Physician Engagement in Quality and Safety

1. Physician Engagement in Quality and Safety Nishi Rawat, M.D. Johns Hopkins Community Physicians Armstrong Institute for Patient Safety and Quality

2. What Motivates Human Beings…. • Motivation 1.0: we need food, security, and sex • Motivation 2.0: we respond to awards and punishments • Motivation 3.0: we have the drive to learn, create, and improve the world ‘Drive’ by Daniel Pink Armstrong Institute for Patient Safety and Quality

3. What Motivates Human Beings…. • Autonomy: control and choice over work • Task, time, team, technique • Accountability • Mastery: get better at what they do • Requires hard work and struggle • Requires engagement: goals, feedback, challenge and effort itself is rewarding • Purpose: be a part of something bigger • Extrinsic motivators: decrease creativity, encourage short cuts, foster short-term thinking, extinguish intrinsic motivation ‘Drive’ by Daniel Pink Armstrong Institute for Patient Safety and Quality

4. Physician Engagement • Physicians working to reduce unjustifiable variation in care, considering the system • Safety and quality improve when physicians are engaged and committed • High-performing US healthcare organizations: • high levels of physician engagement • 4:1 to 6:1 return on every dollar • Very little happens in the system without a physician’s order Taitz et al. BMJ QualSaf 2011 Armstrong Institute for Patient Safety and Quality

5. Barriers to Physician Engagement • Physician’s primary business focus is their own practice: • priorities of their own system are not aligned with the priorities of the greater system • Physicians have little time to spare outside of their own clinical practice • Doctors also have a strong belief that quality is a personal responsibility • physicians find it hard to take a systems perspective and have a tendency to blame individuals IHI 2007 Armstrong Institute for Patient Safety and Quality

6. IHI Framework for Physician Engagement in Quality and Safety Armstrong Institute for Patient Safety and Quality

7. IHI Practical Strategies for Physician Engagement • Reinforce the common purpose • Reframe the problem: • ‘how can we engage physicians in the hospital agenda’ vs ‘how can we engage the hospital in meeting the physician’s quality agenda’ • Know what is important to doctors: • outcomes • waste • Doctors are life-long learners: keep projects data-driven • Involve physicians from the beginning • Make physicians partners as opposed to customers IHI 2007 Armstrong Institute for Patient Safety and Quality

8. IHI Practical Strategies for Physician Engagement • Identify a good physician champion • intrinsically motivated -respected • courageous -communicator • resilient • Standardize only what is standardizable • Make harm visible • Give hard feedback frequently: raw, light and meaningful IHI 2007 Armstrong Institute for Patient Safety and Quality

9. Physician Engagement Strategies Specific to Eliminate VAP project • Support new VAP definition with data • Support process and structural measures with data • Involve physicians from beginning: team formation, data collection planning, reporting data, new definitions • Choose physician champion carefully • Don’t make the protocols too complex • Provide frequent data feedback: raw, light, meaningful • Extrinsic rewards: quality bonus affected?, ‘lead’ title, unit reputation, opportunity to present data to MEC and board, highlight in local publications Armstrong Institute for Patient Safety and Quality