Podcast | Engaging Physicians

Better Never Stops | Engaging Physicians

Chris Backous: Thank you for joining us for Better Never Stops, our podcast for healthcare leaders and everyone committed to transforming healthcare. We interview leaders from our clients and partners around the world as well as leaders right here in Seattle who work to maintain a culture of continuous improvement at Virginia Mason Franciscan Health.

In each episode, we hope to explore a philosophy of “go see, ask why, and show respect.” My name is Chris Backous and I’m an executive partner for Transformation Services at the Virginia Mason Institute. I’ll be your host for this episode of Better Never Stops. Today we’re talking about how to engage physicians in healthcare improvement.

We have some exciting guests with us today from across the world. And so our term of physician, which is mainly US based, will also take different forms as we discuss and share information. Today, our panel will be helping us explore the question of how do we engage the key healthcare participants in improvement to truly make a difference for the care of patients.

I’d first like to introduce Wendy Korthius-Smith. Wendy, can you introduce yourself and talk a little bit about why this topic of engaging physicians in healthcare improvement is so important? 

Wendy Korthius-Smith: Absolutely. Thank you Chris. So I am the executive director for Virginia Mason Institute for the past seven years.

But my tenure goes back to Virginia Mason Franciscan Health in the mid nineties. And so for those of you who are less familiar with Virginia Mason Institute, our vision is really to support leaders. Transforming healthcare across the globe, and so spent the last three decades driving large-scale change and transformation across healthcare and corporate sectors as well as government.

And I would say most notably, this work has included melding the timeless principles of the Toyota Production System and leading edge practices to help systemize transformation, learning and improvement internationally. So excited to be here, Chris, for us to discuss this topic. I absolutely love this topic.

You asked me to comment a bit on the why. Most know that over the past two decades we’ve been on this remarkable journey trying to transform healthcare across the globe and within our own system, which we call the Virginia Mason Production System. And then we partner with leaders across the globe to help them create their own system for transformation, trying to really leverage and accelerate the learning. And throughout this we’ve held onto this belief that physician engagement is really essential for this work. We’ve seen firsthand that physicians are much more than care providers.

They can be key leaders, decision makers, and powerful influencers of change. And we’ve also learned their engagement is really essential and foundational for creating and sustaining improvement across our system. And yet despite this critical role, we see engagement of clinicians, and physicians in particular, remains inconsistent or underutilized in many health systems.

And I think often intentions are to protect, because they seem too burdened, too busy. They need to be too involved in direct patient care. However, we recognize that if we really want to unlock the full potential of the hearts and minds of those closest to the work, we have to do more.

Chris Backous: Thanks, Wendy. You know, it really is about engaging physicians. One of my greatest joys is when I see the lights go on for people, and that they can make a difference in the work they do, and they do have an influence. When people realize the opportunity is bigger than any one person, any one role, that transformation is something we all can participate in.

I go back to something that Don Berwick said about the patient experience: “nothing about me without me,” but that really applies to improvement as well. So in the spirit of engaging physicians, I’d like to welcome in our two guests. Our first is Eliot Fagley. Eliot, you’re here in Seattle with Virginia Mason Franciscan Health. Can you give us a little bit more about your background and then we will introduce our next guest? 

Eliot Fagley: Sure. It’s good to see everybody. Thanks for having me. This is really one of my favorite topics. This is a real pleasure to get a chance to talk about, so I appreciate the invitation. My name’s Eliot Fagley. I’ve been at Virginia Mason for 13 years now. Can’t believe it’s been 13 years, but it has been. I actually came to Virginia Mason originally from St. Louis, from Wash U, where I was a cardiac anesthesiologist and intensivist. My wife and I moved to Seattle and I had heard about this little place in the Northwest that was doing some really interesting quality improvement work from, I believe it was a Newsweek article about the Leapfrog group at the time. And I remember first hearing about Virginia Mason then, and when we were thinking about moving to Seattle, it was the first place that I came knocking on the door. I had heard about the Virginia Mason Production System from back before I ever moved to Seattle, and it was one of the real draws for me to come to Virginia Mason in the first place.

