engaging physicians as partners in quality
Post on 22-Feb-2016
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Engaging Engaging Physicians as Physicians as
Partners in Partners in QualityQuality
Bruce Roe, MDBruce Roe, MDChief Medical OfficerChief Medical Officer
Executive Director, Clinical ProgramsExecutive Director, Clinical ProgramsExecutive Champion, TransformationExecutive Champion, Transformation
EndocrinologistEndocrinologistSt. Boniface HospitalSt. Boniface HospitalWinnipeg, ManitobaWinnipeg, Manitoba
Engaging Physicians in Engaging Physicians in QualityQuality
WhyWhy WhenWhen HowHow WhoWho For How Long For How Long
(sustaining and building (sustaining and building engagement)engagement)
My Videos\edsrunningwith.mov
Engaging Physicians in Engaging Physicians in QualityQuality
What would the ideal world look like to you when it comes to physician involvement?
Challenges in Engaging Challenges in Engaging PhysiciansPhysicians
- AvailabilityAvailability- InterestInterest- SkepticismSkepticism- Buy-in – different goalsBuy-in – different goals- FragmentedFragmented- Attachment to individual autonomyAttachment to individual autonomy- Accountability for errors / lack of Accountability for errors / lack of
systems perspectivesystems perspective
early experience shows less expensive less complex better patient outcomes
The medical profession is changing
From craft-based practice individual physicians, working alone (housestaff ::= apprentices) handcraft a customized solution for each patient based on a core ethical commitment to the patient and vast personal knowledge gained from training and experience
To profession-based practice groups of peers, treating similar patients in a shared setting plan coordinated care delivery processes (e.g., standing order
sets) which individual clinicians adapt to specific patient needs
Adapted from B. James, IHC
Judgment vs. LearningJudgment vs. Learning
Judgment -based approaches ask "Who?”(craft – based)
Learning -based approaches ask "Why?”"What?”"How?“
(profession – based)
Adapted from B. James, IHC
Engaging PhysiciansEngaging PhysiciansIHI FrameworkIHI Framework
1.1. Discover common purposeDiscover common purpose2.2. Reframe values and reliefsReframe values and reliefs3.3. Segment engagement planSegment engagement plan4.4. Use “engaging” improvement Use “engaging” improvement
methodsmethods5.5. Show courageShow courage6.6. Adopt an engaging styleAdopt an engaging style
Discover Common Purpose:Discover Common Purpose:Aim StatementAim Statement- Does it speak to physicians?Does it speak to physicians?- Does it align with physician goals?Does it align with physician goals?- Does it overcome differences in mental Does it overcome differences in mental
model or create new divisions?model or create new divisions?- Is it lost in the process of Is it lost in the process of
improvement?improvement?
Who’s agenda is this?
physician physician hospital system hospital system
outcomes time/hasslesoutcomes time/hassles
Segment Engagement PlanSegment Engagement Plan
Avoid the blanket approachAvoid the blanket approach
Juran:Juran:““No such thing as improvement in general”No such thing as improvement in general”
Specific physicians Specific physicians specific roles specific roles
Segment Engagement PlanSegment Engagement Plan Who are your early adopters?Who are your early adopters?
Physician RolesPhysician RolesChampionsChampionsStructural LeadersStructural LeadersTeam players – test of changeTeam players – test of changeAdopters – who will use the “tools”Adopters – who will use the “tools”
Engaging champions – Engaging champions – telling the storytelling the story
Stories trump Statistics Stories trump Statistics (Rule of Rescue)(Rule of Rescue)
Relationships trump StoriesRelationships trump StoriesI don’t care how much you I don’t care how much you
know until I know how much know until I know how much you careyou care
Adapted from B. James, IHC
Physician Champion:Physician Champion:AttributesAttributes
CourageCourage Social SkillsSocial Skills CredibilityCredibility Insight into individual vs systems Insight into individual vs systems
approachapproach
ChampionChampionConsiderations:Considerations:1.1. Do you have a champion?Do you have a champion?2.2. How do you know she is on board?How do you know she is on board?3.3. How has she helped in the past?How has she helped in the past?4.4. How have you equipped her?How have you equipped her?5.5. Do you pay?Do you pay?6.6. How will you support?How will you support?7.7. Respect their timeRespect their time8.8. Celebrate involvementCelebrate involvement
Med Rec Team
Champion
Use “Engaging” Improvement Use “Engaging” Improvement MethodsMethods
Generate light, not heat, with dataGenerate light, not heat, with dataVisual….Run chartsVisual….Run chartsUnderstand variation……Control chartsUnderstand variation……Control chartsStandardization of processesStandardization of processesMake the right thing easy to tryMake the right thing easy to tryMake the right thing easy to doMake the right thing easy to do
Adopt an engaging styleAdopt an engaging style- Involve physicians from the beginningInvolve physicians from the beginning- Work with Work with realreal practice leaders, early practice leaders, early
adoptersadopters- Manage the messageManage the message- Make physician “involvement” visibleMake physician “involvement” visible- Value physician’s timeValue physician’s time- Champions can recruit champions Champions can recruit champions
spreadspread
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