Engaging Physicians: Engaging Physicians: Physician Advice & Tips Physician Advice & Tips from the Fieldfrom the Field

Judy Frisch, RN, MBA, CPHQJudy Frisch, RN, MBA, CPHQ

Quality Consultant; MetaStar, Inc.Quality Consultant; MetaStar, Inc.

July 15, 2010July 15, 2010

Teleconference Objectives Teleconference Objectives

Define the meaning of physician engagementDefine the meaning of physician engagement

Identify barriers blocking physician involvement Identify barriers blocking physician involvement particularly with quality and safety initiativesparticularly with quality and safety initiatives

Describe a way to improve physician involvement Describe a way to improve physician involvement with safety and quality initiativeswith safety and quality initiatives

Apply tips and ideas that will help get physicians Apply tips and ideas that will help get physicians involvedinvolved

Engagement Definition Engagement Definition

To “Engage” is to:To “Engage” is to:Become Involved Become Involved

Commit Commit

Attract Attract

Bring on Board Bring on Board

Bring into BattleBring into Battle

Physician Engagement Physician Engagement

Means: Means: Getting physicians’ Getting physicians’ AttentionAttention & &

Getting physicians actively Getting physicians actively Involved Involved &&

Getting physicians Getting physicians CommittedCommitted

Physician Engagement Physician Engagement

Looks like:Looks like:““We have lowest infection & med error rate again this We have lowest infection & med error rate again this quarter”quarter”

Does not look like:Does not look like:““Let’s complete this treatment so we can go to lunch Let’s complete this treatment so we can go to lunch early”early”

Really does not look like:Really does not look like:““This would be a great place to work if it weren’t for This would be a great place to work if it weren’t for the patients”the patients”

Engagement Stages Engagement Stages

This quality improvement is worthlessThis quality improvement is worthless

This may be a true statement; but it isn’t This may be a true statement; but it isn’t importantimportant

This is interesting, especially the dataThis is interesting, especially the data

This is exactly my point!This is exactly my point!

Physician Leadership PerceptionsPhysician Leadership Perceptions

Physicians do not see themselves as leadersPhysicians do not see themselves as leaders

Nor do they see themselves as followers Nor do they see themselves as followers

Thus, do not recognize organizational Thus, do not recognize organizational leaders to have authorityleaders to have authority

Mindset is lacking Mindset is lacking

Leadership is a new dynamic between Leadership is a new dynamic between leaders, team members, and organizationleaders, team members, and organization

Medical EducationMedical Education

Anatomy

Physiology

Histology

Finances

Customer Service

Quality

Pediatrics Medicine

Surgery

Documentation

Quality Not Always Chief ConcernQuality Not Always Chief ConcernTriaging Among Too Many PrioritiesTriaging Among Too Many Priorities

051015202530354045505560

051015202530354045505560

How can I help my hospital on

quality initiatives?

How can I shift my practice mix?

How can I perform more procedures?

How can I improve my productivity?

What services can I add to my

practice?

Other Outstanding ConcernsOther Outstanding Concerns

Surgical Concerns Surgical Concerns Potential of bleeding Potential of bleeding

Potential of infection Potential of infection

Malpractice Concerns Malpractice Concerns Increasing malpractice insurance premiumsIncreasing malpractice insurance premiums

Potential suit Potential suit

Family Family Fitting family into the balanceFitting family into the balance

Loss of Autonomy Loss of Autonomy

CMSCMSCDCCDC

IOMIOM

NQFNQF

AHAAHA

LeapfrogLeapfrog

Commercial payors Commercial payors

AHRQAHRQ

Physicians’ PerceptionPhysicians’ PerceptionHow many Americans die in hospitals annually because of preventable medical How many Americans die in hospitals annually because of preventable medical

errors?errors?

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

500 5,000 50,000 100,000 >500,000

Source: Blendon, R et al. “Views of Practicing Physicians and the Public on Medical Errors.” New England Journal of Medicine 2002

Physicians’ Perceptions of Largest Problem in Physicians’ Perceptions of Largest Problem in Health Care, 2002Health Care, 2002

0%

5%

10%

15%

20%

25%

30%

Malpractice Insurance &

Lawsuits

Cost of Healthcare

Problems with Health

plans

Medical Errors

Source: Advisory Board interviews and analysis

In SummaryIn Summary

Inadequate training with little or no: Inadequate training with little or no: Education concerning patient, staff and personal safety Education concerning patient, staff and personal safety

Meaning of as well as applicable quality improvement Meaning of as well as applicable quality improvement activitiesactivities

Ability to be customer service focused Ability to be customer service focused

Difficulty balancing all of their responsibilitiesDifficulty balancing all of their responsibilitiesBoth professional and personal Both professional and personal

In Summary In Summary

Do not perceive medical errors or safety as Do not perceive medical errors or safety as being a problembeing a problem

Malpractice insurance and lawsuits Malpractice insurance and lawsuits

Cost of healthcare rising Cost of healthcare rising

Inconsistencies and problems with health plans Inconsistencies and problems with health plans