And I had the opportunity to then do the VMPS for Leaders Training and Leadership Development Institute. And I’m a graduate of the advanced VMPS training and just recently got to do the Japan Kaizen trip where we go visit the factories and really see that firsthand and got to lead a group through that.

So, I’m pretty dyed in the wool VMPS, and have really, used it in a lot of different ways over the course of my last, several years as a leader. I currently serve as the Northwest Region Director for critical care, so 10 hospitals across Washington and Oregon. And lead all of our physicians as we deliver high quality critical care across the region.

Chris Backous: Excellent. Thanks so much, Eliot. And then you just personally, it’s been always such a great joy to work with you because you have this spirit of what’s possible. You know that mindset of what if and why not give things a try. I’d also like to bring in Magnus Harrison. Another person that I’ve had a real great opportunity to have that shared experience with is also a good colleague of ours from across the pond, over in the UK.

And that’s Magnus, Chief Medical Officer for Leeds Teaching Hospitals Trust. So, Magnus, would you introduce yourself and give us a little bit of your background as well? 

Magnus Harrison: Thanks, Chris. Hello. Hi, Wendy and Eliot, lovely to meet you. Welcome from Leeds Teaching Hospitals in the north of England. My name’s Magnus Harrison.

I’m an emergency physician by training and I’m the Chief Medical Officer at Leeds Teaching Hospitals. And to just give you a little bit of context about where we are, Chris, we’re a seven center, multi-specialty center. So anything from standard hip care for your grandma who’s in the community, right the way to pediatric liver transplants, so half of England, and everything in between.

So integrative care with the community that we serve directly, and then a more specialist approach. We do a bit of everything. I’ve only been here two years, however I’ve been aware of the VMI work around quality improvement since you came into the UK in 2015.

And I was actually a CMA then. I was still a Chief Medical Officer in 2015 and we bid to be a VMI hospital and failed. I was mortified. Why am I interested in it? First and foremost, it’s, top of any pyramid is patient. There’s a single word. It’s how we look after patients in a more effective, timely, responsive, equitable way.

And I think if you’ve got the right improvement science backing up that thought process. And it all becomes a lot easier. And in the UK, listeners may be aware that we’re in a kinda unique position. We’ve got a new government, we’ve got very little funding coming forward for the National Health Service.

So we’ve got significant weights throughout the whole of the UK. And what I’m seeing at the moment is that the altruistic nature of clinical care is not – we’re not creating the right environment, for clinicians of all stripes to actually deliver care in a meaningful way, in a timely way. And I see that leading to burnout.

So physician burnout, consultant burnout is, is really something that I’m focusing on. And I think if we get this right with the right improvement science and people understand it and apply it in a correct way, we enable people to do 

And I’ve really been interested in the work that Tait Shanafelt in Stanford and coming outta the Mayo Clinic about physician wellbeing, and a significant portion of physician wellbeing is actually driven by the altruistic nature of what we’re trying to deliver. So if improvement size helps me to deliver more healthcare, both operational effectiveness and an improvement in clinical outcomes, guess what?

I’ve got a happier physician workforce. And there’s, again, just to contextualize, we’ve got 1300 consultants. 1300 physicians as part of the group, 3000 doctors altogether. So there’s a lot to go out and lead. really happy to be here, Chris.

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Wendy: So let me just start with a couple things to get the conversation going of kind of the why. First I’ll start with something very simplistic, and I think that’s just simply we need to transform healthcare, right? Like we’re at this point of unprecedented change and challenges and there’s this significant opportunity to kind of think differently, shift our thinking, innovate, explore, and really improve.

Even that we’ve been on this journey for 20 years, there’s vast untapped opportunity and potential for transformation, and so the future of our healthcare globally, as well as locally, really depends on our ability to lean into the improvement science and innovation, and leverage the lessons learned. And this is engaging all of our people and physicians really must be at the forefront of that effort.

The second thing I’d mention is: we’ve seen firsthand on our journey how engaged physicians can be these central navigators for complex systems. They’re these phenomenal catalysts for change and healthcare is described as one of the most complex organizations today, and physicians bring this really unique and natural improvement lens, that deep clinical insight, that frontline experience, and really a passion for patient-centered care. 

