Physician Engagement in Quality and Safety
Nishi Rawat, M.D.
Johns Hopkins Community Physicians
Armstrong Institute for Patient Safety and Quality
What Motivates Human Beings….
• Motivation 1.0: we need food, security, and sex
• Motivation 2.0: we respond to awards and
punishments
• Motivation 3.0: we have the drive to learn, create,
and improve the world
‘Drive’ by Daniel Pink
Armstrong Institute for Patient
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Safety and Quality
What Motivates Human Beings….
• Autonomy: control and choice over work
– Task, time, team, technique
– Accountability
• Mastery: get better at what they do
– Requires hard work and struggle
– Requires engagement: goals, feedback, challenge and
effort itself is rewarding
• Purpose: be a part of something bigger
• Extrinsic motivators: decrease creativity, encourage
short cuts, foster short-term thinking, extinguish
intrinsic motivation
‘Drive’ by Daniel Pink
Armstrong Institute for Patient
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Safety and Quality
Physician Engagement
• Physicians working to reduce unjustifiable
variation in care, considering the system
• Safety and quality improve when physicians are
engaged and committed
• High-performing US healthcare organizations:
– high levels of physician engagement
– 4:1 to 6:1 return on every dollar
• Very little happens in the system without a
physician’s order
Taitz et al. BMJ Qual Saf 2011
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Armstrong Institute for Patient Safety and Quality
Barriers to Physician Engagement
• Physician’s primary business focus is their own practice:
– priorities of their own system are not aligned with the
priorities of the greater system
• Physicians have little time to spare outside of their own
clinical practice
• Doctors also have a strong belief that quality is a
personal responsibility
– physicians find it hard to take a systems perspective
and have a tendency to blame individuals
IHI 2007
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Armstrong Institute for Patient Safety and Quality
IHI Framework for Physician
Engagement in Quality and Safety
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Armstrong Institute for Patient Safety and Quality
IHI Practical Strategies for Physician
Engagement
• Reinforce the common purpose
• Reframe the problem:
– ‘how can we engage physicians in the hospital agenda’
vs ‘how can we engage the hospital in meeting the
physician’s quality agenda’
• Know what is important to doctors:
– outcomes
– waste
• Doctors are life-long learners: keep projects data-driven
• Involve physicians from the beginning
• Make physicians partners as opposed to customers IHI 2007
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Armstrong Institute for Patient Safety and Quality
IHI Practical Strategies for Physician
Engagement
• Identify a good physician champion
– intrinsically motivated
– courageous
– resilient
-respected
-communicator
• Standardize only what is standardizable
• Make harm visible
• Give hard feedback frequently: raw, light and
meaningful
IHI 2007
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Armstrong Institute for Patient Safety and Quality
Physician Engagement Strategies Specific to
Eliminate VAP project
• Support new VAP definition with data
• Support process and structural measures with data
• Involve physicians from beginning: team formation, data
collection planning, reporting data, new definitions
• Choose physician champion carefully
• Don’t make the protocols too complex
• Provide frequent data feedback: raw, light, meaningful
• Extrinsic rewards: quality bonus affected?, ‘lead’ title,
unit reputation, opportunity to present data to MEC and
board, highlight in local publications
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Armstrong Institute for Patient Safety and Quality