1. 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 20 2015, Quality Forum 2015, Vancouver BC

7. 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

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

11.  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

12.  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??

15. physician X

17.  A. Drive patient satisfaction ?

18.  B. Drive improved patient safety ?

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

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

21.  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 ?

22.  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

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

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

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

26. 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…

30.  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

31. 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?

32. 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

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

35.  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!

36.  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

37. 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

38.  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

39.  NSQIP: 18-24 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…