Engaging Physicians as Partners in Quality

1. Engaging Physicians as Partners in Quality Bruce Roe, MD Chief Medical Officer Executive Director, Clinical Programs Executive Champion, Transformation Endocrinologist St. Boniface Hospital Winnipeg, Manitoba

2. Engaging Physicians in Quality • Why • When • How • Who • For How Long (sustaining and building engagement)

3. My Videos\edsrunningwith.mov

4. Engaging Physicians in Quality What would the ideal world look like to you when it comes to physician involvement?

5. Challenges in Engaging Physicians • Availability • Interest • Skepticism • Buy-in – different goals • Fragmented • Attachment to individual autonomy • Accountability for errors / lack of systems perspective

6. 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 • early experience shows • less expensive • less complex • better patient outcomes Adapted from B. James, IHC

7. Judgment vs. Learning Judgment -based approaches ask "Who?” (craft – based) Learning -based approaches ask "Why?” "What?” "How?“ (profession – based) Adapted from B. James, IHC

8. Engaging PhysiciansIHI Framework • Discover common purpose • Reframe values and reliefs • Segment engagement plan • Use “engaging” improvement methods • Show courage • Adopt an engaging style

9. Discover Common Purpose: Aim Statement • Does it speak to physicians? • Does it align with physician goals? • Does it overcome differences in mental model or create new divisions? • Is it lost in the process of improvement?

10. Who’s agenda is this? physician hospital system outcomes time/hassles

11. Segment Engagement Plan Avoid the blanket approach Juran: “No such thing as improvement in general” Specific physicians  specific roles

12. Segment Engagement Plan • Who are your early adopters?

13. Physician Roles Champions Structural Leaders Team players – test of change Adopters – who will use the “tools”

14. Engaging champions – telling the story

15. Stories trump Statistics (Rule of Rescue)Relationships trump Stories I don’t care how much you know until I know how much you care Adapted from B. James, IHC

16. Physician Champion: Attributes • Courage • Social Skills • Credibility • Insight into individual vs systems approach

17. Champion Considerations: • Do you have a champion? • How do you know she is on board? • How has she helped in the past? • How have you equipped her? • Do you pay? • How will you support? • Respect their time • Celebrate involvement

18. MedRec Team Champion

19. Use “Engaging” Improvement Methods Generate light, not heat, with data Visual….Run charts Understand variation……Control charts Standardization of processes Make the right thing easy to try Make the right thing easy to do

20. Adopt an engaging style • Involve physicians from the beginning • Work with real practice leaders, early adopters • Manage the message • Make physician “involvement” visible • Value physician’s time • Champions can recruit champions  spread