Physician Engagement

Learning Objectives

• To relate what is meant by physician engagement

• To discuss strategies at management and staff levels to enhance physician engagement

What Do We Mean by Engagement?

• Engagement: “To involve one self or become occupied; to participate fully and deeply”

• Active support of the project

Where Does Engagement Fit?

• Work involves technical problems– Evidence– Measurement

• Adaptive problems– Engagement of nurses, physicians, leaders, IPs– Competing priorities– Overcoming barriers– Ameliorating safety and teamwork climate

Stages of Engagement

Engage Physician’s Intellect

• Show them– The evidence– Your hospital’s CLABSI rates– What others have achieved– That you can do the same

Engage by Creating Trust

• Caring– Keep patients as your “North Star,” your focus– Preventable harm is not acceptable– Tell your own Josie story

• Competent– Learn from mistakes and implement teamwork

tools– Demonstrate early successes/project results

Physician Engagement Strategies

• Management level – Identify physician champion for project

• Unit director, chief medical officer, or senior physician

• Someone other physicians look up to– Reward physician champions for their efforts

• Obtain hospital support for their time• Feature in newsletters• Provide opportunities to present to senior leaders

Physician Engagement Strategies

• Management level (continued)– Create a compact (agreement)

•Clearly define what is expected of physicians•Review performance regularly

Example: Physician Champion Compact

• Hospital will provide support for percent of physicians’ time

• In return, physician will– Monitor and improve quality– Implement CUSP and CLABSI toolkit– Hold regular meetings with team– Involve other members of medical staff in quality– Report CLABSI rates and learning from defects

results to senior leaders and board

Example: Physician Champion Compact

• Further, the physician will– Work with hospital to clarify what will be

measured, who will measure it, and who will produce reports

– Meet quarterly to discuss progress

Physician Engagement Strategies

• Staff level – Create containing vessel (environment) to have a

dialogue with physicians (eliminate decoding errors)

• M and M, grand rounds, quality meetings, etc. – Identify and overcome barriers to engagement

• Clinician, intervention, system• Try physician engagement self-diagnostic tool

(safercare.net)

Physician Engagement Strategies

• Staff level (continued)– Communicate prior to start of project

• No surprises• Who, what, when, where, how

– Listen to those who resist/value the dissenter– Create mechanisms to feed results back to

physicians

Handling Barriers to Change

• Tune in to WIFM (What’s In It For Me?)• People resist loss, not change

– Try to surface and mitigate real and perceived loss– Physician’s time is likely a major concern– Perceived losses often much greater than real loss– Perceived loss high when communication is low

Manage Communication

• At each step or meeting– Clarify message– Determine who needs to know– Make time for feedback

• Assume that all staff have patient as their “North Star”• Remind staff they are participating in something

greater – “Ohana”

Action Plan

• Cultivate a physician champion for this project• Create compact for physician champion role• Create containing vessel for communication• Develop communication plan for CUSP education• Listen to physicians to surface and mitigate loss