Ramesh Sahjpaul MD, MSc Head, Department of Surgery, Lions Gate Hospital Co-Medical Director, Surgery Program, Lions Gate Hospital Clinical Associate Professor, Division of Neurosurgery Vancouver Coastal Health, UBC Feb , Quality Forum 2015, Vancouver BC

As Jauhur puts it, “American doctors are suffering from a collective malaise,” for reasons ranging from bureaucratic hassles to increased pressure to see more and more patients. Hence surveys showing that up to 40% of current doctors would choose a different career if they had to do it all over again, and even more say they would try to talk their kids out of a career in medicine. Physicians also tend to have unusually high suicide rates. According to the American Society for Suicide Prevention, male physicians commit suicide at a 70% higher rate compared with other professions, and femaleAmerican Society for Suicide Prevention

 An agreement to be married  An arrangement to meet or be present at a specific time or place  Emotional involvement or commitment

 An agreement to be married  An arrangement to meet or be present at a specific time or place  Emotional involvement or commitment  A hostile encounter between military forces

 An agreement to be married  An arrangement to meet or be present at a specific time or place  Emotional involvement or commitment  A hostile encounter between military forces …..Sound familiar??

physician X

 A. Drive patient satisfaction ?

 B. Drive improved patient safety ?

 A. Drive patient satisfaction ?  B. Drive improved patient safety ?  C. Drive improved quality of care ?

 A. Drive patient satisfaction ?  B. Drive improved patient safety ?  C. Drive improved quality of care ?  D. Drive reduction in costs ?

 A. Drive patient satisfaction ?  B. Drive improved patient safety ?  C. Drive improved quality of care ?  D. Drive reduction in costs ?  E. Drive improvement in operational efficiency ?

 A. Drive patient satisfaction ?  B. Drive improved patient safety ?  C. Drive improved quality of care ?  D. Drive reduction in costs ?  E. Drive improvement in operational efficiency ?  ANSWER: All of the above

Physician happiness Physician engagement In our best interest to get involved and engaged!

 Pleasant, quiet, uninvolved ?  Loud and always negative?  Involved, critical yet constructive ?

CORE ASPECTS OF ENGAGEMENT  Collaborative  Shared vision  Requires patience  Working in the fuzzy areas  Schedules  Budgets  Policies

CORE ASPECTS OF ENGAGEMENT CORE QUALITIES OF MOST PHYSICIANS  Collaborative  Shared vision  Requires patience  Requires accommodation  Working in the fuzzy areas  Schedules  Budgets  Policies  Busy > lots of distractions  Lots of patients but not always a lot of patience  Limited knowledge of systems/budgets  Weary and cynical from years of being beaten down…  Fiercely independent…

 Engagement is optional  No formal training in systems/institutional operations  *now increased recognition/support for leadership training  A lot going on  Credentialing overhaul  NSQIP  TPOT Wait time targets/MOH deliverables

An engaging leader – preferably a physician colleague -ie we’re on the same team… Feedback – closing the loop Win-win scenario What’s in in for me? For my patients?

An engaging leader – preferably a physician colleague -ie we’re on the same team… Feedback – closing the loop Win-win scenario What’s in in for me? For my patients?  Leadership: Inspiring change through shaping belief

 Can’t (easily) fire the bad apples…  In industry, 80% of success is firing/hiring…

 Can’t (easily) fire the bad apples…  In industry, 80% of success is firing/hiring…  We’re working with a tough crowd!  Imagine a hockey team full of Alexander Ovechkins!

 Can’t (easily) fire the bad apples…  In industry, 80% of success is firing/hiring…  We’re working with a tough crowd!  Imagine a hockey team full of Alexander Ovechkins!  Asking more and more of physicians’ time without compensation

LEADERSHIPENGAGEMENT  Provide the mandate but not the tools  No leadership or top-down leadership  Tell people what they have to do but not why  Don’t listen to people  Don’t provide feedback  Don’t reward success

 Value their time  Invest in leadership  Listen to their concerns  Tell them what you heard  Tell them what you’re going to do  Tell them what you did  Tell them again…..  OVERCOMMUNICATE…..  >> build a culture of trust one step at a time

 NSQIP: months before scepticism died down  TPOT: just starting…  Monthly quality council meetings (3 division heads)  Surgical Safety Checklist…a 2 year journey  Slowly but surely the Culture is changing  Avoid heavy-handed approach …. Can’t mandate engagement  Can’t do it alone…