Tom Closson, head of the Ontario Hospital Association, has written a blog post finding fault with my interpretation of a lack of interest on the part of doctors to take advantage of a funded program to improve care in the province's hospitals.
The link to his article is here. But I also reprint it in its entirety to let you decide if he answers the concerns I raised. (I feel like we are talking past each other. See what you think.)
I recently read a blog written by Paul Levy called $33 million (Canadian). Any interest? To read the blog, click here. The blog was Paul’s interpretation and opinion of an article in the Canadian Medical Association Journal written by Lauren Vogel, entitled “Uncertainties Surround New Funding for Most Responsible Physicians”. To read the article, click here.
I was quite surprised to read how Paul thinks that uncertainty surrounding the challenges with physicians participating in Ontario’s MRP Collaboration Incentive Fund implies that Ontario physicians are not interested in improving patient quality and safety. I know this is not the case.
Physicians are often engaged in quality improvement activities. The challenge, however, seems to be the ease of alignment of physician engagement with hospital and government agendas. The Ontario Hospital Association (OHA) recently hosted an event featuring keynote speakers Jack Silversin and Steven Lewis. Both speakers noted that there are many reasons for the lack of involvement of physicians with quality improvement activities, including lack of time, being funded for only fee for service activities, and the lack of training in quality improvement methodology. Put simply - if we want physicians to engage, we need to give them the skills and opportunities to do so and we need to invest in physician leadership. We also need to ensure that provider reimbursement models are aligned with good practice.
The Saskatchewan Medical Association along with the College of Physicians and Surgeons and the Health Quality Council of Saskatchewan have invested in physician leadership so that they are equipped to lead health system transformation rather than just play a part in it. In Ontario, the Ontario Medical Association (OMA) recently launched a Physician Leadership Development Program with the Schulich School of Business and the Canadian Medical Association (CMA).
We are also trying to play our part at the OHA. We recently formed a Physician Provincial Leadership Council aimed at working with physician and hospital leaders to inform health system change. To formally launch this Council, the OHA will be hosting an inaugural Physician Leadership Summit in Toronto on June 9 & 10, 2011 which will focus on physician leadership and the role of physicians in quality improvement. For more information on the Summit, click here.
Quality improvement is hard work and we need to work together to ensure that we are making health care better for all Ontarians.
Paul and Blog Readers:
ReplyDeleteI have worked with and taught physicians and other clinicians in Ontario - from Health Canada to ISMP-Canada (I live "nearby" in Michigan).
For example, University Health Network and Sunnybrook Hospital (Toronto) have featured seminars leading to a "fellowship" in safety for clinicians, including many physicians (where I have taught). My colleague and wife has participated in many safety and quality projects in Ontario through ISMP-Canada and Canadian Patient Safety Institute.
All that to say we have not really encountered anything that is much more or less than various places we work in the USA.
As for lack of participation, I can only provide what I encounter with "naive" med students, residents, and attendings: they truly do not know what "we" are talking about; when they find out, most love it and cannot believe they missed out on it. The effectiveness of any outreach/development effort CANNOT rely on the usual needs assessment and implementation methods.
Recently, I wrote about a patient safety design competition that ensnared lots of new participants here at Univ of Michigan
http://redforestconsulting.com/blog/2011/02/
The Ontario Hospital Association (OHA) recently hosted an event featuring keynote speakers Jack Silversin and Steven Lewis. Both speakers noted that there are many reasons for the lack of involvement of physicians with quality improvement activities, including lack of time, being funded for only fee for service activities, and the lack of training in quality improvement methodology.
ReplyDeleteFrom Facebook:
ReplyDeleteThis is a good example of the different perceptions and perspectives in our health care system. Paul, you are right to be frustrated with the physicians participation in the quality improvement effort (but the physicians should be building teams to address this, not trying to do it on their own) . The real problem is the fundamental attribution error(again)- the proposal assumes that individual physicians can improve the quality and that is not realistic. In reality, the core system structure for how we provide health care will need to be redesigned if we want any sustainable and significant improvement in our health care outcomes. The plan to engage physicians individually is flawed in its design. Iit will take diverse teams (including patients and their families) to implement realistic quality improvement initiatives.