Engaging Physicians in a Shared Quality Agenda

The Goal:
Identify and engage a cadre of physicians who will serve as champions for the TCAB program and provide meaningful insights to it.

Why It's Important:
Engaging physician leaders in the TCAB process can be a challenge for nursing leaders who are eager to change the work environment of a unit. While groups of physicians are involved in regular activity on a nursing unit, individual physicians often have patients scattered throughout different units in a hospital. The traditional autonomy of the medical profession also may create barriers to engaging physicians in team activities. Hospitals that have successfully implemented TCAB, however, say that the support of physicians has been instrumental to their success.

How To Do It:
Key strategies for involving physicians include identifying at least one physician champion as a regular member of the TCAB core team from the early planning phase.

1. Identify formal and informal leaders among physicians to assist with the eventual engagement of larger groups of doctors.
Engaging physicians early in the process is key to avoiding the perception that TCAB is just a nursing initiative. Identify a physician champion and maximize his or her time by involving the doctor in an issue that he/she is particularly interested in. Focusing physicians on their interests can be helpful to gaining their engagement and support of others. Some sites have found that work done around improving the patient and family experience got the most traction for physician interest.

2. Involve physicians in the "deep dive" and "snorkeling" process.
You should also involve physicians in brainstorming potential areas to improve and new procedures to test. Perhaps hold a brainstorming session with doctors on ways TCAB may improve physicians' work life, such as reducing redundancies and interruptions (e.g., MD/RN rounding, MD/RN unit meetings, etc.).

3. Link physician involvement to the four themes of TCAB.

  • For example:
    • Staff Vitality: Implementing multidisciplinary rounds to include physicians, nurses, other caregivers and patients improves patient-centered care and often increases staff vitality through improved physician-nurse communications.
    • Reduction of Waste: Efforts at reducing waste, through streamlining processes and documentation, increases value-added care for patients and often heightens physician satisfaction as well.
    • Patient Satisfaction: Physicians have a strong sense of personal responsibility for individual patients and want to get the most out of their interactions with patients. Efforts to improve quality and efficiency in the care delivered will result in doctor-patient relationships that are higher-quality and more efficient as well.
    • Safety and Reliability: It is essential that physicians be involved in the process of planning systems improvement for the patients they treat. The involvement of the doctors and nurses that patients rely on as their front line of care will result in realistic improvements that can reliably be implemented, will make real achievements without disrupting systems that work well, and be sensitive to patient care preferences.

Tip: If physicians who are initially engaged do not become champions of the program, move on and identify new ones to involve. Physician leadership is critical, so it's important to keep working to have strong supporters on board.

RWJF Video

Physician-Nurse Collaboration to Enchance the Quality of Care

June 2008. Christopher Ng, MD, Director, Laproscropic Urologic Oncology and Robotic Surgery at Cedars-Sinai Medical Center speaks about their collaborative care model. Transforming Care at the Bedside (TCAB) program.

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