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Looking for Looking for Quality in Your Quality in Your CandidatesCandidates

Marion C. Martin, RN, MSN, MBACOO, The Center for QualityRoper St. Francis Healthcare

Healthcare ValueHealthcare Value

Patient Experience

Present StateA hospital is only as good as the care it provides, and no hospital renders quality care to a patient without the leadership of a quality physician

With the economy steadily improving ,physicians who have come out off retirement or switching jobs are starting to make moves.

Some 44, 250 full time doctors could be lost in the next 4 years equaling about 91 million fewer patient encounters each year.

Millions of new patients are expected to grab health insurance from insurance exchanges and flood the healthcare system starting in 2014 further worsening the physician shortage.

To stay competitive , hospitals should avoid behaviors that might dissuade doctors from landing elsewhere : drawn out hiring processes or unwieldy contract negotiations

Present State

asdfasdfPrimary Care

Value-Based Market Forces

Healthcare is being reformed by Healthcare is being reformed by the market placethe market place

Medicare & Medicaid paying lessMedicare & Medicaid paying lessSelf Pay increasingSelf Pay increasingCommercial insurance and Commercial insurance and

employers no longer willing to employers no longer willing to accept cost shiftaccept cost shift

RealitiesRealities

6

More payors will be reimbursing More payors will be reimbursing us at Medicare ratesus at Medicare rates

Need to take >15% of cost out to Need to take >15% of cost out to break even on Medicarebreak even on Medicare

Technology and Quality initiatives Technology and Quality initiatives driving cost up, not downdriving cost up, not down

7

RealitiesRealities

Healthcare: Facing the Perfect Storm?Healthcare: Facing the Perfect Storm?CONSISTENT THEMES NATIONALLY, REGIONALLY, AND LOCALLYCONSISTENT THEMES NATIONALLY, REGIONALLY, AND LOCALLY

8

Rising Costs• Inflation

• Excess Capacity• Information Technology

• Advanced Medical Technology

Shifting Demographics Aging Population

(shifting from private plans to Medicare) Health Reform Coverage Changes

Increasing Demand for Quality/Cost Performance

By Patients, Payers, Government Migration of care to

lowest cost setting

Limited Access to Capital Credit Barriers

Changing Debt TermsBond Rating Pressures Bankrupt Bond Insurers

(e.g., AMBAC)

Declining Revenues Federal & State budget crisis

Reimbursement Cuts Decline in Elective Procedures

“Great Recession”Investment Losses

Decreased philanthropy

New Payer Strategies / Payment Reform

P4P, Bundling, Shared Savings (ACO)“No Pay” for Underperformance

Never Events, Readmissions, etc.Overutilization

Converging StrategiesConverging Strategies

9

Reengineering Workflows to

Improve Outcomes

QualityQuality FinanceFinance

Improved Improved Clinical Clinical OutcomesOutcomes

Improved Improved Financial Financial ControlsControls

• Individuals, families, businesses, municipalities can’t afford health care

• Health care costs continue to escalate

• Costs shifting to individual employees & their families

• Access, Quality, Safety & overall Population Health is mediocre

• Clinicians & staff stress is high (and worsening) due to inefficiencies

• Lack of Physicians (especially PCP’s) for aging & obese population

Current Situation is UnsustainableCurrent Situation is Unsustainable

System of CARE Alignment Is System of CARE Alignment Is the Imperativethe Imperative

Retail Pharmacy

Wellness and Fitness Center

Diagnostic/ Imaging Center

Urgent Care Center

Hospital

Home Care

Home

Acuity

Acute Care

Post-Acute Care

Physician Clinics

Ambulatory Procedure Center

OP Rehab

IP Rehab

SNF

IP = inpatient; OP = outpatient; SNF = skilled nursing facility.

Preventive Care

Community-Based Care

Developed for Toyota by Mr. Developed for Toyota by Mr. Ohno after WWII involved:Ohno after WWII involved:

reengineering the culture reengineering the culture eliminating waste for their eliminating waste for their

processesprocessesimproved quality improved quality

Lean ManagementLean Management

Hold a work session to look at your Hold a work session to look at your recruiting processesrecruiting processesMap the current process: include every Map the current process: include every step and everyone involved in the step and everyone involved in the processprocessAll involved become part of the processAll involved become part of the process

Steps in your processSteps in your process

Pool the staff’s collective Pool the staff’s collective knowledge: this prevents a build up knowledge: this prevents a build up of inbound workof inbound workUtilize the tools of Lean: mapping, Utilize the tools of Lean: mapping, cause and effect diagrams, value cause and effect diagrams, value stream mapping, cycle times and stream mapping, cycle times and error proofingerror proofing

Steps to successSteps to success

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Improvements You Can Make Using Lean Techniques

Proactive versus reactive recruitingElimination of duplicate work my medical staff office and hospitalEnhancement of candidate screening processReduction in the amount of time from physician presentation to the department decision makersReduction in the time between confirmation and the start of the credentialing processChange responsibilities among staff to promote better process flow

What is the state of your hospital/ system right now in terms of cost, quality, customer satisfaction, market share?

What are your strengths, weaknesses, opportunities and threats?

Where do you want the health care system to be in the future?

Collaboration

Quality services: Data collection

Data Collection:

FPPE OPPEQuality Metrics Publicity Reported Data

The “Quality” talk with Candidates

RoundingSafety huddlesPatient and Family engagementLeadership opportunitiesLean training

Making those Behavioral choices

Make interview process stand out

Do everything better than your competition

Develop a core group of interviewers: Who would that be in your organization?

Train your core group to become expert interviewers and evaluators: Do you include a patient or family member in the process?

Behavioral Interviewing skills

Start with : Tell me about a time……

Sample questions

Tell me about a time you were running late and needed to spend extra time with a patient due to their diagnosis.

A nurse makes a critical comment about you in front of others, tell me how you would handle that.

Tell me what patient and family engagement means to you

Tell me how you worked with those that provided you with data

Tell me about a time you led change to provide better patient outcomes

Under what circumstances do you feel it is okay to terminate a relationship with a patient ?

How do you know if a patient understands what you are telling them?

If you could customize your schedule, what would it look like?

Tell me how you work with Case Management to ensure a safe transition for your patient ?

Tell us about a time you had a conflict with a co-worker. How did you handle the situation?