Removing Barriers to Clinician Engagement: Partnerships in Improvement Work

This report is based on a 2019 Healthcare Analytics Summit (HAS 19) presentation given Jack Beal, JD, Vice President, Performance Improvement and Deputy General Counsel, The University of Kansas Health System, and David Wild, MD, MBA, Vice President, Performance Improvement, Assistant Professor, Department of Anesthesiology, The University of Kansas Hospital, titled, “The Doctor’s Orders for Engaging Clinicians to Drive Improvement.”

Clinicians play a significant role in all decisions affecting health system quality and cost, making them critical players in improvement work. However, reimbursement pressures, competing time pressures, misaligned incentives, and a lack of credible data often make engaging clinicians in improvement work one of the biggest challenges in healthcare.

This report describes effective strategies for overcoming barriers when engaging clinicians in improvement work and shares how to achieve the following goals:

• Partner with clinicians in improving quality and reducing cost.
• Align improvement work with all aspects of the organization.
• Identify problems and improvement ideas at all organizational levels.

Understanding Barriers to Clinician Engagement

Clinicians face mounting challenges in addition to delivering care, including climbing student debt, administrative requirements (e.g., regulatory measures), and the undelivered improvement promise of the EMR. While clinicians are accustomed to a professional culture in which they’re the primary decision makers at the point of care, data-driven decision making and improvement work are altering that paradigm. Health systems must strategically engage with clinicians regarding improvement work by inviting clinicians to become partners in these efforts rather than adding to the burden.

Clinician engagement is not a technical problem; it’s an adaptive problem. As such, simply throwing more technology at the issue won’t solve it. Instead working to deeply understanding clinician challenges will drive solutions that account for clinician needs, provide clinician-centered data around improvement initiatives, and create partnerships with engaged clinicians.

An ideal setting for improvement work aligns and engages clinicians through ownership and shared accountability throughout the organization. Improvement leaders build this partnership with trust and transparency.

A Three-Part Data-Driven Improvement Framework

To support data- and analytics-driven improvement, organizations need a workforce dedicated to collecting, sharing, and using data efficiently. Three levels of improvement teams make this possible: a team to share information throughout the organization; an advanced analytics team responsible for predictive and prescriptive modeling; and a team to develop, support, and deploy improvement across the organization. These performance improvement teams have responsibilities across the system and the entire continuum of the organization, across clinical and business opportunities.

Health systems, however, still need to close the gap between improvement data and analytics and planning and the clinicians who will carry out changes on the frontlines. This is where clinician engagement strategies become critical.

Three Levels of Clinician Engagement

Health systems can apply clinician engagement strategies at three strategic levels: local departmental or divisional (value-based performance), and leadership (department finance and planning sessions).

Local-Level: Clinician-Led Improvements

A program that engages clinicians in point improvements at the local level (e.g., the University of Kansas Health System Care Connections Program) establishes clinician partnerships in improvement work. Through Care Connections, the University of Kansas Health System provides foundational support for each improvement project with data, measurement, and analytics resources. The program has four main features that engage clinicians from the ground up:

1. Moves from paying for clinician time to paying for project completion.
2. Encourages practicing clinicians and their teams to generate improvement ideas.
3. Ensures organizational alignment by providing executive oversight and coaching for project, measure, and outcome selection.
4. For academic medical centers, improves academic productivity by requiring clinicians to present and publish their work.

Two arms make up the Care Connections Program: care advancement and care transformation:

• Under care advancement, the health system suggests improvements with a request for proposal (RFP) announcement. Interested clinicians submit a proposal with a hypothesis, proposed project, and proposed measures. An executive steering committee then reviews all submissions and approves funding.
• Care transformation aims to support great ideas from clinicians and their teams, even for projects leadership hasn’t identified. Clinicians submit projects to the executive steering committee for approval and funding.

Departmental or Divisional-Level: Value-Based Performance

Value-based performance (Figure 1) engages clinicians at the divisional or departmental level (e.g., all pulmonologists or orthopedists) in line improvement. This level engages a group of clinicians to provide data to problem solve, present solutions, and measure and share financial gains with department on a quarterly basis in four steps:

1. Find improvements.
2. Support the department of division.
3. Remove barriers to support.
4. Generate and share value.

Leadership-Level: Department Planning and Finance Sessions

The department planning and finance sessions engage senior clinician leaders in conversations about what to improve, why, and how. This level engages with multiple departments and specialties to discover how the health system delivers care as well as the quality of that care. At this engagement level, improvement teams produce information for clinicians on improvement work, hold office hours with analytics leadership and a planning meeting with senior leadership, and develop an annual improvement plan.

Clinician Improvement Partnerships Drive Meaningful Change

With clinicians making the vast majority of decisions that affect quality and cost, improvement efforts can’t succeed without their engagement. Health systems that create alignment with clinicians around improvement projects, rather than dictating to them, will build lasting partnerships to delivery high quality of care at lower costs.

Additional Reading

Would you like to learn more about this topic? Here are some articles we suggest:

1. Physician Burnout and the EHR: Addressing Five Common Burdens
2. Survey Points to Major Burnout Concerns Among Clinicians
3. EHR Integration: Achieving this Digital Health Imperative

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