systems and practices can adapt to suit their own environments:

Orientation. All ProMedica new hires attend a mandatory two-and-a-half-day orientation that includes comprehensive overviews of all aspects of the organization. For example, attendees learn not only about the organization’s culture, but also about error prevention and practitioner burnout.

Practitioner Academy. All new practitioners are encouraged to attend a practitioner academy during their first year of employment. The academy rotates through discussions, presenting system information and providing reporting information relevant to the practitioner. For example, attendees learn about proper coding and receive leadership development, including coaching regarding growth opportunities. They also have the opportunity to learn about personal finance.

Transformers Group. To facilitate cultural transformation across the entire system, this group of physicians, advanced practice clinicians, and administrative leaders works together to improve patient access, network optimization, and leadership engagement.

Culture Can Generate Cycles of Confidence and Quality

My working hypothesis has always been that when practitioners care about each other, culture improves—which improves care quality while facilitating success. For instance, when physicians know and trust their colleagues in other specialties, they are more likely to refer internally, rather than sending patients traveling to another big brand name in the region. These internal referrals can improve not only patients’ timely access to care, but also the organization’s revenue stream.

In this spirit, at ProMedica we placed primary care in the same building as our subspecialists, so that our practitioners could walk their patients down the hall rather than referring them for appointments several weeks later. Efficiencies like this help create professional satisfaction for practitioners and quality care for patients. They reduce unnecessary delays and their accompanying risks, which also take a bite out of costs.

The confidence that these virtuous cycles inspire in practitioners, relative to not just themselves but also to their workplace, translates into better results each time you approach your team with: “If you see a problem, let’s fix it. Let’s recruit to fill gaps. Let’s get what we need to provide quality care here.”

Examples of this culture include the creation of food pharmacies throughout the Toledo area. Our physicians had the ability to write prescriptions for food, and the patient could also get other information on available services. As lack of transportation is a common barrier to accessing care, Medicare and Medicaid cover some transportation costs for eligible patients, and onsite social workers alert patients to these and other resources. In addition, patients can take advantage of classes in cooking healthy meals, as well as job training and other educational opportunities. Also, we built a grocery store downtown in a food desert. This was staffed by local individuals who learned valuable work skills.

A Culture of Teamwork Elevates Safety

As I have always told interns and residents: “Listen to the nurses—they’ll help you.” The core skills of teamwork include both listening and speaking up, and stronger teamwork has been linked to improved patient safety over and over again.³

Learning to work on a healthcare team is not something that happens automatically. The early days of the pandemic disrupted established pathways for hands-on training, so that now, at the top of ECRI’s 2024 list of patient safety concerns, we see the transition of new practitioners from education into practice: “Without sufficient preparation, support, and training as they transition into practice, clinicians can experience loss of confidence, burnout, and reduced mindfulness around culture of safety.”⁴ Our destabilized professional climate amplifies the need for organizations to commit to maintaining healthy cultures and taking deliberate steps to welcome and orient new practitioners.

Culture Can Foster Connections and Health

Through persistent efforts to support new and seasoned healthcare professionals, both as individual practitioners and as members of teams, healthcare organizations can grow flourishing cultures in which medical professionals will be proud to practice.

The three-part approach that I’ve laid out above is a recipe for success for any healthcare organization that wants to improve retention, enable standardization, and improve patient safety and outcomes.

Our connections to our colleagues are not window dressing—they are the supplies in the store. As I like to remind patients, fostering social connections enhances emotional well-being and promotes heart health simultaneously. That goes for medical professionals, as well.