Leaders at The Ottawa Hospital have developed a layered approach to improving collaborations with physicians that invests in their leadership development and gives them a clearer voice in the organization.
Five years ago, physician and administrative leaders at The Ottawa Hospital, Ottawa, Ontario, embarked on a comprehensive strategy to improve physician engagement. As one of Canada’s largest teaching hospitals, the organization is home to approximately 2,500 independent (non-employed but contracted) physicians, residents, and fellows. Specifically, leaders wanted to better engage the medical staff to help the organization join the top 10 percent of performers in North America for care quality and safety, as well as patient experience.
One of the earliest steps toward better physician engagement was creating a survey, say Virginia Roth, MD (pictured at right), chief of staff, and Renate Ilse, vice president. When designing the 70-item questionnaire, leaders at The Ottawa Hospital wanted to know what physicians were saying about the organization, how likely they were to stay, and how willing they were to go above and beyond their basic clinical work for the betterment of the organization. For example, questions measured how likely physicians were to recommend The Ottawa Hospital to other physicians as a place to practice, how likely they were to think about leaving the organization, and how much the organization inspired physicians to do their best work every day.
Findings from the survey revealed that physicians wanted the organization to focus on four key areas:
- Improving the work environment
- Promoting physician health and wellness
- Improving leadership development
- Enhancing the value of performance reviews
Following are some of the strategies that leaders implemented to address these concerns—and ultimately promote a higher level of physician engagement.
Addressing Environmental and Health Issues
To improve the work environment for physicians, leaders at The Ottawa Hospital created a dyad leadership structure at all levels to better integrate physicians in hospital decision-making and resource allocation. They also added more networking and recognition opportunities for physicians. In addition, they made easy changes to address workplace irritants and “technostress” resulting from IT issues, such as difficult passwords, electronic health record (EHR) entry, or software quirks.
The physician engagement survey also revealed that only 30 percent of physicians believed the organization was invested in their health and wellness. To better understand this issue, the hospital hosted a focus group, during which physicians offered ideas such as healthier food options, peer mentorships, and coaching. Many of these ideas have already been implemented.
Also underway is an initiative to use hospital-led mediation to address work conflicts before they escalate. In addition, leaders are investigating ideas to better support physicians following adverse clinical events and other professional crises.
Improving Leadership Development
Each year, The Ottawa Hospital invests approximately $154,000 (U.S.) to develop four types of physicians: aspiring leaders, program leaders, strategic leaders (typically service line directors), and executive leaders (department heads). For each group, the hospital created a graduated development plan designed to help physicians build their competencies over time. Part of the focus is on identifying and mentoring women for leadership positions.
Roth estimates that her organization has trained approximately 150 physician leaders, including many who are on the front line, through various leadership development opportunities—an effort that has had a positive impact across the hospital. “These frontline physicians are so influential in terms of engagement of their colleagues,” Roth says.
Enhancing the Value of Performance Reviews
The Ottawa Hospital’s physician engagement survey also revealed that only 35 percent of physicians understood how their performance was measured. Often times, performance evaluations were perfunctory, and physicians did not receive regular feedback on how they could improve. To address this issue, the hospital rolled out annual, hour-long, face-to-face performance reviews led by a physician’s direct supervisor. Leaders also implemented physician-developed performance metrics, although the medical staff was not measured against the metrics until the second year. “We really wanted them to focus on the process during the first year,” Roth says. Although the change did not impact individual compensation, a small portion of departmental funding is now linked to achievement of specific quality metrics. The intent is to increase the proportion of funds at risk over time.
A patient satisfaction metric is part of each physician’s evaluation. Roth credits the new performance review process for the organization’s rising patient satisfaction scores, with an increase in “excellent” overall rating of care from 35 percent in 2011 to 71 percent in 2018. During their reviews, physicians are encouraged to share three strategies that they will implement to boost their patient satisfaction scores.
Implementing a more robust evaluation process did create anxiety among some physicians, who initially approached their review as a test they had to ace, Roth says. Some also openly questioned whether their supervisor—rather than an independent coach—was the best one to conduct the review. Ultimately, physicians came to recognize that their performance evaluation helped them showcase their good work and got them an hour of face time with their supervisor—which often came with a commitment to offer more or continued support. “It’s such a powerful opportunity when the physician has that dedicated time with their leader,” Roth says.
Key to the success of this program has been training physician leaders on how to give effective feedback, Roth says. The hospital’s human resources department and external experts developed a training package with tools to help physician leaders practice giving feedback to high performers, low performers, and those who fall in-between—whom Roth calls “solid citizens.”
Administrators also created written scripts for the performance reviews at the request of physician leaders. “They didn’t want to have it in front of them during the meeting, but they did want to practice using the words and phrases,” Roth says.
Some physician leaders are implementing face-to-face performance reviews with physicians every quarter. “It’s a huge time commitment for them, but they’re really seeing the payoff in terms of engagement,” Roth says.
Roth and Ilse offer some additional suggestions for physician leaders seeking to improve physician engagement in their organization.
Create your own compact with physicians. “We realized that the top hospitals across North America had a compact that really guided expectations between the hospital and physicians,” Roth says. Recognizing the importance of creating their own compact rather than using a template, leaders at The Ottawa Hospital hosted a focus group of physicians who were randomly selected from different groups and specialties.
External facilitators asked questions such as:
- What kind of organization do you want to work in?
- What should you expect from the organization?
- What should you expect from yourself and your colleagues?
“The premise was to understand their values and what they thought would make a strong organization,” Roth says. The process affirmed that the goals of the physicians and hospital were completely aligned around the quality of care and the patient experience, and identified concrete behaviors for physicians and managers that would help them achieve those organizational goals.
Offer quality and innovation grants. The Ottawa Hospital offers physicians small grants as a way to compensate them for their work on improving quality and innovation. For example, grants have supported the development of mobile apps that allow patients with end-stage renal disease to manage their phosphate levels, and transplant patients to track and manage their immunizations after transplant. Other grants have supported process improvement programs designed to improve patient satisfaction and reduce costs, such as one initiative designed to promote outpatient labor induction.
Create more opportunities for physicians to offer feedback. Roth suggests that organizations host open forums and develop online feedback tools that allow physicians to voice their ideas and concerns to physician leaders as well as administrators.
Reaching Organizational Goals
Today, The Ottawa Hospital is closer to achieving its goal of reaching the top 10 percent of performers in quality and patient safety in North America. Roth and Ilse attribute this progress to a higher level of physician engagement, which leaders have built incrementally by creating a framework for collaboration, integrating physicians into operational leadership, and investing in education and support for physician leaders.
Having physicians more engaged will likely help leaders at The Ottawa Hospital implement some of their key initiatives this year, including the rollout of a new EHR. As Ilse says, “When the hospital helps physicians meet their goals, physicians are more likely to help the hospital meet its goals.”
Laura Ramos Hegwer is a freelance writer and editor based in Lake Bluff, Ill.
Quoted in this article: Renate Ilse, DHA, past vice president, The Ottawa Hospital, Ottawa, Ontario; Virginia Roth, MD, chief of staff, The Ottawa Hospital, Ottawa, Ontario.
This article is based in part on a presentation at the 2018 ACHE Congress in Chicago.