Engaging physician leadership in multi-hospital clinical information technology transformation

C. Robin Walker, MB;

Glen Kearns, HBA;

Tom Janzen,MD;

and Sarah Jarmain, MD

 

 

CASE STUDY

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Ten hospitals in southwestern Ontario, already sharing a common EHR platform, implemented computerized provider order entry, an electronic medication record, electronic medication reconciliation, and closed-loop medication administration including bar codes. The project leaders included many physicians and considerable effort was made to engage as many physicians as possible in every stage of the project. Adoption was excellent and, 3 years after implementation, data show significant patient benefits. Much of this success relates to strong physician engagement and leadership. However, even stronger physician leadership and more consistent engagement would have eased the transition for many physician users and might have resulted in even faster adoption. This article presents an outline of physician involvement during the project and lessons that may help others engaging in large-scale clinical transformations better plan their physician partnership strategy.

 

KEY WORDS:  electronic health record, electronic medical record, physician leadership, physician engagement, clinical transformation

 

In the United States, the adoption of electronic health/medical records (EHR/EMRs) by hospitals has increased rapidly in the last 8 years. According to the Office of the National Coordinator for Health Information Technology, by 2015, 96% of non-federal acute care hospitals possessed a certified EHR system (i.e., had a legal agreement with an EHR vendor), representing a nine-fold increase from 2008 when that number was only 9.8%. Fully 83.8% of acute care hospitals had actually adopted a basic EHR system (i.e., a system meeting ten “essential” core functionalities, including clinician notes).1

 

In Canada, adoption of EHRs has been much slower. The Health Information Management Systems Society (HIMSS) scores the level of adoption of hospitals on a seven-point scale. Their EMR adoption data for Canadian and US hospitals show that 4.3% of the 5456 US hospitals in their database have already achieved stage 7, compared with only 0.2% of 641 Canadian hospitals. Even at lesser stages, Canadian adoption levels are much lower than in the US: 29.1% of US hospitals have achieved stage 6 compared with 0.9% in Canada; and 34.4% US hospitals are at stage 5 compared with only 3.6% in Canada.2 Given the well-established safety and quality benefits of EHRs, the slow rate of implementation of these systems represents significant opportunity lost for our patients. Top

 

The HUGO project in southwestern Ontario

 

In southwestern Ontario, 11 hospital organizations had previously formed a voluntary coalition based on a common EHR platform. In 2011, ten of those hospitals agreed to move their EHR adoption forward with a project to implement computerized provider order entry (CPOE), an electronic medication administration record, electronic medication reconciliation, and closed-loop medication administration including bar codes. The project, named HUGO (Healthcare UnderGoing Optimization), took place over 3 years, from 2011 to 2014, and cost $32 million (< 1% of a single year’s budget for these hospitals). Over 6000 users had to be trained in the expanded EHR, including over 2000 physicians. Three years from the last hospital’s “go-live,” it is now possible to assess the outcomes of this significant expansion in the region’s EHR.

 

From the beginning, the project leaders recognized that physician leadership and engagement would be one of the most important factors in the project’s success or failure. A readiness assessment, undertaken at the largest hospital in the region, suggested that the “burning platform” for the change (i.e., improving quality of patient care) was well understood, including by physicians. However, expectations of success were not high, and there was evidence of change fatigue among many physicians and other professionals. Therefore, a decision was made to appoint a physician to act as executive sponsor for HUGO to clearly establish that this was a clinical project, owned and led by clinicians, and carried out to ensure clinical benefits for our patients. Top

 

The governance structure for the project included both clinician (non-physician) and physician advisory committees reporting to the Steering Committee. These committees frequently met together and provided leadership and advice on every aspect of the project from the point of view of the various health professions involved. The leadership team included physicians from several departments, who were funded to assist in implementation of every aspect from order set development to program build and through the implementation. Physician champions were identified in every department/division of each hospital and worked with their colleagues to promote the need for the change and to support physician involvement at every stage of the project.

