Do relationships between colleagues raise the bar? A new analysis of how physicians who know each other provide better patient care could impart wide-ranging lessons for the business world.
Specialists who received referrals from primary care physicians (PCPs) with whom they trained were rated 9 percentage points higher in patient satisfaction surveys than specialists with whom the primary care doctor didn’t train, finds new research published in JAMA Internal Medicine. PCPs and specialists who spent their early years together tended to show improved outcomes years after medical school or residency, including on metrics such as patients’ likelihood of recommending their specialist, write Maximilian J. Pany, a doctoral candidate at Harvard Business School and MD candidate at Harvard Medical School, and J. Michael McWilliams, Warren Alpert Foundation Professor of Health Care Policy and Professor of Medicine at Harvard Medical School.
So, what does the connection between patient outcomes and physician relationships mean for business? It shows how personal connections and trust can improve performance, more so than incentives and rewards. In fact, investing in working relationships could have positive long-term implications to any organization’s success.
“We were surprised by the magnitude of the effects,” Pany says, noting that future studies could examine just how such relationships form and evolve. “There’s just something especially salient about these relationships.”
Almost 10,000 specialist visits
To gauge just how much relationships forged in training help patients, Pany and McWilliams sifted through electronic records for nearly 10,000 visits to 502 specialists at a large hospital system. The records spanned from 2016 to 2019.
The researchers traced first-time referrals from primary care physicians to specialists using a medical licensing database to identify doctors who attended the same medical school or residency program. By doing so, the researchers could see when doctors completed programs to infer whether they might have crossed paths.
They then compared surveys for patients referred to specialists with whom a PCP had at least one year of overlap in those formative groups to those physicians who didn’t overlap with each other from those early years. They also looked at a subgroup who trained in the same year and were therefore highly likely to have formed a relationship.
The authors chose to focus on patient ratings of specialists instead of specific medical outcomes because they assess an “important dimension of quality” that transcends the clinical boundaries of medical specialties and are valued by the medical profession writ large.
Even asynchronous and virtual interactions can be influenced by peer training relationships, drawing “tangible benefits for patients many years later,” suggesting such relationships continue to pay off for a long time, the authors write.
Implications beyond medicine
Stoking these formative relationships through team-building efforts may have broad implications outside hospital systems to community health centers and beyond, the authors write.
Much like the camaraderie formed in the armed forces during basic training, teams that spend formative years together may want to foster their reputation through those ties and may take pride in a reputation for a higher standard of performance when observed by a valued peer, the researchers note.
In some ways, analogous effects may be observed in customer service in other professions and may have implications beyond health care’s specific—and systemic—physician training model, says Robert Huckman, one of Pany’s doctoral advisors and the Howard Cox Faculty Chair at the HBS Health Care Initiative.
“This research shows that specialists achieve better patient ratings when they know the generalists who refer patients to them. That is analogous to a subcontractor increasing effort when they have a deep prior relationship with the general contractor who engages them for a job,” Huckman says. “The subcontractor appreciates the effort that they have already put in to building a relationship with the general contractor and wants to ensure that their performance builds off that solid foundation.”
Look at wider team-building
Managers may want to build on the main finding: going through rigorous training together forms bonds that benefit the patient—or the customer—by fostering mutual accountability and/or a sense of shared purpose. Some large consultancies and accounting firms already do this by putting “cohorts” of new employees on similar professional development tracks, with shared workshops, activities, and milestones designed to strengthen their connection.
“People are social creatures. Support them so that people can be who they naturally want to be and that, then, can motivate them to do better.”
In health care settings and beyond, organizations could craft deeper interactions—at the beginning of the careers for other professionals or well into their professional practice. The goal would be to foster “team-based” approaches that encompasses all workers on the task. In health care, this would mean extending team-based care to providers beyond physicians, including nurses, support staff, and other health care personnel. It could also mean team training across institutions and systems.
“There are ways in which you can support your workforce to tap into their intrinsic motivation rather than coming up with complicated schemes for paying them based on certain performance measures,” Pany says. “People are social creatures. Support them so that people can be who they naturally want to be and that, then, can motivate them to do better.”
Managers and policy makers should take care when setting up new team building programs to avoid seeming exploitive or manipulative, Pany says. People—whether they’re health care providers or any other professional—generally want to succeed and do right by others, whether it’s patients, customers, or colleagues.
“There are natural ways in which you can support these social impulses,” Pany says. “We now have a good deal of evidence on what might motivate workers to do better because they liked their job more, or, even because it’s enjoyable.”
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Feedback or ideas to share? Email the Working Knowledge team at hbswk@hbs.edu.
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