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A framework for engaging physicians in quality and safety
  1. Jonathan M Taitz1,2,3,
  2. Thomas H Lee1,3,4,
  3. Thomas D Sequist1,3,5
  1. 1Brigham and Women's Hospital, Division of General Medicine, Boston, Massachusetts, USA
  2. 2Sydney Children's Hospital Network, Sydney, Australia
  3. 3Harvard Medical School, Boston, Massachusetts, USA
  4. 4Partners Healthcare System, Boston, Massachusetts, USA
  5. 5Harvard Vanguard Medical Associates, Boston, Massachusetts, USA
  1. Correspondence to Jonathan M Taitz, Brigham and Women's Hospital, Division of General Medicine, 1620 Tremont Street, Boston, MA 02102, USA; jtaitz{at}


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.

  • Physicians
  • engagement
  • quality
  • safety
  • framework
  • graduate medical education
  • health policy
  • hand-off
  • healthcare quality improvement
  • information technology
  • evidence-based medicine
  • patient safety
  • diagnostic errors
  • continuous quality improvement
  • financial incentives
  • management
  • lean management
  • governance
  • qualitative research
  • leadership

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  • Additional materials are published online only. To view these files please visit the journal online (

  • Funding This study was supported by the Commonwealth Fund Harkness Fellowship in Health Care Policy and Practice.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.