 

Although all physicians involved in the project had to demonstrate Leadership, Communication, and Collaboration competencies, as described in the CanMEDS 2015 framework,3 these competencies were particularly important for those providing project leadership. Using the LEADS framework,4 the role of the physician project leaders was principally to “achieve results,” whereas the physician champions endeavoured to “engage others.” Every physician was invited to participate in critical stages of development, such as workflow analysis and design and order set development, thus fulfilling the CanMEDS Collaborator role.3 Top

 

By the time the project was implemented, about 50% of full-time hospital physicians had been involved in it, in one way or another. Throughout the project, a full-time communications consultant ensured the dissemination of frequent region-wide and hospital-specific bulletins, web sites, and messages, including physician-specific strategies. Project physician leaders, including the executive sponsor, traveled the region to ensure that physicians at every site had opportunities to meet with them frequently, as they presented progress, answered questions, and attempted to allay concerns.

 

As issues arose among specific groups, project and physician leaders met with those concerned to listen, provide data and literature, and, in several cases, arrange visits to US centres with a similar system already implemented, so that our local users could assess for themselves the impact and outcome of the proposed changes. At the same time, the Medical Advisory Committees (MACs) of all ten hospitals agreed that use of the system would be mandatory for all physicians and amended their policies to ensure compliance after implementation. Top

 

The go-lives at the ten hospitals (14 sites) were staged over 6 months with short gaps of 2–3 weeks between each to allow the implementing team time to resolve issues and prepare for the next launch. In the weeks immediately preceding each go-live, nurses, physicians, and other professionals received profession-specific training on the new system. “Super users,” including many physicians and residents as well as nurses, allied health professionals, and students, were chosen from as many departments as possible and received additional training, so that they would be able to support other users in their department and others. In addition, a large group of nursing students was trained on the system as super users.

 

At each go-live and for some weeks following, the super users provided “at the elbow” support to users to assist their transition to the new functionalities. The nursing students proved so effective in this role — and the need for ongoing support, particularly for physicians, so great — that their engagement was extended well beyond the original intent. Every user was able to signal a problem via a dedicated HUGO “hot line,” and help could usually be dispatched within minutes. All reported system problems were logged, triaged, and addressed in order of severity and urgency. Any reported system errors were tracked and subsequently analyzed to identify whether the system was at fault versus workflow or user issues. Top

 

Outcomes

 

Three years after the last go-live, medication error rates for almost all ten hospitals have substantially decreased. At the two largest institutions, the decrease is 35–40% in overall errors, with wrong patient/wrong drug errors decreased by 85–90%. Turnaround times for medication and laboratory orders have been substantially reduced. Although there was an initial negative impact on productivity, particularly for providers such as physicians, all measures of productivity have returned to at least their levels immediately before implementation, and patient flow in a few ambulatory areas may have improved.

 

Adoption rates are excellent. In our largest hospitals, about 85% of all orders are processed via CPOE, and successful scanning rates for both medications and patients are 85–90%. Top

 

Acceptance of the system was high from the beginning for nurses and allied health professionals, but slower for physicians. In a few departments, serious concerns were expressed initially about the intuitiveness of the system and its impact on productivity. The most serious concerns were expressed in our largest emergency departments (EDs). There, it was necessary to implement a 30/60/90-day program of rapid optimization to prevent a return to paper orders (which was, briefly, requested by physicians). Following success of that rapid improvement plan, the system has continued to be used in the EDs, and many of those physicians are now champions of further expanding the EHR to include even broader functionality (e.g., electronic clinical documentation).

