At the 2021 Virtual Indiana Lean Healthcare Summit, several incredible Lean leaders shared their experience fostering a state of healthcare excellence within their organizations. This blog post is a recap of one speaker's presentation, Deanna R Willis MD MBA FAAFP FNAP, Otis R Bowen Professor of Family Medicine at Indiana University, in which she discussed “Engaging Physicians in Lean.”
There are several ways to help support and engage physicians through a Lean mindset. Let's take a look at seven steps we can use to engage physicians in Lean:
1. Understand the Local Culture of Quality Improvement
For physicians, quality improvement has been used for decades in healthcare and healthcare systems. But in the past, quality improvement work has been tied to financial incentives and disincentives. This gives quality improvement a bad connotation and ties improvement to extrinsic motivation. Understanding this misconception is essential in changing the narrative to show physicians and healthcare workers the value of quality improvement independent of financial motivations.
2. Address What Matters
People become physicians because they want to help patients truly. Therefore, focusing on what matters to the physicians and what they think has meaning to their patients will be extremely valuable. They will begin to see the importance of improvements when they see the direct benefits to their patients.
3. Bring the Data to Life
Physicians are trained to understand research and data - but there is a stark difference between understanding research data like physicians have all learned, and quality improvement data, which is a significant component in Lean thinking. A few aspects that differ between the two include bias, flexibility on hypothesis, and testing strategy. Being able to articulate this difference is huge!
4. Identify Quick Wins
It's common for younger physicians to be more exposed to quality improvement principles and lean skills than their older colleagues. These younger physicians, who may lack official leadership titles, can be excellent role models and informal thought leaders for process improvement across an organization. With lean-minded leaders in place, focusing on breaking bigger problems into smaller ones and targeting improvements where you are most likely to get early wins is ideal. These younger, Lean-minded physicians can help pave the way for these improvements.
5. Deal with Skeptics
There will always be skeptics, and it's the process improvement team's job to prove them otherwise. This can be done through the use of data by showing how and why it was collected and why the data proves that a change is needed. You must engage early adopters to set the example of process improvement concepts and actions. Finally, formal leaders will need to be on board to confirm the need for change and create an environment for quality improvement.
6. Address Burnout
There are several important ways to ensure physician engagement does not turn into burnout, including:
- Understanding the causes and factors contributing to burnout locally
- Using Lean to implicitly and explicitly reiterate these practices
- Finding ways to simplify physician workflows
- Finding ways to empower the healthcare team to support the work to the “top of their license.”
7. Don't Give Physicians a "Bye"
It is important to include physicians in daily process improvement work with the rest of the team. It may be easy to give physicians a pass, but it is essential to include physicians in every step of the Lean work. If we give them a "bye," this prevents them from serving as active team members. Once again, keeping titles at the door ensures that everyone has an equal voice in quality improvement. The only way to truly execute quality improvement is to engage each and every member.
These seven steps in Engaging Physicians in Lean from Dr. Willis are influential in creating more engaged physicians and a highly effective organization. Engaged physicians are:
- More loyal
- More productive than their counterparts
- Willing to work through challenges
- Trust and cooperate with others
- Speak out about problems
- Offer constructive suggestions for improvement