The spirit of teamwork that once defined the culture of hospitals is on the road to renewal through BC’s Facility Engagement Initiative (FE).
“When I look back to the ‘80s, I worked in hospitals where physicians were leaders and had good relationships with staff and administration,” says Dr. Dayan Muthayan, Executive Medical Director for Fraser Health. “Then through the ’90s, we saw a deterioration of relationships universally when health care became more about the bottom line. Physicians started feeling pushed away or withdrew from decision-making and leadership,” he says.
“So it is encouraging now to see a resurgence towards engaging staff and physicians, while putting the patient in the centre and trying to make the health system better.”
BC is not alone. Across Canada, pressures on health care budgets, rounds of organizational redesign and continual cycles of change have taken a toll on collaborative relationships among physicians and health authorities. Here in our province, the Facility Engagement Initiative aims to change that. Medical staff in 67 hospital sites across the province – including all 12 Hospitals in Fraser Health – are involved in activities to improve relationships, communication and collaboration; as well as their working environment and ultimately, patient care.
This is welcome news. Meaningful physician partnerships are critical to support the delivery of quality patient care, as well as our work to create an integrated, patient-centered health care system. Physician collaboration and leadership will ensure that our efforts and results are effective. By leading change together, we can also enjoy a more rewarding work environment.
Forging partnerships in Fraser Health
In late fall 2017, 15 Fraser Health physicians – including specialists and family doctors –and 18 Fraser Health executive leaders from 11 different sites met to discuss ways to improve communication, renew supportive relationships, and create a culture of open dialogue.
The gathering was one of many combined operational and medical leadership gatherings taking place or planned across the province, where meeting face-to-face is an opportunity to connect personally, and share perspectives about barriers preventing engagement – as well as next steps. A few examples of perspectives shared by participants follow:
ON THE OPPORTUNITY: We need to recognize opportunities for positive change when they occur and seize them. They don’t always happen all that often, or in ways that can change what is happening in a fundamental way. We don’t know if this one will, but this one could.
ON PHYSICIAN LEADERSHIP: Facility Engagement allows physicians the time and ability to spring forth with some of their creative, intellectual, and innovative problem-solving abilities.
ON RELATIONSHIPS: Engagement is just another way of saying ‘relationships.’ The most important part of making effective change that benefits both and physicians and health authority and ultimately patients, is about having relationships you can trust.
ON BUILDING TRUST: It is an evolution. In the beginning, we needed to be reassured this was real, so activities were mainly doctor-focused. Then we moved to start projects to improve processes and make collaboration better. That has evolved over many months to inviting the executive director [of the hospital] to our meetings.
ON DECISION-MAKING: Consultation may not always mean being involved in co-designing decisions. Decisions are made in many different ways. We make assumptions and may think that our opinion did not matter. It is important to understand the method used.
We hit our stride when we moved from a checkbox approach early on, to now inviting the administration / executive to the working group for meaningful discussions.
ON BARRIERS TO ENGAGEMENT: Administrators come and go, and doctors stay. The constant shift is a huge challenge. Meaningful succession planning is needed both with the health authority and physicians when people leave, to retain the knowledge and institutional memory and get new people up to speed faster.
ON COMMUNICATING INFORMATION: It is important to communicate in a more timely way, and use multiple channels to distribute information. But whether by text or personal e-mails, it is just the transaction. It supports, but doesn’t speak to the partnership we are trying to build. The relationship is the transformational part of this.
ON SUPPORTING GOOD ENGAGEMENT: Health authorities as well as physician groups need to model a culture of open discussion and transparency and develop solutions to engage physicians when that is not always possible [such as with union confidentiality matters]. We need to involve site administration early in meetings and hold joint partnership meetings with MSAs, health authorities and where needed, Divisions of Family Practice, to talk about collaborative goals.
Fraser Health Facility Engagement Activities
As of January 1, 2018, physician groups have formed in all 12 acute care sites where physicians and other medical staff members are now actively engaged in more than 100 Facility Engagement projects, including many collaborative activities that involve site administrators and staff.
It is early days, and laying a strong foundation of relationships and communication is an important first step to determine how Facility Engagement evolves.
“We’re proud of how far we have come in just a year’s time, from setting up legal structures to making significant impacts in the lives of physicians, health authority representatives and patients,” says Dr. Muthayan. “It will be exciting to see where we could be over the next two years.”