PRACTICING EXCELLENCE:How to Align Physicians in a

Shared Agenda

Stephen C. Beeson MDStuder Group Medical Director

Sharp Rees-Stealy Medical Group

The Objective of our Time

Create physicians that will align with organizational efforts to execute positive

outcomes in quality, safety, cost- effectiveness, the patient experience and evidence-based care

The Physician Change Equation

Physician Behavioral

ChangePhysician

Buy-in

Physician Training

Performance Feedback

Performance Incentive

Effective Physician

Leadership

Trust in Hospital

LeadershipManagement of misaligned

Behaviors

Recognition

Selection and Orientation

Visibility of Organizational

Culture

Physicians Align When

They trust those leading the effortThere is compelling evidence this is necessaryTheir role is clear and well articulatedPhysician leaders amplify the alignment messageThey are invested to “get it done”The destination is about a mission they can “back”Those around them seem to be doing it

Diagnostic Criteria for Physician Engagement

Physicians are aware and support organizational goalsPhysicians actively involved in quality, safety, and service initiativesPhysician behaviors are consistent with the organizational “signature”Physicians will say/do something if standards are breeched

What We Need Physicians To Do:

Comply with evidence, clinical protocols and order setsDeliver the patient experienceManage cost of careSupport the group missionFoster system safety

4 Tactics to Create Physician Alignment

Creating physician buy-inBuilding physician trustAligning physician leadershipTraining physicians

Tactic #1: Creating Buy-in

He who has a compelling enough Why, can overcome any How

Basic Truths about Buy-in

If physicians resist or protest, it is likely related to ineffective buy-inThis is a key leader responsibility and ability

How Do You Create Buy-in For:

The patient experienceCost reductionA culture of safetyReduction of variance

Guidelines for Creating Buy-in

Believe it yourselfKnow the evidenceTranslate data to storiesBe intense

How Do You Know If You Have Made the Case Sufficiently?

Physicians are asking when it will happenThe uptake for initiatives is fastPowerful group sentiment that “we must do this”Leaders have articulated an irresistible futureVocal resistors are seen as outliers

Tactic #2: Creating Physician Trust

If physicians don’t trust those that lead them, they will, at best, become indifferent and

uninvolved in organizational efforts.

More likely, they will protest and resist efforts to defend their differing agenda.

Trust Defined

“The state of readiness for unguarded interaction with someone or something”Tenants of Trust

Capacity for trustingPerception of competencePerception of intentions

TRUST BUILDER: Including Physicians in Strategic Planning and Goal Setting

Strategic planning is setting the course for the future

Defining an overarching visionIdentifying strategies and actions to execute the visionSetting system goalsAllocation of resources

Why Include Physicians:

The dialogue and process of planning is as important as the plan itselfPhysician will own and support a plan they help createOpen and responsive dialogue fosters physician trustPlanning for a collective future will reduce physician suspicion of administrative activities

TRUST BUILDER: Survey Physicians

To deliver an effective treatment plan, leaders must diagnosis what physician issues need to be fixed

If we could fix three issues for you tomorrow, what would those be?1.

2.

3.

Leadership to

Physicians

TRUST BUILDER: Medical Staff Hotline

We are here to provide you the best place to care for patients, 24 hours a day, 365 days a year. If

there is anything that falls short of what you need, let us know and we will do what is necessary to make it right. Our leadership team will respond and communicate a response within 48 hours of

your call. Guaranteed.

TRUST BUILDER: Physician Recognition

Recognizing physicians for contributions, involvement and going above and beyond is one of the simplest and most effective ways to build physician trust with leaders and loyalty to a system

Tactic #3: Aligning Physician Leadership

“Leadership has been identified as the most important ingredient in transformational

improvement.”

From Joint Commission Resources presentation; Executive quality improvement survey results. Journal of Patient Safety. 2 March 2006

The Role of the Physician Leader

Create and project a specific destinationCreate consensus around that destinationCreate goals to verify “arrival” at the destinationDeploy and manage strategies to execute goalsMeasure, report and communicate progressConvey expectationsManage low performanceRecognize high performance

The True Role of a Leader

To get others to do what must be done because they want to do it

The Pathway to Effective Physician Leadership

Selecting Physician LeadersDeveloping Physician Leaders

Leader Selection

First who, then what

Signs of the Wrong Leaders

Defenders of “physician turf”Indifferent or disinterestedChanges position depending on who they are talking toFail to respond when there is a clear violation to the system way of doing things

Physician Leader Selection Criteria:

Intensity and passion for the mission and loyalty to the systemA desire to leadRespected by colleaguesHas led something in the pastCan defend a position in face of resistance

Physician Leader Selection Criteria

Strong presenter and ability to communicate in a straight-forward fashionSubject matter expert (or willing to learn)An ability to convey performance expectations to othersPersonal connection to those around them

Guiding Leader Selection Principles

Clear position responsibilitiesAppointment/election process promotes leaders that have a high probability of successTake time for this - get it right

Physician Leadership Development

We didn’t learn this during medical school or residency

Trainable Physician Leadership Skills

How to present and communicate a compelling Mission and VisionHow to make the case for changeHow to round on colleaguesHow to run a meetingHow to manage a disruptive colleagueHow to recognize high performanceUnderstanding the external health care environment

Physician Leadership Development

Invest in the development of the physician leadership team

Physician Leadership AcademyCreates shared, simultaneous learningParticipation is required for that part of the leadership team

Training Works When:

We believed the change was important (buy-in)The destination is crystal clear (vision)There was a compelling need to change (current performance)We knew how to do the change (training)Expectations were clear and disseminated (behavioral standards)Our change effort was measured and reported back

Leader Performance Predictors

Proper leader selection Development of skills to execute Clear description of responsibilitiesAssigned goal set for full time leaders in area of responsibilityLeader assessment by the execution of goalsPerformance transparency among the leadership team

A Leader’s Self Reflection…

Do I love the work that I do?Do I convey a sense of hope?Do I honor my word?Am I interested in others?Do others trust me?When things go poorly, how do I respond?

Action From Today

In order to “Align Physicians” one must first diagnose physician relationsOutreach to physician for inclusion in organizational strategyDevelop communication mechanisms to convey mission, strategy and resultsInvest in training and developing physician leaders