Engaging Physicians: Physician Advice & Tips from the Field Judy Frisch, RN, MBA, CPHQ Quality Consultant; MetaStar, Inc. July 15, 2010

Teleconference Objectives Define the meaning of physician engagement Identify barriers blocking physician involvement particularly with quality and safety initiatives Describe a way to improve physician involvement with safety and quality initiatives Apply tips and ideas that will help get physicians involved

Engagement Definition To “Engage” is to: Become Involved CommitAttract Bring on Board Bring into Battle

Physician Engagement Means: Getting physicians’ Attention & Getting physicians actively Involved & Getting physicians Committed

Physician Engagement Looks like: “We have lowest infection & med error rate again this quarter” Does not look like: “Let’s complete this treatment so we can go to lunch early” Really does not look like: “This would be a great place to work if it weren’t for the patients”

Engagement Stages This quality improvement is worthless This may be a true statement; but it isn’t important This is interesting, especially the data This is exactly my point!

Physician Leadership Perceptions Physicians do not see themselves as leaders Nor do they see themselves as followers Thus, do not recognize organizational leaders to have authority Mindset is lacking Leadership is a new dynamic between leaders, team members, and organization

Medical Education Anatomy Physiology Histology Finances Customer Service Quality PediatricsMedicine Surgery Documentation

Quality Not Always Chief Concern Triaging Among Too Many Priorities 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 Concerns Surgical Concerns Potential of bleeding Potential of infection Malpractice Concerns Increasing malpractice insurance premiums Potential suit Family Fitting family into the balance

Loss of Autonomy CMSCDCIOMNQFAHALeapfrog Commercial payors AHRQ

Physicians’ Perception How many Americans die in hospitals annually because of preventable medical errors? 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 Health Care, 2002 Malpractice Insurance & Lawsuits Cost of Healthcare Problems with Health plans Medical Errors Source: Advisory Board interviews and analysis

In Summary Inadequate training with little or no: Education concerning patient, staff and personal safety Meaning of as well as applicable quality improvement activities Ability to be customer service focused Difficulty balancing all of their responsibilities Both professional and personal

In Summary Do not perceive medical errors or safety as being a problem Malpractice insurance and lawsuits Cost of healthcare rising Inconsistencies and problems with health plans Medical errors

Necessary Solutions for Change Understand the common goal Update education and training Encourage participation Standardize Become accountable Communicate, communicate, communicate

Common Goals Quality patient care Safe patient care Affordable patient care Reduction of hassles and wasted time Understand organizational culture

Quality & Safe Patient Care Clinical Tools Performance tracking CPOE/EMRBarcoding/eMAR Standing Orders Medication Reconciliation

Affordable Patient Care Identify and Decrease Waste Duplicate testing End of life issues Overuse

Organizational Culture Change in expectations from their own set to the organizations’ set Price of not changing Advantages of future change

Physician Education & Training Where does the education and training of the following fit in: Quality Patient Safety Finances Core Measures

Participation Cues Encourage physician leadership on QI projects ICU Medical Director, Chief Medical Officer, Senior Physician Present clear direction for expectations Provide support Administrative time for project work Assistant time Evaluation time

Strategies Identify and overcome physician barriers Time, money, lack of understanding Communicate prior to the start of a change No surprises Listen to those that are resisting Valid points Celebrate and share successes Newsletters, recognition, acknowledgement

Standardize Reduce Variability Eliminate Defects Makes it Simple Evidenced Based Potential Value Added

Accountability Accountability (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 blame Unwillingness to accept underperformance, even in face of the greatest challenges

Communication Physicians are “data driven”; show them their numbers Physicians are competitive so show them their colleagues and competitions’ numbers Publicly reported data Review Committee for chart fallouts Evidenced base feedback

Appropriate Skill Sets The Workers are chopping their way through the jungle. The Managers are coordinating, making sure the tools are sharp, etc. The Leaders climb a tree and shout: “Wrong Jungle” The Managers shout back: “Be quiet! We’re making progress”

New Set of Questions How often do you or your CEO effectively “round” with physicians and surgeons? Do you or your CEO talk with physicians and surgeons about safety and quality? Why does the Medical Affairs Department exist?

Medical Affairs Department Board assigns responsibility for monitoring and improving the quality of care to the medical staff and management Responsible for the quality of care at your hospital

References “Leading Physicians Through Change” by Jack Silversin and Mary Kane Kornacki “Physician Engagement” by Martin Landa, MD FACEP

Questions?

Contact Information: Judy Frisch, RN, MBA, CPHQ Quality Consultant MetaStar, Inc Landmark Place Madison, WI (800) or (608) , ext 8216 This 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