And essential to identifying the opportunities helpful in designing the solutions and really driving meaningful change that is practical, sustainable, and really impactful. The third piece I’ll mention is, you know, while people think of physicians as clinical encounters and clinical engagements, it’s not just about the delivery process and clinical outcomes.

The engagement of physicians in this work we’ve seen positively impacts team collaboration. Patient experience and then physician satisfaction itself. So seeing it as sort of that ripple effect of engagement that’s so powerful that we can leverage across our systems. And the last piece I’ll just say is kind of in that spirit of partnership, most of our transformation improvements happen with physicians, not just around them. And so really leveraging that spirit of partnership, and I’m gonna pause there. Because there’s so much more that I could say, but I really am looking forward to hearing from our physicians today and seeing where the conversation takes us.

Chris: Thanks Wendy. So let’s get into our conversation.

I go back in time, you know, 23 years ago I was doing some of the initial improvement work of Virginia Mason. You know, we called it lean before we ever called it the Virginia Mason Production System. And having a brother who’s a surgeon, I knew quite a few surgeons before I came into the role of improvement and one of the surgeons I talked to, I said, so what’s your fear about all this?

And he said, you know, my greatest fear is you’re going to tell me how to operate. I said, you know, the good news is I’ll never tell you how to operate. My goal is to make it so easy that all you have to think about is the operation that you’re about to start, and the rest of things just fall into place and make it easy to do that.

You may find that when we remove many of the other burdens of work, you may find the method being an effective way for you to improve the way you do your own operating. I’ll never do the method to you, but we may use the method together. You know, flash forward five years later, that’s exactly what we’re doing.

He reminded me of what I had shared with him as, you know, you said this was gonna happen and it’s actually happening, and things are going to be much better because of that. And I’m just wondering, when you start working with consultants, physicians, high credentialed clinicians.

What are their concerns when you start talking about process improvement? So maybe Eliot, we start with you and then Magnus. 

Eliot Fagley: Yeah. I mean, you really identify an important question to start with, when engaging folks in this kind of work. I think the first thing many people get concerned about is, I’ve done something this way for a really long time and I’ve been successful in doing it this way.

Why do you want me to change and how do I know things aren’t gonna get worse? Yeah, and you know, it’s, especially in healthcare, it’s such a high stakes environment. You know, we’re dealing with people’s health, we’re dealing with people’s lives. We’re trying to deliver the highest quality healthcare outcomes that we possibly can.

Those are pretty high stakes to be involved in. So I think this is where this Venn diagram of engagement, stakeholdering, you know, bringing people in on the ground floor, is really incredibly important. I think if our team members get the opportunity to help build the system, then they really can understand how the tools that we’re using and the system that we’re building is actually going to be able to improve the way we deliver care to their patients.

These folks have very, very deep social contracts with their patients. They care very deeply about their patients and keeping that in mind is, is incredibly important. But you know, as we bring these providers into quality improvement work, they do care deeply about how they deliver care to their patients.

Chris Backous: You know, and that’s so important, Eliot. I think about one of our respect for people elements is to walk in the shoes of others. It’s one thing to see someone who could do better, but to take a moment and understand why they care so much. You know, listen through the words to the intention and what they truly are most concerned about.

And there’s a lot at stake. And, it may sound better, but what I do every day is known and I can trust it enough. And so there is that, that element. Magnus, I’m wondering, you know, you had talked about, burnout and so you know, we often say, well, let’s get you involved in improvement.

But having, by having a say in how the work is done going forward may help you contribute, which might help reduce burnout. But again, it’s how do we get you started and what barriers do we need to overcome with the clinical group to make improvement happen? 

Magnus Harrison: I recognized everything that Eliot’s just said.

Very great similarities in the UK physician group. I’d like to go back a little bit further though, so if you, if you go right back to medical school. We just don’t teach this, so we teach subject matter expertise on an individual level, and we want people to be clinically autonomous in their decision making.

We actually teach them that. And if you imagine, fast forward 20 years from the day you entered medical school, you’re going wanting to make a difference. Nothing changes in that 20 years. You still wanna make a difference and you believe your ways are the only way. And I stepped forward as a CMO and said, oh wow, we’ve got this improvement science, and they look at you and they, it’s kind of snake oil witchcraft, and they don’t believe you.

