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MEANINGFUL ENGAGEMENT, MEANINGFUL CHANGE

DOCTORS
RECOMMENDATIONS ON PHYSICIAN ENGAGEMENT IN HEALTH-CARE SYSTEM NOVA
CHANGE SCOTIA
2017 Position Paper

MEANINGFUL ENGAGEMENT, MEANINGFUL CHANGE

RECOMMENDATIONS ON
PHYSICIAN ENGAGEMENT IN
HEALTH-CARE SYSTEM CHANGE

1 Doctors Nova Scotia | 2017 PHYSICIAN ENGAGEMENT POSITION


MEANINGFUL ENGAGEMENT, MEANINGFUL CHANGE
MEANINGFUL
RECOMMENDATIONS ENGAGEMENT,
ON PHYSICIAN MEANINGFUL
ENGAGEMENT IN HEALTH-CARE SYSTEMCHANGE
CHANGE

RECOMMENDATIONS ON PHYSICIAN ENGAGEMENT IN HEALTH-CARE SYSTEM CHANGE

POSITION STATEMENT
Nova Scotias physicians are vital contributors to the health-care system and must be meaning-
fully engaged, early and appropriately, in all health-care system change initiatives that will
impact their patients or the way they practise medicine. In addition to opportunities for individu-
al physician engagement, meaningful engagement respects the medical profession by collective-
ly engaging physicians through their professional association.

GOALS
To support and encourage stakeholders to seek physician involvement early in matters per-
taining to health system planning, policy and patient care
To promote and support physicians in leading initiatives that contribute to innovative, effec-
tive and efficient health-care and public health services
To have fair representation of various medical specialties, geographical regions and funding
models on health-care committees and working groups
To communicate opportunities for physician involvement and the benefits of that engage-
ment to the entire membership of Doctors Nova Scotia
To encourage and support positive, collegial engagement between physicians and the
Department of Health and Wellness, the Nova Scotia Health Authority and the IWK

INTRODUCTION
Physicians play a critical role in the delivery It has been well established that the orga-
of health care in Nova Scotia. They direct, co- nizations that effectively engage physicians in
ordinate, advocate for and deliver health care health system design, change processes and
across the entire spectrum of patient care and leadership development opportunities are
population health. Physicians, as clinicians, most likely to experience improved outcomes
business owners and leaders, have a great (Denis, 2013). Understandably, physicians
interest in the ongoing transformation of our do not typically support health care chang-
health-care system and es or initiatives in which they have not been
EFFECTIVE PHYSICIAN ENGAGEMENT health-related policies to meaningfully engaged from the outset or when
IS ESSENTIAL TO MAKING CHANGES ensure high-quality, safe their perspectives have not been considered.
and sustainable health Effective physician engagement is essential to
WITHIN ANY HEALTH-CARE ORGANIZATION
services delivery for all making changes within any health-care organi-
AND THE HEALTH SYSTEM AS A WHOLE Nova Scotians. Physicians zation and the health system as a whole.
also contribute to our un- Physicians control many of the decisions
derstanding of the health that impact health-care utilization, such as
of our communities and work with others, ordering tests, hospitalization and the use of
inside and outside of the health-care system, prescription medications. Physicians also work
to improve population health. with community and political leaders to create
environments that facilitate good health.

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MEANINGFUL ENGAGEMENT, MEANINGFUL CHANGE
RECOMMENDATIONS ON PHYSICIAN ENGAGEMENT IN HEALTH-CARE SYSTEM CHANGE

WHAT DO WE MEAN BY PHYSICIAN ENGAGEMENT?


Physician engagement is not only about the Physician engagement has many purpos-
appointment of a small group of leaders to es, including to educate, consult, collaborate
roles such as medical or clinical director. It is with and empower physicians in health-care
recognition that leadership is a social func- delivery and health-care system transfor-
tion and not just defined mation (LIHN Collaborative, 2010). Effective
EFFECTIVE PHYSICIAN ENGAGEMENT by hierarchical reporting physician engagement occurs within a culture
OCCURS WITHIN A CULTURE THAT lines. Enhanced medical that respects and values physicians autono-
RESPECTS AND VALUES PHYSICIANS engagement should work my, knowledge and ability to advocate for their
towards a model of dif- patients and the communities in which they
AUTONOMY, KNOWLEDGE AND ABILITY fused leadership, where work. Organizations that seek physician input
influence is exercised early and often through a variety of mecha-
across relationships, sys- nisms contribute to a safe, high-quality patient
tems and cultures. It should apply to all rather experience within the health-care system.
than a few (Clark, 2008).