 

A survey of users 1 year after implementation showed that nurses were generally very satisfied with the system. About 75% scored it as meeting their expectations for ease of use and functionality. In the same survey, physicians were less satisfied, with a substantial minority still finding the system not fully meeting their expectations. Nevertheless, none of the MACs in the ten hospital organizations has found it necessary to use any sanctions to ensure compliance of physicians in using the system. Top

 

Lessons in physician leadership and engagement

 

The clarity of purpose achieved by having an executive sponsor who was a physician helped reassure physicians in the hospitals that this project and the resulting huge change to their practice were based on important clinical imperatives to improve patient safety and quality of care. Accordingly, although the executive sponsor was clearly functioning in the Leader role (CanMEDS3), attempting to ensure “systems transformation” (LEADS4) through this major change in health care practice, his most important function was arguably as a Communicator (CanMEDS3) who worked to “engage others” and “develop coalitions” (LEADS4) among  physicians, between their leaders, and with other professional groups.

 

In hospitals where the Medical Advisory Committee was fully engaged and supportive, its chair played the same roles locally as the executive sponsor did regionally, further strengthening the clinical leadership of the project. The multiple physician leaders in the project structure, together with a strong physician advisory committee, provided further clarity and reassurance that physician input into designing and building the system was important. The uniform and consistent approach of the region’s MACs ensured that all physicians would be held to the same standards of accountability wherever they worked in the region. Top

 

However, there was still some variation from hospital to hospital in engagement of medical and nursing leaders before and during implementation. As a result, transition to the new system was more difficult at sites where engagement had been weaker. Team culture also appeared to play a role. In cases where interprofessional relationships were strong, physicians received significant support from their nursing colleagues. In larger hospitals, there was also variation in engagement between departments or divisions, which again translated into more difficulty in adoption where fewer physicians had been engaged in building the new system.

 

For future projects, therefore, we plan to engage both medical and nursing leaders in our executive sponsor roles and support even more physician leaders within the project team. We will also more fully support physicians who help design and build the system as well as those who provide user support. This will include financial support, which was provided during the HUGO project only to physicians with the greatest time commitments. We will also better support physicians during their essential training. Top

 

Meanwhile, we have changed the governance of our e-practice committees to ensure that physicians become the main drivers of change and help lead all our planning for future EHR expansion. Finally, we will plan to have a part-time medical informatics lead in every large department in our academic centres during the pre- to post-implementation period.

Training was another area where we learned much: generic training on system functionality is insufficient for physicians, whose practices vary significantly between specialties. Hands-on training using cases drawn from a physician’s area of practice is much superior to generic training, and at-the-elbow support while the physician is actually using the system is best of all. Our at-the-elbow super users were invaluable, but we learned that they are needed for far longer than we originally planned. Top

 

We also underestimated the importance of our trainees, both in pre-implementation engagement to ease their transition and in terms of their potential use as fast learners and super users. Our assumption that “tech-savvy” residents would transition easily was not completely true and resulted in difficulties in several areas of care. Moreover, we have subsequently realized that residents who are well trained and familiar with the system make excellent trainers for other physicians and we are now using this knowledge to facilitate our current training approaches for new users.

 

We also underestimated the impact of the change on medical students, both in terms of their role in electronic workflow and on the availability of residents and faculty as their teachers during implementation. Top

 

Conclusion

 

With strong physician leadership and engagement, ensuring use of important aspects of the CanMEDS 20153 and LEADS4 frameworks, a major multi-hospital clinical transformation can be successfully accomplished with significant benefits to patients. However, our experience suggests that even stronger physician leadership and engagement, starting from the planning of projects through their implementation and beyond, would result in easier transition for physicians and other users and help ensure the most rapid adoption.

 

Multi-hospital EHRs with a full range of functionality promise real improvements in integration and quality of patient care. However, success in such projects depends on the breadth and depth of engagement of physicians. As described in the Institute for Health Improvement’s “Framework for engaging physicians in quality and safety,” this requires the discovery of a common purpose to improve patient outcomes, courage in leadership at all levels, and the involvement of physicians from the beginning.5 Successful transformation can only be achieved if physicians are fully engaged in leading the development and implementation of these systems.

