Table 3

Framework for engaging physicians in quality and safety

Theme	Quote	N	%
1. Engaged leadership	‘Leadership, ie, able to get physician buy-in to quality and safety, their commitment and belief in its value and the importance of making the final product better’	29	70
1. Engaged leadership	‘You need engaged leaders to have engaged physicians’
2. Physician compact	‘The compact captures the focus on the patient. It also creates a common framework for why physicians are here, our relationship with the organisations, other physicians and our patients.’	6	15
2. Physician compact	‘The compact is a living, breathing, dynamic reciprocal agreement that aligns expectations between the organisation and our physicians’
3. Appropriate compensation	‘Quality is not an add-on to busy physicians' schedules, otherwise you don't get full commitment’	21	50
3. Appropriate compensation	‘You can't do quality between surgical cases and at tea time’
4. Realignment of financial incentives
Support financial incentives	‘Have your professional values dominate and then align financial incentives around them’	15	33
	‘Payment of incentives is important. Physicians are like everyone else, the monetary rewards are the power to drive behaviour.’
Oppose financial incentives	‘Financial incentives are an insult to the professionalism of physicians’	13	31
	‘We should rather reward value’
5. Data and enablers	‘Physicians are data connoisseurs—it is imperative to get accurate data’	30	66
	‘There is no greater force than peer pressure in a structured format’
	‘Physicians don't just need data, they also need enablers or processes to improve their performance’
5b. Data reporting
Support internal transparency	‘Need complete transparency internally to transform the culture of the organisation’	40	95
	‘Internal transparency is more a driver of change than external transparency’
Support external transparency	‘We want to demystify the data and make it understandable to the public’	22	52
	‘Data should be completely transparent so that patients know what we do well’
Oppose external transparency	‘Be wary of publishing individual performance publically, external reporting should reflect system results’	11	26
	‘Public reporting can be misleading’
6. Academic promotion	‘Tie academic promotion to outcomes and participation in quality-and-safety activities’	6	14
6. Academic promotion	‘Quality-and-safety publications should be treated on a par with traditional research publications’