Physicians as Equal Leaders Dr. Harsh Hundal, Executive Medical Director Physician Engagement and Resource Planning Physician Lead for Facility Engagement HAMAC Chair
Disclosure Presenter / Faculty Dr. Harsh Hundal Relationships with commercial interests: Grants / Research Support None Speakers Bureau/ Honoraria None Consulting Fees None Other None 2
2017 Health Authority Engagement Survey We have an aging patient population with increasing service needs. Yet, we have finite resources to serve them. We have an aging physician workforce. Yet, they feel marginalized and burnt out. Physicians direct over 75% of health care utilization (spend)! We need a new approach. Physicians need to lead.
Physician Burnout • Burnout is a major problem in the medical profession and work overload is the primary driver. • Many physicians and residents feel they have little control over their workloads and this combination — high demand and low control = perfect storm • Other contributing factors include: insufficient recognition for many extra hours of work, conflicting values in the practise of medicine, and a breakdown of community within the profession. Collier, R. Physician Burnout a Major Concern. CMAJ October 02, 2017 189 (39) E1236-E1237
What Are the Impacts of Physician Disengagement to Patient Care? Acceptability Appropriateness Accessibility Safety Effectiveness Efficiency Equity Care that is Care provided is Ease with which Avoiding harm Care that is Optimal use of Distribution of health What should Happen? respectful to evidence based and health services resulting from care known to resources to yield care and its benefits patient and family specific to individual are reached achieve intended maximum benefits fairly according to needs, preferences, clinical needs outcomes and results population need and values • Lower and staff • “Shift Survival • Reduced • 2/3 of • Increased LOS • Failure to • Lack of interest to • Longer post patient mode” - hours, closed malpractice “Choose work with the satisfaction narrowing of practices, drop cases in USA are discharge Wisely” at point Health Authority to • Disruptive cognitive focus out of call linked to recovery time of care improve patient What does happen? • Failure to consider • Limited clinical • Higher • Forget that behaviors disengagement care • Poor • Lack of team • Narrowing of different focus, complication physicians are communication diagnosis recruitment approach to & revision stewards of practices • Increased • Rote responses • Reduced and retention patient care rates health system • Lack of • Failure to complaints not considering spiral, resources population health • Stereotypic • Increased • Workarounds to the latest participation in adopt best focus. • Orphaned patients responses evidence churn M&M rounds, practices, address system • Workarounds to • Suicide and critical incident maintain process issues. • Loss of cope disability reviews, quality currency committees, etc. collegiality BC Patient Safety and Quality Council (2002, Sept, 09). BC Health Quality Matrix . Retrieved from: https://bcpsqc.ca/documents/2012/09/BCPSQC-Matrix_FEB20.pdf.
Transformational Leadership Culture & Values The capability of medical staff members to champion The capability to live out healthy personal, professional, and drive transformation throughout Interior Health and moral/ethical values in daily work, finding meaning in the cultivate new talent to sustain and spread the same. same, and to demonstrate commitment to the mission. “Community at Work” Organization The capability of creating belonging and social support for medical staff in the workplace including collegiality The capability to clearly define and operationalize of practice, strong interdisciplinary teams, physical medical staff accountabilities, structures and committee mandates to ensure physician oversight of daily space and social interaction. operations and the furtherance of strategic objectives. These are the Strategic Capabilities Healthy Approach to Work & Life required to engage Efficiency & Resources The capability of ensuring medical staff members are the Medical Staff to The capability to understand the resource needs of able to render excellent patient care while attuned and set new standards of the medical staff (and their teams) to render attending to their own physical, emotional and familial excellence in the excellent patient care, thus ensuring their personal wellbeing. and clinical program efficacy and efficiency. delivery of health care services in Meaning in the Work British Columbia. Meeting Population Needs The capability of finding joy in one’s daily work, shape it according to personal interests, receive recognition for a job The capability of aligning the medical staff resources (e.g., well done and avail oneself of professional development recruitment, leadership development, public health training) opportunities with well-defined career advancement paths . with the right supports (IT, analytics, incentives) to meet the needs of patient populations and improve their outcomes. Adapted from: Shanafelt, T.D. & Noseworthy, J. Engagement & Relationship Management Commitment to Quality Mayo Clin Proc. n January 2017;92(1):129-146 Executive Leadership and Physician Well-being: The capability for the medical staff to define, lead/participate in The capability to continually identify and effectively engage medical staff, Nine Organizational Strategies to Promote the implementation transformation projects within the 7 community physicians and other partners to hear and address concerns and Engagement and Reduce Burnout. Retrieved from: dimensions of quality, achieving measurable improvements for the to foster enthusiastic commitment to the organization and its http://dx.doi.org/10.1016/j.mayocp.2016.10.004 same. transformational agenda. www.mayoclinicproceedings.org
Engaged Physicians Are the Cornerstone of High-Performing Health System! 3 Align Incentives Culture = Relentless Pursuit of Quality 1 • Pay for protected physician time to lead Re-orient the organizational culture toward or participate in QI “new standards in patient care excellence.” • Reinvest any savings found back into the • Identify high potential QI leadership talent clinical program for innovation. • QI Training, Dyad Partnership Coaching • Focus on Innovation • Strengthen HAMAC’s role as Quality Assurance Provide clinical teams with the talent needed to and Improvement oversight body. transform: • Clear QI performance expectations of dyad • Process modelling, costing, outcomes partners. monitoring • • Robust, real-time monitoring and reporting Project and change management • capabilities Clinical informatics & analytics 2 4 Governance & Performance Measurement Strategy + Execution Capabilities Louis-Denis, Baker et al. (2013, April 4). Exploring the Dynamics of Physician Engagement and Leadership for Health System Improvement. Retrieved from http://www.getoss.enap.ca/GETOSS/Publications/ Lists/Publications/Attachments/438/Expedited Synthesis_CIHR_2013-04-10-Final.pdf
Results (QI) = Leadership x Culture x People “Every system is perfectly designed to get the results it gets.” – Paul Batalden, IHI Senior Fellow and Founding Chair of the IHI Board of Directors
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