Transcript Presentation Template - Healthcare Analytics Summit

Session #11 – Creating Physician
Engagement
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Session #11
Creating Physician Engagement
Bryan Oshiro, MD
Chief Medical Officer, Health
Catalyst
Dr. Oshiro is currently the Chief Medical Officer for Health
Catalyst. He is also currently an Associate Professor at
Loma Linda University School of Medicine in Loma Linda,
CA and was the clinical leader of the first quality
improvement initiative at Utah’s Intermountain Healthcare,
in the 1990s. Dr. Oshiro obtained his M.D. degree from
Loma Linda University, where he also completed his
residency in obstetrics and gynecology. He has
participated in numerous multi-center trials and has
published numerous articles and book chapters in the
areas of quality improvement, perinatal infectious
diseases and high-risk pregnancy conditions.
Christopher D Spahr, MD
Enterprise Quality Program
Development Executive,
Children’s Hospital of
Wisconsin
Dr. Spahr is a specialist in Pediatric Emergency Medicine
and currently serves as the Director of Quality for the
pediatric emergency department. Dr. Spahr was one of
the clinical leaders in the design and implementation of a
new electronic health record system and continues to lead
the optimization of the EHR to improve patient care. Dr.
Spahr is serving as a primary physician leader in the
design and development of an enterprise performance
management program. Dr. Spahr has been pivotal in
engaging providers in change and adoption of a data
driven culture with prioritized improvement areas.
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Learning Objectives
• To describe the importance of physician
engagement in quality improvement (the
“why”)
• To describe the challenges and barriers to
truly have physicians lead quality
improvement (“the what”)
• To identify strategies to enhance physician
engagement (the “how”)
Exercise Objective: To build the tallest selfsupporting structure with the contents of one
box of Tinker toys.
1.
2.
3.
Each group has exactly
3 minutes to plan their
work.
During the planning
phase, there can be no
assembly of parts, even
for practice. Pieces can
be looked at and
handled, but cannot be
connected to each
other.
At the end of the
planning phase, all
pieces go back in the
box with the lid closed.
4.
5.
6.
At the signal, you will have
exactly 40 seconds to
assemble your structure.
At the end of the
construction phase, all team
members will step away
from their structure. The
structure must stand alone,
without resting on any other
object and without personal
assistance, for 30 seconds.
Each team should attempt
to draw upon the principles
of team work and good
management in planning
and executing this assigned
task.
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Healthcare Revolves
Around Physicians
Opening line…
“The words “alignment” and
“coordination” have been tossed
about as the government and
the healthcare industry wrestle to
provide more value for every
healthcare dollar spent. Under
those words, every strategy to fix
the problem revolves around one
thing: physicians.”
HealthLeader's Media Breakthroughs. Aligning Hospitals and Physicians toward Value.
Dec. 2009. In collaboration with PricewaterhouseCoopers.
Engagement matters
• 75-85% of the decisions that drive quality and
cost are determined by physicians
• Gallup reported at one health system,
outpatient volume increased +17.5 for
engaged physicians in the top quartile for
improved engagement.
• Disengaged physicians in the bottom quartile,
their outpatient volume declined -11.7%.
Gallup Business
Journal “ what the
doctor ordered”
Sept 8, 2005
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The Challenge
• Almost every aspect of physicians’ lives is
changing or seems uncertain
 Autonomy
 Income
 Social stature
• Physicians are going through something akin to
the stages of grief
 Most are beyond denial
 Many are stuck at anger
• How do we get these physicians to play a positive
constructive role in the needed change?
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The Realities of Engagement
• The physician is at the center of health care delivery

Ordering drives most health care actions

Physician engagement is a key component to
successful quality improvement (QI) projects.
• The physician's focus is primarily on their own
practice or quality of care

The physician’s goal and hospital’s goals and
incentives may not be aligned

Lack of commitment (time, support) to system
improvements
• Personal responsibility for quality is powerfully
engrained in physicians.
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Systems Issues
• Physicians are too busy
• Physicians are not compensated for their help
• Poor knowledge management support
• Malpractice issues
• Lack of meaningful measurements
• Poor data analytic support
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What Won’t Work
• Isolated simple measures combined with good
intentions
 Inspirational speeches
 Appointing physicians to key leadership
positions
 Financial incentives for improvement
 Sharing of best practices
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Maslow’s Hierarchy of Needs
SelfActualization
Esteem
Belongingness and Love
Safety
Physiological
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Focus on What We are Trying to
Create
• We spent too much time talking about what’s
wrong with healthcare
• We need to spend more time talking about what
we are trying to create
• That future vision has to be something important
and noble
 It could be better for patients- and just might be
great
 It is more important than the concerns of any of us
as individuals
 To imply otherwise would be to mislead our
colleagues
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First question: Engagement with
What?
•
•
Traditional definition – extent to which clinicians see their
own futures as intertwined with those of larger organization

Want MDs to be “loyal” with referrals

Want them to be cooperative
Needed- a modern concept to unlock transformation of
healthcare

More than agreement not to sabotage – but to actually
integrate care, be creative, and relentlessly push for better
outcomes/ experience and efficiency

