Strategies for increasing physician engagement
After reading this article, you will be able to:
- Describe methods for alleviating physician concerns when addressing Joint Commission standards
- Identify specific Joint Commission standards where problems of timing and dating of medical records is addressed
In the quest to meet Joint Commission standards, it is very helpful to have a highly engaged medical staff. While usually not employed by the hospital, the medical staff is key to the hospital's success in meeting many of the Joint Commission standards. But how does a healthcare facility get physicians to care about the success of a hospital?
There are some strategies that a hospital can utilize to increase the collaboration and level of participation of the medical staff. Some hospitals have tried forcing the issue through requiring attendance at all meetings, and making in-services and workshops mandatory. But does this really engage the medical staff? Or does it create resentment?
This article will focus on positive strategies to help a hospital create a collaborative, supportive, and symbiotic relationship with the medical staff. As Henry Ford said, "Coming together is the beginning, keeping together is progress, working together is success."
Consider the physicians' concerns
One of the most effective strategies for successful physician engagement may also be one of the simplest: Take a step back and listen to what physicians are saying. This helps build trust, which is the foundation for any productive partnership. Avoid focusing your first conversation with a physician on what he or she can do for you. Instead, get the physician's input on where he or she sees opportunities to improve processes and performance, and put yourself in a position to deliver something from that conversation.
These early conversations with physicians can also provide insight into the quality of communication within an organization, and whether the goals of physicians and hospital administration are aligned or contentious.
When good interpersonal dynamics exist, it is often easy to determine expectations from both sides as well as predict the level of cooperation expected at the outset. In situations where relationships could be strained, one-on-one meetings with physicians will yield details on the issues that present challenges, the roadblocks to navigate, and the potential solutions.
Cardiologist Mark Hanson, MD, chief of staff at Newton Medical Center, says, "Whether or not I'm going to agree, I appreciate that I understand what the hospital is doing and why. Transparency builds trust and will go a long way toward resolving any conflicts with medical staff."
Once the concerns of the physicians are known, hospitals and physicians can find ways to resolve issues and broker deals that focus attention on the true problems at hand, such as how to decrease the cost of physician preference items while preserving the quality of care, or how to gain physician support in meeting new or particularly challenging standards.
When trust is established and communication issues are resolved, the concept of physician engagement can become a reality. If physicians have an issue regarding one of their areas of practice, it is most beneficial to get their input first and ask for their guidance in how to respond. In turn, a hospital can expect that the physicians will help manage any changes and improvements needed to deal with the issue or standard.
Identify physician champions
A critical step in establishing the level of trust necessary for effective collaboration is identifying champions among the medical staff who will serve as liaisons to the hospital and administration and provide leadership, accountability, and clinical oversight for initiatives intended to meet standards or improve processes. Having point-of-contact physicians who can take issues back to other members of the medical staff will provide the best framework for ensuring targeted, efficient communication.
Another benefit of physician champions is that they are usually willing to help. Physicians can offer a unique viewpoint that may not have been considered within the organization. "Who else knows the view of the physician, if not the physician?" says hospitalist Josh King, MD.
The process of engaging physician champions can vary. Selecting physicians who are stakeholders in a particular process is a way to respect the preferences of physician leaders and obtain needed insight and support for hospital-led initiatives. An informal process is often effective, with the hospital acknowledging the value and expertise the physician brings to the table in making any changes.
If the process is formal, the expectations of the physician leader and of the hospital must be clearly defined. This helps avoid role confusion and the impression that the physician is "taking the hospital's side" when working through a challenging initiative. Keep in mind that the expectations of both parties are usually higher in a formal process, and the collaborative relationship may be damaged if the initiative is not as successful as either party believes it should be.
Watch practice patterns
When it comes to Joint Commission compliance, most compliance officers are all too familiar with RC.01.01.01: "The hospital maintains complete and accurate medical records for each individual patient."
