AS: One thing of importance is you. This is about your doctors and hospitals. So as we come to a pause we are going to ask you about your institution . Once Upon a Time there were “doctors.” Remember your own family doctor. Did he come to your home with a black bag and take care of your ear ache. Did he do the surgery in the OR and even deliver babies? Once upon a time Dr. Dismond, a wonderful doctor in Michigan that I will tell you more about in a few moments, did all of those things. He was a doctor. Today, the images of doctors is what our grandchildren will tell theirs about Once upon a time, there were lots of different kinds of doctors. My doctor was a woman and she was very nice to me. But when I went to the hospital I never saw here there. What does engagement mean to which doctors and by which hospitals? What is marketing ’s role as it expresses the brand of healthcare and attracts/engages the right doctors to “buy into” that institution’s brand? Critical issue for the healthcare business Recently published “Guide to Physician Engagement” by Research and Markets has key topics: Keys to physician engagement Physician structure and decision making Engagement in Wellness and prevention Engagement in Pay for Performance Really scoping out the wide range of areas—deconstructing the physician culture and suggesting tactics for connection reluctant physicians into champions for healthcare improvement. The tools that the experts provide include skills assessment, communications, incentives and marketing that can turn physician push-back into support. What does engagement mean to which doctors and by which hospitals? What is marketing ’s role as it expresses the brand of healthcare and attracts/engages the right doctors to “buy into” that institution’s brand? Critical issue for the healthcare business Recently published “Guide to Physician Engagement” by Research and Markets has key topics: Keys to physician engagement Physician structure and decision making Engagement in Wellness and prevention Engagement in Pay for Performance Really scoping out the wide range of areas—deconstructing the physician culture and suggesting tactics for connection reluctant physicians into champions for healthcare improvement. The tools that the experts provide include skills assessment, communications, incentives and marketing that can turn physician push-back into support.
AS Which hospital might I be in? The each have their own culture, their style of doing things. Their own relationships with their doctors.
AS The ones that are in group practices—big groups that are doing much of what a hospital is doing; or smaller specialty groups focused on just orthopedics; or a PHO; maybe they are owned by the hospital as a GI doctor I know is doing; or they just became doctors and couldn ’t wait to become a staff doctor, a hospitalist in the hospital taking care of those other doctor’s patients? Or maybe they are soloists: as many doctors still remain, just a “doctor” as one nice Dr. Espinosa told me; just a good doctor. What will engagement mean to each of them? What will engagement mean to each of them?
AS Can you see it in their body language? I watched a group of doctors at a strategic planning session and I was hard pressed to know the engaged from the unengaged. Not only were they doing many things but they would come in and out of the conversations. Yet they were at the session and among the 500 doctors on staff they were the engaged ones. The actively disengaged were interesting as well. No one had really ever tried to engage them. And the one doctor who had the longest length of stay problems was also among the most engaged. Fully Engaged Physicians are the most valuable to a hospital when they have a strong emotional bond with the organization. Engaged Physicians have an emotional bond that is less strong and the feel less loyal Not Engaged Physicians are emotionally and attitudinally neutral. NO positive association with the organization Actively Disengaged Physicians have an active emotional disatachment form the organization and are antagonistic towards it
Andi, if you have better or different data that you would like you can eliminate my next 2 slides. Or if you want to add to these slides or add an additional slide, please do
AS To Kris ’s point, and that of Brian and Jeff, why does engagement matters, as does change because times are changing. Two areas of particular importance: patients expectations are changing. Young people who have grown up digital, who expect things immediately and on their iphone are very different attitudinally towards healthcare practitioners than the Boomers who sit for a long time to see a “doctor” and in NY pay cash to have a hip replaced because that doctor is the “best.” But you need not go too far to see the financial challenges at all levels as we shift from FFS to Value based pricing. And the supply-demand relationship puts different hurdles into those hospital/doctor/ambulatory center relationships.
AS What does the data tell us about physician engagement and how it effects care, caring and hospital bottom lines? reports a drop of about 5 percent in the number of physicians who are fully engaged and an increase of about 10 percent in the actively disengaged. He attributes that to worries about the impact of value-based purchasing, and changing reimbursement and incentives.
AS background What about you. Can you tell use about what you are doing in your institutions to assess physician engagement and to change it? AS
AS Which means how are you engaging? Do you meet one-on-one with all physicians at least once each year? Are we, as leaders and employees, meeting your expectations and those of your patients? Do you have any concerns with our values or our goals? How can we help you provide higher quality care to your patients? Hosting a retreat with executive management and physician leaders to encourage doctors' input on the hospital's strategic plans and operations. ] Requiring managers and leaders to participate in medical staff committees to listen for potential concerns and conflicts Facilitating effective communication between doctors and key department managers (for example, between cardiologists and the manager of cardiac rehab) to ensure that they are working as a team and share a sense of trust Including physicians in recognition activities and acknowledging their efforts to improve quality and efficiency or achieve strategic goals
AS MOTIVATION ABILITY PERSONAL 1. LINK TO MISSION AND VALUES 2. OVERINVEST IN SKILL BUILDING SOCIAL 3. HARNESS PEER PRESSURE 4. CREATE SOCIAL SUPPORT STRUCTURAL 5. ALIGN REWARDS AND ASSURE ACCOUNTABILITY 6. CHANGE THE ENVIRONMENT (Grenny, Maxfied, Shimberg, “How to Have Influence” MIT Sloan Management Review, Fall, 2008) Change Anything Labs in Utah Learning a great deal. It is not about “willpower” although that is what we think it is. It is about staying power and skills. Six areas you need to focus on to change the brain, the mind and the behavior of your culture: Motivational Skills Some around social group Some around the ability to do what you are asking Some around the leadership Some around the WIIFM: compensation, recognition, ritual celebrations So what will you change to get to “where?” Engagement? And I know it when I will see it? Right? Among which doctors?
