engaging physicians: physician advice & tips from the field judy frisch, rn, mba, cphq quality...
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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
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
[email protected]@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.