Why It Matters
If you want to transform care, you need to tap into physicians' desire to do the best they can for their patients and give them the skills to do it.
People sometimes ask me why physician engagement is challenging for so many health care organizations. It’s a funny question because physicians are engaged. They’re engaged in doing their job, trying to do the best they can for their patients, with many demands on their time, attention, and energy.
Just because the physicians in your organization are not engaged in the project you’re putting in front of them, it doesn’t mean they don’t care about improvement. There is probably something else they care about deeply.
And identifying what they care about is the key to physician engagement.
Learning What Matters
As a physician, I’ve learned that the key to engaging physicians is to find their passion. If you’re leading or coaching quality improvement, your role should be to find what the physicians want to improve. How do they want to make a difference?
Recently, there was a young attending plastic surgeon my team worked with who didn’t have much improvement experience. He already knew he had very good outcomes. What got him excited was thinking about value.
When his team looked at their data more closely, they realized they could do a procedure in a slightly different way and achieve the same excellent clinical outcomes at a lower cost. He was fascinated by the value equation because it was a new way of thinking for him. He called the experience “transformational.”
A few years ago, I worked on a large project in the UK. We markedly improved outcomes for patients undergoing emergency surgery. It took off quickly and had so many people deeply involved that it felt like a social movement. I believe it was successful because everybody who works in an operating room as an anesthesiologist, a surgeon, an intensivist, or a nurse has seen things that could be better for patients. People were eager to help fix the problems once we helped them do it.
The Keys to Successfully Engaging Physicians in QI
- Identify early adopters — Going back to Everett Roger’s work, get some early adopters on board. They can be junior or senior doctors, but look for the people with leadership talent and help involve them in projects that are important to them.
- Get the data — Many physicians I’ve worked with say that being able to see and understand the data has been essential. Physicians are driven by data and data helps them get others on board. Getting access to data can be difficult, so do your best to make that process as easy as possible.
- Provide opportunities to learn basic quality improvement skills — It’s easy to forget that many organizations haven’t heard about IHI or the IHI Open School. It’s still not common for quality improvement to be taught in medical schools. For the course I’ve taught for physicians at the University of Southern California, we did a five-day program on QI skills. With some data and some coaching, it didn’t take long to transform participants into change agents.
- Break the challenge into segments — Many physicians I’ve worked with have not learned how to break down large problems into more manageable segments. For example, tackling problems for emergency medical admissions can be less overwhelming if you work with other teams to separate the issues into smaller projects. The ED team can focus on early pieces of the process and care-management teams can pick projects at transitions. Everyone can come together to contribute to whole pathway improvement.
- Identify where you have the best chance of making change — Where do you have the most influence? For internists, that is on the medical floors. Bring all the stakeholders together early in the project to talk about the whole pathway. Target your efforts where you’re most likely to get some early wins.
Dealing with Skeptics: Show the Data, Know the Data
There will always be people who doubt the value of quality improvement. This means you need to have data indicating why improvement is necessary.
As a physician who has worked closely with colleagues all over the world on change management, I know it can be challenging to get senior clinicians in the room — they have to see the real value for their time. If people are saying that the problem you want to address is not a problem for them, I’ve learned a useful technique to get physicians attention: Tell them to look at five sets of their patient data.
For example, for emergency surgery patients, asking some key questions will indicate whether care is happening in the way the physician believes it should. Was the patient screened for sepsis at admission? If antibiotics were required, were they given within the appropriate timeframe? Was a risk assessment conducted? Were senior clinicians involved early in the management of patient care? Did the patient go to the OR within an appropriate time frame? Just a small sample review can reveal gaps in reliable delivery and can be very helpful in getting engagement.
Here’s another important lesson: If you’re the person trying to engage doctors and you’re saying, “Look at this data. We need to do better,” you have to know the data back to front. You will be challenged on every aspect of those numbers.
Then you have to make it their data. Explain how it was collected, so they believe in its integrity. Once they believe the data demonstrating the need for improvement, you can start to talk about making changes.
Addressing Burnout
One of the great things about doing improvement work is the joy in work it can bring. When we can improve the care we provide to patients and influence the environment we work in, we reconnect to why we became physicians in the first place.
I’ve worked with many physicians who describe how making improvement changed them personally as well as professionally. Many talk about how they now apply QI skills in their daily lives. Developing QI expertise can reenergize senior doctors.
I’ve also seen this with junior doctors. Doctors in training, residents, fellows, and interns can feel quite ground down by medical school, internship, and residency and they can end up feeling disempowered. Working on quality improvement can show them that they are a very important part of the system. They don’t have to accept what doesn’t work. They can be part of making care better for their patients.
At the end of the day, it’s hard to make a change if doctors aren’t engaged. If you want to transform care quickly, you need to tap into their desire to do the best they can for their patients and give them the skills to do it.
IHI faculty member, Carol Peden, MB ChB, MD, MPH, is a Professor of Anesthesiology and Executive Director of the Center for Health System Innovation at the University of Southern California in Los Angeles. She is also a former IHI fellow.
You may also be interested in: