A framework for engaging physicians in quality and safety

BMJ Qual Saf. 2012 Sep;21(9):722-8. doi: 10.1136/bmjqs-2011-000167. Epub 2011 Jul 14.


Background: Physicians should be engaged in quality-improvement activities to make the systems in which they work safer and more reliable. However, many physicians are still unable to contribute to patient safety initiatives that lead to safer, high-quality care for their patients.

Objective: To survey 10 high-performing hospitals in the USA to determine how they engage their physicians in quality and safety.

Design: Qualitative study that used site visits and a semistructured 20-question interview.

Setting: Ten high-performing US hospitals were chosen from the 2010 US News and World Report Best Hospitals and the Leapfrog Group on Patient Safety.

Participants: Forty two interviews were conducted with forty-six quality leaders including CEO's, Chief Medical Officers, Vice Presidents for Quality and Safety and physicians.

Measurements: Site visits and in-person interviews were conducted during 2010-2011. The interviews were transcribed and coded using the constant comparative method for further analysis by the team.

Results: The authors developed a six-point framework for physician engagement in quality and safety as a constellation of the best strategies being used across the country. The framework consists of engaged leadership, a physician compact, appropriate compensation, realignment of financial incentives, data plus enablers and promotion.

Limitation: The qualitative design and the small number of hospitals surveyed mean that the results may not be generalisable.

Conclusion: There remain many ongoing barriers to physician engagement in quality and safety. Some high-performing hospitals in the USA have made significant improvements in engaging their physicians in quality and safety. The proposed framework can assist organisations in the development of strategies to engage physicians in quality-and-safety activities.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administrative Personnel
  • Benchmarking
  • Health Care Surveys
  • Humans
  • Interprofessional Relations*
  • Leadership
  • Patient Safety*
  • Physicians / psychology*
  • Quality of Health Care*