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Engaging Physicians in Quality Improvement

Thursday, February 21, 2019 - 12:15

Dr. Heather McLeanWhen Heather McLean, MD, was appointed Vice Chair for Quality in the Department of Pediatrics at Duke University in 2015, she was eager to expand Duke’s quality efforts to improve care for pediatric patients.

However, “it seemed that only a few faculty members were excited to drive change,” Dr. McLean, also Associate Professor in the Division of Pediatric Hospital Medicine, recalls. “The barrier is that everyone is busy!”

Dr. McLean’s sentiment is not uncommon. It seems that everyone is busy. So how can health care leaders responsible for quality and safety break through that barrier?

The Institute for Healthcare Improvement (IHI) notes that most hospitals struggle with engaging physicians in quality and safety improvements.1 To help organizations such as Duke increase engagement, IHI outlined an easy-to-follow framework with suggestions that include discovering a common purpose (e.g., improved patient outcomes), involving physicians from the beginning, making quality improvement (QI) easy, and valuing physicians’ time.

Dr. Lloyd WerkLloyd Werk, MD, MPH, Division Chief, General Academic Pediatrics at Nemours Children’s Hospital in Orlando, FL, and ABP Portfolio Sponsor Manager for Nemours Children’s Health System, discussed the IHI’s framework during the annual ABP Pediatric Portfolio Sponsor meeting in June and provided practical tips on its application. “For example, you might find a common purpose around reducing time wasted or reframe discussions to focus on patient outcomes instead of processes and widgets,” he says. “Seek natural allies in educators and among those who can help publish findings.”

Other engagement methods discussed at the meeting included embedding QI in training programs, identifying QI champions, establishing quality councils, providing coaching, making physician involvement visible, and communicating often.

Members of Duke's Quality Review Board

To increase physician engagement with quality initiatives at Duke, the Department of Pediatrics’ Quality Review Board (pictured) is developing a longitudinal course to teach faculty and staff how to design and lead a quality improvement project. “Physicians in the course will be learning and doing simultaneously,” Dr. McLean says. “Our goals are for each participant to have a scholarly project worth publishing and to spread quality champions across all divisions.”

Doreen ToochDoreen Tooch, Program Specialist for Medical Staff Services at Arkansas Children’s Hospital, also coaches pediatricians involved in QI and encourages their engagement by giving them a Maintenance of Certification (MOC) checklist at the beginning of each year, hoping they don’t wait until the last minute to begin QI. “We coach them to keep their project small enough to be comfortable, and then they can expand later.”

Dr. John KohlerJohn Kohler, MD, MBA, Vice Chair for Quality in the Department of Pediatrics and Medical Director for Quality, Women’s and Children’s Services at East Carolina University, encourages engagement — and the spread of improvements to other settings — by breaking down silos. “We empower hospital-acquired condition (HAC) champions from across the organization [to run their own projects], but they have a requirement to pull physicians and nurses from every place that the HAC touches so that ideas come from everywhere and the best practices we want to incorporate are disseminated across the organization.”

Mimi SafferWhen an interest in improving care is not enough motivation for physicians, some organizations institute peer recognition. Mimi Saffer, Vice President, Quality Improvement and Quality Measurement, at the Children’s Hospital Association, says recognition can be at the institutional level, health system level, unit level, and individual level. “Clearly, what the Board has done with MOC Part 4 credit is at a very personal level of recognition,” she says.

Dr. Francis RushtonFrancis Rushton, MD, a private practitioner representing the South Carolina Chapter of the American Academy of Pediatrics, agrees. He uses MOC as a “carrot” to engage physicians to participate in his South Carolina Medicaid project. “MOC has been a huge boon to us,” he says.

Other institutions have found that financial rewards work best. For example, Children’s Mercy Kansas City gives a Patient Safety award to recognize an individual or group of individuals who have worked tirelessly to improve the safety of patients and eliminate harm. Recipients receive a plaque and a small stipend during a formal annual faculty awards event. The Children’s Advisory Board at St. Luke’s Children’s in Idaho gives $100,000 in quality and safety grants to at least 20 individuals annually. And Duke University’s Department of Pediatrics offers a travel grant to support individuals who are invited to give a presentation at a national conference about their quality improvement project.

In the past few years, Duke’s Department of Pediatrics has seen a leap in quality work and improved clinical outcomes.

“We’re trying very hard to get all of the incentives to line up properly,” says Dr. McLean.

1 Reinertsen JL, Gosfield AG, Rupp W, Whittington JW. Engaging physicians in a shared quality agenda. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2007. Available on Accessed February 1, 2019.