Determinants of hospital-based physician participation in quality improvement: A survey of hospitalists in British Columbia, Canada
Vandad Yousefi1, Alaleh Asghari-Roodsari2, Sarah Evans3, Cynthia Chan4
1 Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada; Hospitalist Program, Vancouver General Hospital, Vancouver, British Columbia, Canada
2 VIP Doctor 247, Dubai, United Arab Emirates
3 Royal Roads University, Victoria, British Columbia, Canada; Sarah Evans Coaching and Consulting, Victoria, British Columbia, Canada
4 Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada; Department of Family and Community Practice, Vancouver Community, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
Hospitalist Program, Vancouver General Hospital, 899 W 12th Avenue, Vancouver, British Columbia, V5Z 1M9.
Source of Support: None, Conflict of Interest: None
Objective: We aimed to understand the extent of hospitalist involvement in system improvement efforts across the province of British Columbia in Canada and provide insights into determinants of such participation. Materials and Methods: We designed a web-based survey and asked about individual, programmatic, and institutional characteristics that may facilitate or impair hospitalist involvement in quality improvement (QI) activities. The survey was sent to all individuals who participated in “hospitalist care” from January 2014 to February 2015, in the province of British Columbia, Canada. We conducted both quantitative and qualitative analysis of responses. Results: We received 57 complete responses to the survey of 322 invited individuals (17.7% response rate). Of these, 15 individuals (26.3%) indicated that they had participated in QI initiatives. Respondents highlighted high clinical workload and lack of time, lack of QI skills and training, lack of access to performance data, poor support from hospital/health authority administration, and lack of financial compensation as main barriers to QI involvement. These themes were also supported in logistic regression, where QI training and the number of weeks worked as a hospitalist showed significant predictive properties for involvement in QI initiatives. Conclusion: Our study attempts to understand the various individual or organizational attributes that could facilitate involvement by hospital-based generalist physicians in QI activities. Our findings show lack of formal QI training is an important barrier for hospitalist involvement in QI, and highlight the need for formal training, dedicated time, support from physician leadership, and financial incentive as important facilitators for participation in systemic improvement efforts.