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A sense of ownership

What comes first to your mind when you think of UI Physicians?

One of the most important aspects of the UI Physicians group is that physicians feel like they have some ownership of the enterprise, especially, in the way they practice. Every physician strives to practice in the best way possible. In a large institution that is difficult some time, for a variety of reasons. UI Physicians is now the core group where physicians can consider and implement change to enhance practice and provide the best care possible.

Previously, physicians felt as though they were more like employees and that their ideas and frustrations about patient care were lost in institutional inertia. Now, UI Physicians is the organization where physicians have valued input into strategic goals. People feel less disenfranchised. It’s one thing to be told how to practice by somebody who sits at a desk versus having your own ideas of the way practice should flow because you’re actually in the trenches all day long.

Previously, physicians felt disenfranchised because they had little control of their occupational destiny. Rules and regulations were implemented with little thought into how it affected patient care. Within the University setting, physicians are charged with a tri-partite mission. Historically, the hospital has been focused on the clinical mission and the College’s focus is on teaching and research. While faculty tried to serve both entities to various degrees, UI Physicians irons out these imbalances.

But faculty still come here driven by the opportunity to teach and make research. How does this tie up with their strengthened clinical role?

You’re right, physicians come here not only to serve, but also to teach and conduct research. But because UI Physicians is made of the same physicians who, in addition to practicing, also do research and teaching, the UI Physicians Board not only wants to improve the way they practice: they want to improve the way research and teaching are recognized and how each of them is integrated into the system of practice.

So you are basically saying that UI Physicians just strengthens the clinical side of the tripartite mission.

Yes, UI Physicians provides a good balance for that. Before, the hospital wanted you to emphasize your clinical mission, the college wanted you to emphasize your teaching and research missions. There was no single umbrella to [take care of] what people thought was their core contribution to these missions. And now, UI Physicians is that umbrella.

How do you feel about your job on the Board and the Finance Committee?

As an assistant professor, or a junior faculty member on the tenure track, my participation offers a different perspective than those who’re already tenured. We’re talking about strategic goals of patient care, research, and teaching activities and how to allocate funding to recognize all of those responsibilities of the members of UI Physicians.

What is the progress you would attribute to UI Physicians since its inception more than a year ago?

There’s been a tremendous progress. UI Physicians has put together ways to measure many things we couldn’t measure before, such as patient satisfaction, clinic flow, timeliness of chart documentation, referring entity patterns, etc. The UIP Dashboard enables physicians to track their own billing and collections. All of this has given us a feedback on an individual or departmental basis, which we have never had before. The only way to make improvements in your practice is to know what your metrics are and these new tools provide a fantastic ability to measure all kind of things that are really important. Some of them have been the result of the collaboration between UI Physicians and the hospital. But certainly the idea and the driving force has been UI Physicians. And the hospital benefits tremendously from that, because now we’ve been able to recognize which processes are slow, where we need to intervene, and how we can improve them.

If so many positives come through UI Physicians, how would you explain that many faculty still don’t know about UI Physicians, are slow to join, or just do not care?

I think one of the reasons is that for decades people have been frustrated by the organization. Physicians, in general are hard a group to organize; they are especially skeptical of any organization that tries to organize them. In the beginning, I think, they didn’t really believe UI Physicians was going to do for them what they wanted it to do. Already, UI Physicians has accomplished a lot what it set out to do. And in the process it has discovered more of what it wants to do. As far as I’m concerned, it has already exceeded my expectations. I think a lot of those physicians who’ve been skeptical are appreciating the ongoing change.

Can you give me evidence of how UI Physicians has directly affected patient care “in the trenches,” as you said?

It comes down to the measurement. Quality is defined by the metrics. Prior to UI Physicians there were few metrics; there were very few measures for patient satisfaction in a continuous way. By establishing the new metrics, UI Physicians set out to measure what the current quality is. We can'tt make improvements if we don’t know what our deficits are. Actually, there has been a lot of perceived deficit, but perceptionof where the problems were have changed. For example, our department had a Kaizen event and it revealed to us the little pebbles that we needed to remove so that we feel absolutely comfortable in our shoes: things that none of us knew about or things that we couldn’t have figured out on our own. And now, actually, we’re able to implement changes right away; improve patient wait time, improve staff efficiency, check-in times, etc.

UI Physicians has taken a leadership role in trying to determine measures and define their effect on quality. For example, from a non-physician perspective people believe that quality is denoted by cure and survival, where we all know that we can provide the best care possible to a patient, but they still may not survive their disease or the disease may not improve despite the best medication and the best care. So, from my perspective, quality lies in whether to patients perceive that they received the best care available.

Residents are important care providers in this enterprise. Do you have any ideas about how residents can be brought into the process of quality improvement?

Residents have a tremendous role in teaching medical students and providing care. When I first became faculty, I felt like a regular employee of the hospital, the same as I was in my capacity of resident. As a resident, I felt like a small part of an institutional machine. As a faculty member, I felt the same way —until UI Physicians started.

I think we can bring residents into the process by providing them with the same quality measures that we provide faculty physicians: patient satisfaction, wait time, billing, collecting, etc. Once you see your numbers on these measures—what patient satisfaction was in your continuity clinic as a resident, for example—you have ownership of this information, and then you say: wow, my patients are really unsatisfied with the way I do this. Without that feedback there is no reason to evaluate the way they provide patient care. And as far as I know they have not previously been provided with that feedback.

Dr. VanBeek is a graduate of the UI Carver College of Medicine. She completed both her internship in internal medicine and residency in dermatology at the UI Hospitals and Clinics. Her clinical focus is on Melanoma, Hyperhidrosis, and HIV Dermatoses; her research interests include health related quality of life in patients with inflammatory skin disease, the epidemiology of skin cancer, and behavioral risk factors for cutaneous malignant melanoma.