So there’s an educational piece so that people understand. As Eliot said, I’m not gonna change what you do and the social contract you have with your patients, I’m not gonna change. I just want you to think about this slightly differently and that we could do things in a more timely way.

If we thought about waste as an example, we thought about non-value added stuff that goes on in every patient journey, how would we identify it and remove that? And I think running alongside that, Chris, the bit that I kind of struggle with: medicine is a team sport, whatever brand of medicine, there’s so very little I used to do clinically that I would lead on as an individual in any sort of clinical scenario.

And you’re relying on teams solving complex problems all the time. And you take a bunch of physicians and you put ’em in a room with multidisciplinary teams that they’re not used to. It’s trying to tell them there’s a different sort of, maybe slightly more effective way of doing what they’re doing.

And there’s a number reaction you create reacting straight away in that group. So it’s partly education, and introducing new concepts slowly and gently so that they understand and they can see the evidence based behind it. Then, then it’s integrating that into the whole team approach to whichever PA pathway, patient pathway you care to think about.

The operational effectiveness that you can improve with Virginia Mason Production System is there. I try and tie that in with clinical outcome improvement as well. And if you can hit that sweet spot and you know what, you’ve suddenly got engaged consultants and Chris, I might have made that sound really easy.

And if anybody thinks it is, this is hard work. It’s hard emotional work and you’ve gotta grit your teeth a bit as well. ’cause you’ve gotta keep going. Even when it might feel that it’s really too difficult. You keep plowing on. 

Chris Backous: Well, you know, you both, and Wendy, you talked about this a little bit as well, is, we’re talking about scientists, who trust data, who trust known things, and yet we come and say, here’s a way to make things better.

But when you’re just starting out, you don’t always have that evidence. What are some of the things that, and this is an open question to the group, what are things that have been successful, kind of overcoming that initial doubt? Is it, you know, helping them see examples from others?

Is it getting them involved in something small that’s easy for them to kind of wrap their head around? What do you think would be effective strategies or things that have been effective for you?

Eliot Fagley: This is one of my favorite things, bringing folks into these projects in ways that, maybe they didn’t necessarily expect to be as engaged as they end up being. As you’ve just said, we’re talking about scientists, we’re talking about people who have been, you know, they’re smart enough to get through medical school and they’re smart enough to get through their residency, they’re infinitely curious people who are, you know, it is a professional demand to remain intellectually curious throughout the, the course of your career.

Our physicians love data, and this is one of my favorite things to do, is to just lay the data out for them. Data transparency for physicians and other providers is I think one of the most powerful levers to get them interested in what we have the opportunities to to improve. If you’re not being introspective about your practice and you’re not looking at where the opportunities are for improvement, you’re never gonna have the chance to improve.

So we are very transparent with our data. And in fact we have several collaboratives. We call them our quality collaboratives, and we do a little lesson at the beginning of each one of those that there are big dot metrics that our executive team is gonna want to see. We have outcome metrics that are things that, you know, we want to see from inside our unit, but the area that we can really.

Have a big impact is in the area of process metrics, the things that we can actually write an order for. Touch a patient, move physically through the system. Good process metrics make for good outcome metrics, which then make for good big dot metrics if you focus on good process.

All of the other stuff comes along with it and laying that data out for our physicians to be able to see, they often identify the areas that they have a lot of passion and want to go work on themselves. So that’s actually been an incredibly powerful tool for us in getting physicians engaged.

The other aspect of this is that engagement begets engagement. So if you can find small opportunities for your physicians, consultants, providers to, to get even just a little taste of system engagement, oftentimes they take that bait and run with it in ways that you just could never imagine. And the more engaged they are, the more engaged they get.

You know, the thing about being a physician thinking about quality improvement science is that, you know, we as healthcare providers have a superpower. We get to take care of people and that’s a real blessing to be able to do that. And it really is kind of a superpower.

Not everybody gets to do that. You can take a physician and have them thinking about their patient. And what the outcomes are going, the potential outcomes are going to be for their patient and use that to apply to quality improvement. But it’s a little bit difficult to do that the other way around.

