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CVForward  >  4 stages of physician acceptance of performance metrics


Many cardiovascular service line (CVSL) leaders face pushback from physicians when it comes to performance metrics. This infographic breaks down the 4 stages that physicians go through and provides guidance at managing through each stage.

CVForward Updates

Four Stages of Physician Acceptance of Performance Metrics

Enormous time, effort, and budget go into establishing metrics in the CVSL. This guide can help you partner with your physicians in making your performance metrics as successful as possible.

<40% of cardiologists believe their metrics accurately represent quality of care <40% of cardiologists believe their metrics accurately represent quality of care

I'm outraged I'm outraged

Physicians, and cardiologists in particular, are used to having unchallenged authority. Their first reaction to any performance metric is to fight it.

What's the impact? What's the impact?

Your authority, and the success of the metrics you are rolling out, is being undermined. Cardiologists are angry at you, going to your superiors, and making it clear that you don’t put patient care first.


How do I manage this? How do I manage this?

Be calm and rational. Be ready to respond calmly, empathetically, and

Have the data ready. Be ready to show how each metric you propose has been proven to impact outcomes.

How do I avoid this? How do I avoid this?

Co-create the metrics. Before you roll out your metrics, bring in key physician partners and create the metrics together.

Warn everyone well ahead of time. Make it clear there are new performance metrics coming and ensure that they will be well trained on the new metrics.

Bring money up right away. Very often, a physician’s main concern is their own compensation—but they don’t want to say that. Don’t shy away from that—address it up front.

I'm confused I'm confused

They know there are metrics—but they are completely overwhelmed by the complexity of them. They don’t know how they impact their job or how they will be judged.

What's the impact? What's the impact?

Your physicians don't know how to move forward in their daily tasks. They are not partnering with you, and they are not aligned with the overarching goal of your CVSL.


How do I manage this? How do I manage this?

Have a very clear handbook. Create a guide that clearly explains the new metrics and how you roll them out. This guide should boil it down to a few simple-to-understand pages (no 100-page tomes).

Be patient. Be ready to explain the process and then explain it again the next day.

Always bring it back to the bigger picture. Reiterate that these metrics are in place to improve performance and provide the best care possible.

How do I avoid this? How do I avoid this?

Have a pilot group. Have a small group of physicians test-drive the new processes. This helps work out the kinks, and your test-group can be invaluable teachers for their physician colleagues.

Provide administrative support. Give your physicians a 3-month window where they will have dedicated staff helping them every step of the way. But make it clear this support is for a limited time only.

I'm gaming the system I'm gaming the system

They’ve accepted your metrics, but they still don’t agree with their value at all. They are just doing what it takes to make sure their scores are high and their compensation is maximized.

What's the impact? What's the impact?

You have a talented physician focusing on paperwork, not patients. This is not a physician who is in line with the overarching goals of the CVSL.


How do I manage this? How do I manage this?

Wait it out. Physicians love data and over time they may naturally start to see the value that the new performance metrics can bring.

Report results. Constantly share scores with your physician team. Show them how things are progressing and tie it to outcomes. If they start to see evidence of better outcomes, they will begin to get on board.

How do I avoid this? How do I avoid this?

Emphasize alignment on the vision. Include physicians at every stage and make sure they are part of the rollout. If they have agreed that the goal is better patient care, then it makes gaming the system a lot more difficult.


I'm on board I'm on board

You have a partner who sees the value of the performance metrics and is working with you to maximize the scores for the good of the CVSL and the patients you serve.

What's the impact? What's the impact?

This is your ideal physician and getting them to this stage is essential for success. Healthcare will continue to undergo dramatic change. Continue to approach performance as a team and it will keep your CVSL ahead of the curve.


How do I manage this? How do I manage this?

Refine constantly. Get together monthly and review the scores. Find ways to improve, refine, and maximize your success.


How do I replicate this? How do I replicate this?

Turn your believers into ambassadors. You will still have physicians who are not convinced. Use your “on board” physicians to try and convince others to support your metrics.



1. Casalino L, Gans D, Weber R, et al. US physician practices spend more than $15.4 billion annually to report quality measures. Health Aff. 2016;35(3):1-6.

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