 

References

1.Henry J, Pylypchuk Y, Searcy T, Patel V. Adoption of electronic health record systems among U.S. non-federal acute care hospitals: 2008–2015. ONC data brief 35. Washington, DC: Office of the National Coordinator for Health Information Technology; 2016. Available: https://tinyurl.com/ya382lz9

2.Healthcare provider models: electronic medical record adoption model. Chicago: HIMSS Analytics; 2016. Available: https://tinyurl.com/y88ttdfy. Accessed 26 July 2016.

3.CanMEDS: better standards, better physicians, better care. Ottawa: Royal College of Physicians and Surgeons of Canada; 2017. Available: https://tinyurl.com/j5fcykv. Accessed November 3, 2017.

4.LEADS in a Caring Environment framework. Ottawa: LEADS Canada; 2017. http://leads.in1touch.org/site/framework?nav=02. Accessed 3 Nov. 2017.

5.Reinertsen JL, Gosfield AG, Rupp W, Whittington JW. Engaging physicians in a shared quality agenda. IHI innovation series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2007. Top

 

Authors

Robin Walker, MB, CCPE, is integrated vice president medical affairs and medical education at St Joseph’s Health Care and London Health Sciences Centre and a professor of pediatrics at the Schulich School of Medicine and Dentistry, Western University.

 

Glen Kearns, HBA, is the chief information officer and integrated vice president Diagnostic Services at St Joseph’s Health Care London and London Health Sciences Centre.

 

Tom Janzen, MD, CFPC, is chief medical information officer at St Joseph’s Health Care London and London Health Sciences Centre and a primary care physician with a focus on mental health.

 

Sarah Jarmain, MD, FRCPC, is chair of the Medical Advisory Committee at St Joseph’s Health Care London and an associate professor of psychiatry at the Schulich School of Medicine and Dentistry, Western University.

 

Correspondence to:  robin.walker@sjhc.london.on.ca

 

Sponsorship/funding sources: None

 

Conflict of interest: The authors have no conflicts of interest to declare.

 

This article has been peer reviewed.

 

Top

 

 

Ten hospitals in southwestern Ontario, already sharing a common EHR platform, implemented computerized provider order entry, an electronic medication record, electronic medication reconciliation, and closed-loop medication administration including bar codes. The project leaders included many physicians and considerable effort was made to engage as many physicians as possible in every stage of the project. Adoption was excellent and, 3 years after implementation, data show significant patient benefits. Much of this success relates to strong physician engagement and leadership. However, even stronger physician leadership and more consistent engagement would have eased the transition for many physician users and might have resulted in even faster adoption. This article presents an outline of physician involvement during the project and lessons that may help others engaging in large-scale clinical transformations better plan their physician partnership strategy.

 

KEY WORDS:  electronic health record, electronic medical record, physician leadership, physician engagement, clinical transformation

 

In the United States, the adoption of electronic health/medical records (EHR/EMRs) by hospitals has increased rapidly in the last 8 years. According to the Office of the National Coordinator for Health Information Technology, by 2015, 96% of non-federal acute care hospitals possessed a certified EHR system (i.e., had a legal agreement with an EHR vendor), representing a nine-fold increase from 2008 when that number was only 9.8%. Fully 83.8% of acute care hospitals had actually adopted a basic EHR system (i.e., a system meeting ten “essential” core functionalities, including clinician notes).1

 

In Canada, adoption of EHRs has been much slower. The Health Information Management Systems Society (HIMSS) scores the level of adoption of hospitals on a seven-point scale. Their EMR adoption data for Canadian and US hospitals show that 4.3% of the 5456 US hospitals in their database have already achieved stage 7, compared with only 0.2% of 641 Canadian hospitals. Even at lesser stages, Canadian adoption levels are much lower than in the US: 29.1% of US hospitals have achieved stage 6 compared with 0.9% in Canada; and 34.4% US hospitals are at stage 5 compared with only 3.6% in Canada.2 Given the well-established safety and quality benefits of EHRs, the slow rate of implementation of these systems represents significant opportunity lost for our patients. Top