BEST PRACTICES IN PHYSICIAN ENGAGEMENT IN


HEALTH SYSTEM DESIGN
The physician engagement toolkit designed ability to develop a trusting relationship for en-
by the LHIN Network in Ontario identified a gagement comes from open communication,
number of key principles for effective physician willingness to share relevant data, creating a
engagement based on experience and best shared vision and accumulating evidence of
available evidence, including: successful collaboration.
Ensure engagement occurs early enough In their research on effective physician en-
to make a difference gagement, Atkinson et al. (2013) emphasized
Dedicate resources to support effective the necessity of effective communication. Two
engagement processes of their key findings were:
Monitor the effectiveness of engagement It is critical to communicate widely and
activities effectively, using many different methods
Ensure the purpose, expectations, con- and persistence to ensure messages are
straints and decision-making processes both received and understood.
are transparent Frequent face-to-face communication from
Eliminate barriers to participation senior leaders is important. Facilitating
Engage with the full diversity of stake- open, honest and frank discussion on a
holders (for example, a single physician routine basiswith an emphasis on listen-
asked to participate in an ing and responding, closing the feedback
PHYSICIAN ENGAGEMENT IS BUILT initiative cannot represent loop to confirm what actions had or hadnt
UPON A FOUNDATION OF TRUST AND the diverse perspectives been taken and whyeffectively broke
of his or her colleagues) down barriers and guarded against a nat-
IS SUPPORTED BY REGULAR AND OPEN
Promote a culture of ural tendency to work in silos (Atkinson,
COMMUNICATION participation (LIHN Collab- 2013).
orative, 2010) Effective physician engagement is built
No matter what pro- upon a foundation of trust and is supported by
cess is used for physician engagement, the regular and open communication. This commu-
research is clear that trust between physicians nication includes making all physicians aware
and organizations is a key element of suc- of the work being done by their colleagues
cessful engagement (Denis, 2013). According on their behalf and the benefits of becoming
to research conducted by Denis (2013), the engaged themselves.

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MEANINGFUL ENGAGEMENT, MEANINGFUL CHANGE
RECOMMENDATIONS ON PHYSICIAN ENGAGEMENT IN HEALTH-CARE SYSTEM CHANGE

ENGAGING INDIVIDUAL PHYSICIANS


AND THE MEDICAL PROFESSION
Individual physicians continue to be engaged decision-making in a meaningful, purposeful
in various health system planning processes in way that respects the diversity of physicians
Nova Scotia. This is one appropriate strategy experiences and perspectives.
for physician engagement, but it cannot be Doctors Nova Scotia is the voice of all phy-
the only mechanism. It is equally important sicians in the province for matters pertaining
that health system decision-makers engage to compensation, policy, health system reform,
physicians collectively in an organized man- physician leadership, and patient care and
ner. In a series of discussion groups held with advocacy. As significant changes are being
physicians in Nova Scotia in late 2015 and considered and implemented in the provin-
early 2016, physicians clearly identified to cial health system, physicians expect health
Doctors Nova Scotia (DNS) that they view their system decision-makers to respect the medi-
association as a means for them to influence cal profession by engaging DNS to represent
policy, advocate on behalf of physicians and the collective voice of physicians, rather than
their patients, and contribute to health system engaging just a few selected physicians.

RESPONSIBILITIES FOR DOCTORS NOVA SCOTIA


To support meaningful physician engagement, if they work with the government or the
DNS will: health authority)
Support training for physician leaders Assist stakeholders in determining what
through a specially designed program, in level of physician engagement is needed
partnership with the Canadian Medical for a particular initiative (such as the num-
Association ber, specialty, location or area of interest
Communicate regularly with all members of physicians), appropriate remuneration,
about health system change and the work and any other recommendations that will
of engaged physicians, using the asso- create an environment that encourages
ciations communication tools (website, physicians input and involvement
emails, e-newsletters and doctorsNS mag- Actively seek opportunities for physician
azine) engagement. Check to make sure partic-
Provide staff support to physician leaders ular initiatives are engaging physicians
when necessary and appropriate to sup- effectively and, if not, reach out to stake-
port their role in engaging in health system holders to determine if DNS can help them
decision-making on behalf of the associa- to do so
tion. This would include consideration and Remind physicians of the value of engag-
support for physicians around barriers to ing at all levels of an organization
engagement such as compassion fatigue Remind stakeholders to engage physicians
and negative perceptions by their peers at all levels of their respective organiza-
(for example, the idea that physicians are tions
no longer representing their colleagues

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MEANINGFUL ENGAGEMENT, MEANINGFUL CHANGE
RECOMMENDATIONS ON PHYSICIAN ENGAGEMENT IN HEALTH-CARE SYSTEM CHANGE