The reason this standard is so familiar is that currently, The Joint Commission lists it as the standard with the most compliance issues. Almost all hospitals have had challenges with physicians signing, dating, and timing orders and other documentation in a timely manner.
It is important for documentation and medical records compliance to be part of physicians' ongoing professional practice evaluation (OPPE). If a physician has a track record of stellar compliance with documentation standards on OPPE, he or she could easily become your physician champion for changing processes to meet a particular standard. Perhaps this physician has created a personal system that helps him or her remember to ensure documentation compliance with each patient-this best practice can be shared with others.
It is similarly important to identify physicians who consistently fail to comply with standards. You can then utilize the peer influence of your physician champion to change their behavior.
Involve physicians in monitoring
When it comes to understanding standards put forth by The Joint Commission, physicians don't have to fall back on "we do this because The Joint Commission says we have to." Instead, they can gain the upper hand. If physicians are part of the process of the hospital adopting processes and policies in alignment with Joint Commission standards, they are more likely to understand the rationale behind the standards.
If physicians are able to attain a better understanding of why certain standards are created, they may become more interested in monitoring other physicians for compliance. In this era of healthcare reform, physicians realize that it is important for hospitals to be successful and preserve high-quality patient care.
If a standard is particularly challenging to a hospital, engaging physicians in creating processes and monitoring the standard can be helpful. Physicians can bring some processes to their own practices, or integrate hospital practices for better continuity of care and a feeling of cooperation.
Newton Medical Center in Covington, Ga., created a strategy to keep all preprinted order sets in a software program accessible throughout the hospital. The order sets could be customized if the physician requested it, and could be printed with patient information included. To bring physicians further into the process of using the order sets, the hospital is setting up a physician portal for admitting physicians, so the same order sets available in the hospital will also be available in offices.
The medical executive committee can help facilitate collaboration between the hospital and medical staff. The committee can go on record in support of policies and processes that comply with Joint Commission standards. Department chairs can work with peers to monitor compliance and cooperation. It is important that a medical staff OPPE program is set up to reflect physicians' individual rate of compliance with standards.
Feedback on compliance and resources for assistance can be provided to physicians as part of their OPPE program. Medical staff leaders, if knowledgeable and engaged about compliance with regulatory agencies, will be valuable champions for hospital processes.
Use data to support changes in behavior
Positive results of physician engagement efforts are not earned on the basis of goodwill alone. For physicians, data is a critical component in making decisions that could benefit them and the hospital.
Physicians are not likely to simply accept the word of hospital administration at face value when being asked to make a change. When administration can present physicians with benchmark data, regardless of the clinical indicator, it makes the task easier.
"Most of us are data driven, and do things in response to data and studies," says Hanson. Physicians are scientists, he adds, and will respond to objective data presented along with workable solutions.
Data is an effective tool for driving changes in physician behavior and practices. King notes, "Physicians may initially be resistant to anything that is presented as a critique, but may end up being surprised at what the data shows. It levels the playing field since it is fact, not driven by the goals of the hospital or regulatory agency."
Hanson agrees. "If you showed me that I was the most expensive physician in the hospital, I would reevaluate how I practice," he says.
The same could be said for compliance with regulations. A physician may think he or she is doing well with Joint Commission standards, and may resist any suggestions for improvement. Presentation of data can eliminate opinion and room for disagreement. Physicians are scientists, and they are more receptive to change if detailed information is provided while processes are being constructed. Diligent tracking is also important to keep physicians current on the results of practice changes. Ensuring physicians are up to date on progress made and providing them with feedback will help maintain positive behaviors and compliance.
Build momentum for success
Physician engagement strategies require a unique mix of people skills, process maneuvering, technological and clinical expertise, and careful follow-up. Providing physicians with the data they need to make informed decisions is a key component of engaging physicians in improving processes and meeting standards. Success creates its own momentum, and the more positive outcomes are achieved, the more likely physicians will trust the processes and agree to become part of them. The benefit of successful physician engagement can be realized by the hospital, the physicians, and the community as a whole.