As healthcare leaders, how do we encourage physicians to be more interested and involved in quality and safety? Is there a way for physicians and hospital leaders to achieve a shared quality and safety agenda? Key questions Interior Health (IH) leadership carefully considered while revamping their approach to physician engagement.
For the past eight months, quality and safety leaders at IH have rolled out a new physician engagement framework that is bringing physicians into the fold of patient safety discussions, and keeping them engaged throughout the entire process. The result?
Physicians at IH are now more committed to the organization’s quality and safety goals than ever before. Improvements in quality of care can be seen across the organization.
How did they do it?
To learn more, I spoke with Dr. Michael Murray, Executive Medical Director, Quality Improvement and CMIO, and Ms. Patty Garrett, Director, Risk Management, Quality, Risk and Accreditation, about their journey to successfully build collaborative partnerships with IH physicians. Speaking from their office in Kelowna, Michael and Patty offer an honest and novel perspective on this thought-provoking topic.
Early Days of Physician Engagement at IH
“In 2010, I was asked to revise our Incident Management Policy and develop a process for how we would conduct our patient safety event reviews,” says Patty. “Particularly, how we would investigate events that resulted in serious harm to our patients, or critical incidents. As a first step we recruited a team of Patient Safety Investigators who assisted in the completion of that piece of work, devoting a lot of time and energy to improving the robustness of our event review process. But, we quickly learned it wasn’t enough.”
While praising the efforts of the team, Patty sincerely described the struggles she faced with engaging physicians in collaborative discussions about patient safety.
“Part of our process was to hold ‘safety huddles’ with the site where a patient safety event occurred, but in those days it was extremely difficult to get physicians to attend those discussions. The physicians that did come had limited background in patient safety and quality, which meant we came to decisions in a very inconsistent way.”
At the same time, Patty says physicians didn’t find value in the BC Patient Safety & Learning System (BC PSLS), BC’s web-based system for learning about, and preventing, patient safety events in all healthcare settings.
“We found that physicians didn’t see the relevance of BC PSLS. We kept hearing that BC PSLS was a system for nurses, not physicians. We just couldn’t work together with the physicians. We knew where we wanted to be, but we just couldn’t get there because everyone was following their own processes.”
So when Dr. Jeremy Etherington, Vice President, Medicine & Quality, created an Executive Medical Director position with a portfolio that would focus specifically on quality and patient safety, things began to shift in the right direction.
New Medical Leadership Gives Physician Engagement a Boost
“Before our renewed Executive Medical leadership structure, there were several medical leaders with a little piece of quality in their portfolio,” Michael says. “But from a physician-leadership perspective, it’s really hard to advance quality and safety when there are so many other competing priorities. We just didn’t have the capacity to drive proactive changes in our approach to quality and safety. Now, as the Executive Medical Director for Quality Improvement, I bring a focused physician presence to our overall quality and safety agenda.”
In addition, Michael holds the position of Chief Medical Information Officer (CMIO). The two roles are closely linked, resulting in enhanced collaboration with IH physicians and the organization’s many quality committees.
“My primary focus is to bring the relevance of quality and safety to physicians. To highlight the importance of this work, to demonstrate the value of BC PSLS from a physician perspective and to follow proven methodologies such as the Canadian Patient Safety Institute’s Incident Analysis Framework.”
In terms of governance structures and operational leadership, BC’s health authorities vary, so comparisons are difficult. But IH’s model of physician engagement seems to be working.
“I focus on physician engagement in safety because it’s so important for building a system and a process for quality improvement and patient safety,” Michael says. “Moving quality and safety into the VP, Medicine and Quality portfolio was extremely strategic. Dr. Etherington feels the same way as I do about partnering with physicians on safety. Word is getting out. Physicians are more engaged and operational leaders are too. This is where we’re starting and so far we’ve been very successful.”
Patty and Michael both credit Dr. Halpenny, President and CEO, with bringing quality and safety to the forefront of higher-quality care at IH.
“When Dr. Halpenny chose to move Quality into the VP Medicine portfolio it really galvanized the work we were doing (patient safety reviews) and launched it to a different level,” Patty says. “Initially, we had all the pieces in place, but we struggled to get physicians engaged because we didn’t have these roles to support us. Now, with a consistent physician voice at the table, we’re seeing remarkable results.”
Key Drivers of Physician Engagement at IH
Part of Michael and Patty’s strategy is to help physicians understand what it means to be a just culture. A key component of that education, they say, is responsibility, particularly at the site where patient safety events occur.
“If we’re going to improve quality and safety at a system level, it has to begin at the local level,” Michael says. “I offer support and expertise to physicians while ensuring they understand their piece in this – I believe they know what solutions will work best at their site because they work there every day.”
Michael is quick to point out that he keeps physicians engaged by including them early on, being flexible to their demanding schedules and ensuring content stays relevant.
“When a critical safety event happens, a meeting is convened with the site within 72 hours. Key physician and administrative leaders are invited to attend and expected to be there. Meetings are brief – 30 minutes maximum – and we focus our discussion around what happened, how are we going to manage our resources to investigate it, what are the key decisions we need to make and who’s going to take on that physician reviewer role?”
Michael is a fan of making sustainable improvements through collaborative teamwork, but he says not enough physicians understand how important and interesting patient safety is.
“Quality and safety is a fascinating field of medicine. When I speak with my colleagues I tell them that it’s clinical-based, it’s about solving problems, and it’s about coming up with diagnoses and recommendations to heal problems.”
And, it’s working. So far this year, IH is on track to double the amount of patient safety investigations because physicians see the value in it.
At the same time, Patty says IH physicians are now seeing the value of BC PSLS.
“We’re seeing greater commitment with reporting in BC PSLS and that’s so encouraging. We’ve come a long way in just eight months. I also credit our dedicated Patient Safety Investigators. Having their expertise and their devotion is so important. Otherwise we would be pulling in IH leaders who have other operational responsibilities, which we know doesn’t work.”
As we began to wrap up our conversation, Michael and Patty shared that they’re now looking to spread their physician engagement model to other areas of IH.
“This journey has been quite a positive experience for us and for those we’re working with,” Michael says. “It’s still early days, but we’re inspired by the increase in physician engagement in safety at IH and we look forward to taking this important work into the next phase.”
Ms. Patty Garrett is Director, Risk Management/Patient Care Quality Office, Quality, Risk and Accreditation at Interior Health. She is a Registered Nurse and she completed a Master’s Degree in Health Administration from Central Michigan University. She transitioned into senior management while at the Victorian Order of Nurses and moved from Winnipeg, Manitoba to the North Okanagan to take on the role of Chief Nursing Officer. She transitioned into Risk Management when BC’s Health Authorities underwent re-organization.