sustaining physician engagement
TRANSCRIPT
Sustaining Physician Engagement
Kenneth W. Bradley
Chief Executive Officer, Winter Park HospitalSusan D. Douglass
President, Susan Douglass & Associates LLC
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Session Overview
• Each Path Is Unique Best Practice: Sustainable Engagement Creating Consensus: Partnering for Progress The Path To Engagement A Framework For Sustainable Engagement Questions
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Each Path Is Unique…
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Each Path Is Unique
Each of us is on our own unique path to achieving high quality, affordable care.
We are operating on different timelines in different markets with different strengths and challenges.
We have different histories (i.e. generations of physicians practicing and relationships with primary care and specialists in our markets) Academic, Employed, Independent, Contracted. Historic differences of opinion.
We share the universal burning platform of federal and market reform. We realize now more than ever that the administrative and clinical side of
healthcare should work together to meet today’s challenges. Or suffer the consequences.
Survival may be the spark for a willingness to work together as we never have before.
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Best Practice: Sustainable Engagement
When physicians and executives invest consistently
on doing what is required for their healthcare organization to succeed
andOn a daily basis
actively make positive contributions within their working roles
to maintain and enhance the performance of the organizationbecause they are committed to its mission, vision and values.
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Why Has This Been So Difficult
Constantly crossing boundaries –total integration “group mind”
Interacting unique roles while still playing the game
Game played solo, with interaction at handoffs –overlapping boundaries
Game played solo –accumulate score
Administration Physicians
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Why Has This Been So Difficult
Simply put: Leaders within this dynamic, complex business setting (i.e. physicians and
executives) have not had to have a shared vision. Distrust and resistance has been addressed episodically so it lingers. Until now, our viability was not being challenged so we were not motivated to
go beyond our myriad of differences in: Training Socialization Values orientation Workplace pressures Day to day expectations.
Or develop the skills together required for the new era of healthcare...
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Creating Consensus – Partnering For Progress
• At a minimum, we share the pursuit of “perfect care” and want to be the best in:• Quality• Safety• Outcomes• Patient Satisfaction
• This environment demands we work together to develop scenarios for success.• With the understanding that the definition of success for the executive and
physician may distinctly differ.• By building a mental engagement.
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Creating Consensus – Partnering For Progress
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A Fresh Look
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Executives,Employed,
Affiliated, ContractPhysicians
LISTEN
DEFINE/ENGAGE
REINFORCE
DELIVER
ALIGN
Reinforce the success by celebrating successes, reward as defined and
look for next opportunities
Deliver on agreed to expectations ( behavior
standards, staffing, resources, quality, patient
satisfaction) in all communications and
interactions
What does engagement mean to us, what works
well, where we are having challenges, what
are our opportunities
Identify and Engage Physician Leaders.
Define success from our respective perspectives, and Identify opportunitiesLeverage existing
resources, define expectations, select 2-3
clear, manageable physician led initiatives
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Listen
Engage in honest, facilitated dialogue. Share vulnerabilities and a willingness to understand each others needs and
perspectives. Recognizing the different frames of reference.
Air historic differences. Understand what is working and why. Communicate functional/personal barriers (work environment, trust level) Emphasize points of agreement. Provide timely feedback on what was heard. Agree on the valued collective objectives and a draft “stop doing it” list.
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The “Stop Doing It” List: Illustrative Example
Not valuing a physician’s time. The haste to hire. A focus on protecting one’s income. The inability to listen to feedback without getting defensive. The lack of physician involvement at the strategy table. The lack of physician involvement within the governance structure. A black box approach to physician professional development. The existence of the “secret deal.” The haste to implement.
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Economic engagement:Shared risk / reward
Maybe contractually alignedMutual benefits = “Win Wins”
Business engagement:Shared and mutual strategyJoint business development“Live and thrive” togetherFull profit and loss sharing
Mission Engagement:Aligns / supports missionMaybe relationship based
Clinical Engagement:Always puts patients first
Desires mutual excellence and success
Goal
Creating Consensus
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Creating Consensus
Working within our current medical staff model Academic Employed (FHMG) Private Practice Contract
Forming a closer engaged network Shared Value (and the ability to share resources and wealth) Superior Outcomes Face the future together
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Creating Consensus
We decided to step back, take a candid look at issues that were festering in our organization and focus on the key, critical priorities.
