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One expert says incentive programs to motivate physicians miss the mark. Here’s what he recommends instead.
Providing financial incentives is one of the most-used methods for increasing clinician engagement, but recognizing the hard work of physicians and helping them to feel they are truly making a difference may be an even greater motivator.
Jatin Dave, MD, MPH, chief medical officer at the New England Quality Care Alliance, a network of almost 1,800 community and academic physicians in Massachusetts, spoke about energizing front line clinicians for quality improvement at the 7th Annual HEDIS & Quality Improvement Summit in Miami on October 17. He says clinician engagement is the top pillar in a high-value, high-performing healthcare system. Without it, good programs, good data, aligned incentives, and all the other measures do little to support the system.
“If you don’t have physician leadership, the other pillars don’t even matter,” Dave says.
While many clinician engagement programs have focused on offering financial incentives to help motivate providers to meet quality improvement goals, Dave says those miss the mark and fail to acknowledge what truly inspires clinicians.
Here are five ways he says organizations can improve physician engagement:
Clinicians want to help patients and see improvements in health. Often, they don’t understand what’s behind the measures they are being asked to meet.
“Once we help them understand why we are doing what we are doing, they are really smart about finding ways to improve performance,” Dave says. “Our organization is made up of really small independent practices with very limited back-end infrastructure, but we performed remarkably well on quality because once we explained to them what really matters, they were able to make the necessary changes.”
Acknowledging the difficult work they do in caring for their patients and reporting on measures can make a big difference, says Dave.
“Once I recognize their work, they are willing to do other things,” he says. “It’s partly because of how clinicians are trained and how their community and culture works.”
By acknowledging the work clinicians are already doing and using that praise to motivate more change, you can harness the competitive nature of clinicians to improve performance.
Having trusted leaders who are early adopters also helps, Dave says, as well as a good infrastructure for shared success.
Beyond that, Dave says healthcare leaders also need to recognize the burden of the quality improvement system on clinicians. “We have been getting regular and consistent feedback that we have gone overboard in measuring quality,” Dave says.
He cited several reports in his presentation detailing the burden of quality reporting on physicians, stating that the average physician spends about 100 working days each year on reporting quality measures. This heavy reporting burden is a huge contributor to clinician burnout and dissatisfaction, he says. The sense is that the industry is more focused on measures and control than on innovation and improvement, and Dave says this has to change.
“We have to recognize that this is where we are right now and try to balance that,” he says. “If we don’t make clinicians feel like we are listening to their feedback and working to reduce the measurement burden, we will lose our credibility as healthcare leaders.”
There are over 800 quality measures initially cataloged to report on in Massachusetts alone, which were then narrowed down to 138 measures. Clinicians need to know that there is some effort being made to help reduce the time spent on activities that impede their ability to care for patients and truly improve practice.
“At the end of the day, engagement doesn’t mean they have to agree with everything we are saying. Agreeing to engage in healthy debate and dialogue can also help drive improvements,” Dave says.
When he is debating a process with a physician after a long day of patient care, it shows that physician is invested. The real problem, he says, is when no one is pushing back.
“As long as they are giving feedback in a constructive and professional manner, we should listen intently and try to make changes.”
Financial incentives do play a role in increasing clinician engagement, but that’s only a small piece, he says. The true motivator is for physicians to feel good about what they are doing, that they are providing excellent care, and that they have a larger purpose.