News and Updates

• Across BC’s acute care facilities and programs, 72 Medical Staff Associations (MSAs) in 6 health authorities have galvanized more than 4,300 physicians to participate in 2600+ Facility Engagement activities. (Updated to February 2020).
   
• A combination of new structures, funding, physician leadership, and administrative supports are enabling MSAs and their physician members to improve engagement and teamwork among colleagues and with health authorities, in ways that were not possible in the past.
   
• The UBC evaluation of Facility Engagement to March 2019 found that medical staff and health authority leaders think that participation in the initiative is worthwhile.

With all of this activity  – and a lot of hard work  – a sense of optimism is fueling a growing culture of engagement across BC, with renewed teamwork and positive experiences reported by many of those involved.

Big themes: Foundation for change

“This is an exercise in relationships – setting a foundation that allows us to grow as an organization, as people, as a team, as partners in care.” – Dr. Harsh Hundal,  Executive Medical Director Physician Engagement & Resource Planning, Interior Health

• Physician-to-physician communication and relationships are improving as a key step for MSAs to build a strong foundation for engagement and a medical staff voice. Physicians are connecting and meeting across sites and regions – for the first time ever in some cases – to get to know and support each other, discuss priorities and work on projects that strengthen their hospital, patient care, and personal well-being. 

• Communication with health authorities is improving. At many sites, MSA working groups and physician members are regularly meeting and establishing collaborative processes with health authority administrators and leaders to discuss respective priorities, and to work on projects together. 

• Physician wellness has also surfaced as a priority, with MSAs across BC initiating activities that aim to reduce the risk of burnout and support physicians to provide patient care in a healthier way.  Some MSAs are now starting to elevate these efforts to an organizational, regional and system level to look at potential improvements that can reduce the risk of burnout. (Doctors of BC is further working on this priority through the Physician Burdens engagement and policy development process.)

• ​With the new 2019 Physician Master Agreement, Facility Engagement is also officially supporting medical staff engagement in the implementation of electronic health records, starting with Lower Mainland hospitals that are adopting the Cerner syste

Moving Forward

There is more work to be done to achieve sustained change, and further evaluation of the Facility Engagement Initiative will to measure its ongoing impact. Meanwhile, both physicians and health authority partners from many parts of the province report they are making headway to build trust and to make decisions together that impact their hospitals, programs, work culture and patient services.  Stay tuned as this great work continues to unfold!

Read examples and successes > www.facilityengagement.ca/stories

Physician health is a common theme for MSAs, with 100+ wellness-related activities underway across BC. They range from group fitness to social opportunities, to relationship-building across medical disciplines, to tackling workplace and system frustrations. The engagement of physicians in a health care organization is, in itself, a key factor to reducing burnout.

The FE provincial team is looking at how to coordinate MSA physician wellness activities with other regional / provincial efforts including those of Doctors of BC.  As a start, new FE funding guidelines for physician wellness have been introduced to elevate physician health activities to a strategic level moving forward. Find them here under 'funding.'>

Meanwhile, last November, Fraser Health’s regional Medical Staff Wellness Committee welcomed 45 physician health champions from its 12 hospitals and 10 divisions, as well as health authority leadership, to brainstorm how Fraser Health could support and promote physician health.  As their ideas unfolded, the Committee realized that they were sowing the seeds for a regional Physician Health Program. Read about it here >

Trusted expert and internationally recognized caregiver advocate for reducing clinician fatigue and improving employee engagement, Dr. Stephen Swensen,  Professor Emeritus, Mayo Clinic, met with members of the Vancouver Physician Staff Association this January. He shared lessons learned over his three-decade-long career with the Mayo Clinic.

“Many physicians are working in a state of professional distress,” stated Dr. Swensen. “This goes beyond burnout and includes PTSD, emotional exhaustion, clinical depression, moral injury, compassion fatigue, and suicidal thoughts. When you’re in this state, you’re more likely to make a medical error. You have relationship problems, addiction problems; your productivity goes down as does your level of quality of care. One of the biggest opportunities we have to improve patient care is by caring for each other.”

An ideal workplace has three elements that Dr. Swensen calls agency, coherence and camaraderie. The happiest teams at the Mayo Clinic, he said, have the agency to make decisions, feel connected to their group, and celebrate each other’s milestones.

Leadership behaviours

Dr. Swensen identifies five behaviours (Leader Index Behaviours) that make for better leaders:

1. They are inclusive.
2. They communicate transparently.
3. They value your ideas.
4. They are interested in your career.
5. They appreciate your work.

Mayo Clinic staff are surveyed annually on how their leaders rate in these areas. Those with low scores are coached to improve these or are moved out of leadership roles because leaders who don’t exhibit these five behaviours are causing harm to patients.

Medicine is a calling

Some people go to work every day for the paycheque; others see their career as a means to accomplish goals and receive acknowledgement of their contributions. It is common for those who choose a career in health care to also see their work as a calling, as a means of helping patients, their families and the greater community. When that sense of purpose is lost, said Dr. Swensen, physicians can develop professional distress.

“Engagement is the antipode to burnout; it connects us to meaning and purpose,” he said. “The number one driver of happiness is meaningful work so you would think health care should have the lowest rate of burnout. But sometimes we lose sight and have to be reconnected to our purpose. Coherence can do that. Coherence exists when all parts of the system fit together to form a united whole.”

To create coherence, leaders need to ask, listen and empower.

“It’s that annoying pebble in your shoe that holds you back rather than the mountain you need to climb. The research is clear that when departments work together to identify the ‘pebble’ they reduce burnout. You can apply this to Cerner. Superusers could monitor who’s using the system on weeknights and weekends and then ask them if they need assistance. A superuser can save a physician three to five hours a day by teaching them shortcuts.”

Architects rather than carpenters

The pronouns we use when we talk about our organization are a clue to how well that organization is thriving. When we think in terms of ‘us’ and ‘them’ rather than ‘we’ and ‘our,’ the institution flounders.

“If physicians are treated as partners, they behave that way,” said Dr. Swensen, who recalled how the Mayo’s chair of haematology addressed her team’s high burnout rate.

“She decided to be a leader, a champion—rather than a middle manager. Instead of saying this is what they’re telling us to do, let’s all just be carpenters, she empowered her physicians to be architects. They weren’t going to be told how to do something by people who don’t understand what they do. The team created the solutions.”

When we do our work, improve our work, and care for each other, our patients have the best doctors imaginable. Lean into tomorrow, Dr. Swensen encouraged, to see what difference you can make.

Further reading: Finding and Creating Joy in Work white paper (IHI white paper, co-authored by Dr. Swensen)

 
Thank you to the Vancouver Physician Staff Association (VPSA) for sharing this article and photos. >

My father, who was an obstetrician, worked at the tertiary care teaching hospital in Edmonton. He used to say he would frequently see Dr Snell—the CEO of the hospital at the time—in the hallway. If there was an issue to discuss, the two of them would just talk about it. Today, doctors may never see the CEO or other senior executives.  Read more >

Physician burnout was the topic of a recent Doctors of BC event, hosted by Dr Andrew Clarke, Executive Director of the Physician Health Program (PHP). Attendees included close to 50 physicians representing medical staff associations (MSAs) and divisions of family practice. For Dr Clarke’s brief summary of the background, intention, and goals of the session and the PHP, read “Helping to meet the challenge of physician burnout.”