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Dr. Shaun MacCormick Chief of Staff/Medical Doctor Colchester East Hants Health Authority (CEHHA) Colchester Regional Hospital Regional Health Authority Truro, Nova Scotia shaun.maccormick@cehha.nshealth.ca
When was your practice implemented? Strategy development began in 2006. Implementation of the strategy has been ongoing.
Describe the issue that prompted the implementation of your practice: An employee/physician satisfaction survey was implemented in 2005. The results of this survey indicated that the physicians working in CEHHA did not feel that they had a positive or effective relationship with the health authority.
Describe your practice: Based on the feedback received through the 2005 satisfaction survey, CEHHA wanted to work with the physician group to better understand their issues and challenges and to identify ways to work together and improve their relationship. Many of the issues that were identified centered on quality (quality of care, quality of work life/practice, quality of relationships). Based on this common theme, the Physician Engagement Steering Group decided to base the implementation of the physician engagement strategy on the principles of the IHI White Paper "Engaging Physicians in a Shared Quality Agenda".
Describe how your practice was implemented and the resources required (e.g. people, time, money): The Physician Engagement initiative is a partnership between the CEO, Chief of Staff/Medical Director & Primary Health Care (PHC). The funds for the initiative are provided primarily through PHC. A series of focus groups were held with physicians across CEHHA. A respected peer was hired & was able to provide neutrality to the process. A report was developed that highlighted the key issues identified by the physicians and a series of recommendations for implementation around the framework for the strategy. A physician steering group was established to oversee the implementation of the recommendations with issues focused in four key areas: Medical Leadership, Decision Making Processes, Clinical Voice, & Physician Resource Planning. A provincial forum was hosted by CEHHA where IHI faculty came for the first time to N.S. & presented the "Engaging Physicians in A Shared Quality Agenda" workshop. A district Physician Quality Council has been established and quality initiatives are underway.
Explain the impact of your practice: The practice has improved the dialogue and relationship between the health authority and physicians. A rapport has been established with physicians who although working within CEHHA had poor engagement with the district. This work also has provincial implications. CEHHA has been a leading district in physician engagement activities in Nova Scotia and other districts and the Department of Health are interested in the learnings from this work. Physicians and district administration across the province were able to benefit from the IHI workshop curriculum.
How did it improve quality of worklife? * The improved relationship between the physicians and the district has enhanced communication and therefore issues can be more readily addressed before they escalate.* The district has a better understanding of how to effectively engage physicians so that they feel valued and are able to have input on appropriate clinical issues.* Increased collegiality between physician groups.* Physicians feel that they are increasingly part of the solutions and decision-making processes, rather than have things done to them.* With improved feedback processes, the district has been able to be responsive to physician issues and concerns and this had built a better trust with the group.
How do you know? (e.g. surveys to staff, a formal evaluation process, specific outcomes, feedback) There has been no formal evaluation of this work to date but this is a case in which actions speak louder than data. After attending the IHI workshop, the president of the medical staff did presentation to the broader physician group on what he had learned, how he felt that the district was a true partner and how they should all work together to do better. There have been a number of anecdotal observations by physicians about the work that has been initiated as part of the physician engagement strategy. In terms of specific outcomes, the following were implemented, all of which were in direct response to feedback received from the physician group: * District Physician Resource Plan* District Physician Engagement Policy* Re-establishment of the Joint Conference Committee* Establishment of Physician Quality Council
What lessons learned and issues to consider are you able to share with colleagues? * Using a respected physician peer to help facilitate the dialogue was key.* Do what you say you will do and do it in a timely manner.* Work with physicians on how they would like to be engaged, value their input.* Make a conscience and demonstrated investment into making things better. When the physicians saw how much time, effort and resources that the district was willing to put into the strategy, they noticed and thought that this time the district was serious.