Our quality improvement team is there to facilitate that thinking. Not necessarily responsible for the outcomes of the patients. So, you know, it’s nice to have folks who are thinking about both of those things. How do I improve the delivery system to make the quality of care delivered to my patients as good as it can possibly be?

And you know, oftentimes you lay the data out in front of them and they say, oh geez. I would love to be able to take care of one more patient a day, two more patients a day. You know, it’s just more lives touched. It’s more opportunities to help your community, 

Chris Backous: You talked about sharing data. It’s, you know, replace the word data with information, sharing information, that why message, Wendy, you talked about the importance of the why. How many times do we talk at people or talk to people instead of with, and I think that’s the piece is, you know, people who get labeled as resistors aren’t always resistant.

We’re just not listening to what they’re really saying. Magnus, I’m wondering, what thoughts do you have about engagement and strategies that have been effective? 

Magnus Harrison: I think you’ve gotta create the conditions for success. You’ve got to have the right ingredients in the right places at the right time for people to actually want to engage in the right way.

So, partly conditions, I think having an executive team who understand what is actually going on and been able to role model, you know. For me, being able to go out and say, yeah, yeah, I’ve done the improvement around my emails. Just something so simple as emails and only 9% of them actually need my activity.

And you can put a bunch of rules in and guess what? My to-do list, which used to be emails, is no longer emails. And you know, you can see people thinking only 9% only if I do that on mine. So there’s that exec engagement. And the executive actually understanding, role modeling throughout the hospital as Eliot was talking there, I think that there’s quite a lot of custom and practice that we’ve got to debunk as well.

I’ve been doing this this way for X years and I think taking people into what is actually a really uncomfortable place for them is what I believe actually true. Given that I’ve been doing it for 20 years and I’ve heard you guys describe it as mental values. I love that concept and being able to.

Actually just put it on the table and say, is this a mental valley? Can we just gently, curiously challenge ourselves about what we know and is what we know really true? And, and one of those things that, you know, when I’m walking around the various hospitals and I. And we’ve always done it that way. Here it’s kind of a hedge shrink moment for me.

Oh no, who know? We’ve got work to do in this area, so you can identify areas that you’d want to delve into. You can identify teams where you want to get involved more with an improvement science as well. So quick wins. Culture, um, uh, uh, set by the executive and role modeling the conditions for success, Uhhuh, and then that ability to gently challenge, you know, subject matter.

It’s probably be the same for Eliot. There’s internationally renowned physicians of every type here. Um, challenging and internationally renowned expert is what you think. Really true. There’s a skill to that as well, and that mental valley conversation, if you do it the right way, you can see people thinking.

Uh, maybe, maybe there is something in there. 

Wendy Korthius-Smith: Yeah. 

Chris Backous: You know, Wendy, one of your greatest gifts I think is just observing how you engage leadership teams and help them see things maybe from a different perspective. And I know you’ve been in the room where someone has said, you know, if the doctors would just.

And you help reframe. I’m wondering, so Magnus, you’re talking about the importance of executive modeling, so how do we help? Executive teams understand the importance of engagement of their physician group. Wendy, do you wanna pick that up? 

Wendy Korthius-Smith: And maybe I can add to the previous question just a little bit in my response. So there’s so much, again, that could be said about this, but in trying to be succinct, I guess I would say one of the things that’s been most impactful is having the opportunity to go see. And so taking leadership teams, taking physician groups to actually the site where the work is happening.

I think Eliot, you described information and data, making that visible. And I think seeing these practices, these concepts at work in real settings is so powerful as well, and then people can see what’s happening. They can experience it and they can ask questions. I know Magnus, we’ve brought groups to Leeds.

We’ve brought groups to Coventry. We’re bringing groups to Seattle and the Pacific Northwest. So they can have that go see experience. And I think, you know, we always say, make it yours. You know, learn from the lessons and make it yours. And sometimes it’s not until they see how others have made it theirs, they go, oh, that’s what you mean.

You really want us to make it ours. Like build on our success and make it unique to our culture, but with these timeless principles. So I think that’s one piece that is so important. I think the other piece I would say is building on what Magnus said around conditions for success. And so when we talk about this, I think of how do we wraparound with a management system to support this work?

