Improving physician engagement: Steps to take (and not take)

Physician engagement and leadership are hot topics within hospital C-suites. Despite significant attention and resources provided to physicians and their respective teams, the level of alignment and effective collaboration needed to produce improved patient outcomes has proven difficult to create, implement and sustain.

The reasons for such challenges are clear. Physicians are an independent lot and today, many are not only over-burdened with the increasing demands of the profession, but have become disillusioned with industry changes and the near endless array of so-called "solutions" for healthcare delivery.

As a result, the steps to take to improve physician engagement are often unclear to hospital leadership struggling with the many big picture issues they must address; from expanding access, to controlling costs, to meeting performance metrics.

But there are hospitals that have found an approach that works for their organization and their physicians. It can be done.

One Hospital's Experience
Prior to July of 2013, St. Agnes Hospital Emergency Department, located in Southwest Baltimore, was facing the traditional ills of the typical busy inner city Emergency Department (ED). The realities of a busy urban ED often include full waiting rooms with unhappy patients waiting for hours see a provider, dismal protracted throughput times, high left without being seen (LWBS) rates, and poor patient satisfaction scores.

At St. Agnes, clinical teams worked tirelessly to care for an aging and medically complex patient population. While staff and administrators were willing, and many initiatives implemented, none produced desired results. The ongoing challenges and inability to meet patient demands led to low morale among caregivers. Unfortunately, department woes also led to high physician turnover, leading to recruiting difficulties for the ED physician staff.

With most measurable department metrics below goals, hospital medical staff and administrators became frustrated with performance, and the patient experience continued to slowly degrade. It became clear that fresh eyes and new leadership was in order to drive significant change.

At St. Agnes, this was achieved by contracting with an outside organization, which came in to partner with physicians in the ED. There was an almost immediate change in focus, goals and processes.

With a new partnership model in place, St. Agnes was able to recruit 12 new providers to commence the contract on July 1st, 2013. With new physician leaders, a strong emphasis on collaboration and teamwork, and drawing on a network of best practices and processes, an urban busy emergency department was transformed.

Within one year of launching the program, significant improvements were seen in the ED.
- Patient satisfaction scores doubled
- ED visits up 10%
- Admission times down by two hours
- Discharge time decreased by just over one hour
- Left-without-being-seen rate dropped from 5.4% to 1.7%
- Ambulance diversion rate down from 170 hours to 5 hours

The new culture reaped significant benefits for staff morale as well. The work environment became more pleasant, effective and most of all, enabled the staff to deliver high quality patient care.

Steps to Take
While creating an efficient quality-focused environment must be the foundation for any engagement program, there are other important steps to take. Here are several St. Agnes found to be beneficial.

1. Create site leadership teams that will engage multiple physicians. Encourage leadership on ED and hospital wide committees. We have found that ED physicians are an untapped pool for hospital-wide leadership.
2. Create a culture of collaboration and teamwork. A multidisciplinary team composed of nurses, ED techs, physicians, registration members, imaging leaders, lab leaders etc., often holds weekly meetings to discuss challenges, solutions and to work through metric-driven improvements.
3. Implement processes and systems to enable greater efficiencies and better outcomes. At our organization, we implemented Rapid Medial Evaluation (RME), a trade-marked front end reengineering process. We also created an (EPIC) Emergency Department Performance Improvement Committee to help reduce the need for ER visits and hospital admissions.
4. Ensure physicians have an excellent support system. Physicians often spend valuable time filling out paperwork or typing notes into EHRs, leaving less time for patient care and staff engagement. Highly skilled medical scribes are cost-effective staff that can assist with EHR and administrative duties, allowing MDs to focus on bedside patient care, what physicians want to, and should, be doing.
5. Empower nurses to practice at the top of their licenses. Continuous education, engagement and involvement of front line RNs leads to efficient departments and also contributes to stronger teams, which all work together to improve engagement for physicians, and all staff.

Avoid the Pitfalls; Reap the Rewards
While those are important steps to take, there are some that are harmful to engagement efforts. One of the most egregious is a lack of follow through. To announce a program and then for physicians to see no results or activities can greatly hinder the next effort to be launched. If you start a program, see it through. If you aren't ready, hold until you are.

A strong engagement initiative is important and can produce positive results. At our organization, the results were more engaged physicians who were more supportive and satisfied in their jobs, as well as improved performance metrics. The takeaway from our effort and experience is that physician engagement is a worthy and a beneficial endeavor for hospital leadership to undertake. As that famous tagline goes, "just do it."

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About the Author:
Dr. Crosley is Vice President at CEP America and the former Chair of Emergency Services at St. Agnes Hospital in Baltimore, MD. He is also a member of the Maryland Chapter of the American College of Emergency Physicians (ACEP). Dr. Crosley holds a Bachelor's degree in Biological Sciences from Towson University in Maryland and a medical degree from New York College of Osteopathic Medicine in Old Westbury, NY. He completed his residency in Emergency Medicine at Albert Einstein College of Medicine and joined CEP America in 2005.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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