Healthcare Insights: Enhancing Doctor Engagement in the Nation’s Largest Public Health System

The Scheinman Institute is very proud of its ongoing 10-year collaboration with the Doctors Council, SEIU.  Since 2013, the Institute has provided technical assistance and consulting to the union, which represents 2,500 attending physicians, and dentists who provide care in the nation’s largest public health system, New York City Health + Hospitals (NYC H+H).  The public health system serves 1.4 million patients annually in 11 acute care hospitals, 50+ primary care and diagnostic community centers, and 5 large nursing homes.

Most of the patients come from Medicaid or other publicly financed health insurance, in addition to taking care of migrant people who in many cases have no insurance at all.  As such, the public health system and its workforce in New York City struggle to make ends meet while serving the City’s most vulnerable population. The Institute’s work with Doctors Council is especially important today. Not a day goes by without multiple news stories about the nation’s doctors growing interest in organizing.

Doctors Council sought out the Scheinman Institute’s capacity and expertise in healthcare issues in early 2013. At their request, we developed and conducted a survey, which asked its members what was the most important issue that the union should take up on behalf of its members.  By a 98% margin, the answer was that doctors wanted more of a voice in the improvement of patient care!

Since that time, I, in my capacity as Director of Healthcare Labor Relations for the Institute, have advised and provided training and facilitation for the union’s leadership, staff, and members to establish Collaboration Councils through collective bargaining. I was at the bargaining table to advise the union on the terms for the establishment of the Collaboration Councils for the new contract in 2015.The Councils have been established in all twenty-one of the health systems’ facilities. 

The Facility Based Collaboration Councils (FBCCs) launched in February 2016 and meet each month. Every 90 days, there is a System Wide Collaboration Council, which brings together doctors and executives from across the system.  This governing council evaluates the progress of the Facility Based Collaboration Councils and from time to time makes recommendations for improvement. 

Their frontline doctors and facility leadership meet to discuss the implementation of improvement projects, which are designed to improve the patient experience and enhance doctor engagement.  Hundreds of projects have successfully developed from the FBCCs. Such projects include a reduction of waiting times for patients, expanded collection of health information data from dentists’ visits, and increased screenings for diabetic patients with diabetic-related vision loss, among many others.

My role among others has been to advise Doctors Council staff on how to develop improvement projects, how to engage executive leadership, and assist in assessing progress at each of the Councils.

In March 2020, the world was shaken by the COVID-19 pandemic.  One of the first and most devastating epicenters of the pandemic was in New York City.

We recall the blaring sirens, the overwhelmed emergency rooms, and the heroic effort by healthcare workers who provided care and comfort in the face of an unknown pathogen and its unstoppable impact.Some of the Collaboration Councils had to suspend or curtail activity for a period of time.  Others continued to meet but found it difficult to continue improvement projects.

As the pandemic finally waned by mid-2022 and continuing to the present, I have continued to assist the union to develop some new focus in the Collaboration Councils as a way of revitalizing them post-pandemic.  That new focus did not de-emphasize improvement projects but added a dimension and emphasis to more fully develop a problem-solving dialogue with the executive management at each facility.

The results of these improvements have now become the focus of this past year’s System Wide Collaboration Councils.  Each meeting showcases Facility Based Collaboration Councils which have significantly improved participation and enthusiasm based on the meetings’ reimagined focus on executive-frontline dialogue that identifies issues that impact patient experience and doctor morale.

In the post-acute state of the pandemic, the overwhelming majority of the Collaboration Councils function at a very high level measured by high attendance, problem-solving, and deep engagement between executives and front-line doctors and dentists that solves real issues, large and small.

Some examples of new success include:

Bellevue Hospital:  Dr. Nate Link, the Chief Medical Officer reported at a recent System Wide Collaboration Council that: “Our department chiefs and I view the Collaboration Council as a forum for our own accountability to solve issues that otherwise would not be solved but for doctors bringing them to our attention.  These suggestions have given us the ability to in some cases hire staff in order to in this case streamline laboratory results. We look forward to these meetings as never before”.

North Central Bronx: “Physician wellness has become a central feature of our Council,” reports Dr. Jana Romm, a founding member of the Collaboration Council. 

And at Queens Hospital, the FBBC was seen as having a direct positive impact on recruiting and retention, workplace safety and self-care, technology improvement, patient experience, healthcare disparities, and continuing medical education

I look forward to advising the Doctors Council in upcoming negotiations for the new collective bargaining agreement this fall.  Enhancing the success of the Collaboration Councils will be a major focus.

John August is the Scheinman Institute’s Director of Healthcare and Partner Programs. His expertise in healthcare and labor relations spans 40 years. John previously served as the Executive Director of the Coalition of Kaiser Permanente Unions from April 2006 until July 2013. With revenues of 88 billion dollars and over 300,000 employees, Kaiser is one of the largest healthcare plans in the US. While serving as Executive Director of the Coalition, John was the co-chair of the Labor-Management Partnership at Kaiser Permanente, the largest, most complex, and most successful labor-management partnership in U.S. history. He also led the Coalition as chief negotiator in three successful rounds of National Bargaining in 2008, 2010, and 2012 on behalf of 100,000 members of the Coalition.