And so thinking about the routines and the behaviors and the structures so that it’s not person dependent. It’s not one leader, it’s not one physician. It’s a system at play that really helps. And so when they can see that as well, they can see the routines and the behaviors and the actions that are at play, they can resonate with that and think about how they can apply that to their own setting.

I would also add. One of the things, I think this goes a little bit back to the previous question about, physician engagement in itself and concerns is the compacts that we’ve seen come into play or the psychological contracts, which is about the give and gets. And I think this kind of ties to your question, Chris, too, around leadership, right?

Because, when we think about psychological contracts, you know, it’s like, here’s what the organization is gonna give, here’s what the leaders are gonna set out in terms of expectations and here’s what the gets and the gives are from a physician or from a leader perspective as well.

And so you can see that interplay and it’s really about making that implicit, explicit. And trying to get a clear understanding of how we are gonna be reacting and engaging in this environment. And that can be, that clarification in itself can ease concerns and because then, then all of a sudden, now I know how to inter engage in this system at play. 

Um, and then the last thing I’m gonna say, because again I said there’s so much that can be said, but I wanna hear from Magnus and Eliot as well. And one of the things I was thinking about, especially Magnus, when you’re talking about data, is the language that we use with this. And so I can’t help because I’m also thinking of Magnus on this conversation.

In the UK it’s, you know, productivity and financial pressures, and so when you talk about data, sometimes people think, you know, oh, the language of what we’re hearing. Can actually be, you know, somewhat of a negative for physicians. When you talk about, you both talked about the passion and the patient-centered care, and so I guess I’m curious about any comments you would make about the language of sharing that information that, you know, somebody listening might think, oh yeah, we wanna provide the data, and then they go in and say, you know, here’s the productivity data, here’s the data on finances. What, what would you say about that? 

Magnus Harrison: So, Wendy, you’re absolutely right. So, you know the go see, we still call a Gemba walk here, and that sort of shrouds it in mystery slightly. 

So if you say productivity, all physicians hear is, are you saying I’m lazy? The problem we’ve got at the moment is the national rhetoric is around productivity. You’ve had this many more staff since Covid and productivity has gone down, and you know, there’s still many reasons why that’s right.

And that’s why we’d wanna discuss it. So there is something about the language, and that’s why I’m trying to not turn it round in a surreptitious way into altruism. I just knew the moral injury that I witnessed during covid, the morally, um, damaged folk I dealt with who couldn’t operate on the upper GI cancer during covid.

I still see that now, and what I’m trying to almost change and change the way people think is that in actual fact, if you want to be more altruistic, I can give you a method for doing that. I can give you a different way of thinking about doing more for the patients in which you’ve got that deep social contract.

It feels like I’m selling it. I don’t want to be seen as a salesman. I just wanna provide a different way of thinking abou delivering care in a more effective, impactful way for our patients. 

Chris Backous: Well, you know, it’s, it’s interesting, I think what you’re really getting at here is words matter. It’s not what you want to say. It’s how you need to say it is. And engagement begins by understanding the other, and I think some of that is we just don’t always understand our roles or do they understand the role the way I understand.

Have we had that conversation, Wendy, you talked about the compact, which is that two-sided understanding. Have we ever started out with a conversation about here’s what you can expect and here’s what we need you to do, Eliot, I’m, I’m wondering if you’ve ever had kind of a, a challenging situation where you’ve had to kind of be clear on it and, and listen and understand at the same time.

Eliot Fagley: Never, I’ve never had a challenging situation like that, ever once. We’ve actually undergone a really, really big change in our critical care program, just over the last couple of years. So I’ll use a very concrete example for you. We had a group of physicians, it was a contracted group that was providing service across five of our locations in the South Puget Sound area.

And we wanted to offer them employment. So this was a private practice group that was contracted with our hospital system. We wanted to bring them in. As I’m sure you can imagine, when the initial conversation comes up and somebody says, in one of those meetings, we’re going to exercise the no cause termination clause in your contract, everybody in that group says, why, what do you, why are we getting fired? And you know, to go back to your idea that words matter, you know, if you present that conversation in a slightly different way, then it turns into no we’re not firing you. We are actually so happy with the work that you’re doing, that we want to bring you in as employed members of our system.

