This week I reviewed the most recent minutes of a hospital committee charged with initiating and managing clinical quality initiatives. As usual, the minutes documented a substantial amount of conscientious hard work by a very motivated group. However, one item caught my attention: they were sending a draft of quality goals for 2012 to the four Division Chiefs for approval, with a deadline of 9 days later.
After the quality goals for 2011 had been determined and then announced last year, there had been discussion about the need to open the process to broader participation within the provider community, both to widen the range of options considered and to improve buy-in. As written, the minutes suggested the process had not been changed.
I sent an email to the committee members pointing out that a Senior Management Committee had recently been formed to address a lack of engagement by providers in decision making within the medical center, and asking for clarification: what plans were afoot for involving providers in the selection of provider quality goals for the coming year. I only got two responses from a committee of about 30, reflecting our culture of non-participatory voyeurism: come and watch, but don’t get involved.
The first response, from an administrator, said that provider involvement had already occurred as part of ongoing dialog among the managing providers and Division Chiefs. However, when I checked with two managing providers, both told me that there had been an ‘informational’ mention of the upcoming need to identify next year’s quality goals, but that no discussions had occurred within the group as a whole. Both told me that they anticipated receiving a document to approve at the next meeting. When I checked with my Division Chief, I was told that provider engagement existed at the committee that had forwarded the goals to the Division Chiefs, and that after the core group of about 10 had decided the goals, and after they were finalized, they would be presented to the managing providers for input and feedback. There was no mention of intent to involve the full provider community of about 300.
It was one of those moments reminiscent of a novel by Kafka. My request for an opportunity to participate in a process that affects me was clearly met - with no trace of irony - with an offer to hear feedback, but only after the process was complete. On the one hand, it is discouraging to see so little senior-level understanding of collaboration, along with an inability to differentiate collaborative action from compliant, coordinated or cooperative action. On the other hand, it will be a good example of a dis-engaging decision making process for me to bring to the Provider Engagement Committee for discussion.
