4 E's of Physician Engagement in Quality Improvement

Physician and front-line staff engagement in a change initiative is imperative for the project to succeed. Downers Grove, Ill.-based Advocate Health Care experienced this maxim firsthand when it implemented a blood management program in 2011 with the help of consulting firm Strategic Healthcare Group.

Dr. Timothy HannonTimothy J. Hannon, MD, CMO and founder of Strategic Healthcare Group and former medical director of the St. Vincent Indianapolis Hospital blood management program, shares his four E's of engaging physicians in any change process.  

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1. Evaluation. The first step is to evaluate the organization's current performance and identify gaps. "This assessment gets people past the perception that 'everything's fine here and we don't need to change our practice,'" Dr. Hannon says. Evaluation helps build a clinical and business case for establishing the change initiative. In the case of a blood management program, Dr. Hannon says organizations can typically reduce blood use 25 percent to 30 percent by following evidence-based guidelines and clinical best practices. Leaders can use this information to estimate cost savings and patient safety benefits of reducing blood transfusion-associated complications.

Advocate Health Care had SHG evaluate its blood utilization to quantify the blood bank staff's perception that there was overutilization. In the first year of its blood management program, Advocate reduced blood costs by 21 percent, representing a savings of $3.4 million, and improved patient safety.

2. Education. Educating physicians about current performance gaps and the change's impact on patient safety and quality will help engage physicians in the initiative. "Educating physicians is not just about what the evidence says, but why it's important to patient care," Dr. Hannon says. "It starts to pull them into the process."

Beth HalperinFor example, when Advocate educated physicians about blood transfusion, the physicians began to view the initiative as a patient safety project rather than a "management" project, according to Beth Halperin, manager of transfusion safety at Advocate.

Advocate educated physicians and front-line staff about blood transfusion safety in a variety of ways, including meetings and grand rounds with Dr. Hannon and an internal marketing campaign around blood management guidelines. "We took this message wherever we could — medical executive meetings, department meetings [and even] physician lounges so Dr. Hannon could talk with physicians as they came in," Ms. Halperin says.

Blood transfusion as liquid transplant
One of the facts Dr. Hannon tells physicians is that a transfusion is a liquid transplant. Framing blood transfusions as transplants highlights their safety risks, which helps gain buy-in to a transfusion reduction initiative, according to Dr. Hannon.  "Although a blood transfusion can be life-saving, it puts a stress on the immune system, just like a patient getting a kidney or liver transplant. And the more blood a patient gets, the more exposures to foreign substances [he or she] gets," he says. This exposure puts patients at an increased risk for infections and adverse outcomes.

3. Engagement. To truly engage physicians in a change process, physicians have to take a leadership role in the initiative. Involving well-respected physician champions in a change effort can encourage other physicians to accept and own a new process.

Dr. Rishi SikkaGathering physician thought leaders to discuss the latest evidence and reach a consensus on guidelines was essential for the blood management program's success at Advocate, according to Rishi Sikka, MD, the system's vice president of clinical transformation. "If you take a top-down approach, I don't think you'll be successful," he says. "You need to build from the bottom-up, from the front-line clinicians and thought leaders."

4. Empowerment. Engaging physicians and sparking excitement about a change initiative is not sufficient to make a change, however. Physicians and front-line staff need the tools to execute process improvement, according to Dr. Hannon, so SHG provides a wealth of program resources through online resources and direct program management support.

Physicians at Advocate developed electronic order sets to embed the new blood transfusion guidelines into everyday practice. The fact that physicians created the order sets meant that the orders fit into existing workflows and conformed to the way physicians think about blood management, according to Ms. Halperin and Dr. Sikka. "They weren't cumbersome," Dr. Sikka says. "They made sense to doctors and nurses and their flow of work."

More Articles on Quality Improvement:

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6 Steps to Lower Heart Failure Readmissions

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