Then we get into conversations about, well, why is that better for us? And you know, why would that matter? And then we get to have a really good conversation about the alignment of incentives. And aligning incentives for a group of employed positions is a really powerful tool in improving engagement and in improving quality outcomes. Now, instead of, you guys are getting paid a certain amount of money to provide X amount of service and you’re not interested in going above and beyond your contract, now as employed physicians, I’ve got this whole group of ICU doctors who are now engaged in committee work.

They’re engaged in quality improvement work. They’re getting more and more excited about the opportunities that they see to improve the care model, the delivery care model. They’re looking for additional opportunities to spread from our virtual ICU and touch other parts of our region, giving them the opportunity to help take care of more patients.

So that alignment of incentives was, has been really fantastic. When we have these challenging conversations looking for those opportunities to show that incentives can be aligned and you can get people rowing in the same direction so that the organization sees benefit you as individuals see benefit, and most importantly, your patients see benefit.

That really ended up being a great opportunity. It started with an unfortunate message delivery, but it’s ended with something really pretty fantastic. We lost almost none of those providers. There were one or two folks that were gonna be leaving anyway because they were moving to different parts of the country.

But it’s really challenging to bring a group from contracted to employed and to be able to do it without losing anyone is almost unheard of. And we really did it by making sure that we understood. Aligning incentives and, and delivering better care to our community. 

Chris Backous: You talked about, um, connecting big dot metrics to metrics that matter to teams, and I think it’s, it is that leadership role of being able to connect dots, you know, like what are we asking you to do and why that matters.

Maybe I have to understand the dot you’re starting from and Magnus, you had talked about, you know, that’s not the way we do things around here. And we’ve been kind of dancing around the fact that sometimes the culture, the way things are, the way things that get done maybe need to change and that courage to try things differently. Magnus, what are your thoughts about that? 

Magnus Harrison: So Chris, just, um, going back to your previous point and to Eliot’s point about rowing in the same direction, I think one of the things we get wrong quite regularly as an executive group is assuming the intent of others. Yeah. So you have this fundamental attribution area.

Doctor X is behaving in this way because of y and you know what, we’ve never even gone to Doctor X and said, what? What? Just, just being interesting, a bit curious, tell me about this, tell me a bit more about what you’re saying. So that level of understanding and the ability to assume their intent, just get rid of that.

We’ve gotta move away from that. And I think it’s almost that transactional analysis piece about adult and adult conversations and the executive not being viewed as patriarchal or parents in that, in that triangle. Don’t assume intent on the behalf of others. And Chris, when you were saying linking up, then all I’m thinking about is the golden thread.

So the signals you send out as an executive. So you know, every meeting I start, I start with our blue triangle. I talk about our patients. I talk about Leeds’ mission to be the best for specialized and integrated care. We’ve got our strategic priorities for the next five years. We’ve got our annual commitments.

And guess what? There’s a golden thread that runs through everything we do, which gets to that. North star at the top, which is our patients. I dunno whether I’ve answered your correct question, Chris. 

Chris Backous: Well, it’s, it’s the connecting the dots and the golden thread and, you know, you’re talking about that alignment to purpose and Eliot, you talked about alignment, you talked about assumptions. I remember very early on doing some process improvement in one of our outpatient centers in Seattle and I was told, don’t go over to that corner because Dr. So-and-so will not do in-room documentation. 

And I knew the physician, he was a pediatrician for my niece and nephew, and I walked over and I said, I’m hearing that you don’t want to do this. He said, Chris, I never said I wouldn’t do it. I said I couldn’t. And he showed me, the rooms were too small for a full PC, so they had to use laptops and they had track pads and he had a tremor in his hand.

And no one ever thought about that. And I said, you know, give me a day. I came back with a travel mouse and I set it up on all of his computers, and that was the day he started documenting in the room. I just remember: don’t assume. Understand, seek to understand, you know, walk in their shoes for a minute, demonstrate that respect.

That’s important. We’re kind of nearing our time and I’m wondering if you were to distill down this wisdom of how to best engage physicians, clinicians in improvement. If you had like two top tips for people to take away from this, what would you say? So Eliot, we’ll start with you then Magnus, and then Wendy.

Eliot Fagley: Oh, geez. Only two. That is quite a distillation. 

