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)

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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 Attachment to individual

autonomyautonomy- 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 purpose

2.2. Reframe values and reliefsReframe values and reliefs

3.3. Segment engagement planSegment engagement plan

4.4. Use “engaging” improvement Use “engaging” improvement methodsmethods

5.5. Show courageShow courage

6.6. 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 Does it overcome differences in

mental model or create new divisions?mental 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 No such thing as improvement in general”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 Roles

ChampionsChampions

Structural LeadersStructural Leaders

Team players – test of changeTeam players – test of change

Adopters – 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 Stories

I 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

ChampionChampion

Considerations: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 data

Visual….Run chartsVisual….Run charts

Understand variation……Control chartsUnderstand variation……Control charts

Standardization of processesStandardization of processes

Make the right thing easy to tryMake the right thing easy to try

Make 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

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