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Physician Engagement in Quality and Safety Nishi Rawat, M.D. Johns Hopkins Community Physicians Armstrong Institute for Patient Safety and Quality
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What Motivates Human Beings…. 2 Motivation 1.0: we need food, security, and sex Motivation 2.0: we respond to awards and punishments Motivation 3.0: we have the drive to learn, create, and improve the world Armstrong Institute for Patient Safety and Quality ‘Drive’ by Daniel Pink
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What Motivates Human Beings…. 3 Autonomy: control and choice over work –Task, time, team, technique –Accountability Mastery: get better at what they do –Requires hard work and struggle –Requires engagement: goals, feedback, challenge and effort itself is rewarding Purpose: be a part of something bigger Extrinsic motivators: decrease creativity, encourage short cuts, foster short-term thinking, extinguish intrinsic motivation Armstrong Institute for Patient Safety and Quality ‘Drive’ by Daniel Pink
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Physician Engagement Physicians working to reduce unjustifiable variation in care, considering the system Safety and quality improve when physicians are engaged and committed High-performing US healthcare organizations: –high levels of physician engagement –4:1 to 6:1 return on every dollar Very little happens in the system without a physician’s order 4 Armstrong Institute for Patient Safety and Quality Taitz et al. BMJ Qual Saf 2011
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Barriers to Physician Engagement Physician’s primary business focus is their own practice: –priorities of their own system are not aligned with the priorities of the greater system Physicians have little time to spare outside of their own clinical practice Doctors also have a strong belief that quality is a personal responsibility –physicians find it hard to take a systems perspective and have a tendency to blame individuals 5 Armstrong Institute for Patient Safety and Quality IHI 2007
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IHI Framework for Physician Engagement in Quality and Safety 6 Armstrong Institute for Patient Safety and Quality
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IHI Practical Strategies for Physician Engagement Reinforce the common purpose Reframe the problem: –‘how can we engage physicians in the hospital agenda’ vs ‘how can we engage the hospital in meeting the physician’s quality agenda’ Know what is important to doctors: –outcomes –waste Doctors are life-long learners: keep projects data-driven Involve physicians from the beginning Make physicians partners as opposed to customers 7 IHI 2007 Armstrong Institute for Patient Safety and Quality
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IHI Practical Strategies for Physician Engagement Identify a good physician champion –intrinsically motivated-respected –courageous-communicator –resilient Standardize only what is standardizable Make harm visible Give hard feedback frequently: raw, light and meaningful Armstrong Institute for Patient Safety and Quality 8 IHI 2007
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Physician Engagement Strategies Specific to Eliminate VAP project Support new VAP definition with data Support process and structural measures with data Involve physicians from beginning: team formation, data collection planning, reporting data, new definitions Choose physician champion carefully Don’t make the protocols too complex Provide frequent data feedback: raw, light, meaningful Extrinsic rewards: quality bonus affected?, ‘lead’ title, unit reputation, opportunity to present data to MEC and board, highlight in local publications 9 Armstrong Institute for Patient Safety and Quality
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