Fast Track Strategies for Physician
Engagement in Performance
Improvement
Virginia Davis, MSN, RN
Paulette Clay, RHIA
April 27, 2011
1
OBJECTIVES
• List three tools to rapidly gain physician
engagement with performance
improvement initiatives
• Define the role of physician leaders in
clinical performance improvement
initiatives
• List three benefits to physicians of
participation in performance
improvement initiatives
2
Telling the Story
• From the physician’s perspective
– Why participate?
– What are the benefits?
– What resources were needed for
physicians to effectively participate?
– What were the results?
3
Performance Improvement
The Pre-work
– Identify the “need”
– Identify the key stakeholders
– Data aggregation
– Prioritize improvements
– Outline the “methodology”
– Define the roles of staff, physicians,
others
4
Performance Improvement
• Performance refers to the
way people do their jobs and
the results of their work
• PI utilizes a systematic
methodology to find the root
causes of a performance
problem and correct the
specific performance deficit
• PI activities should be datadriven and evidence-base
 PI measures the
functioning of important
processes, services and
identifying changes that
enhance performance
 PI focuses on outcomes
of care, treatment and
services
 PI reduces factors that
contribute to
unanticipated adverse
events and/or outcomes
“To the person who only has a hammer in the toolkit,
every problem looks like a nail.”
Abraham Maslow
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Identify the “Need” and the “Key
Stakeholders”
Need
 What “needs” to be addressed
 What “needs” to be the desired outcome/expectation
 What “needs” to be the next steps in the process
Key Stakeholders
 Stakeholders may or may not be integral to the project
 Those from whom requirements will be drawn,
 Those who will influence the success of the project
 Those who will be impacted by the project/new design
 Those who will benefit from project success
•
•
•
6
Know who influences the stakeholders and who the stakeholders
influence
Know what the stakeholders value (time, financials, ease of practice,
recognition, reputation, etc.)
Stakeholder involvement in and knowledge of project builds confidence
and acceptance
Define the opportunity AND the
project
• Define desired performance, goal, target
• Define the project purpose and scope
• Define performance gaps between desired and actual
performance
• Find root causes of performance gaps
• Prioritize (the root causes) for action
– Impact – small, major
– Resources required – minimum, significant (personnel,
costs, IT)
– Time to address – short term, long term
• Select and design interventions
• Implement interventions
• Monitor and evaluate performance
7
Data Aggregation
– Aggregate data result from combining data elements from multiple
time frames or over a period of time, from a variety of sources,
reflect a variety of sub-populations, provide information regarding
multiple providers and/or sites (e.g. process results, outcomes,
costs, impact of improvements)
– The data should tell a story – e.g. hospital performance
compared to national data base, individual physician performance
compared to other internal medical staff performance
– The aggregate data are usually presented collectively or in
summary form
– Aggregated data should provide information expressed in a
summary form for purposes of reporting, analysis, action
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Prioritizing Actions/
Achieve the Goal
Assess the situation
– Review historical information
– Document current status
– Trend/Process analysis
Define a realistic vision
– Brainstorm ideas for improvement
– Group related improvement ideas
– Identify areas that are working well
– Evaluate and prioritize potential initiatives
and existing services
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Prioritizing Actions/
Achieve the Goal
Plan to reach the vision
– Timeline
– Measurable objectives
– Commitment & Communication of plan
Implement, Evaluate, Update
– Obtain the necessary resources
– Implement the operational plans
– Evaluate performance measures
– Update plan
10
Performance Improvement
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Objectives:
Fast Track Methods for Physician Engagement in
Performance Improvement
– List three tools to rapidly gain physician
engagement with performance
improvement initiatives
– Define the role of Physician Leaders in
Clinical Performance Improvement
Initiatives
– List three benefits to physicians of
participation in performance improvement
initiatives
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Fast Track Methods for Physician
Engagement
6. Adopt an
Engaging Style
1. Discover
Common Purpose
Engaging
Physicians
2. Reframe Values
and Beliefs
5. Show courage
3. Segment the
Engagement Plan
4. Use “engaging”
PI plan
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Reinertsen JL, Gosfield AG, Ripp W, Whittington JW.
Engaging Physicians in a Shared Quality Agenda.
Engaged Physicians
• Physician Roles in Performance Improvement
– Champion – advocate, defender, challenger,
respected
– Mentor – trusted counselor, guide, coach
– Supporter – adherent
• ENGAGED – attracted by influence or power,
to mesh, to bind
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Champions/Engaged LeadersCommon Purpose
– Understanding the “stakeholders” –
• The Physicians’ “World View”
• Physician practice environment and life
– Physician leadership development
– Physician benefits –
• WIIFM (What’s in it for me?)
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The Physicians’ “World View”Common Purpose?
– Primary focus –
•
•
•
•
Own business
Own practice
Want what is best for their patients
TIME
– Responsible for care provided patients –
• Focus is on own performance……related to patients
• Autonomy vs. system view
• (“If I work hard enough/study hard enough, I won’t make mistakes”)
– Within hospitals –
• Organized Medical Staff
• Voluntary
• Contract – Faculty, Medical Director, Services such as “hospitalists”,
anesthesiologists, radiologists, etc.
– “Administration as a partner” is desirable
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Physician Leadership
Development – Reframing
– Medical Staff Institute
– Off-site training
– On-line training
– Board education and participation
– Succession and Leadership planning
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Physician Benefits
WIIFM (What’s in it for me?)
–Improved patient outcomes
–Reduce hassles and wasted time
–Make the “right thing” easy to do
–Feedback re personal performance
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Communicating the Need and the
Benefit – Segment the Plan
• TOOLS of the trade
– Use data and evidence as a catalyst
– Use of a Performance Improvement Team
Charter
– Know the “Beauty” of a Work plan
– Tell the Story
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Telling the Story
• From the physician’s perspective
– Why participate?
– What are the benefits?
– What resources were needed for
physicians to effectively participate?
– What were the results?
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Need and Data
– VTE prophylaxis
– VAP prevention
– Use of Rapid Response Team
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Need and Data
– VTE Prophylaxis
• Comparative Data
• Physician Champion
• Ongoing data
– VAP Prevention
•
•
•
•
Comparative Data and Rates
Proven bundles
Desire for different practice of Respiratory Therapists
Champion
– Use of Rapid Response Team
•
•
•
•
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Comparative Data
Published impact
Defined interventions
Advisory Role
Performance Improvement Engagement –
Use an “engaging” PI Plan
– Data
• Comparative
• External benchmarks
– Champion – and other influential leaders
– Charter
•
•
•
•
•
•
•
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Purpose/Goal
Objectives/Deliverables
Members
Time Frames
Key Measures
Reporting to/Direction from - Structure
Sponsorship and other resources
Performance Improvement Engagement –
Use an “engaging” PI Plan
Work plan
• Number of meetings
• Pre-planned agenda and data requirements for
each
• Notices
• Expectations for all
• Accountability a pre-requisite
• Key measures, data collection/reporting,
RESULTS
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Telling the Story
• Reduction of VTEs
• Comparative data
• System-wide
• Ongoing updates – recognition
• Prevention of VAPs
• Monthly reports
• Champion speaking
• Transition/commitment story
• Use of Rapid Response Team
• Ongoing reports – Medical Staff Quality Council, Quality
Committee of the Board, Medical Staff Dept
• Amount of time and impact on physicians
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Telling the Story –
“Straight from the physician’s mouth”
- Engaging Style
– Motivators
– Benefits
– Data/information as catalyst
– Champion – function
– Preparation for role – training, education,
experiences
– Staff support needed
– Advice for recruitment and partnership
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OBJECTIVES
• List three tools to rapidly gain physician
engagement with performance
improvement initiatives
• Define the role of physician leaders in
clinical performance improvement
initiatives
• List three benefits to physicians of
participation in performance
improvement initiatives
27
References/Bibliography
– Reinertsen JL, Gosfield AG, Ripp W, Whittington JW. Engaging
Physicians in a Shared Quality Agenda. IHI Innovation Series
white paper. Cambridge, Massachusetts: Institute for Healthcare
Improvement; 2007 (Available on www.IHI.org)
– Performance Improvement Stages, Steps and Tools. IntraHealth
International/Prime II www.intrah.org/sst 2002 August
– Pisek PE and Kilo CM. From Resistance to Attraction: A Different
Approach to Change. Physician Executive 1999 Nov; 25(6): 40-44
– Guthrie M. Engaging Physicians in Performance Improvement.
American Journal of Medical Quality 2005 Sep/Oct; 20(5): 235-238
– Bader BS. Time for a New Model for Hospital Physician
Collaboration. www.GreatBoards.org 2002 August; 2(3): 1-3
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