Engagement with other care givers in real teams

Engagement with community of colleagues so that peer
pressure actually works

Engagement with greater goals of organization
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Roger’s Adopter Categories
Stages of Engagement
Aversion
Apathy
Engaged
Levels of Physician Engagement
• Confidence: Physicians believe that the hospital can
always be trusted to consistently deliver on it’s
promises.
• Integrity: Physicians believe that the hospital always
treats them fairly and will satisfactorily resolve any
problems that might occur.
• Pride: Physicians feel good about using the hospital
and hospital use reflects upon them.
• Passion: Physicians view the hospital as irreplaceable
and as an integral part of their lives and their practice
of medicine.
Gallup Business Journal “ what the doctor ordered” Sept 8, 2005
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Audience participation
Poll Question 1
Which stage best describes the engagement
level of the majority of physicians in your
organization?
a. Aversion
b. Apathy
c. Engaged
d. Unsure or not applicable
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Scenario 1
• Situation: Hospital management wants to
implement a quality initiative to decrease the rates
of Elective Deliveries before 39 weeks.
• Background: Other initiatives were imposed on
physicians which changed their work load and
work flow through increased documentation and
time burdens on the MDs. The programs were
generally not successful and caused tension and
mistrust of administration.
• Setting: A hospital administrator is trying to get
convince physicians on board with this program.
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Reinertsen JL,
Gosfield AG, Rupp W,
Whittington JW.
Engaging Physicians
in a Shared Quality
Agenda. IHI
Innovation Series
white paper.
Cambridge, MA:
Institute for Healthcare
Improvement; 2007.
(Available on
www.IHI.org)
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Discover Common Purpose
• Improve patient outcomes
 Primary focus of your aims
 “Wisconsin kids will be the healthiest in the
nation”
• Reduce hassles and wasted time
• Understand the organization’s culture
 Improvement Readiness Assessment
 If possible, learn from efforts in other areas
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Reframe Values and Beliefs
• Make physicians partners, not customers
 Make them part of the decision making
 Enterprise Performance Management Plan
• Promote both system and individual
responsibility for quality
 System-wide improvement structure, process,
and plan
 All key stakeholders involved
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Audience Participation
Poll Question 2
How well do you feel the physician and health
system goals are aligned in your organization?
a. Not aligned
b. Somewhat aligned
c. Moderately aligned
d. Very aligned
e. Extremely aligned
f.
Unsure or not applicable
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Scenario 2
• A follow-up meeting occurs with physicians
where data is presented showing a lack of
compliance with the 39 week elective
induction program.
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Engage the Physicians’ Intellect
• Show them the evidence and be transparent
about the data
 Utilize tools like the KPA to provide direction
and then perform deeper investigation
• Show them what others have achieved
 Look outside your system
• Show them you can do the same!
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Segment the Engagement Plan
• Identify and activate champions
• Educate and inform structural leaders
• Develop project management skills
 Provide support and education
• Identify and work with “laggards”
 Allow for review of improvement ideas or tests
of change
 One on one meetings with trusted colleagues
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Use “Engaging” Improvement
Methods
• Standardize what is standardizable no more
• Use data sensibly
 Focus on system performance first
• Make the right thing easy to try
 Address the perfectionist culture
 Agile project management
• Make the right thing easy to do
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Show Courage
Provide
backup all the
way to the
board
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Adopt an Engaging Style
• Involve physicians from the beginning
• Identify real leaders, early adopters
 Director, CMO, Chair, senior physician
 Opportunities for career growth
• Choose messages and messengers carefully
 We will function as a system
• Make physician involvement visible
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Adopt an Engaging Style
• Reward the efforts of the Physician Champions
 Reimburse for their time
 Clinician-Administrator promotion track
 Maintenance of Certification
•
Build Trust within each quality initiative
•
Communicate candidly, often

•
Call a time out
Value physicians’ time as equally as any
hospital executives’ time
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Physician Contracts
• Hospital will provide support for percent of
physicians’ time
• In return, physician will do the following:
 Monitor and improve quality
- Implement CHF bundle and CLABSI toolkit
- Hold regular meetings with team
- Involve other members of Medical staff in quality
- Report CHF bundle compliance and CLABSI rates
and learning from defects results to senior leaders
and board
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Physician Contracts - continued
• Furthermore, 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
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Action Plan
• Cultivate a healthy and safe culture for
physicians
• Create a shared vision
• Create a support structure and align
resources
• Administrative support
• Data analytics and reporting
• Training
• Develop communication and education plan
• Listen to physicians concerns and answers
concerns in a timely fashion
Audience participation
Poll Question #3
Which of the action plan steps do you feel would be
the most important in your organization to increase
physician engagement?
a. Cultivate a healthy and safe culture for
physicians
b. Create a shared vision
c. Create a support structure and align resources
d. Develop communication and education plan
e. Listen to physicians concerns and answers
concerns in a timely fashion
f.
Unsure or not applicable
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On the Journey Together
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Analytic
Insights
Questions &
Answers
A
Session Feedback Survey
1. On a scale of 1-5, how satisfied were you overall with this session?
1)
2)
3)
4)
5)
Not at all satisfied
Somewhat satisfied
Moderately satisfied
Very satisfied
Extremely satisfied
2. What feedback or suggestions do you have?
3.
On a scale of 1-5, what level of interest would you have for
additional, continued learning on this topic (articles, webinars,
collaboration, training)?
1)
2)
3)
4)
5)
No interest
Some interest
Moderate interest
Very interested
Extremely interested
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