Time constraints, financial pressures, and a waning sense of obligation to hospitals are hindering physician participation in hospital quality improvement efforts, according to a study by the Center for Studying Health System Change.
"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," says Debra A. Draper, HSC associate director and a coauthor of the study. "While hospitals are making gains in quality, greater alignment of hospitals and physicians working together on quality improvement would likely spur considerably more improvement."
The study, Hospital Strategies to Engage Physicians in Quality Improvement, interviewed hospital leaders in Detroit, Memphis, Minneapolis-St. Paul, and Seattle, and identified strategies to involve physicians in quality improvement initiatives, 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.
Hospitals historically have relied on the voluntary medical staff model to solicit physician participation—a 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, which was funded by the Robert Wood Johnson Foundation.
The study also found that:
- 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 aren't just administrative or regulatory requirements increases their willingness to participate.
To identify and promote quality improvement measures, the study recommends that the nation's healthcare 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 programs;
- Creating mechanisms to assist hospitals to use data to improve patient care quality, such as centralized data repositories
- Establishing financial and other incentives to support hospital quality improvement while also examining state and federal regulations, such as gain-sharing prohibitions, that may impede hospitals' engagement of physicians in quality improvement.