 

The HUGO project in southwestern Ontario

 

In southwestern Ontario, 11 hospital organizations had previously formed a voluntary coalition based on a common EHR platform. In 2011, ten of those hospitals agreed to move their EHR adoption forward with a project to implement computerized provider order entry (CPOE), an electronic medication administration record, electronic medication reconciliation, and closed-loop medication administration including bar codes. The project, named HUGO (Healthcare UnderGoing Optimization), took place over 3 years, from 2011 to 2014, and cost $32 million (< 1% of a single year’s budget for these hospitals). Over 6000 users had to be trained in the expanded EHR, including over 2000 physicians. Three years from the last hospital’s “go-live,” it is now possible to assess the outcomes of this significant expansion in the region’s EHR.

 

From the beginning, the project leaders recognized that physician leadership and engagement would be one of the most important factors in the project’s success or failure. A readiness assessment, undertaken at the largest hospital in the region, suggested that the “burning platform” for the change (i.e., improving quality of patient care) was well understood, including by physicians. However, expectations of success were not high, and there was evidence of change fatigue among many physicians and other professionals. Therefore, a decision was made to appoint a physician to act as executive sponsor for HUGO to clearly establish that this was a clinical project, owned and led by clinicians, and carried out to ensure clinical benefits for our patients. Top

 

The governance structure for the project included both clinician (non-physician) and physician advisory committees reporting to the Steering Committee. These committees frequently met together and provided leadership and advice on every aspect of the project from the point of view of the various health professions involved. The leadership team included physicians from several departments, who were funded to assist in implementation of every aspect from order set development to program build and through the implementation. Physician champions were identified in every department/division of each hospital and worked with their colleagues to promote the need for the change and to support physician involvement at every stage of the project.

 

Although all physicians involved in the project had to demonstrate Leadership, Communication, and Collaboration competencies, as described in the CanMEDS 2015 framework,3 these competencies were particularly important for those providing project leadership. Using the LEADS framework,4 the role of the physician project leaders was principally to “achieve results,” whereas the physician champions endeavoured to “engage others.” Every physician was invited to participate in critical stages of development, such as workflow analysis and design and order set development, thus fulfilling the CanMEDS Collaborator role.3 Top

 

By the time the project was implemented, about 50% of full-time hospital physicians had been involved in it, in one way or another. Throughout the project, a full-time communications consultant ensured the dissemination of frequent region-wide and hospital-specific bulletins, web sites, and messages, including physician-specific strategies. Project physician leaders, including the executive sponsor, traveled the region to ensure that physicians at every site had opportunities to meet with them frequently, as they presented progress, answered questions, and attempted to allay concerns.

 

As issues arose among specific groups, project and physician leaders met with those concerned to listen, provide data and literature, and, in several cases, arrange visits to US centres with a similar system already implemented, so that our local users could assess for themselves the impact and outcome of the proposed changes. At the same time, the Medical Advisory Committees (MACs) of all ten hospitals agreed that use of the system would be mandatory for all physicians and amended their policies to ensure compliance after implementation. Top

 

The go-lives at the ten hospitals (14 sites) were staged over 6 months with short gaps of 2–3 weeks between each to allow the implementing team time to resolve issues and prepare for the next launch. In the weeks immediately preceding each go-live, nurses, physicians, and other professionals received profession-specific training on the new system. “Super users,” including many physicians and residents as well as nurses, allied health professionals, and students, were chosen from as many departments as possible and received additional training, so that they would be able to support other users in their department and others. In addition, a large group of nursing students was trained on the system as super users.