Chris Backous: I’ll give you three if I want three. 

Eliot Fagley: I think this, this last topic that we talked about is a really big one. Identifying opportunities to align incentives is enormous. Assuming positive intent and knowing that our providers really do care deeply about the delivery of high quality outcomes to our patients. You know, I often hear folks say, well, you know, we’re not building cars. So why are we dealing with a production system? But we actually do have a product that we are trying to put out. That product is healthy outcomes for people.

Keeping in mind that that social contract with our providers runs very deep. They take it very seriously. And that is going to be the thing that you want them to focus on as they’re engaging in this quality improvement work. And then the last one is just that engagement begets engagement.

You know, the more folks start to get involved, the more they want to get involved in it. There have been very few situations that I’ve run into where somebody suddenly gets involved in a bunch of, you know, committee work around the hospital or, you know, find something that really excites them.

It’s very rare that they don’t continue that in an ongoing fashion. So those are my big three. 

Magnus Harrison: Don’t ever underestimate the power of signaling. So as an executive team, people are watching you all the time and whatever meeting you are in, even if you’re walking around, we’ve got a concourse with a Marks and Spencer Food Store.

Some of you might know where that is. It’s a food shop in the hospital. Even when you’re in there, people are watching you. They’re watching what you’re doing. They’re watching how you’re behaving. So don’t underestimate that. And I think role modeling is vitally important. I think the second one for me is listen to understand.

We’ve got two eyes, two ears, and one mouth. And I think that 80/20 ratio is about where we need to be. So don’t go in with an answer, just go in being curious. I spend a lot of time just sitting with clinical teams listening, Chris, and it’s really valuable.

Wendy Korthius-Smith: So for me, I would echo, I love the comments that both Magnus and Eliot had shared as well. And I guess I would add, based on some of our discussion, like how do you capture attention? You know, there’s so much going on right now with physicians, with providers challenges andpressures. And so in this noise and this busyness, how do you really capture the attention?

And I think some of the things we talked about around value for the patient, given that as the area that they are so passionate about and so focused on. And then it’s also value for the physician or the provider around reducing burden and making sure that the time they spend is on the most impactful things and what they want to be spending their time on, which is, again, direct care and making improvements and thinking of how do you work at top of line?

How do you make sure you’ve got the right language? How do you make sure there’s the demonstration of that? And I think back, Chris too, when we were introducing flow stations, for example. It was the physicians who were going home earlier than who had implemented those flow stations. And just that, it goes back to what you said kind of about signals, right?

Here’s a signal of where someone has tried something different and it’s working and capturing that attention. So that would be one thing. And then the second I, I feel compelled to say, how do you support these amazing people with a systems approach? And so it’s not people centric, it’s not so heavily dependent on the person, but it’s providing these simple tools that everybody can do. It’s about, you know, training and continuous learning and feedback and two-way interchange. And Eliot you mentioned this about engagement and buy-in, by helping them co-create whatever this is and how important that is. And so I feel compelled to be like that wraparound all of this, to let that happen and have that routine and behaviors that send some of those signals that Magnus was talking about as well. There’s so much that could be said, but I’ll pause there ’cause I know Chris, you’ve probably got some things to add as well. 

Chris Backous: Yeah, I’m taking to heart what you all said about listening to understand and so what is this really leading me to is, engagement isn’t accidental.

It’s intentional. And so, you know, if your prize is physician/consultant engagement, then think about it, plan for it. And then another takeaway I got from you all is assume good intent because we are caregivers, we do care, and that there are real pressures. And is there a way to just listen through to find the thing of value and build from there?

You know, ’cause I think everyone does come to work wanting to do a good job and, sometimes maybe we just need to help them see that they are doing something really amazing, you know, and reward them because all they hear is what we’re not doing, but what are we doing? And I think that’s always a, you know, to Eliot your point about, start small, you know, and help them see success because the world isn’t really giving them any messages of success. So I think that kind of brings us to the end of our conversation. I really want to thank you all for joining us. So Magnus, thanks for joining us from the UK. Eliot, thanks for joining us from the Pacific Northwest.

And Wendy, I think you’re right now in the Pacific Northwest spending your time between the UK and the Pacific Northwest. So thanks for being here.

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