ENGAGING PHYSICIANS IN OUR HEALTHCARE SYSTEM
Presented by: Dianne Doyle, President and CEO, Providence Health Care Zulie Sachedina, VP Human Resources & General Counsel, Providence Health Care Astrid Levelt, Director Medical Affairs, Providence Health Care
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BC HEALTH LEADERS CONFERENCE 2015
October 21, 2015
PRESENTATION OVERVIEW
1. About Providence Health Care
2. Context of Physician Engagement
3. Measurement
• Case study
• Large-scale engagement survey (Gallup)
4. Engagement Strategies
• Implementation/Activities
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PROVIDENCE HEALTH CARE
• PHC is one of the largest Catholic Health Care organizations in Canada
• Over 115-year presence in health care in BC
• Strong commitment to our Mission:
Inspired by the healing ministry of Jesus Christ, Providence Health Care is a Catholic health care community dedicated to meeting the physical, emotional, social and spiritual needs of those served through compassionate care, teaching and research
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OUR VALUES
BRINGING OUR VALUES TO LIFE
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THE PROVIDENCE PLAN
Linking our mission, values and strategic directions to help us achieve our vision
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OUR VISION
Driven by compassion and social justice, we are at the forefront of exceptional care and innovation.
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ENGAGEMENT
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An engaged workforce:
• Feels more valued
• Experiences a sense of belonging and community
• Experiences more opportunity to make improvements in work
Engagement leads to:
• Enhancement of one’s own sense of self-worth
• Commitment to organizational goals and values
• Organizational success
ENGAGEMENT
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Engagement supports: • Patient and family centered care
• Enhanced patient, staff and physician safety
• Greater efficiency and use of resources
• Greater collaboration and active participation in practice collaboratives
• Investment in both clinical and service outcomes
• Alignment with the mission of the organization
• Greater discretionary effort to patients / the organization
• Willingness to go above and beyond
• Recruitment
PHYSICIAN ENGAGEMENT: CONTEXT
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PHYSICIAN ENGAGEMENT: CONTEXT
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Historic • Physicians led most hospitals up until the 1970s • Growing populations & medical advances increased demand
for care, costs, and complexity • Consolidation led to larger structures which diluted the
physician voice
Situational • Hospital Employees vs. Independent Contractors • Misaligned Compensation / Competing Incentives • Good Intentions vs. Time Commitments • Professional autonomy of decision making
TODAY’S HEALTHCARE MATRIX
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Lowery, M , SUPPORTING PHYSICIAN PARTICIPATION IN ORGANIZATIONAL IMPROVEMENT INITIATIVES, July 2015
Figure 1. The system diagram identifies how relationships and stakeholders are connected within the Medicine Program
THE MEDICINE
PROGRAM
Nursing Staff and Allied
Health disciplines
Patients, Families &
Visitors
Director & Operations
CEO & VP’s (Senior & Clinical
Leadership)
Housekeeping, Maintenance &
Volunteer Services
Physician Governance
The Catholic Church
Quality Improvement &
Change Initiatives
Physician Champions
The Ministry of
Health
Physician Leaders
Nursing Leaders
Patient & Family
Council
Nursing Unions -
BCNU & HEU
Allied Health
Leaders
Professional Practice
Medical Affairs
VCH
Medical Practice & Academics
13 Department Heads, 37 Division Heads
DEPARTMENT & PROGRAM STRUCTURE
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13 Departments •Anesthesia
•Emergency
•Family & Community Medicine
•Pathology & Laboratory Medicine
•Midwifery
•Medicine
•OB/GYNE
•Ophthalmology
•Orthopedics
•Pediatrics
•Psychiatry
•Radiology
•Surgery
8 Clinical Programs •Elder Care / Palliative Services
•Emergency / ICU
•Heart & Lung
•Medicine
•Mental Health & Addictions
•Renal
•Surgery & Maternity Services
•Urban Health & HIV/AIDS
Care Delivery Teams
Program Directors
Physician Program Directors (12), Leads (37)
CHALLENGE
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Help us design the perfect system for:
100% Medical Staff Disengagement
PHC FOCUS ON ENGAGEMENT
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PHC Physician Engagement Gallup Survey (2012)
• Pilot program with Ministry of Health
• 1100 Medical Staff, 54% response rate
• Gallup tool using Customer Engagement tool (CE11) plus custom questions.
Survey
Assess
Plan
Implement
Re-survey
2012 MEDICAL STAFF ENGAGEMENT
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Fully Engaged
4%
Engaged 19%
Not Engaged
36%
Actively Disengaged
41%
Providence Health Care Overall
Fully Engaged
18%
Engaged 23%
Not Engaged
32%
Actively Disengaged
27%
Gallup 2011 CE11 Physician Database 50th Percentile
Fully Engaged Strongly attached and loyal; these are your physician
partners.
Not Engaged Emotionally and attitudinally neutral; no positive association: They practice at their hospital as a matter of convenience.
Engaged These physicians are generally pleased with their relationship
with their hospital, but do not see themselves as partners.
Actively Disengaged Active emotional detachment and antagonism.
Copyright © 2012 Gallup, Inc. All rights reserved.
• I have confidence and trust in the people with whom I work
• Collaborate effectively with
other medical staff • At work, I am always treated
with respect • Differences among individuals
are respected and valued
• Administration manages effectively
• Communication between medical staff and leadership
• Operational decisions consider medical staff
• Department/Program receives the attention and respect it deserves from others
STRENGTHS OPPORTUNITIES
A connection to colleagues as individuals
Disconnect with leadership; lack of support/respect
STRENGTHS AND OPPORTUNITIES
Copyright © 2012 Gallup, Inc. All rights reserved. 16
FINDINGS OF NOTE
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• Level of engagement was not a function of the frequency with which a physician worked at the hospital
• Engagement was highest amongst current physician leaders; lowest among former physician leaders
• The specialties ‘favored' at the outset of engagement work did not necessarily have the highest engagement scores
• Even when decisions went in a physician’s favour, they were more concerned with involvement and process
• Most favourable response: “how likely are you to continue to work at Providence Health Care?” Mean score: 4.13/5.0
ENGAGEMENT STRATEGIES
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1. Physician Leadership Development • Develop physician leadership capacity
2. Physician involvement in decision-making • Promote physician involvement in decision-making
3. Influence • Ensure physician involvement in matters of strategic
importance
4. Integration • Develop and sustain a culture of integration; reduce “us”
and “them” thinking.
IMPLEMENTATION
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1. Physician Leadership Development
• Sauder Physician School of Leadership
• Transforming LINX Leadership Course
• Conference sponsorships
IMPLEMENTATION
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2. Physician Involvement in Decision Making • Representation at decision-making forums
• Clinical Leadership Teams
• Clinical and Systems Transformation
• Senior Leadership Team
• Budget Development Process
• HAU Preferred Option Development
• Dyad Program Leadership Model
IMPLEMENTATION
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3. Influence
• PHC Redevelopment
• Physician Strategic Advisory Leadership Meeting
• Joint Leadership Forum
• CEO attendance at regular meetings/forums
IMPLEMENTATION
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4. Integration • Recognition
• Responding to Feedback
Office of Innovation
Innovation Board Committee
PHC Associate CMIO role
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