 

At each go-live and for some weeks following, the super users provided “at the elbow” support to users to assist their transition to the new functionalities. The nursing students proved so effective in this role — and the need for ongoing support, particularly for physicians, so great — that their engagement was extended well beyond the original intent. Every user was able to signal a problem via a dedicated HUGO “hot line,” and help could usually be dispatched within minutes. All reported system problems were logged, triaged, and addressed in order of severity and urgency. Any reported system errors were tracked and subsequently analyzed to identify whether the system was at fault versus workflow or user issues. Top

 

Outcomes

 

Three years after the last go-live, medication error rates for almost all ten hospitals have substantially decreased. At the two largest institutions, the decrease is 35–40% in overall errors, with wrong patient/wrong drug errors decreased by 85–90%. Turnaround times for medication and laboratory orders have been substantially reduced. Although there was an initial negative impact on productivity, particularly for providers such as physicians, all measures of productivity have returned to at least their levels immediately before implementation, and patient flow in a few ambulatory areas may have improved.

 

Adoption rates are excellent. In our largest hospitals, about 85% of all orders are processed via CPOE, and successful scanning rates for both medications and patients are 85–90%. Top

 

Acceptance of the system was high from the beginning for nurses and allied health professionals, but slower for physicians. In a few departments, serious concerns were expressed initially about the intuitiveness of the system and its impact on productivity. The most serious concerns were expressed in our largest emergency departments (EDs). There, it was necessary to implement a 30/60/90-day program of rapid optimization to prevent a return to paper orders (which was, briefly, requested by physicians). Following success of that rapid improvement plan, the system has continued to be used in the EDs, and many of those physicians are now champions of further expanding the EHR to include even broader functionality (e.g., electronic clinical documentation).

 

A survey of users 1 year after implementation showed that nurses were generally very satisfied with the system. About 75% scored it as meeting their expectations for ease of use and functionality. In the same survey, physicians were less satisfied, with a substantial minority still finding the system not fully meeting their expectations. Nevertheless, none of the MACs in the ten hospital organizations has found it necessary to use any sanctions to ensure compliance of physicians in using the system. Top

 

Lessons in physician leadership and engagement

 

The clarity of purpose achieved by having an executive sponsor who was a physician helped reassure physicians in the hospitals that this project and the resulting huge change to their practice were based on important clinical imperatives to improve patient safety and quality of care. Accordingly, although the executive sponsor was clearly functioning in the Leader role (CanMEDS3), attempting to ensure “systems transformation” (LEADS4) through this major change in health care practice, his most important function was arguably as a Communicator (CanMEDS3) who worked to “engage others” and “develop coalitions” (LEADS4) among  physicians, between their leaders, and with other professional groups.

 

In hospitals where the Medical Advisory Committee was fully engaged and supportive, its chair played the same roles locally as the executive sponsor did regionally, further strengthening the clinical leadership of the project. The multiple physician leaders in the project structure, together with a strong physician advisory committee, provided further clarity and reassurance that physician input into designing and building the system was important. The uniform and consistent approach of the region’s MACs ensured that all physicians would be held to the same standards of accountability wherever they worked in the region. Top

 

However, there was still some variation from hospital to hospital in engagement of medical and nursing leaders before and during implementation. As a result, transition to the new system was more difficult at sites where engagement had been weaker. Team culture also appeared to play a role. In cases where interprofessional relationships were strong, physicians received significant support from their nursing colleagues. In larger hospitals, there was also variation in engagement between departments or divisions, which again translated into more difficulty in adoption where fewer physicians had been engaged in building the new system.

 

For future projects, therefore, we plan to engage both medical and nursing leaders in our executive sponsor roles and support even more physician leaders within the project team. We will also more fully support physicians who help design and build the system as well as those who provide user support. This will include financial support, which was provided during the HUGO project only to physicians with the greatest time commitments. We will also better support physicians during their essential training. Top

 

Meanwhile, we have changed the governance of our e-practice committees to ensure that physicians become the main drivers of change and help lead all our planning for future EHR expansion. Finally, we will plan to have a part-time medical informatics lead in every large department in our academic centres during the pre- to post-implementation period.

