On the CUSP: STOP BSIOn the CUSP: STOP BSIPhysician EngagementPhysician Engagement

Immersion Call OverviewImmersion Call Overview

1. Project overview

2. Science of Improving Patient Safety

3. Eliminating CLABSI

4. The Comprehensive Unit-Based Safety Program (CUSP)

5. Building a Team

6. Physician Engagement

Learning ObjectivesLearning 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 What do we mean by Engagement?Engagement?

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

• Active support of the project

Where does engagement fit?Where does engagement fit?

• Work involves technical problems– Evidence– Measurement

• Adaptive problems– Engagement of nurses, physicians, leaders, IPs– Competing priorities– How to overcome barriers– How to ameliorate safety and teamwork climate

Stages of EngagementStages of Engagement

Aversion Apathy Engaged

Engage Physician’s IntellectEngage Physician’s Intellect

• Show them the evidence

• Show them your hospital’s CLABSI rates

• Show them what others have achieved

• Show them you can do the same!

Engage by Creating TrustEngage 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 (CUSP

– Demonstrate early successes/ project results

Physician Engagement StrategiesPhysician 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 support from hospital for this person’s time

• Feature in newsletters• Provide opportunities to present to senior

leaders

Physician Engagement Physician Engagement StrategiesStrategies

• For Management, cont’d.

– Create a Compact (an Agreement)• Clearly define what is expected of physicians• Review performance regularly

Example: Example: Physician Champion CompactPhysician Champion Compact

• Hospital will provide support for percent of physicians’ time

• In return, physician will do the following:– 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: Example: Physician Champion CompactPhysician Champion Compact

• Further, physician will do the following:

– 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 StrategiesPhysician 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 Physician Engagement StrategiesStrategies

• For Staff, cont’d.

– 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 back results to physicians

Handling Barriers to ChangeHandling 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

– Perceived loss high when communication is low

Manage CommunicationManage Communication

• At each step or meeting clarify– Message– 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 PlanAction Plan

• Cultivate a physician champion for this project

• Create compact for this role

• Create containing vessel for communication

• Develop communication plan for CUSP/BSI education

• Listen to physicians to surface and mitigate loss