AS Like theater Brian and Jeff are both going to speak more about what they are doing to change the culture: more of and less of. Flesh it out. I want you to start to make notes about how you can apply this in your own hospital environments. Remember it is not one thing—a new vision, or a new compensation plan, it is in six areas: both motivational and ability
AS Once upon a time in a place in Michigan all the doctors split among all the hospitals. Then one day, everything changed. Some doctors still split, but others became loyal to one institution. And then the Buick plant left Flint, and with the closing all those insured patients migrated out as well. Now, we have an aging county and a state with a lot of great institutions competing for patients from well beyond their typical local market places.
My second tour of duty at Hurley—CEO and I …. Asked to come back, after they had achieved a margin, sustainable, to get them growing again. Declining inpatient admissions was serious. How to build better, loyalty and admissions among doctors, which? How? Who? When? Why?
AS Doing business with McLaren is easy. ” “ They know what I want, and have it ready ahead of time, so I don’t waste my time.” “ It’s a pleasure to work at McLaren.” “ I never have an issue there, and I suspect if I do, they will move quickly to fix it.” “ The nurses are very helpful.” “ The nurses go out of their way to be helpful and can respond on their feet to situations.” “ Equipment and technology is never an issue, you don’t even have to think about it.” Had technology Great nurses who go out of their way to be helpful and can respond on their feet to a situation Marketed them Had their CEO visit them and the senior leadership did the same Felt “TISP”: Trust, Important, Special and Pleased
AS Various issues, VERY slow response is most common. Very slow turnaround on IT issues – Issues vary, from vital signs not available in medical records to medication records According to Gallup research, 2005, only 15% of U.S. physicians believe that hospitals provide fair resolutions to problems. Again, an individualized approach is essential. Studies show that as conflicts with hospital policy or operations arise, physicians want to be involved in decisions that affect their patients and their medical practices. They want a partnership with healthcare leaders who will follow through on their promises, treat them with dignity, and resolve their problems fairly Since physicians are more emotionally driven than many people realize, healthcare leaders must build strong relationships with their medical staff based on trust, integrity, and personal values. Gallup's research has discovered that doctors want to align themselves with leaders who are truthful and candid, share common ethics, respect their input, and focus attention on what helps them be successful as a doctor. In essence, physicians choose to work closely with leaders who make them feel good about practicing medicine at their hospital. What's more, building strong relationships with physicians will require individualized solutions and attention, not just general "free breakfast in the lounge" programs. Top-performing hospitals consistently deliver on even the simplest factors in physician engagement. "Many hospital executives don't even know the names their doctors like to be called," says Rick Blizzard, D.B.A., principal consultant at the Gallup Healthcare Group. "If leaders want physicians to feel comfortable identifying with the hospital and that their values and the organization's align, it's important to sit down with each physician periodically to get to know him or her as a person -- not just as a referral source. Calling a doctor 'John' when he prefers to be called 'Dr. Smith' sends a clear message that you don't know him and haven't taken the time to appreciate his preferences." Blizzard notes that at hospitals that rank highest in Gallup's database for physician engagement, doctors believe that the executives listen to them and deliver on their promises. These doctors have a personal relationship with the leadership team that goes beyond the hospital walls. These physicians know that the hospital's leaders are interested in helping them be successful both clinically and financially and trust them to fairly resolve issues that concern them. "Physicians are less concerned about business operations than they are about a personal connection," Blizzard says.
AS background Perception is reality What they expected they experienced Difficult to change expectations without demonstrable changes in how things were done and a lot of statements of the changes. Trust is missing.
AS background What did we do: Gave doctors a short survey for their patients to see what they would like to learn or hear from the hospital. We went an hour away. A lot around diabetes, and we had a wonderful diabetes education center. But you had to come to the hospital for the care. Now it was time to go mobile out to the doctors, and do it in a neutral place like a restaurant so there was an emotional pleasure in learning more about how to manage their diabetes. Held joint replacement seminars out in or near doctors offices so it was easier for their patients to come to learn more from the orthopedists and to market the doctors. How do we add value in innovative ways? Mens health, another area that doctors were not focused on. We began to engage them as Men ’s Health Champions so they could speak to men in community organizations and churches on men’s health with the hospital. Not all doctors wanted to shift to EMR. The physician services team got it together, motivated the doctors, ran their organized process and worked with them to get them the times they needed to get trained. Collaboration was key to the success. At Hurley You Are Never Alone: Provided guest services for doctors sending patients. Began with those doctors in the periphery so their patients would be able to call someone the day before, have someone greet them at the door, take them to xray and labs, and never leave them alone. Whether it was bariatric surgery or general same day surgery, the patient responses were terrific and they played back those experiences to the doctors. Each touch point led to the next. More engagement for them and their patients meant more interest in what was happening at the hospital and how to get engaged with the leadership. Leadership visits increased. And onwards Measured—very important but also difficult. Benchmark and then go forward.
