ENGAGING PHYSICIANS IN OUR HEALTHCARE SYSTEM

Presented by: Dianne Doyle, President and CEO, Providence Health Care Zulie Sachedina, VP Human Resources & General Counsel, Providence Health Care Astrid Levelt, Director Medical Affairs, Providence Health Care

1

BC HEALTH LEADERS CONFERENCE 2015

October 21, 2015

PRESENTATION OVERVIEW

1. About Providence Health Care

2. Context of Physician Engagement

3. Measurement

• Case study

• Large-scale engagement survey (Gallup)

4. Engagement Strategies

• Implementation/Activities

2

PROVIDENCE HEALTH CARE

• PHC is one of the largest Catholic Health Care organizations in Canada

• Over 115-year presence in health care in BC

• Strong commitment to our Mission:

Inspired by the healing ministry of Jesus Christ, Providence Health Care is a Catholic health care community dedicated to meeting the physical, emotional, social and spiritual needs of those served through compassionate care, teaching and research

3

OUR VALUES

BRINGING OUR VALUES TO LIFE

4

THE PROVIDENCE PLAN

Linking our mission, values and strategic directions to help us achieve our vision

5

OUR VISION

Driven by compassion and social justice, we are at the forefront of exceptional care and innovation.

6

ENGAGEMENT

7

An engaged workforce:

• Feels more valued

• Experiences a sense of belonging and community

• Experiences more opportunity to make improvements in work

Engagement leads to:

• Enhancement of one’s own sense of self-worth

• Commitment to organizational goals and values

• Organizational success

ENGAGEMENT

8

Engagement supports: • Patient and family centered care

• Enhanced patient, staff and physician safety

• Greater efficiency and use of resources

• Greater collaboration and active participation in practice collaboratives

• Investment in both clinical and service outcomes

• Alignment with the mission of the organization

• Greater discretionary effort to patients / the organization

• Willingness to go above and beyond

• Recruitment

PHYSICIAN ENGAGEMENT: CONTEXT

9

PHYSICIAN ENGAGEMENT: CONTEXT

10

Historic • Physicians led most hospitals up until the 1970s • Growing populations & medical advances increased demand

for care, costs, and complexity • Consolidation led to larger structures which diluted the

physician voice

Situational • Hospital Employees vs. Independent Contractors • Misaligned Compensation / Competing Incentives • Good Intentions vs. Time Commitments • Professional autonomy of decision making

TODAY’S HEALTHCARE MATRIX

11

Lowery, M , SUPPORTING PHYSICIAN PARTICIPATION IN ORGANIZATIONAL IMPROVEMENT INITIATIVES, July 2015

Figure 1. The system diagram identifies how relationships and stakeholders are connected within the Medicine Program

THE MEDICINE

PROGRAM

Nursing Staff and Allied

Health disciplines

Patients, Families &

Visitors

Director & Operations

CEO & VP’s (Senior & Clinical

Leadership)

Housekeeping, Maintenance &

Volunteer Services

Physician Governance

The Catholic Church

Quality Improvement &

Change Initiatives

Physician Champions

The Ministry of

Health

Physician Leaders

Nursing Leaders

Patient & Family

Council

Nursing Unions -

BCNU & HEU

Allied Health

Leaders

Professional Practice

Medical Affairs

VCH

Medical Practice & Academics

13 Department Heads, 37 Division Heads

DEPARTMENT & PROGRAM STRUCTURE

12

13 Departments •Anesthesia

•Emergency

•Family & Community Medicine

•Pathology & Laboratory Medicine

•Midwifery

•Medicine

•OB/GYNE

•Ophthalmology

•Orthopedics

•Pediatrics

•Psychiatry

•Radiology

•Surgery

8 Clinical Programs •Elder Care / Palliative Services

•Emergency / ICU

•Heart & Lung

•Medicine

•Mental Health & Addictions

•Renal

•Surgery & Maternity Services

•Urban Health & HIV/AIDS

Care Delivery Teams

Program Directors

Physician Program Directors (12), Leads (37)

CHALLENGE

13

Help us design the perfect system for:

100% Medical Staff Disengagement

PHC FOCUS ON ENGAGEMENT

14

PHC Physician Engagement Gallup Survey (2012)

• Pilot program with Ministry of Health

• 1100 Medical Staff, 54% response rate

• Gallup tool using Customer Engagement tool (CE11) plus custom questions.

Survey

Assess

Plan

Implement

Re-survey

2012 MEDICAL STAFF ENGAGEMENT

15

Fully Engaged

4%

Engaged 19%

Not Engaged

36%

Actively Disengaged

41%

Providence Health Care Overall

Fully Engaged

18%

Engaged 23%

Not Engaged

32%

Actively Disengaged

27%

Gallup 2011 CE11 Physician Database 50th Percentile

Fully Engaged Strongly attached and loyal; these are your physician

partners.

Not Engaged Emotionally and attitudinally neutral; no positive association: They practice at their hospital as a matter of convenience.

Engaged These physicians are generally pleased with their relationship

with their hospital, but do not see themselves as partners.

Actively Disengaged Active emotional detachment and antagonism.

Copyright © 2012 Gallup, Inc. All rights reserved.

• I have confidence and trust in the people with whom I work

• Collaborate effectively with

other medical staff • At work, I am always treated

with respect • Differences among individuals

are respected and valued

• Administration manages effectively

• Communication between medical staff and leadership

• Operational decisions consider medical staff

• Department/Program receives the attention and respect it deserves from others

STRENGTHS OPPORTUNITIES

A connection to colleagues as individuals

Disconnect with leadership; lack of support/respect

STRENGTHS AND OPPORTUNITIES

Copyright © 2012 Gallup, Inc. All rights reserved. 16

FINDINGS OF NOTE

17

• Level of engagement was not a function of the frequency with which a physician worked at the hospital

• Engagement was highest amongst current physician leaders; lowest among former physician leaders

• The specialties ‘favored' at the outset of engagement work did not necessarily have the highest engagement scores

• Even when decisions went in a physician’s favour, they were more concerned with involvement and process

• Most favourable response: “how likely are you to continue to work at Providence Health Care?” Mean score: 4.13/5.0

ENGAGEMENT STRATEGIES

18

1. Physician Leadership Development • Develop physician leadership capacity

2. Physician involvement in decision-making • Promote physician involvement in decision-making

3. Influence • Ensure physician involvement in matters of strategic

importance

4. Integration • Develop and sustain a culture of integration; reduce “us”

and “them” thinking.

IMPLEMENTATION

19

1. Physician Leadership Development

• Sauder Physician School of Leadership

• Transforming LINX Leadership Course

• Conference sponsorships

IMPLEMENTATION

20

2. Physician Involvement in Decision Making • Representation at decision-making forums

• Clinical Leadership Teams

• Clinical and Systems Transformation

• Senior Leadership Team

• Budget Development Process

• HAU Preferred Option Development

• Dyad Program Leadership Model

IMPLEMENTATION

21

3. Influence

• PHC Redevelopment

• Physician Strategic Advisory Leadership Meeting

• Joint Leadership Forum

• CEO attendance at regular meetings/forums

IMPLEMENTATION

22

4. Integration • Recognition

• Responding to Feedback

Office of Innovation

Innovation Board Committee

PHC Associate CMIO role

23