RESPONSIBILITIES FOR HEALTH SYSTEM DECISION-MAKERS


Doctors Nova Scotia hopes that the Depart- knowledge and values, as well as the
ment of Health and Wellness (DHW), the Nova rights of physicians to make recommen-
Scotia Health Authority (NSHA) and the IWK dations or raise concerns without fear of
will support improved individual and collec- reprisal when taking part in discussions
tive physician engagement by developing and with stakeholders.
implementing strategies that encourage and Physicians who choose to pursue lead-
respect physicians participation in health ership roles should be provided with
system decision-making. adequate resources, training and support.
Recommendations Physicians and other health system lead-
The DHW, NSHA, IWK and other health ers should openly discuss and formally
system stakeholders should seek early, commit to clear roles, expectations and
appropriate and meaningful physician rep- accountabilities.
resentation through DNS when creating, The data and information used to make
implementing, maintaining and evaluating health system decisions should be shared
health-care and public health services. in a transparent manner, to enable the
Engagement of physicians in health development of a mutual level of trust
system decision-making should be based between stakeholders and physicians.
upon respect for physicians autonomy,

RESPONSIBILITIES FOR PHYSICIANS


Physicians are cognizant of their role in the engagement, whether front line, service
health system beyond direct patient care, or institutional, will respect, support and
and they desire and respect opportunities value the contributions of their physician
for meaningful engagement in improving the colleagues.
health system. Physicians will recognize and respect that
Recommendations other stakeholders are operating within
Physicians will participate in different cultures, expectations and man-
decision-making when opportunities dates.
are presented and will provide feedback Physicians will respect those who choose
whenever possible. to become engaged and understand that it
Physicians who pursue leadership roles is advantageous for themselves, their pa-
will take appropriate training in order to tients and their professional association
ensure they are providing quality leader- to have colleagues actively taking part in
ship for their colleagues, organizations decision-making at all levels of the health-
and the health system overall. care system.
Physicians at each level of physician

Doctors Nova Scotia is committed to fulfilling the responsibilities listed above by


continuing to advocate for more effective physician engagement within our health-
care and public health systems. We will encourage government, other health system
decision-makers and physicians to acknowledge the value of physician engagement
and leadership, and to consider their respective responsibilities in improving the level
of physician inclusion in health system decision-making.

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MEANINGFUL ENGAGEMENT, MEANINGFUL CHANGE
RECOMMENDATIONS ON PHYSICIAN ENGAGEMENT IN HEALTH-CARE SYSTEM CHANGE

REFERENCES
Atkinson, S., Spurgeon, P., Clark, J., & Armit, K. (2011). Engaging Doctors: What Can We Learn from Trusts with High Levels
of Medical Engagement? Retrieved from http://www.aomrc.org.uk/wp-content/uploads/2016/05/Engaging_Doctors_
trusts_with_high_level_engagement_2011.pdf

British Columbia Medical Association. (2013). Policy Paper: Working Together: An Exploration of Professional Relation-
ships in Medicine. Retrieved from https://www.doctorsofbc.ca/sites/default/files/bcma_policy_paper_med_prof_
final_web.pdf

Clark, J., Spurgeon, P., & Hamilton, P. (2008) Medical professionalism: Leadership competencyAn essential ingredient.
International Journal of Clinical Leadership, 16(1), 3-9. Retrieved from http://www.mckinsey.com/industries/
healthcare-systems-and-services/our-insights/when-clinicians-lead#0

Cowell, J., McBrien-Morrison, C., & Flemons, W. (2012). Physician Advocacy, Physician Engagement Two Sides of the
Same Coin. Qmentum Quarterly, 4(3), 26-29.

Denis, J.L., Baker, G.R., Black, C., Langley, A., Lawless, B., Leblanc, D., Lusiani, M., Hepburn, C.M., Pomey, M.P., & Tr, G.
(2013). Exploring the Dynamics of Physician Engagement and Leadership for Health System Improvement. Retrieved from
http://www.cfhi-fcass.ca/sf-docs/default-source/reports/Exploring-Dynamics-Physician-Engagement-Denis-E.pdf?
sfvrsn=0

Doctors of BC. (2013). Policy Paper: Partnering with Physicians. Retrieved from https://www.doctorsofbc.ca/sites/
default/files/policy-partneringwithphysicians-january212014.pdf

LIHN Collaborative. (2010). Engaging Primary Care Physicians in LIHN Processes: Primary Care Physicians Engagement
Resource Guide and Tool Kit. Retrieved from www.nelhin.on.ca/Page.aspx?id=9776

McGuire, S., Kitts, J., Turnbull, J., Worthington, J., & Forster, A. (2012) Developing an Organizational Strategy to Support
Physician Engagement and Quality. Qmentum Quarterly, 4(3), 14-17.

Norbeck, T. (2012). Drivers of Health Care Costs: A Physicians Foundation White Paper. Retrieved from http://www.
physiciansfoundation.org/uploads/default/Drivers_of_Health_Care_Costs_-_November_2012.pdf

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