Hospital Strategies to Engage Physicians in Quality Improvement
Hospitals Compete Against Physicians' Time/Financial Pressures for Involvement
Oct. 15, 2009
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WASHINGTON, DCWhile physicians are essential to hospital
quality improvement efforts, competing time and financial pressures pose hurdles
to physician participation, according to a study released today by the Center
for Studying Health System Change (HSC).
Although hospitals have long engaged in quality improvement activities, they
continue to face escalating demands to participate in a wide range of quality
improvement and reporting programs. Many hospitals historically have relied
on the voluntary medical staff model to solicit physician participationa model
generally premised on a loose affiliation between hospitals and community-based
physicians. However, as more services shift to outpatient settings and physicians
confront quality-of-life issues and financial stresses, physicians feel less
obligated to volunteer time for hospital activities, including quality improvement,
according to the study.
Funded by the Robert Wood Johnson Foundation, the study included interviews
with hospital leaders in Detroit, Memphis, Minneapolis-St. Paul and Seattle
and identified hospital strategies to involve physicians in quality improvement
activities, including employing physicians; using credible data to identify
areas needing improvement; providing visible hospital leadership support; identifying
and nurturing physician champions to help engage their peers; and communicating
the importance of physicians contributions.
"Many physicians are spending less time in hospitals and increasingly
are reticent about voluntarily giving their time to hospitals, so finding effective
ways to engage physicians in quality improvement is an important challenge for
hospitals," said Debra A. Draper, Ph.D., HSC associate director and coauthor
of the study with Allison Liebhaber, a former HSC health research analyst, and
Genna R. Cohen, an HSC health research assistant.
"While hospitals are making gains in quality, greater alignment of hospitals
and physicians working together on quality improvement would likely spur considerably
more improvement," Draper said
The studys findings are detailed in a new HSC Issue BriefHospital
Strategies to Engage Physicians in Quality Improvementavailable
here. Other key study findings include:
- While respondents often described medical staff bylaws as encouraging
physicians to "be good citizens" and participate in quality improvement
activities, bylaws often lack the specificity or accountability that clearly
outline physicians responsibilities.
- Hospital employment of physicians is becoming more common, often as part
of a larger set of alignment strategies, such as securing emergency call coverage
and initiating new service lines to attract patients. Typically, quality improvement
is not the main reason driving tighter alignment of physicians and hospitals,
but employment can create incentives for physician involvement in quality improvement
by lessening competing pressures on physicians time and increasing physician
accessibility and visibility in the hospital.
- Credible data to identify areas that need improvement and systematically
assess progress are essential to securing physician participation in hospital
quality improvement. Many respondents recounted how physicians assume they are
providing good quality of care until they are shown data proving otherwise.
- Visible commitment by hospital leadership can foster physician involvement
in quality improvement activities. An important role of hospital leadership
is creating a strong quality culture by publicly demonstrating that quality
improvement is important, supported and encouraged.
- Physician involvement in quality improvement reportedly is often limited
to a fraction of the active medical staff. Finding ways to engage more physicians
is critical to quality improvement, which ultimately requires all members of
the medical staff to adopt process and practice changes.
- In soliciting physician involvement in quality improvement, hospital
leaders reported the importance of clear communications. Respondents believe
that showing physicians that quality improvement activities improve patient
outcomes and arent just administrative or regulatory requirements increases
their willingness to participate.
To identify and promote policies and practices that encourage hospitals and
physicians to work together to improve quality, the study concluded that policy
makers driving the nations health care quality improvement agenda should consider:
- Rationalizing the demands placed on hospitals and physicians, focusing
on a limited number of quality improvement initiatives that demonstrate the
most promise for significant improvement and striving for consistency across
- Creating mechanisms to assist hospitals to use data to improve patient
care quality, such as centralized data repositories; and
- Establishing financial and other incentives to support hospital quality
improvement while also examining state and federal regulations, such as gainsharing
prohibitions, that may impede hospitals engagement of physicians in quality
The Center for Studying Health System Change is a nonpartisan policy research
organization committed to providing objective and timely research on the nations
changing health system to help inform policy makers and contribute to better
health care policy. HSC, based in Washington, D.C., is funded in part by the
Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research.