1. Engaging Physicians as Partners in Quality Bruce Roe, MD Chief Medical Officer Executive Director, Clinical Programs Executive Champion, Transformation Endocrinologist St. Boniface Hospital Winnipeg, Manitoba

2. Engaging Physicians in Quality Why Why When When How How Who Who For How Long (sustaining and building engagement) For How Long (sustaining and building engagement)

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4. Engaging Physicians in Quality What would the ideal world look like to you when it comes to physician involvement?

5. Challenges in Engaging Physicians - Availability - Interest - Skepticism - Buy-in – different goals - Fragmented - Attachment to individual autonomy - Accountability for errors / lack of systems perspective

6. u early experience shows è less expensive è less complex è better patient outcomes The medical profession is changing From craft-based practice u individual physicians, working alone (housestaff ::= apprentices) u handcraft a customized solution for each patient u based on a core ethical commitment to the patient and u vast personal knowledge gained from training and experience To profession-based practice u groups of peers, treating similar patients in a shared setting u plan coordinated care delivery processes (e.g., standing order sets) u which individual clinicians adapt to specific patient needs Adapted from B. James, IHC

7. Judgment vs. Learning Judgment -based approaches ask "Who?” (craft – based) Learning -based approaches ask "Why?” "What?” "How?“ (profession – based) Adapted from B. James, IHC

8. Engaging Physicians IHI Framework 1. Discover common purpose 2. Reframe values and reliefs 3. Segment engagement plan 4. Use “engaging” improvement methods 5. Show courage 6. Adopt an engaging style

9. Discover Common Purpose: Aim Statement - Does it speak to physicians? - Does it align with physician goals? - Does it overcome differences in mental model or create new divisions? - Is it lost in the process of improvement?

10. Who’s agenda is this? physician hospital system physician hospital system outcomes time/hassles

11. Segment Engagement Plan Avoid the blanket approach Juran: “No such thing as improvement in general” Specific physicians  specific roles

12. Segment Engagement Plan Segment Engagement Plan Who are your early adopters? Who are your early adopters?

13. Physician Roles Champions Structural Leaders Team players – test of change Adopters – who will use the “tools”

14. Engaging champions – telling the story

15. Stories trump Statistics (Rule of Rescue) Relationships trump Stories I don’t care how much you know until I know how much you care Adapted from B. James, IHC

16. Transformation - Pillars CONTINUOUS IMPROVEMENT RESPECT FOR PEOPLE

18. Physician Champion: Attributes Courage Courage Social Skills Social Skills Credibility Credibility Insight into individual vs systems approach Insight into individual vs systems approach

19. Champion Considerations: 1. Do you have a champion? 2. How do you know she is on board? 3. How has she helped in the past? 4. How have you equipped her? 5. Do you pay? 6. How will you support? 7. Respect their time 8. Celebrate involvement

20. Med Rec Team Champion

21. Use “Engaging” Improvement Methods Generate light, not heat, with data Visual….Run charts Understand variation……Control charts Standardization of processes Make the right thing easy to try Make the right thing easy to do

22. Adopt an engaging style - Involve physicians from the beginning - Work with real practice leaders, early adopters - Manage the message - Make physician “involvement” visible - Value physician’s time - Champions can recruit champions  spread

23. Engaging Physicians In Quality and Safety 1. Discover Common Purpose: 1.1 Improve patient outcomes 1.2 Reduce hassles and wasted time 1.3 Understand the organization’s culture 1.4 Understand the legal opportunities and barriers 2. Reframe Values and Beliefs: 2.1 Make physicians partners, not customers 2.2 Promote both system and individual responsibility for quality 3. Segment the Engagement Plan: 3.1 Use the 20/80 rule 3.2 Identify and activate champions 3.3 Educate and inform structural leaders 3.4 Develop project management skills 3.5 Identify and work with “laggards” 4. Use “Engaging” Improvement Methods: 4.1 Standardize what is standardizable, no more 4.2 Generate light, not heat, with data (use data sesibly) 4.3 Make the right thing easy to try 4.4 Make the right thing easy to do 5. Show Courage: 5.1 Provide backup all the way to the board 6. Adopt an Engaging Style: 6.1 Involve physicians from the beginning 6.2 Work with the real leaders, early adopters 6.3 Choose messages and messengers carefully 6.4 Make physician involvement visible 6.5 Build trust within each quality initiative 6.6 Communicate candidly, often 6.7 Value physicians’ time with your time IHI White Paper 2007