Reinertsen JL, Gosfield AG, Rupp W, Whittington JW. Engaging Physicians in a Shared Quality Agenda. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2007. (Available on www.IHI.org)

 

 

The unique relationship between physicians and the American hospitals in which they practice arose historically when lay board members recognized their need to draw on the expertise of physicians to fulfill the board’s fiduciary responsibility for quality. But the context for this traditional relationship has radically changed in the last few years.

 

Hospitals and their physicians are increasingly in competition with each other. For example, many hospitals have begun to employ various types of physicians whom independent medical staff members fear will steal their business, while the independent physicians themselves build and develop rival surgi-centers, imaging facilities, and even whole hospitals. In some communities, “organized medical staffs” often have trouble generating much enthusiasm from their membership, who are challenged by the demands of their daily professional and business lives, including onerous administrative burdens, lowered reimbursement, escalating malpractice premiums, and overall decreased satisfaction with their roles as physicians.

 

As a result, the medical staff organization is seen by many as an obsolete and moribund structure, incapable of fulfilling its purposes of overseeing quality, at precisely the time that hospitals and physicians are coming under intense pressure to produce measured quality and safety results. Some hospitals are making dramatic improvements in quality, despite the difficulties they face with the organized medical staff, even while many others struggle to implement evidence-based protocols and rigorous safety practices. Yet even in the most advanced hospitals, one of the most common questions raised is, “How can we do an even better job of engaging our physicians in the quality and safety agenda?” Given the deep-seated nature of these realities, and the importance of physician engagement to achieving quality results, it is surprising that so few hospitals have actually articulated a plan to improve the engagement of their physicians.

 

This white paper presents a framework on which hospital leaders might build a written plan for physician engagement in quality and safety. The paper includes tools to help hospital leaders assess organizational factors that will inform the degree of difficulty in engaging physicians, as well as to identify and prioritize initiatives for which physician engagement is essential. While the principal focus of the paper is on American hospitals and their organized medical staffs, the framework might also be applied to many other types of health care systems and in settings outside the United States.