Engaging Physicians:
Physician Advice & Tips
from the Field
Judy Frisch, RN, MBA, CPHQ
Quality Consultant; MetaStar, Inc.
July 15, 2010
Teleconference Objectives
Define the meaning of physician engagement
Identify barriers blocking physician involvement
particularly with quality and safety initiatives
Describe a way to improve physician involvement
with safety and quality initiatives
Apply tips and ideas that will help get physicians
involved
Engagement Definition
To “Engage” is to:
Become Involved
Commit
Attract
Bring on Board
Bring into Battle
Physician Engagement
Means:
Getting physicians’ Attention &
Getting physicians actively Involved &
Getting physicians Committed
Physician Engagement
Looks like:
“We have lowest infection & med error rate again this
quarter”
Does not look like:
“Let’s complete this treatment so we can go to lunch
early”
Really does not look like:
“This would be a great place to work if it weren’t for
the patients”
Engagement Stages
This quality improvement is worthless
This may be a true statement; but it isn’t
important
This is interesting, especially the data
This is exactly my point!
Physician Leadership Perceptions
Physicians do not see themselves as leaders
Nor do they see themselves as followers
Thus, do not recognize organizational
leaders to have authority
Mindset is lacking
Leadership is a new dynamic between
leaders, team members, and organization
Medical Education
Documentation
Anatomy
Finances
Customer Service
Physiology
Histology
Quality
Pediatrics
Medicine
Surgery
Quality Not Always Chief Concern
Triaging Among Too Many Priorities
How can I help
my hospital on
quality
initiatives?
What services
can I add to my
practice?
60
55
50
45
40
35
30
25
20
15
10
5
0
60
55
50
45
40
35
30
25
20
15
10
5
0
How can I shift
my practice mix?
How can I
perform more
procedures?
How can I
improve my
productivity?
Other Outstanding Concerns
Surgical Concerns
Potential of bleeding
Potential of infection
Malpractice Concerns
Increasing malpractice insurance premiums
Potential suit
Family
Fitting family into the balance
Loss of Autonomy
CMS
CDC
IOM
NQF
AHA
Leapfrog
Commercial payors
AHRQ
Physicians’ Perception
How many Americans die in hospitals annually because of preventable medical
errors?
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
500
5,000
50,000
100,000
>500,000
Source: Blendon, R et al. “Views of Practicing Physicians and the Public on Medical
Errors.” New England Journal of Medicine 2002
Physicians’ Perceptions of Largest Problem in
Health Care, 2002
30%
25%
20%
15%
10%
5%
0%
Malpractice
Insurance &
Lawsuits
Cost of
Healthcare
Problems
with Health
plans
Medical
Errors
Source: Advisory Board interviews and analysis
In Summary
Inadequate training with little or no:
Education concerning patient, staff and personal safety
Meaning of as well as applicable quality improvement
activities
Ability to be customer service focused
Difficulty balancing all of their responsibilities
Both professional and personal
In Summary
Do not perceive medical errors or safety as
being a problem
Malpractice insurance and lawsuits
Cost of healthcare rising
Inconsistencies and problems with health plans
Medical errors
Necessary Solutions for Change
Understand the common goal
Update education and training
Encourage participation
Standardize
Become accountable
Communicate, communicate, communicate
Common Goals
Quality patient care
Safe patient care
Affordable patient care
Reduction of hassles and wasted time
Understand organizational culture
Quality & Safe Patient Care
Clinical Tools
Performance tracking
CPOE/EMR
Barcoding/eMAR
Standing Orders
Medication Reconciliation
Affordable Patient Care
Identify and Decrease Waste
Duplicate testing
End of life issues
Overuse
Organizational Culture
Change in expectations from their own set
to the organizations’ set
Price of not changing
Advantages of future change
Physician Education & Training
Where does the education and training of
the following fit in:
Quality
Patient Safety
Finances
Core Measures
Participation Cues
Encourage physician leadership on QI projects
ICU Medical Director, Chief Medical Officer, Senior
Physician
Present clear direction for expectations
Provide support
Administrative time for project work
Assistant time
Evaluation time
Strategies
Identify and overcome physician barriers
Time, money, lack of understanding
Communicate prior to the start of a change
No surprises
Listen to those that are resisting
Valid points
Celebrate and share successes
Newsletters, recognition, acknowledgement
Standardize
Reduce Variability
Eliminate Defects
Makes it Simple
Evidenced Based
Potential Value Added
Accountability
Ac•count•a•bil•i•ty (n): Holding your
team and self responsible for achieving
the best possible outcomes even under
difficult circumstances.
Articulating clear
expectations and
following
through on them
Emphasizing great
outcomes over
assigning blame
Unwillingness to accept
underperformance, even in
face of the greatest
challenges
Communication
Physicians are “data driven”; show them
their numbers
Physicians are competitive so show them
their colleagues and competitions’ numbers
Publicly reported data
Review Committee for chart fallouts
Evidenced base feedback
Appropriate Skill Sets
The Workers are chopping
their way through the jungle.
The Managers are
coordinating, making sure the
tools are sharp, etc.
The Leaders climb a tree and
shout: “Wrong Jungle”
The Managers shout back: “Be
quiet! We’re making progress”
New Set of Questions
How often do you or your CEO effectively
“round” with physicians and surgeons?
Do you or your CEO talk with physicians
and surgeons about safety and quality?
Why does the Medical Affairs Department
exist?
Medical Affairs Department
Board assigns responsibility for monitoring
and improving the quality of care to the
medical staff and management
Responsible for the quality of care at your
hospital
References
“Leading Physicians Through Change” by
Jack Silversin and Mary Kane Kornacki
“Physician Engagement” by Martin Landa,
MD FACEP
Questions?
Contact Information:
Judy Frisch, RN, MBA, CPHQ
Quality Consultant
MetaStar, Inc.
2909 Landmark Place
Madison, WI 53713
(800) 362-2320 or (608) 274-1940, ext 8216
www.metastar.com
jfrisch@metastar.com
This material was prepared by MetaStar, the Medicare Quality Improvement Organization for Wisconsin, under contract with the Centers for Medicare &
Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS
policy. 9SOW-WI-PS-10-116.