Training was another area where we learned much: generic training on system functionality is insufficient for physicians, whose practices vary significantly between specialties. Hands-on training using cases drawn from a physician’s area of practice is much superior to generic training, and at-the-elbow support while the physician is actually using the system is best of all. Our at-the-elbow super users were invaluable, but we learned that they are needed for far longer than we originally planned. Top

 

We also underestimated the importance of our trainees, both in pre-implementation engagement to ease their transition and in terms of their potential use as fast learners and super users. Our assumption that “tech-savvy” residents would transition easily was not completely true and resulted in difficulties in several areas of care. Moreover, we have subsequently realized that residents who are well trained and familiar with the system make excellent trainers for other physicians and we are now using this knowledge to facilitate our current training approaches for new users.

 

We also underestimated the impact of the change on medical students, both in terms of their role in electronic workflow and on the availability of residents and faculty as their teachers during implementation. Top

 

Conclusion

 

With strong physician leadership and engagement, ensuring use of important aspects of the CanMEDS 20153 and LEADS4 frameworks, a major multi-hospital clinical transformation can be successfully accomplished with significant benefits to patients. However, our experience suggests that even stronger physician leadership and engagement, starting from the planning of projects through their implementation and beyond, would result in easier transition for physicians and other users and help ensure the most rapid adoption.

 

Multi-hospital EHRs with a full range of functionality promise real improvements in integration and quality of patient care. However, success in such projects depends on the breadth and depth of engagement of physicians. As described in the Institute for Health Improvement’s “Framework for engaging physicians in quality and safety,” this requires the discovery of a common purpose to improve patient outcomes, courage in leadership at all levels, and the involvement of physicians from the beginning.5 Successful transformation can only be achieved if physicians are fully engaged in leading the development and implementation of these systems.

 

References

1.Henry J, Pylypchuk Y, Searcy T, Patel V. Adoption of electronic health record systems among U.S. non-federal acute care hospitals: 2008–2015. ONC data brief 35. Washington, DC: Office of the National Coordinator for Health Information Technology; 2016. Available: https://tinyurl.com/ya382lz9

2.Healthcare provider models: electronic medical record adoption model. Chicago: HIMSS Analytics; 2016. Available: https://tinyurl.com/y88ttdfy. Accessed 26 July 2016.

3.CanMEDS: better standards, better physicians, better care. Ottawa: Royal College of Physicians and Surgeons of Canada; 2017. Available: https://tinyurl.com/j5fcykv. Accessed November 3, 2017.

4.LEADS in a Caring Environment framework. Ottawa: LEADS Canada; 2017. http://leads.in1touch.org/site/framework?nav=02. Accessed 3 Nov. 2017.

5.Reinertsen JL, Gosfield AG, Rupp W, Whittington JW. Engaging physicians in a shared quality agenda. IHI innovation series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2007. Top

 

Authors

Robin Walker, MB, CCPE, is integrated vice president medical affairs and medical education at St Joseph’s Health Care and London Health Sciences Centre and a professor of pediatrics at the Schulich School of Medicine and Dentistry, Western University.

 

Glen Kearns, HBA, is the chief information officer and integrated vice president Diagnostic Services at St Joseph’s Health Care London and London Health Sciences Centre.

 

Tom Janzen, MD, CFPC, is chief medical information officer at St Joseph’s Health Care London and London Health Sciences Centre and a primary care physician with a focus on mental health.

 

Sarah Jarmain, MD, FRCPC, is chair of the Medical Advisory Committee at St Joseph’s Health Care London and an associate professor of psychiatry at the Schulich School of Medicine and Dentistry, Western University.

 

Correspondence to:  robin.walker@sjhc.london.on.ca

 

Sponsorship/funding sources: None

 

Conflict of interest: The authors have no conflicts of interest to declare.

 

This article has been peer reviewed.

 

Top