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Engaging Doctors in Quality Improvement: Top 10 Mistakes

Doctors play an important rôle in the success of clinical quality initiatives.

Research and experience both indicate that physicians, directly or indirectly, influence 70–90 percent of all medical activities. There is no question that the active participation of physicians in any clinical improvement effort dramatically improves its chance of success. Conversely, the lack of meaningful physician involvement in initiatives could spell failure. Most hospital executives recognise the importance of the rôle doctors play in quality improvement; the perennial question is, “How do we get doctors more involved in quality initiatives?”

Below is a compilation of the top 10 mistakes committed by hospital executives and managers that jettison their attempts at engaging doctors in improvement work.

  1. Focusing on Financial Metrics Instead of Clinical Outcomes and Waste Elimination
    By nature of their profession, doctors are particularly interested in two things: clinical outcomes and reduction of (their) wasted time. The reduction, if not elimination, of time wasters (e.g. unnecessary administrative tasks, directionless meetings, and delays in the flow of patients in the hospital system) allows doctors to spend more time with their patients, thus providing better care, and improves their professional satisfaction. Financial matters, though important to most doctors, are generally not their primary focus.
  2. Inattention to Cultural Issues
    Physicians possess a remarkable memory for past skirmishes with hospital administrators, e.g. over medical staff contracts, change of the elective surgery schedule, failed quality initiatives. If unaddressed, these conflicts negatively impact physician engagement in future quality improvement work. Hospitals that achieve significant physician engagement tend to be more sensitive to the issues that might cause tension among the medical staff and proactively approach them through dialogue before and after the fact.
  3. Treating Doctors Like Customers, Not Partners
    This situation is most often seen when a hospital wishes to implement a policy that they fear might offend a high-revenue generating physician. By treating each physician as a partner in the delivery of care, hospital administrators can create a milieu that is more conducive to physician engagement in quality improvement.
  4. Promoting a Blame Culture
    Often when things go wrong in healthcare (e.g. an adverse event), the “bad apples” are identified and punitive action is taken. This approach tends to reinforce the erroneous idea that quality outcomes are individual provider attributes, rather than system attributes, and is diametrically opposed to physician engagement in quality initiatives.
  5. Generalising Physician Engagement
    There are some initiatives in which physician engagement is absolutely critical, and others in which it is not necessary. Requiring the involvement of doctors in every initiative is a waste of resources and might lead to loss of physician commitment for those initiatives in which their support is imperative.
  6. Appointing a Nurse, Instead of a Physician, to Assume the Rôle of Champion, Structural Leader, or Project Leader
    Initiatives such as those that aim to reduce healthcare-associated infection and improve reliability in evidence-based care require a physician champion. Generally, for such improvement work, teams that employ non-physicians, no matter how experienced or skilled those individuals may be, carry a significant risk of failure. Some initiatives require structural leaders, e.g. Medical Directors or Department Chairs, without which those initiatives will lack the leadership and political muscle to succeed. Another common mistake is selecting a non-physician to fill the rôle of project leader (which is distinct from champion and structural leader) when a physician is actually required. An alternative (more effective) strategy might be to appoint an administrative co-leader to perform the often time-consuming project management tasks, thus freeing up the physician to perform his/her other duties, such as caring for his/her patients. In this way, use of the physician’s core skills is optimised.
  7. Expecting All Physicians to Agree on a Standard Protocol From the Outset
    For instance, in the use of heparin in the management of stroke patients, it might be preferable to have the majority of physicians agree on a standard protocol (and to conduct small tests of change) than to wait for all physicians concerned to agree on one (which might never occur).
  8. Involving Physicians Only Midway Through Development of a Protocol
    Inviting doctors to participate only in the middle stages of developing a clinical protocol or asking them to accept one that is fully developed often leads to lack of buy-in and any positive results achieved could be limited and/or unsustainable.
  9. Not Communicating Openly, Frequently and Candidly
    Many hospital administrators tend to withhold data and/or information when they are sensitive, strategic or difficult. However, it is precisely these situations that call for candid communication, the continued practice of which will foster physician engagement.
  10. No Written Physician Engagement Plan
    As the old adage goes, “If you fail to plan, you plan to fail.”

Reference

  1. Reinertsen JL, Gosfield AG, Rupp 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)

Contact Teh & Associates today to learn how we can help your organisation engage doctors and empower them to take your quality to a whole new level.

{ 3 comments… add one }
  • ashi December 5, 2011, 4:32 pm

    Its unfortunate that this letter was written by a group of physicians. You can see that the end has not justified the means. The usual bias by the you was still demonstrated. In Nigeria when hospitals were headed by seasoned administrators, there was peace and the atmosphere was conducive for the corporate participation of all the stakeholders with consequent quality health service delivery to all Nigerian. Every profession in the field was treated according to the dictates of the statury regulations but the contrary is the experience nowadays. Even when the Laws says give, the physicians tend to disregard the suppremacy of the Laws of the Land. The situation is bad to say the least. Everyone should be given the space to perform base on the provisions of the laws.

  • Andy Teh December 11, 2011, 1:27 am

    @ashi—Thank you for your comment. This article addresses engagement of the medical staff, which is one of the biggest challenges for almost any healthcare organization, regardless of whether the CEO/administrator of the latter is a physician or not. It sounds like leadership and governance might be issues in your setting; needless to say, these have implications on the delivery of care and services.

  • Mayra Montalvo February 7, 2012, 1:48 pm

    Really enjoyed this article post.Much thanks again. Fantastic.

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