Physician engagement in organisational patient safety through the implementation of a Medical Safety Huddle initiative: a qualitative study

Abstract

BackgroundEfforts to increase physician engagement in quality and safety are most often approached from an organisational or administrative perspective. Given hospital-based physicians’ strong professional identification, physician-led strategies may offer a novel strategic approach to enhancing physician engagement. It remains unclear what role medical leadership can play in leading programmes to enhance physician engagement. In this study, we explore physicians’ experience of participating in a Medical Safety Huddle initiative and how participation influences engagement with organisational quality and safety efforts.MethodsWe conducted a qualitative study of the Medical Safety Huddle initiative implemented across six sites. The initiative consisted of short, physician focused and led, weekly meetings aimed at reviewing, anticipating and addressing patient safety issues. We conducted 29 semistructured interviews with leaders and participants. We applied an interpretive thematic analysis to the data using self-determination theory as an analytic lens.ResultsThe results of the thematic analysis are organised in two themes, (1) relatedness and meaningfulness, and (2) progress and autonomy, representing two forms of intrinsic motivation for engagement that we found were leveraged through participation in the initiative. First, participation enabled a sense of community and a ‘safe space’ in which professionally relevant safety issues are discussed. Second, participation in the initiative created a growing sense of ability to have input in one’s work environment. However, limited collaboration with other professional groups around patient safety and the ability to consistently address reported concerns highlights the need for leadership and organisational support for physician engagement.ConclusionThe Medical Safety Huddle initiative supports physician engagement in quality and safety through intrinsic motivation. However, the huddles’ implementation must align with the organisation’s multipronged patient safety agenda to support multidisciplinary collaborative quality and safety efforts and leaders must ensure mechanisms to consistently address reported safety concerns for sustained physician engagement.

Mixed methods evaluation of a specialty-specific system to promote physician engagement in safety and quality reporting in a large academic health system

“…Evidence-based IRS best practices include having clear roles and responsibilities for events, greater engagement from clinicians of diverse professions and fostering of shared experiences from reports with visible action. 18 Publicly rewarding high-impact reports, 19 fostering physician-specific spaces for discussion of safety concerns 20 and involving managerial non-clinician staff 21 can increase engagement. Most research to date focuses on hospital-wide IRSs, but a greater understanding of the complementary role of physician-specific and specialty-specific IRS is needed.…”

Medical safety huddles to engage frontline physicians in patient safety: calling physicians back to the table

“…In this issue of BMJ Quality & Safety, Rotteau et al 8 describe their qualitative study on medical safety huddles implemented at six sites. In contrast with organisation-led, multidisciplinary huddles, these huddles included only physicians.…”

“…And although traditional multidisciplinary huddles are designed as safe spaces for raising safety and performance concerns, Rotteau et al found that physician-specific huddles enabled discussions of 'safety concerns that were specifically related to physicians' clinical roles, especially when contrasted with 'nursing' concerns that are typically discussed in the local unit level huddles'. 8 In other words, medical safety huddles create an opportunity for physicians to share role-specific concerns that they would otherwise be hesitant to raise in a broader group.…”