June 2006

QHN Interviews Peter Norton, Emeritus Professor, Faculty of Medicine, University of Calgary on Physician Engagement (June 2006)

Quality Healthcare Network: Thank you for agreeing to speak to members today about physician engagement. Do you think QI has permeated the culture of professional medicine?

Peter Norton: I think there is a concern for the safety and quality of the system and it is now at the forefront of many physicians’ minds. But I don’t think that as a group, they are aware of quality improvement initiatives like Safer Healthcare Now!. That is unless they are directly involved in these initiatives.

Quality Healthcare Network: Why should physicians be involved in QI?

Peter Norton: For us to achieve a safer, higher quality system it will be necessary for all the members of the healthcare team to be engaged. No particular discipline or individual can do this on his or her own. We know this from many other industries. For example, in the airline industry to ensure that the safety levels are high all the cabin staff - stewardess, pilots and mechanics, all work together. It’s no different in healthcare. We have to work together to achieve a high level of safety. That’s why the physicians have to be involved.

Quality Healthcare Network: What do you see as the barriers to engaging physicians?

Peter Norton: Of course the difficulty in engaging physicians is the physician’s arrangement with the funders of healthcare, which is different than all the other deliverers of healthcare. We have to develop mechanisms that appreciate that difference and facilitate the physician involvement as well as the other players in the arena. I have some practical suggestions on engaging physicians in QI.

First, I suggest you use physician time wisely. You have to understand what you need from physicians or pharmacists before you engage them. For example, it may not be necessary for the physician to attend every meeting of the quality improvement team.

I always tell teams, why don’t you find out what you need from the doctors, the nurses, the pharmacists and then structure it so that those things come together with respect to everyones busy schedule and work patterns.

The second thing that I recommend is to develop attraction strategies. Beauty is in the eye of the beholder. What makes something like Safer Healthcare Now! attractive to physicians? Clearly, one thing is that we are trying to deliver the safest healthcare that we can to our patients. So we need to be continually going back to that message. This isn’t about learning quality improvement techniques, this isn’t about measurement. This is really about care. We’re here to improve the care of patients. We have to continuously go back to that message and make sure we all think about that message all the time.

The third thing I think is important is to display both the stories and the progress of the team. Using stories and data to celebrate success openly to all the members of the team is critical. For example, if you’re getting more and more of your patients on antibiotics at the right time, before surgery, have a graph up in your high traffic hallways and show your progress for every month or every week. Make sure everyone understands what the graphs say. So what I’m saying is that appropriate use of data is important for most of our health professionals. And the stories about things actually getting better is critical.

I also think that we have to use data differently. Historically, we’ve tended to use data to try and judge people, instead of identifying opportunities for improvement and demonstrate that we are improving. This is a different mindset for us and we continually trying to make it clear that the data that we’re measuring here is measurement for improvement and not to show that one hospital is better or worse than the other.

Fourth, I think we should begin to think about hiring physicians to champion QI initiatives. I often get asked by hospital CEOs or regional CEOs, “Do you think we should hire some physicians to champion this". I think many of the places that are accelerating improvement, actually are hiring some physician time by paying physicians to engage in QI. Alternatively, I think we need to find ways to release nurses and pharmacists so they too can work on this improvement work. This may be an important thing for various organizations to consider.

Quality Healthcare Network: Are physicians onboard Safer Healthcare Now!

Peter Norton: We have a lot of physicians involved in Safer Healthcare Now! - both on frontline teams and people who are donating their time to be on the faculty. So physician participation has been great. And we hope that it will only get better as time goes on.

Quality Healthcare Network: How does QI improve the care that physician’s provide?

Peter Norton: What we’re doing from a safety perspective is using QI tools to help us both understand and improve the system in which healthcare professionals work so the end product is safer and higher quality healthcare. The QI tools help us think, not only about the individual patient and physician but also the system in which the care is occurring and look at opportunities to modify the system to enable the physicians and nurses to give the kind of care they want to give all them time.

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About the Quality Healthcare Network:The Quality Healthcare Network (QHN) is a non-profit organization dedicated to fostering the development and adoption of best practices by its members through education and shared improvement projects. Established in 1992 as the CQI Network, the network grew into the  Quality Healthcare Network in 2003, a member-based organization, which now exceeds over 70 healthcare organizations that share the courage to move beyond status quo, inspired towards excellence in care and service. In 2005, the network became the Ontario lead of the Safer Healthcare Now! campaign, an ambitious pan-Canadian effort aimed at reducing the number of injuries and deaths related to adverse events, such as infections and medication incidents. For more information about QHN, visit the network website at www.qhn.ca

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