May / June 2009

Engaging Physicians in Change

A Dashboard for Medical Staff Goals

By Barbara B. Loeb, MD, MBA, CPE

The medical staff organization traditionally focuses on credentialing and peer review, primarily addressing physicians' individual skills, qualifications, and practice patterns. Promoting quality and safety in healthcare today requires a break from this narrow focus into a more global view of processes and systems that are the significant determinants of outcomes. With this transformation, the physicians' role in patient care is in transition. Physicians must continue to work effectively as individuals while simultaneously functioning as part of a more complex healthcare team. No longer can we simply point to one individual or factor as the sole cause of the results we experience. Realistically, we must address all the ingredients involved in the final outcome. Taking this worldview into account, the medical staff leadership at Advocate Good Samaritan Hospital in Downers Grove, Illinois, searched for a more system-based way for physician to have an effect on outcomes at our hospital.

In February 2008, an expanded group of Advocate Good Samaritan's medical staff leaders convened at a retreat. Attendees included Medical Executive Committee (MEC) members, medical directors, and chairmen of key committees. Members of the hospital executive team participated as well. To stimulate the thought processes, the day began with a didactic session focusing on important components of leadership. This was followed by a discussion of how the group could have greater input and impact on practice life and care issues at the hospital. The leaders chose to concentrate on areas that were most significant to physicians and where there was a need for greater physician support.

The group chose four target areas for improvement and specified goals within each one:

• Clinical outcomes
  
  
• Patient safety
  
  
• Patient satisfaction with physicians
  
  
• Physician relations and satisfaction

In the arena of clinical outcomes, reducing the incidence of post-op VTE including DVT and PE was chosen. Limiting these events is critical and had been difficult to achieve. The use of sepsis protocols to promote early and effective treatment of sepsis patients was identified as the second clinical outcome measure. Achieving this goal requires a high degree of physician support. For patient safety, increasing the use of computer physician order entry (CPOE) was targeted. This tool has been held up nationally, by the Leapfrog Group and others, to increase medication safety and decrease errors in hospitals. The third area was identified following the realization that when patients are satisfied, overall outcomes and care flourishes, for this reason patient (inpatient) satisfaction with physicians was chosen. Due to the complexity and high-acuity of the patients we serve, this had been challenging. Finally, to create a collegial, high-quality, efficient work environment, physician satisfaction must be nurtured. Without a high level of physician contentment, optimal outcomes cannot be reached.

To track and promote results in each target area graphically, a dashboard was designed. The specific goals were defined and displayed on a "2008 Medical Staff Goals" dashboard (Table 1). Throughout 2008, baseline numbers were compared to monthly updated performance data and discussed at MEC and Governing Council meetings. Action plans to drive results in each category were presented and input was gathered. To communicate the results, the dashboard was posted in the doctor's lounge and published in the monthly newsletter, Physician Forum. The newsletter was distributed on paper and electronically to all physicians and key hospital leaders. Articles in the Forum communicated the details of progress in each area.

Early in 2008, as a direct result of the monthly review of the dashboard, a new passion developed among the medical staff leadership. When confronted with the poor score for patient (inpatient) satisfaction with physician, the group felt something "had to be done" to address it. The jury is still out, but this heightened level of engagement has been impressive, and tangible plans for action are under way.

The leaders of high performing medical staffs need to search for new ways to more meaningfully engage physicians as a team of champions in their quest for the best systemic outcomes. At Advocate Good Samaritan, we feel the Medical Staff Goals Dashboard has been a useful tool to track and drive results.