How physician feedback is helping improve patient care

By Amber Daugherty

Dr. Holly Knowles knew she had a problem – she was busy. Whenever a patient reached out, she found she might have time to see them in the next few days but it could be a few weeks until she had an opening. So she accessed a new resource at St. Michael’s Family Health Team – a peer mentor. She was matched with a colleague and together they brainstormed ideas for how she could make herself more accessible, including ideas like having patients be seen by nurses for routine follow-ups. At the same time she was being coached, she also became a coach and worked with other peers on issues they were dealing with.

“I think we’re the first family practice in Canada to have this kind of peer coaching embedded within our practice,” said Dr. Tara Kiran, family physician and clinician investigator. “Out of our almost 80 staff physicians, we trained 10 who were selected by their peers as coaches – all with the goal of our teams being able to constantly learn and improve.”

The peer coaching works in tandem with another new resource in the Family Health Team: an interactive data dashboard where physicians can track their own individual impact. Previously, physicians would only be able to see clinic- or department-level data on quality of care. This new dashboard enables physicians to drill down into their own practice to learn more about the types of patients they serve and the quality of care they are providing. The dashboard includes data on patient experience, cancer screening, immunizations, high risk prescribing, diabetes management and more.

“It’s made a tremendous difference in terms of being able to self-assess how we’re doing relative to our peers,” said Dr. Knowles. “And there’s also information that we can action on – for example, if we have patients who are not meeting a target diabetes parameter, we can get them to come back in and loop other team members in so they can connect with a pharmacist and dietitian. Having a one-stop place where you can view all of this information has been transformative.”

The Family Health Team has six clinics that together serve 45,000 patients.

“Essentially, we wanted to make it easier for doctors to see who their patients are and how they’re doing,” said Dr. Kiran. “I’m a big believer in data-driven improvement because it helps us understand what we’re doing well, where we can do better and whether the changes we make are actually leading to improvement.”

Dr. Kiran is leading a study on the peer coaching and dashboard to see what types of data and social interaction help make positive changes for care. The study includes a group of patient and family advisors who are providing feedback and support.

“Our patient and family advisors all agreed that coaching is really valuable – they liked the idea that physicians would talk to someone else about the way we practice because it shows we’re trying to develop a growth mindset,” Dr. Kiran said.

Dr. Knowles has now supported more than five of her colleagues as a peer coach and she’s also done a couple of group coaching sessions. For her, there is no downside to this practice.

“I think just knowing that we have a process where people can get feedback on their practice really creates an open environment where we can discuss anything,” she said. “At the end of the day, we’re all working together to make sure our patients are receiving the best possible care so it makes complete sense that we would collaborate and ask one another for feedback.”

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About Unity Health Toronto

Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit www.unityhealth.to.