Safety of care
Physician leadership in safer medical care
Originally published December 2012
Managing programs, leading departments, championing quality and safety initiatives, and advocating for organization-specific and system-level changes — these are just a few of the areas where physicians play a leadership role in healthcare. When leading quality improvement and safety initiatives, physicians should consider a number of risk management strategies.
Physician leadership skills
Worldwide, many important advancements in healthcare quality and safety have been led by physicians. In today's complex and rapidly evolving healthcare system, physicians' leadership skills and administrative knowledge are sought at all levels. Physician leadership competencies in strategic planning, stakeholder relations, advocacy, change management, and innovative and critical thinking are highly desirable. These skills are sought after in positions such as chief medical officer, vice-president of medical affairs, clinical department head, medical director, and quality and patient safety leader.
The article, "The voice of professionalism within the system of care," provides more discussion of the physician's role as advocate.
Whether in group practice or hospital settings, the growing demands being placed on physicians will only increase the need for physician leaders. This is because doctors have a unique understanding of healthcare quality and safety issues, which makes them invaluable to system change and reform efforts. Where physicians are employed by hospitals or other healthcare institutions, physician leadership can be advantageous for the organization.1
Owing to such factors as increasing complexity of patient care, expanding workload, changing patient expectations, and changing scopes of practice, physicians sometimes share a leadership role with other members of a healthcare team. From the CMPA's perspective, clarity of roles and effective communication are key elements in reducing the number of adverse events and avoiding medico-legal difficulties that might result from shared leadership within a healthcare team.
Physicians as advocates for healthcare safety and quality
Physicians play a leadership role when they advocate for patients or for healthcare system improvements. They have deep knowledge of healthcare needs, are connected to their communities, are well regarded by the public, and are well positioned to work with government and other stakeholders to identify quality and safety improvements. To advocate effectively, physicians must recognize the importance of offering strategies to address quality of care issues, and be aware that misdirected advocacy may be disruptive to the provision of care.
Doctors are well-positioned to participate in decision-making that affects patient care. The CMPA encourages physicians to remain engaged in decision-making at the health authority and hospital level. Doctors can do this, in part, by seeking both formal and informal leadership roles that advance quality care.
Physician leaders and quality improvement
Quality improvement (QI) for healthcare organizations means proactively making improvements in patient care, clinical practices, and systems of care; analyzing (usually by a quality improvement committee) any harm from healthcare delivery; and implementing recommended improvements. Quality improvement efforts are patient-centred, and typically focus on safety, effectiveness, efficiency, accessibility, and continuity of service. Physician involvement in QI allows the full spectrum of issues and challenges to become known, options and potential solutions to be debated, and the required changes to be implemented and sustained.
Physician leadership is needed to engage other doctors in quality improvement activities. Physicians need to know that their involvement in QI will help to address their legitimate patient care needs.
When working in hospitals or other healthcare institutions, physicians must be familiar with the organization's policies and procedures for quality improvement. They should also know and leverage the QI infrastructure and systems to facilitate positive change. Leaders are responsible for articulating the vision for change, providing the necessary resources for quality improvement, and sharing responsibility for QI-related decision-making.
Physician leadership during reviews of adverse events and near misses
In a just culture of patient safety, hospital leaders and staff are committed to providing the safest possible care to patients and to protecting the interests of both patients and providers. This includes a shared commitment to learn from adverse events and near misses, and to make subsequent improvements.
A properly structured review of an adverse event and near miss is an effective approach to improving patient safety in a healthcare organization. Both quality improvement reviews (focusing on system issues to identify the causes of adverse events and near misses) and accountability reviews (focusing on the conduct or performance of individual healthcare providers) require the active involvement of relevant physicians. The CMPA encourages members to participate in properly structured quality improvement reviews in the interest of improving patient safety.
Reviewers should be chosen for their skills and knowledge in analyzing unexpected outcomes, adverse events, and near misses, and for their clinical expertise and ability to effect change. The CMPA believes it is generally inappropriate for those who play a role in annual performance reviews, and accountability and disciplinary matters, such as a department chief, to be involved in quality improvement reviews of providers who report to them.
Empowering clinicians to improve patient safety
Quality and safety improvement initiatives may stem from senior managers, or they may emerge from the front lines. Physician leaders may set the expectations for quality improvements, and then allow clinicians to seek the solutions and initiate the changes. In other cases, physician leaders may take a more active role in the actual quality improvement work. Regardless, physician leaders must be visible to encourage healthcare providers to engage in and support change.
The following actions may help physician leaders to engage other physicians in improving the quality of care, and may encourage potential physician leaders to participate:
- provide QI teaching and learning early (in undergraduate medical school and early in medical training)
- identify and leverage QI champions
- offer practical training on QI concepts and techniques
- establish the necessary infrastructure for QI
- use information technology such as electronic medical records as a QI enabler
- promote the collection and dissemination of information, including where physicians can make improvements (e.g. management of patient blood pressure, stroke rates, hand washing, immunizations, annual screenings, patient satisfaction)
- include QI responsibilities in physician job descriptions, where relevant
- include QI indicators instructively and supportively in physician performance evaluations
- provide remuneration or other rewards to physicians for their QI activities
- engage patients to obtain their perspective on QI opportunities
- promote and emphasize the benefits of QI and its uptake
- celebrate and promote physician leadership in achieving safer medical care
Information on the requirements and processes for reporting adverse events and near misses, and the best approach for reviewing these events is available in the CMPA publication, Learning from adverse events: Fostering a just culture of safety in Canadian hospitals and health care institutions.
Physician leaders essential to quality improvement
Physicians are on the front line of improving healthcare systems. Physician leaders are crucial for nurturing a quality culture in healthcare organizations and to achieving quality improvement goals. Continued success in achieving safer medical care depends on identifying, engaging, and developing such leaders.
- Stagg Elliott, V., "Hospitals ramp up physician training for leadership roles," American Medical News (February 23, 2012) Retrieved on February 28, 2012 from: http://www.ama-assn.org/amednews/2012/02/20/bisf0223.htm