We are placing the patient and their needs at the center of our conversations and we are finding ongoing conversations to be quite productive.
We believe this approach enables us to focus our collective expertise on solving our challenges because we are making decisions focused on a shared value.
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Define/Engage
Assemble a group of executive and physician leaders. Resist the urge to just get started! Discuss the collective valued objectives to tackle. Agree on 2-3 clear goals and the targeted audience for each. Discuss what success means from both perspectives.
Candidly and openly. Determine what are the motivators to get started and who needs to be at the
table. Define participant expectations for the committee, develop a short role
overview and agree on how to record time. Agree on compensation to be paid for hours spent.
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Participant Expectations: Illustrative Example
Actively listen and participate.• Openly exchange ideas and viewpoints.• Work to build on each other’s ideas to find the best solution.• Ask for help when you need it.• Be willing to develop and coach others• Share responsibility for deadlines and ownership of results.• Keep the discussions of this group confidential• Be on time and available.• Serve as role models.
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Align
In partnership, examine the collective goals for their viability and ability to motivate physician peers to participate.
Can it be developed as a “win-win” for both physicians and executives? Do they create the opportunity for a physician to lead the initiative? Is this where physicians want to contribute? Do we have reliable performance data to call attention to the need for change
and the definition of improvement? Can we identify other champions to assist in solution design and consensus
building? Who needs to be at the table, lead process etc.
Do physicians have the leadership ability required for implementation?
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How Peers Engage
PassionTo Help
Agree with change
Reliable Data Supports The Change
Confidence In My Abilities To Affect Change
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Where Some Have Started
Improving HCAHPS score Identifying disruptive physician behavior Reducing the “Hassle Factor”for all physicians
Improving communication with hospitalists Improving patient “hand offs”across the continuum of care
Focusing on reducing readmissions Providing future skills development strategies for our physicians
Adaptive leadership, team conflict resolution, communication etc.
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Use Reliable Data
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Deliver
Assemble the teams that need to be at the table given the agreed upon goals. Within each team, agree upon the goals and who needs to be involved beyond
the team to accomplish this goal. Nursing Line managers.
Widely communicate the efforts with physician leaders asking their peers for their assistance.
Develop a communications strategy for each initiative and customize messaging to various audiences.
Report progress against goals frequently.
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Reinforce
Recognize the physician leaders for their leadership. Using reliable data, identify the physicians that were the early adopters of the
initiatives and recognize them for their new behaviors. Create consensus for the next set of initiatives for consideration and a more
formal model for sustained success.
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Current State
Transition State
Improved State
Creating a Shared Goal
Shaping a Vision
Mobilizing Commitment
Adapting To New Behaviors
Reinforcing Behaviors
Engagement
Supporting New Behaviors
Source: GE Healthcare CAP Framework
For Engagement to be Sustainable
Sustaining Engagement
Culture
Recruiting and SelectionFocused on Shared Values
Consistent Onboarding of all Physicians
Ongoing involvement in service and delivery
innovations
Proactively identifying leaders and champions
Making available exciting learning
opportunities
Market based compensation and stipends for results
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The Time Is Now…
Unrest in the profession of healthcare continues to increase. Physician retirement is up 2.9% and projected to rise. Total physician turnover is on the rise, averaging around 6% in 2013. According to a recent American Medical Group Association (AMGA) survey
Recruiting a new physician into employment averages $270,000 Replacing a physician averages $1,200,000.
Not factoring in any financial consideration for the myriad of marketplace challenges when a well liked physician leaves.
It will require our collective viewpoints to find solutions or suffer the consequences.
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Thank You – Time For Questions!
After the Session, Please Contact:
Susan at
or
770.335.4383
With Questions…
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