The Critical Role of Physicians in Organizational Change and Improvement
Physicians play a critical role in the improvement journeys of all healthcare organizations. Instructive examples of effective physician engagement and outstanding physician leadership were showcased at this year’s Health Leadership and Improvement Conference in Toronto.
Practical tips and strategies for improving physician engagement
Dr. Lucas Chartier is an emergency physician and director of quality and innovation at Toronto’s University Health Network (UHN). He began his presentation with reminders of the importance of physician engagement, explaining how “physicians can make or break the culture of your organization”. He made a strong case for consulting with physicians early and often, since physicians can be “unknowing obstructionists” when they are not involved in the design of change strategies, and “aren’t even given the organization’s playbook.”
Dr. Chartier advocates an approach to communication that connects physicians to the organization’s mission, vision and values, and always starts with the why of any initiative before moving to the what and the how. He agreed with comments by conference speaker Chris Power, CEO of the Canadian Patient Safety Institute (CPSI), about how successful change requires a shift in peoples’ feelings, not their thinking (Insight No. 4).
Dr. Chartier described a framework for building engagement that includes “gaining physicians’ trust” and “obtaining physicians’ buy-in” through collaborative processes. When issues are raised by physicians, it is important to respond promptly and communicate how and when the follow-up occurs. The framework also includes “creating a burning platform” using sentinel events and data on local performance, and “competing for performance” – physicians are used to benchmarks and peer comparisons, and will look for data that is valid, timely and accepted.
Recognition, with tactics such as thank you notes, managing up and awards, is important across all components of this framework. It is a high-value practice that costs little, means a lot, builds relationships and improves performance by supporting desired behaviours. Ninety-three percent of recognized workplace behaviours are repeated.
Dr. Chartier closed his talk with guidelines for recruiting and working with physician champions. These individuals are typically respected among colleagues, credible, collaborative and interested in the improvement processes underway. They play key roles by coaching colleagues, role modelling and providing regular interfacing between leadership and frontline teams.
Case studies of physician leadership and engagement in action
Two Canadian healthcare organizations – Hawkesbury and District General Hospital (HGH) in Eastern Ontario and Hôpital Montfort in Ottawa – were featured as examples of organizations that have posted rapid, measurable gains in key emergency department performance indicators such as wait times, patient satisfaction and cost per case (Insight No. 2).
Both organizations are implementing comprehensive ED improvement programs addressing areas such as facility re-design, flow management and patient experience. Both see physician leadership and physician engagement as integral to improvement.
Dr. Yacine Adjaoud, ED Chief at HGH, described how strong leadership commitment is driving a major culture change. The ED has adopted a medical-nursing dyad leadership model and applied measures to strengthen interdisciplinary coordination. Physician engagement has been critical as the ED has moved from primarily family doctors to dedicated ED physicians. Tactics range from AIDET®, to rounding practices to performance measurement systems, with a consistent focus on quality of care and service.
The ED improvement program underway at Hôpital Montfort was outlined by Sophie Parisien, RN, clinical director, emergency department, critical care and ambulatory care. Her presentation included a detailed listing of communication measures that provide the structures required for monitoring and reporting, while also driving engagement. Examples include regular steering committee and team meetings, email updates, daily huddles, and patient and employee rounding.
In her review of lessons learned, Sophie Parisien described how “all initiatives are change initiatives” that “take time to hardwire”. There will be resistance to change, but this can be countered by refocusing everything on improving the patient experience. She recommends that leaders allow creativity and “dare to do what staff want”.
Dr. Gillian Kernaghan represents excellence in physician leadership in many leadership roles. She has served as president and CEO of St. Joseph’s Health Care London in Ontario since 2010. Prior to this appointment, she had a 17-year career as medical vice president at several hospitals. She is also a faculty member of the Physician Leadership Institute of Canadian Medical Association, a Canadian Certified Physician Executive and past president of the Canadian Society of Physicians.
At this year’s Leadership and Improvement Conference, Dr. Kernaghan spoke about 360 reviews, which she began using during her career as a medical VP and has since applied across all aspects of leadership in her CEO role.
In setting the context for 360 reviews, she described a comprehensive model for recruiting, evaluating, developing and identifying leadership excellence. The process starts with the organization’s vision statement, focused on “earning complete confidence in care provided”. The strategic plan is built around this vision and leadership excellence is considered critical to success. The 360 reviews generates parallel rankings by self, leaders and colleagues, and reports on the ability to fulfil key value-based behaviours. It has proven effective at helping leaders reflect on actual and perceived strengths and opportunities to improve.
The 360 reviews are among many leadership tactics Dr. Kernaghan has skilfully overseen at St. Joseph’s Health Care London, a multi-site academic hospital with more than 1,000 beds. St. Joseph’s is using EBL to help drive a culture transformation that is reflected in substantial increases in employee and physician engagement – from 61 to 74 percent and 51 to 73 percent respectively from 2011 to 2016. Top-box, “excellent” patient experience scores have increased by 9 percent during this period. St. Joseph’s is also pursuing aggressive goals of zero harm, and results in Q2 2016 included increasing hand hygiene compliance to 96 percent and reducing medication errors.
In recognition of her leadership during this impressive improvement journey and throughout her career, Dr. Kernaghan has received the Fire Starter Hall of Fame Award, the highest award for excellence presented by Studer Group. The Fire Starter Hall of Fame Award recognizes a leader who, through their dedication and passion, guides and supports an organization's commitment to excellence while keeping the true spirit of an organization alive and flourishing.