What PAs Want in the Workplace: Effective Conflict Management Center for Healthcare Leadership & Management Employer of Excellence

By Bianca Belcher, PA-C, senior advisor at the American Academy of PAs (AAPA) Center for Healthcare Leadership & Management (CHLM)

PAs (physician assistants) are a solution to the nation’s physician shortage and can help meet patient and employer needs.  Studies show that PAs provide high quality care and patient satisfaction ratings of PAs are on a par with physicians.

AAPA’s Center for Healthcare Leadership & Management (CHLM) works directly with hospitals and health systems to enhance team-based patient care and optimize PA practice. CHLM partnered with HealthStream, a leading provider of workforce, patient experience, and provider solutions for the healthcare industry, to gain an understanding of what PAs value in their place of employment.  Based on the findings, CHLM developed five key drivers as criteria for its Employer of Excellence Awards.


This is the second in a series of articles exploring what employers can do to create a work environment that will help attract and retain PAs.

For this article, I talked with Larry Herman, PA-C, MPA, DFAAPA, former president and chair of AAPA, about effective conflict management. He is currently a principal at Palantir Healthcare, and formerly chief PA in a busy New York City Level I trauma center where he oversaw a staff of 72 providers.

BELCHER: How does effective conflict management contribute to an excellent PA workplace?
HERMAN: Effective conflict management makes it okay to ask questions and challenge the status quo without fear of retribution. This is especially important in complex environments like medical settings, where teams of people ensure high quality care for patients. There will be differing opinions, which can lead to conflict. Effective conflict management allows for improvements and enhancements primarily in systems—how we do things on a regular basis—and PAs are frequently the experts in how things get done. This changes the culture such that PAs are heard; their contributions become much more important. They not only feel more valuable, but are more valuable. Greater organizational efficiency means better outcomes for patients, which we all want.

BELCHER: Why is conflict management so important in a hospital setting?
HERMAN: We can improve speed of access, quality, patient satisfaction, PA and physician satisfaction. A lot of conflict management lessons have translated incredibly well from other industries—such as aviation—including the need to resolve differences when people have different or better ways of doing things. Consider that 20 years ago, no one ever challenged anyone in the operating room. We’ve learned, for example, that just introducing all the players in the operating room to each other, so everyone’s on a first-name basis, enhances outcomes.

BELCHER: What are best practices that contribute to effective conflict management for healthcare teams?
HERMAN: It starts from the top. It’s a commitment to listen and be open to new answers. When people start to have conflicts, it’s perfectly fine to ask “What generates the best outcomes?” or “What reduces length of stay or rate of infection?” Nowadays, we recognize that 400,000 to 500,000 people a year in this country needlessly die after being admitted to a hospital. We have to start managing conflicts for better outcomes.

BELCHER: Can you explain a situation where implementing these best practices led to a positive outcome?
HERMAN: Early in my career, I had just been appointed Chief PA in my Emergency Department. The Chair said we needed to increase staff and they would be hiring physicians. I asked why and was told physicians generated more revenue. I asked to see those data, and it turned out they did not have comparative data on the PAs. So I challenged the status quo and the fact that they were not tracking PA contributions. We discovered that PAs billed as much as – and in some instances more than – the physicians. And with identical patient outcomes. Yet PA salaries were less than half. Challenging the status quo and managing this conflict resulted in shifting the preferred hiring category to PAs.

BELCHER: Why is conflict management important to patients?
HERMAN: It’s simple things, like how we’ve changed the standard of care: the patient goes home sooner, better medications, more ambulatory care, lower mortality and long-term disability. And hospitalization is a more pleasant experience: they have less pain, more feeling of respect, knowledge of when things will occur. Patients may not see the conflict management that occurs behind the scenes, but they certainly see the effect downstream. Managed correctly, challenging the way we do things has turned out to be wildly popular with patients.

BELCHER: How do employers recognize when conflict management needs improvement?
HERMAN: They may get complaints about a hostile work environment or more serious employee allegations. Early on, administrators can look at metrics and ask, why aren’t we doing as well as—or better than—industry standards? For instance, efficiencies are down, costs are up, or turnover is rising, even from one department to others in the institution. A good administration asks these questions and welcomes innovative ideas about improving efficiencies and patient care.

BELCHER: How does effective conflict management improve a hospital’s bottom line?
HERMAN: Things like lawsuits tend not to occur. Outcomes improve. You see more patient satisfaction, higher billables, easier recruitment and retention. The best hospitals seek to improve circumstances that other hospitals don’t even see as a problem.

CHLM works directly with hospitals and health systems to enhance team-based patient care and optimize PA practice. CHLM provides expertise, analytics, and industry best practices to help clients evaluate organizational alternatives designed to improve the effectiveness of their provider workforce.

Want to assess and improve your organization? Contact CHLM to help create a more positive environment for PAs and improve your bottom line.  If your hospital already has a supportive PA work environment, apply for a CHLM Employer of Excellence Awards and be showcased as a model of excellence.


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