On the CUSP: STOP BSI
Physician Engagement

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

• To relate what is meant by physician engagement
• To discuss strategies at management and staff levels to enhance physician engagement

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

• 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

Aversion Apathy Engaged

• 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

• 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

• 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)

• 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

• 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”

• 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