Tuesday, January 17, 2017

How to Change Onboarding and OPPE Practices to Affect Provider Behavior



This is truly a sad story and one that should never happen, but it did. This story first appeared in a post by BeckersHosptialReview.com, with excerpts from an article published in The New England Journal of Medicine. The article was written by Dr. Rana Awdish, a critical care physician at Henry Ford Hospital in Detroit. In the article. Dr. Awdish shares how her own near-death experience inspired her, and the hospital to incorporate different training programs and onboarding protocols to facilitate better patient care.

In 2008, Dr. Awdish almost bled to death when a tumor ruptured in her liver, sending her into multi-system organ failure at Henry Ford Hospital. She received 26 units of blood, was put on a ventilator, suffered a stroke and lost the baby she had been carrying for seven months. Dr. Awdish's recovery included five major operations and she had to relearn how to walk and speak.

"[A]s a patient, I learned things about us — physicians and other medical professionals — that I might not have wanted to know," she writes in the article. "I learned that though we do so many difficult, technical things so perfectly right, we fail our patients in many ways."

Dr. Awdish discovered numerous shortfalls in communication, uncoordinated care and an apparent lack of empathy through the experience. She heard doctors saying thing like she is “trying to die on us”. A phrase which she says she had used in the past in her role as a physician. She heard her colleagues say things to her in ways that inflicted more suffering, even when they believed they were helping, such as “Are you sure your pain is an eight? I just gave you morphine an hour ago, and Dr. Awdish felt helpless trying to resolve billing issues over the care of her unborn child.

Utilizing Dr. Awdish’s experience and feedback, her hospital “radically” revised how they onboarded new employees. The institution has a “Culture of Caring” curriculum for nursing. But they understood that to truly change the culture, all new employees, including physicians, needed to internalize the institution’s values. So the hospital expanded their efforts, incorporating the failures and successes of Dr Awdish’s story to build an inclusive culture for better patient care.

New employees are now taught to recognize avoidable and unavoidable suffering. The goal is to find ways to mitigate suffering by responding to the unavoidable kind with empathy and by improving processes and procedures to avoid inflicting the avoidable kind whenever possible. In the article, Dr. Awdish describes how the new training teaches employees to “articulate their purpose as distinct from their job.” Something that drives their “Culture of Caring” and goes a long way to providing an optimal patient experience.

Why is all of this important?  In both your provider onboarding and ongoing provider performance evaluations (OPPE) a measure of success to track for your value based purchasing program scores should be physician behavior. Physician behavior can have a positive or negative effect on general clinical care and also more importantly patient and caregiver experience.

New Addition to Provider Onboarding


Physician onboarding isn’t just about checking medical licenses or granting clinical privileges, physician onboarding provides an opportunity for an organization to help its staff to understand its values and expectations, and to identify opportunities for the physician to integrate into the culture. Physician onboarding emphasizes that health care organizations value interpersonal skills, along with clinical expertise.

Many new physicians experience isolation, the stress of being an outsider, and difficulty adapting to the organizational culture and norms. They are often unaware of the impact of their behavior on others, and some have no idea how to change. Given high rates of turnover, more organizations are investing in coaching for their new hires. Physician coaching can help in many different areas including initial onboarding, leadership development, modifying disruptive behaviors, physician wellness, and in general help facilitate teamwork and departmental success.

Physician Behavior and OPPE


The Joint Commission defines ongoing professional practice evaluation as “a document summary of ongoing data collected for the purpose of assessing a practitioner’s clinical competence and professional behavior”. Key word here is professional behavior. While most of us think this means that the physician haves in a professional manner as we would expect from his or her clinical position, but as Dr. Awdish discovered, poor communication and lack of empathy were really the biggest areas to address.

OPPE is a key component of determining practitioner competence for maintenance of clinical privileges, but it also allows for identification of possible practice trends affecting patient safety and care. OPPE can also uncover opportunities for performance improvement activities. The Joint Commission lists six OPPE standards to evaluate:


  • Medical knowledge
  • Practice-based learning and improvement
  • Interpersonal and communications skills
  • Professionalism
  • Systems-based practice
  • Patient care


While it makes sense to focus on evaluating performance standards that correlate with the core competencies and clinical privileges granted to the practitioner, Interpersonal and communication skills can often get glossed over. Given the significance of Dr. Awdish’s experience as a patient, her organization deemed it necessary to make sure their practitioners focus on an inclusive caring culture and are able to empathize with patients to provide the optimal patient experience.

Click Here to learn more about our Onboarding and OPPE solutions to support your provider integration efforts.


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