Even with most organizations embracing the team approach to healthcare nowadays, the whole system is still very physician-led and directed. To use a football analogy, a play isn’t going to work without the quarterback’s buy-in.
And for rural healthcare organizations like Pella Regional Health Center, the challenge of physician engagement can be even tougher as we balance the lack of staff resources with the ongoing need to secure reimbursements via new value-based practices.
Sometimes I feel like I’m in one of those Mission:Impossible movies, where there’s a dire problem announced by a self-destructing message saying, “Your mission, should you choose to accept it...”
That sort of environment might make for a good movie, but living day in and day out with that kind of stress and tension is no way to live, so I’d like to share what we’ve done at Pella Regional to help engage physicians in quality improvements.
Challenges and opportunities of collecting quality data
I’ve been with Pella Regional Health Center in south-central Iowa for just over 10 years. We are the only hospital in our town of just over 10,000, and we have six primary care clinics in Pella and the surrounding area.
Pella Regional is somewhat unique, in that we’re an independent facility (as opposed to a satellite location for a larger organization), and our patient population has been consistently growing across most of our departments.
At the same time, we’re like many other rural health centers that have experienced a lot of change, especially when it comes to meeting various CMS quality measures — including going from searching for patient data to drowning in it.
And while our administration and managers were on board immediately to doing whatever we needed to meet these new expectations, our physicians were more hesitant, especially considering all the other demands on their time and energy— and who could blame them?
CMS and insurance companies manage many of the programs that are governed by quality measures, and neither of those groups are known for listening to providers, to say the least.
Start with simple concepts to implement complex change
So how do we engage a group of physicians under these circumstances?
To me, physician engagement is much more about your organization’s culture and a collective willingness to accept change, rather than any single process improvement methodology or data management strategy.
With the wide range of strategies about culture change out there, it can be difficult to figure out which one to follow — but I actually find that change theory is a lot like tips for a healthy lifestyle; the core principles are pretty straightforward, it’s the debate over specifics that can make it hard to put them into practice.
One of the models that I use is John Kotter’s 8-Step Process for Leading Change, and our recent experience at Pella perfectly illustrates how one of his simple concepts, “Create a Sense of Urgency,” can determine how quickly and effectively an organization can change its culture.
That sense of urgency was definitely a factor in the quality redesign that we put in place in 2016 — a number of external factors aligned all at the same time that compelled us to move quickly on the project.
First, most of our physicians were on the same contract cycle, which was due for renewal at the end of the year. Second, we were newly engaged with an ACO arrangement with Wellmark Blue Cross Blue Shield of Iowa and about to be subject to downside risk (where if the costs were treating patients were too high, we would have to write the insurance company a check). And third, CMS was in the process of launching MIPS and all of the quality rules and standards that came with that.
Given those three situations, we knew the time was right to put a new quality contract in place.
And we did, though not without overcoming a few challenges — it took until the last week of 2016 to get all of our physicians to sign the final product — but in the end, we had adopted a new process to harness that sense of urgency and get all of our doctors on board with it.
Advice for leading successful culture change
Kotter lists several other concepts in his eight-step plan, like “Build a Guiding Coalition,” and “Communicate the Change Vision,” that we’ve also built into our quality processes at Pella — and it’s definitely made a big improvement for us.
We’ve built our own set of principles on Kotter’s model, specifically to improve physician engagement:
- Consider how you interact with physicians: When we created a Clinic Quality Executive Team (our version of a “guiding coalition”), we did a lot of work around how we interacted with the group. Having five physicians on the CQET gave us great insights in how to effectively communicate with our doctors, so they were more likely to stay engaged with our quality processes.
- Maximize your resources: Every healthcare organization has its own unique challenges and situations as far as EMR capabilities and facility resources for quality, both from an IT and a staffing perspective, but we can get creative with our approach to data to offer providers something extra. It’s also critical to work with your IT staff or vendor, because frequently there are useful tools or reports that most staff aren’t even aware of that can make your life easier.
- Communicate with other departments: We found that our clinics could really benefit from reports created by other departments — colonoscopy data is a great example. There was a time when different reports existed for our surgery department and clinic, both focused on overdue procedures. Not only were our IT resources wasted in the creation of two processes, but we were also duplicating outreach efforts. That doesn’t make sense from a business standpoint, or from a patient-focused approach.
- Look for collaboration opportunities that you don’t expect: We were working on improving breast cancer screening rates at one point last year, and because we were willing to have open communication with our imaging department, they agreed to do a large amount of outreach on our behalf since they had a little flexibility with their front desk staff at the time. It freed our schedulers up to work on other projects and we were able to get even more work done. If we hadn’t talked with them, we would have just instructed our schedulers to make all those calls and would've missed a great opportunity.
After putting these concepts into practice, we’ve seen a lot of improvement in achieving quality measures, and that’s reflected in the other strides we’ve made in caring for our patients.
Just last year, we instituted a seven-day-a-week walk-in clinic that also includes an online check-in system so patients can see what their wait time will be. Thanks to the buy-in from our whole team, we were able to get the clinic up and running in just four months — and now our doctors can treat more patients, more efficiently.
Physician engagement doesn’t have to be “mission impossible.”
Hopefully, our experience at Pella can give your organization some guidance on how to get your doctors on board while achieving better patient quality.