By Shawna O’Neill, RN, MHA

Clinical staff, including physicians, will be critical to efforts to eliminate unnecessary costs and improve quality.  Since physicians drive nearly all care provided to patients, gaining their acceptance of change requires more than being open to cooperation. It requires physician engagement.

ENGAGEMENT IS MORE THAN PARTICIPATION

It’s commitment to processes and results, where individuals identify with the importance of the work and view the project’s success as their own. An important aspect of gaining commitment is analyzing the change (and the change process) from the perspective of the stakeholders.

  • How does the change affect their ability to do their work?
  • How does the change affect the things that are important to them?

Shared purpose is critical to getting people to commit their thoughts and time to ensure the project’s success. Physicians view their time as valuable and in short supply,  any change must be seen as something worthwhile.  Change initiated because it is required by CMS or The Joint Commission will miss on this basis. Instead, employ a more convincing rationale by challenging the staff to assure that every patient gets the care they deserve or designing processes to assure that no patient gets hurt.

Even highly committed physicians can be turned off when they feel their time is wasted. Gone are the days when physicians could willingly offer their time to hospitals. For the most part, physicians, whether employed or in private practice, are compensated based on productivity. Therefore, hospitals should be careful not to lose physicians while these professionals are testing their involvement in hospital initiatives. Keeping the work meaningful is as important as having the right reasons for working on a change initiative.

This four-part series discusses the characteristics that make hospitals successful in engaging physicians as committed participants in an agenda for improvement.

TRANSPARENCY

The concept of transparency has been popularized relative to hospital performance. Since engaging participants is critical for enacting change, involving participants in a transparent priority-setting process earns trust and interest. When physicians and other staff member help hospitals decide on priorities, they are more likely to have more positive attitudes about initiatives to address those priorities. Such a strategy may require an attitude change in some hospitals where administrators are used to setting priorities alone based on their positional authority.

In a transparent process, positional authority has less significance.

Engaging physicians at this early stage can also present a strong case for getting a physician champion.  Being a champion requires a higher commitment of time, energy, and personal identification with the change. For a champion, the change is a personal cause. True champions volunteer to lead causes that are important to them – they can’t really be recruited.

Another reason to include physicians in the prioritizing process is that only a physician can open up some practices to scrutiny. Professional boundaries often prevent criticism from those who are outside the profession, but peers can raise professional concerns to others. By engaging physicians, one avoids the elephant in the room when physician practices or preferences need to be changed.

Of course, not everyone can participate in the prioritizing process. Does this mean that others are unlikely to support change? Not if the planning process considers the social network of the medical staff. In most medical staffs, certain physicians are known as opinion leaders. Engage opinion leaders early in the process. Through their participation, they will guide the development of the project so that it will be more acceptable to other physicians. In addition, they will be persuasive advocates for change initiatives that they support.

GET STARTED ON THE RIGHT FOOT

Many hospitals have experienced failures in clinical projects. As a result, organizations that had physician support have lost it due to unsatisfactory physician experiences from failed or difficult projects. If physicians feel that one project is a failure, it will be very hard to engage them in another project. To get different results, taking new approaches to project planning is necessary.

Projects work best when a champion is pushing for the change. Noting the importance of champions, Donald Schon stated that;

“A new idea either finds a champion or dies.”

Thus, a champion isn’t an assigned position, but rather someone who has adopted an idea as their own and goes far beyond job requirements to assure the success of the innovation. Asking someone to agree to be a champion is likely to undermine project success. If you want to engage physicians in successful projects, make sure the project has a voluntary and committed champion.

Putting physicians on project teams isn’t enough to bring about engagement. Physicians must have a role that warrants their involvement. Making a physician a chairperson can derail the project if the physician is given that role for honorific reasons. Physicians should only chair a project if they have the commitment to drive the project to success. Physicians should be chairs when they have the know-how and commitment to champion the change.

The same is true for senior executives. When chairing projects, they need the commitment of a champion. This requires a high degree of time and investment in activities to encourage the success of the project. Not every project must be led by a senior executive, especially if the senior executive is not willing to champion the project.

Otherwise, engagement as participants is sufficient. Participants, however, must have qualifications. When choosing physicians to serve on committees, consider whether they have unique knowledge or skill, their level of support for the project, how critical their support is, and whether they can effectively influence their peers.  Hospital leaders who choose to participate in clinical projects need to be visible and show their engagement in the project. During the normal course of a day, situations arise that create time conflicts. But if you are asking physicians to commit their time to participate, leaders need to be at meetings and demonstrate their commitment as participants in the project.

Another issue that often derails projects is the reliability of data. Part of a physician’s training is to question the validity of data, and they bring that training to project team meetings. Physicians have high standards for quantitative data. When a project starts, it is important to determine and agree upon what data needs to be collected and how it will be collected.  Just because you have current data and numbers, doesn’t mean the numbers are credible.  The group will need to discuss expectations about data to prevent disagreements later on.

END OF PART ONE