Engaging physicians in hospital quality improvement initiatives

In a recent book published by HCPro and The Greeley Company, Engage and Align the Medical Staff and Hospital Management: Expert Strategies and Field-Tested Tools, we identified that one of the key areas that requires physician engagement is hospital performance improvement initiatives.  Physician engagement is one of the critical factors in the success of these initiatives, which affect how physicians provide patient care. But physician engagement in hospital initiatives can be a difficult and sometimes frustrating process for both physicians and administrative leaders.  

By engaging physicians in performance improvement initiatives, medical staffs can:

• Get it right the first time. By getting physician input and insight up front, leadership can design improvements in a way that will meet the care needs of physicians and their patients.
• Accelerate implementation. By involving physicians in the design process, there is already buy-in for implementation.
• Sustain the change. By involving physicians in the implementation, they are more invested in ensuring that the new approach is sustained over time.

Physician engagement requires leadership. In their book The Leadership Challenge, Jim Kouzes and Barry Posner described leadership as “the art of mobilizing others to want to struggle for shared aspirations.” Using this definition, when you begin to work on a quality improvement project, ask yourself the following questions:

• What are your aspirations for your quality initiatives that require physician engagement?
• Do your physicians share these aspirations?
• Is your culture a help or a hindrance to achieving these goals?

The last question is probably the most critical because your medical staff culture will determine the success or failure of any initiative. If your medical staff culture is a hindrance, you can only change it if you recognize and address the issues that contribute to the culture in addition to the project-specific concerns.

So how do you apply these principles to a quality improvement initiative? Here are five steps that we have found helpful:

Step 1: Identify formal and informal physician leaders
Informal physician leaders will help engage other physicians. By identifying these leaders early, it will help to ensure medical staff buy-in and participation. You may also be lucky enough to find a physician champion who is intensely interested in the issue at hand to lead the group.

Step 2: Ensure physician involvement in the initial evaluation of the problem
Before involving physicians in any performance improvement initiative, make sure the problem you are trying to solve is real and the solution has value. To do this step well, you must respect that physicians are busy individuals who likely will be volunteering their time, which is an expense to them, so anything the hospital can do to become more efficient will likely gain their support.
 
Step 3: Secure physician involvement in the design of the solution
Physicians are extremely knowledgeable about what does and doesn’t work in the system because they use it every day. In addition, they may have already implemented their own individual performance improvement projects, which could save you valuable steps along the way. Be sure to give physicians the time and resources to develop and test solutions.

Step 4: Get physicians involved in the implementation of the solution
Physicians can make the proposed solution happen, or they can derail it. They can also recognize problems and help make adjustments. Most importantly, they can smooth over ruffled feathers of other physicians who have not been as engaged.

Step 5: Ask physicians to evaluate the results
Asking physicians to evaluate the results of the performance improvement initiative provides physicians with recognition they deserve. It also helps them better understand the successes and failures of the implementation process. It also creates culture of physician involvement and cooperation for further engagement. This is best done through data transparency and effective communication.

I hope this brief summary is helpful as you work with your physicians to provide real, sustainable improvements in patient care.

Robert J. Marder, MD, CMSL, is vice president of The Greeley Company, a division of HCPro, Inc., in Danvers, MA.