History of the PHA

In early 2009, a group of physicians and office administrators began meeting on a regular basis to discuss various ways that we could work together more closely in managing our practices, communicating and coordinating the care of our patients. In the course of those meetings we became acquainted with the concept of "Physician Hospital Alignment." This may be defined as:

A close-working relationship in which a hospital and physicians place a priority on working toward common goals and avoiding conduct that damages the other.

The concept of alignment was appealing to us and had a certain ring of truth when thinking about the importance of physicians and hospitals working together in the coordination of patient care and health care delivery; especially considering the uncertain future of health care delivery reform.

Significant issues

As we pondered these issues, it was obvious that we had some significant problems in our community and region. It was clear that there was plenty of blame to pass around, but actions by certain physician groups, clinical administrators, hospital administrators, and individual physicians had led to a toxic and dysfunctional atmosphere.

In recognizing these deep divisions in the medical community, a number of us also acknowledged that St. Charles is a top-tier hospital and highly regarded in the region, St. Charles Health System, Inc. (SCHS) is an excellent health care system, and many physicians have good working relationships with SCHS.

We had to ask ourselves, "What kind of medical community can exist if hospitals and physicians are not working together to build collaboration and trust?"

New mindset, new direction

The Physicians for Alignment were convinced that a new mindset and new direction were needed to rebuild our medical community in an atmosphere of trust and a commitment to collaboration.

A Mission Statement was developed:

To be a unified, principles-based group of physicians that works with St. Charles Health System, Inc., and other partners to build a physician-directed, community-based health care system in Central Oregon that will improve the health of the community, enhance the patient-care experience, and reduce or control the cost of care.

The Mission Statement was carefully crafted to state our intention of working collaboratively with the hospital and other partners and to focus our efforts on the triple aim that was first introduced by Dr. Don Berwick at the Institute for Healthcare Improvement.

We also believed that the following Code of Conduct would be helpful:

To abide by the principles of trust, mutual respect, accountability, and loyalty to the group as a whole.

We then introduced the idea of Physician Hospital Alignment, the Mission Statement and the Code of Conduct to a number of physicians to gauge their interest and ask for support. Within days, more than 80 physicians had endorsed the concept, the Mission Statement, and the Code of Conduct. In mid-July, this concept was presented to the Board of Directors of St. Charles Health System, and that evening the Board unanimously endorsed the concept of Physician Hospital Alignment, the Code of Conduct, and the Mission Statement to develop a physician-directed health care delivery system in Central Oregon. The SCHS Board then issued its own commitment to this alignment

Moving forward

To date, over 475 physicians and providers have signed the Mission Statement and the Code of Conduct.  Many more have expressed their support and indicated their intention of signing. Since July 2009, the Physician Hospital Alignment (PHA) has formed a steering committee and several work committees to begin the substantial task of developing an integrated delivery system.

The concept of integrated delivery systems is not new, and a number of successful models are in place delivering superb, cost-effective care in an atmosphere of collaboration, trust, and mutual purpose. We do not intend to "reinvent the wheel," but rather to glean from the successful systems the features most appropriate to our unique circumstances.

As you know, these are interesting times, and there is great uncertainty about our futures. There have been many questions raised about the PHA and its plans for moving forward. The frequently asked questions will be addressed candidly in upcoming communications to you. We encourage you to keep the questions coming and the dialog ongoing.