Fostering Excellence: Creating An Environment Where Excellent Physicians Want To Work

How We Built A Healthy Work Environment

By Keith Butler, M.D., Chief Executive Officer, and Eric Wilke, M.D., Chief Operating Officer

People decide to make medicine their life’s work because they want to care for others. That was certainly our motivation. But as we have progressed in our careers, we’ve seen a steady stream of colleagues make the agonizing decision to leave the field of emergency medicine. There are many reasons for this – layers of bureaucracy, growing governmental regulations and delays, low reimbursement from payers, complexities of electronic medical records, and more. Seeing good doctors leave the profession got us wondering, how could we combat this trend? How could we build a healthier work environment? We knew we couldn’t change the bureaucracy, but we could change other things to make a work environment where excellent physicians would want to work. 

We started with the process map for care delivery in the typical hospital EDs. What steps could we take to reduce red tape, eliminate barriers to caring for patients, and improve facility design to streamline and improve the work environment? We knew if we could solve these problems, we would attract good people and they would attract other good candidates. Our founding philosophy was that “the foundation for an outstanding patient experience starts with creating an environment where good physicians want to practice.”

From the outset, we also invested significant time developing our core values. Once again, we used our experience to pinpoint the values that have ultimately shaped our culture, a culture within which physicians want to work. It took us two years to hone our values into the foundation for our culture – accountability, doing something good, empathy, and zeal. 

We currently work in two arenas – freestanding EDs and hospital-based EDs, where we provide staffing. We emphasize our values in both settings because we’ve found when we focus on culture, a lot of things fall into place. When we meet with medical leadership, we don’t focus on the typical metrics – productivity and margin. While these are certainly important, we are more interested in what we’ve done well, what are our successes, how we communicate well with each other, and how we work well with our colleagues and our patients demonstrating our values. We spend a lot of time talking about culture and when excellent physicians recognize we’re taking what we say and putting it into practice every day, they are eager to join the TECHealth team.

Whether we’re recruiting physicians for a hospital ER, or hiring staff for a freestanding ED, we interview based on culture and we are deliberate in matching individual values to our company values. We probably spend more time interviewing and screening talent than any other emergency medicine company. When physicians and nurses discover us through interviewing and onboarding, they find they can practice medicine in a way that matters to them, and it recharges their careers and life. Excellent medical professionals crave practicing excellent medicine. 

An important part of our culture is the 5:1 model. Basically, we strive to give five positive comments to a team member about his or her performance in every negative conversation we may have to have with him or her. Deploying the 5:1 model across our values really moved the ball forward for us. We have a program that recognizes staff members who treat others in line with our values. We asked our team members in those hospitals to find at least one person doing something good and to nominate him or her for recognition. One medical director nominated a nurse for his “above and beyond” performance during the height of the COVID-19 pandemic. The nurse received an email and a letter from us informing him he was being honored and recognized for his performance. His hospital supervisor got a copy of the correspondence. When the nurse learned about the honor, he began crying. He told us it was the first time in seven years anyone had told him they appreciated his work. 

At the end of the day ask yourself, where would I rather work, somewhere I get continual praise and constructive conversations about improving my performance, or somewhere I only hear criticism? We’ve found people choose the former. We don’t like quarterly or annual performance reviews. We do regular touch-base sessions. We emphasize immediate correction if poor performance is detected and immediate praise when something good occurs.

We’re gratified our approach and philosophy about emergency medicine are getting noticed by physician and nurse candidates as well as CEOs in hospitals and health systems. We continue to be contacted by potential business partners interested in staffing agreements or operating their own freestanding ED using TECHealth’s approach to emergency medicine. We see great things ahead for our values-based approach at TECHealth.