On the CUSP: STOP BSI Physician Engagement

Immersion 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 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 Engagement? Engagement: “To involve one-self or become occupied; to participate fully and deeply” Active support of the project

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 Engagement Aversion Apathy Engaged

Engage 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 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 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 Strategies For Management, cont’d. – Create a Compact (an Agreement) Clearly define what is expected of physicians Review performance regularly

Example: Physician 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: Physician 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 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 Strategies 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 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 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 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