Medical errors Medical errors

Necessary Solutions for Change Necessary Solutions for Change

Understand the common goal Understand the common goal

Update education and trainingUpdate education and training

Encourage participation Encourage participation

Standardize Standardize

Become accountableBecome accountable

Communicate, communicate, communicateCommunicate, communicate, communicate

Common GoalsCommon Goals

Quality patient careQuality patient care

Safe patient careSafe patient care

Affordable patient careAffordable patient care

Reduction of hassles and wasted timeReduction of hassles and wasted time

Understand organizational culture Understand organizational culture

Quality & Safe Patient Care Quality & Safe Patient Care

Clinical ToolsClinical ToolsPerformance trackingPerformance tracking

CPOE/EMRCPOE/EMR

Barcoding/eMARBarcoding/eMAR

Standing Orders Standing Orders

Medication Reconciliation Medication Reconciliation

Affordable Patient Care Affordable Patient Care

Identify and Decrease Waste Identify and Decrease Waste Duplicate testing Duplicate testing

End of life issues End of life issues

Overuse Overuse

Organizational Culture Organizational Culture

Change in expectations from their own set Change in expectations from their own set to the organizations’ set to the organizations’ set

Price of not changingPrice of not changing

Advantages of future change Advantages of future change

Physician Education & Training Physician Education & Training

Where does the education and training of Where does the education and training of the following fit in:the following fit in:

QualityQuality

Patient SafetyPatient Safety

FinancesFinances

Core MeasuresCore Measures

Participation Cues Participation Cues

Encourage physician leadership on QI projects Encourage physician leadership on QI projects ICU Medical Director, Chief Medical Officer, Senior ICU Medical Director, Chief Medical Officer, Senior PhysicianPhysician

Present clear direction for expectations Present clear direction for expectations

Provide support Provide support Administrative time for project workAdministrative time for project work

Assistant time Assistant time

Evaluation time Evaluation time

Strategies Strategies

Identify and overcome physician barriers Identify and overcome physician barriers Time, money, lack of understanding Time, money, lack of understanding

Communicate prior to the start of a changeCommunicate prior to the start of a changeNo surprises No surprises

Listen to those that are resisting Listen to those that are resisting Valid points Valid points

Celebrate and share successes Celebrate and share successes Newsletters, recognition, acknowledgementNewsletters, recognition, acknowledgement

Standardize Standardize

Reduce VariabilityReduce Variability

Eliminate DefectsEliminate Defects

Makes it SimpleMakes it Simple

Evidenced BasedEvidenced Based

Potential Value AddedPotential Value Added

AccountabilityAccountability

Ac•count•a•bil•i•ty (n): Holding your team and self responsible for achieving the best possible outcomes even under

difficult circumstances.

Ac•count•a•bil•i•ty (n): Holding your team and self responsible for achieving the best possible outcomes even under

difficult circumstances.

Articulating clear expectations and

following through on them

Emphasizing great outcomes over

assigning blameUnwillingness to accept

underperformance, even in face of the greatest

challenges

CommunicationCommunication

Physicians are “data driven”; show them Physicians are “data driven”; show them their numberstheir numbers

Physicians are competitive so show them Physicians are competitive so show them their colleagues and competitions’ numbers their colleagues and competitions’ numbers

Publicly reported dataPublicly reported data

Review Committee for chart falloutsReview Committee for chart falloutsEvidenced base feedback Evidenced base feedback

Appropriate Skill SetsAppropriate Skill Sets

The The WorkersWorkers are chopping are chopping their way through the jungle.their way through the jungle.

The The ManagersManagers are are coordinating, making sure the coordinating, making sure the tools are sharp, etc.tools are sharp, etc.

The The LeadersLeaders climb a tree and climb a tree and shout: “Wrong Jungle”shout: “Wrong Jungle”

The The ManagersManagers shout back: “Be shout back: “Be quiet! We’re making progress”quiet! We’re making progress”

New Set of QuestionsNew Set of Questions

How often do you or your CEO effectively How often do you or your CEO effectively “round” with physicians and surgeons? “round” with physicians and surgeons?

Do you or your CEO talk with physicians Do you or your CEO talk with physicians and surgeons about safety and quality?and surgeons about safety and quality?

Why does the Medical Affairs Department Why does the Medical Affairs Department exist?exist?

Medical Affairs Department Medical Affairs Department

Board assigns responsibility for monitoring Board assigns responsibility for monitoring and improving the quality of care to the and improving the quality of care to the medical staff and managementmedical staff and management

Responsible for the quality of care at your Responsible for the quality of care at your hospitalhospital

References References

““Leading Physicians Through Change” by Leading Physicians Through Change” by Jack Silversin and Mary Kane Kornacki Jack Silversin and Mary Kane Kornacki

““Physician Engagement” by Martin Landa, Physician Engagement” by Martin Landa, MD FACEP MD FACEP

Questions?Questions?

Contact Information:Contact Information:

Judy Frisch, RN, MBA, CPHQJudy Frisch, RN, MBA, CPHQQuality ConsultantQuality ConsultantMetaStar, Inc.MetaStar, Inc.2909 Landmark Place2909 Landmark PlaceMadison, WI 53713Madison, WI 53713

(800) 362-2320 or (608) 274-1940, ext 8216(800) 362-2320 or (608) 274-1940, ext 8216

www.metastar.comwww.metastar.com

jfrisch@metastar.comjfrisch@metastar.comThis material was prepared by MetaStar, the Medicare Quality Improvement Organization for Wisconsin, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.  9SOW-WI-PS-10-116.