Action 1: Prepare to Build an Action Plan
Who initiates action planning preparation conversations?
The service area leader (e.g., Director of Patient Safety, Director of Laboratory Services, etc.) should converse with her key physicians – physicians who are primary users of that service area.
How should action planning preparation conversations be structured?
Because service area leaders are likely well acquainted with their key physicians, conversations about perceptions can be casual. There is no need to schedule an hour and book a conference room. The service area leader may drop into the physician lounge during breakfast to ask questions or walk the physician to her car and have a walking conversation. The goal is to open up lines of communication and build a relationship.
PRC recommends conducting an informal gap analysis. In other words, seek to answer what the differences are between physician groups that rate your service area very highly and physician groups that rate your service area less favorably. (Not all services will see a gap. Some service areas may only have physicians that rate their area very highly. Some service areas may only have physicians that rate their area less favorably.)
Identify whether the gaps are in service (i.e. what you are providing to the physician) or in need (i.e. what different specialty groups require from your service area). Conversations are meant to inform action plans; they can also reap improvement of perceptions in and of themselves. Simply having the following conversations will often boost physician perceptions of your service area.
Conversations with physicians who rate a service area HIGHLY
If a service area leader is speaking with a physician who is part of a group that rates the service area highly, consider these talking points:
- “What is it about our services that you find most helpful?”
- “What do you think of (Key Driver of Excellence® question)?
- “Thank you for taking the time to provide feedback to me.”
Conversations with physicians that rate your service area LESS FAVORABLY
If a service area leader is speaking with a physician who is part of a group that rates the service area less favorably, this is not an opportunity to tell physicians that their perception is wrong. This is the time to listen to why physicians feel the way they feel. Structure the conversation like this:
- “We are really trying to improve and you are part of a key group that we’re interested in.” (Do NOT say, “I noticed your group scored our service area low.”
- “What can we do to make things easier for you?” Listen to feedback from physicians, make note of it, and do any follow-up necessary.
- “What is most important to you in terms of working with our service area? You can even be more specific and ask about the Key Driver of Excellence® in your area.
- “Thank you for taking the time to provide feedback to me.”
Action 2: Construct Service Area Action Plans
Who designs action plans?
At minimum, each service area included in the PRC Physician Engagement Study (e.g. Patient Safety, Administration, Laboratory Services, etc.) should construct a plan for how they are going to improve physician perceptions.
Summarize the information from all of the action plans into one document, the stoplight report (discussed in more detail later).
Following submission of the action plans and the action plans actually being put into place, each service area leader should provide QUARTERLY progress updates to the CEO. What is working? What is difficult? Any wins to report? This information will be updated in the stoplight report and shared with physicians and leadership.
What do action plans address?
Focus on issues that are important to a large portion of physicians in the action plans. The vast majority of physicians are generally positive (responding at least “Good” on the Excellent-Poor scale). Therefore, in order to have the greatest impact on improving physician perceptions, the focus in action planning must be on how to move physicians from being merely satisfied to being impressed by the service area. Success befalls those that can identify and fix problems, but also those that creatively design services that enhance the physician experience. A Service Excellence action plan focuses on moving physicians from feeling “Good” or “Very Good” about the organization to feeling that it is “Excellent.”
Key Drivers of Excellence® are the areas that are most influential to physician perceptions, so they provide an appropriate starting point for service area action plans. Remember, Key DriversSM are not necessarily areas in which your organization is performing well or poorly, but simply areas that have the greatest influence on physicians’ perceptions.
When it comes to creating action plans to improve physician perceptions, service area leaders should consider the difference between doing something differently (e.g., changing the reorder levels on syringes based on physician input) and talking about doing something differently (e.g., telling the physicians that you changed the reorder levels on syringes based on their input). Often, it’s not enough to change something; you have to tell physicians what has been changed. Don’t underestimate the value communication lends to improved perceptions. Saying, “Here is what we’re doing to improve delays and make our services timely…” for example, helps connect the dots for physicians.
What elements do effective action plans include?
Effective action plans require answers to the following questions:
- What is the objective? The objective is not to get better scores. Be more specific and make the objective about physicians, not about the survey scores.
- What are the concrete tasks that need to be done? Actions may include training staff, purchasing materials or equipment, developing checklists, or obtaining approvals.
- What is the timeline?
- How will you measure success? In other words, what will determine whether or not your action plan is working? You cannot wait until the next survey to measure success. You need distinct process measures, whether objective or subjective.
- What needs to be communicated and how will you communicate it? Does this action plan require input from nursing, environmental, or administrative staff, for example?
What does a service area stoplight report look like?
A service area stoplight report is a central repository for all of the service area action plans. Every service area leader provides an action plan to the CEO, along with quarterly updates. From this information, the stoplight report is created and shared with leaders and physicians. Use colors to denote progress: red denotes something cannot be completed (don’t forget to explain why); yellow denotes something is in progress; green denotes something has been completed. View an example Spotlight Report.
Action 3: Build Leader-Physician Rounding Structure
Effective communication requires structure. How do physicians provide feedback to leaders? How do leaders communicate improvements and other information to physicians? The answer at most high-performing organizations in terms of physician engagement perceptions is: senior leader rounding on physicians.
How do we structure leader-physician rounding?
Include all senior leaders in leader-physician rounding. Match specific senior leaders with specific physicians. For example, if there are eight senior leaders and 64 physicians, then each leader is assigned eight physicians.
Effective rounding solicits feedback from physicians AND reports progress to physicians. Gathering feedback from physicians does not end when the PRC Physician Engagement study ends; it’s an ongoing process. Conversations initiated by service area leaders to key physicians inform action plans and help build relationships between physicians and service areas. Leader-physician rounding, on the other hand, helps build relationships between all physicians and senior leadership.
When a senior leader is rounding on a physician, consider these talking points:
- “I am________ and I am here to talk to you because…” If this relationship is just beginning, provide a brief background. Introduce yourself (e.g., role, why you chose to work in this organization, experience, etc.). State why you are rounding – because his/her feedback is important.
- “How is your day going?”
- “Here is what is going on with the hospital…” What is being changed? What is the goal of that change? What is the timeline? NOTE: physicians do not need to know all the features of every change; they do, however, need to know the benefits and how it will affect their work and patient care.
- “What can I do to make your job easier?” Listen to feedback from physicians and perform any follow-up necessary.
- “Thank you for taking the time to provide feedback to me.” Too often, we only go talk to physicians when there is a problem to resolve. Don’t forget to thank them for their dedication and for taking the time to speak with you