AS background Means Changing what we Believe to “See, Feel and Think” about our customers and our business in new ways. Or, our customers will change and we will wonder what happened to our business.
AND BY OCTOBER, I WAS USING THIS SLIDE at CU
AS Can we provide them, with their medical homes, our case managers at a price so they have partners in reducing hospital admissions and readmissions and we can manage the patients. How can we better use our new ED to relieve the pressures on the doctors? What about our hospitalists, can we slowly convert those frequent flier doctors from having to visit their patients in the hospital and making discharge planning more challenging?
Header on this is off the page, please check it on this slide and some of the others too AS Administrative Leadership Engagement (Leveraging Openness and Operational Authority) Outreach Program/Coordinators (Extending Balanced, Personalized Sales/Service) Education/Medical Orientation (Providing Valuable Insights) Print/Electronic Communications (Providing Access to Credible Information) Data on Utilization/Referral Patterns (Identifying and Targeting Opportunity) As healthcare industry leaders, we need to find ways to create balanced relationships that work, engaging physicians as vital partners in successfully negotiating a dramatic shift in how healthcare is delivered.
AS If you look closely, they really have very similar needs and desires. And so do the patients. With the changing revenue streams for healthcare how we get them aligned is simply not a chart or a list of to-do ’s. it is about people helping people change their feelings, emotions, and peer-to –peer support around how they feel about you and your hospital and you think and feel about them.
PLEASE MAKE THIS INTO A PIE CHART with equal parts for each of the elements
Physician Engagement Whats Your Role Jeff Brickman Brian Nester Andrea Simon Kriss Barlow, Facilitator
Agenda• Defining physician engagement• Framework: trends in our world and the market• Methods and models• The physician’s view• Tactical implementation – Needs for a successful organization – Cultivating relationships – Marketing’s role – Evolving relationship strategy
Healthcare Revolves Around Physicians Opening line… “The words “alignment” and “coordination” have been tossed about as the government and the healthcare industry wrestle to provide more value for every healthcare dollar spent. Under those words, every strategy to fix the problem revolves around one thing: physicians.”HealthLeaders Media Breakthroughs. Aligning Hospitals and Physicians toward Value.Dec. 2009. In collaboration with PricewaterhouseCoopers.
Leader Defined Physician Engagement• Healthcare Revolves around Physicians• Health System moving from System focused on volume to system based on value• To be successful every strategy to adapt to this new reality revolves around one thing: • Physicians
Leader Defined Physician Engagement• Physician leadership engagement needed to: • Redesign existing processes of care to improve efficiency • Integrate physician thought leadership in market based strategies to address needs • Address supply chain initiatives • Align financial and strategic incentives to address population needs
The Physician Conundrum■ I’m 55 years old…I lost it all • “SEP?, 401?...I have my real estate”■ I’m 40 years old…how do I get out of this • Is it too late to change careers■ I’m 32 years old…what have I done • My student loan payment will outlast my jeans
Clinical Integration - after decades of FFS, let’s getDoctors & Hospitals to work together Yeah, Right !
Understand the physician network in your market■ Who are the influencers? • Formal (Med Staff President) and Informal (Respected Clinician)■ Confederations or onesy-twosy? • Size matters■ Is there an IPA? • Functional? Aggregator? Contracting Experience?■ Is there a PHO? • Viable? What’s the history? Raise from the dead?
“Marketing Defined” Physician EngagementBut Engage Which Doctors?
Engagement at a MarketLevelexpects better alignment, shared payment and transparency. WhatThe marketcan we learn from the data?• 75-85% of the decisions that drive quality and cost are determined by physicians• Malpractice and manpower shortages concern doctors• Margins from private payers have barely covered the negative, payment to cost ratios from Medicare and Medicaid• Alternative income sources are scrutinized and disallowed
And for Hospitals…• 25% of community hospitals have had negative operating margins• Mounting regulatory requirements• Technology upgrades• Utilization is steady but rates for days have declined• Cherry picking by free standing facilities
Why does it matter? Changing business environment Demographic shifts Patient Changes in expectations Financial Challenges for healthcare institutions Financial Challenges for physicians and ambulatory centers Plain Old Change!!
By 2011, Gallup research… Shows how it matters. Reported a drop of 5 percent in the number of physicians who are fully engaged. An increase of about 10 percent in the actively disengaged. Worries about the impact of value- based purchasing, and changing reimbursement and incentives.
Engagement matters Gallup reported at one health system, outpatient volume increased +17.5 for engaged physicians in the top quartile for improved engagement. Disengaged physicians in the bottom quartile, their outpatient volume declined -11.7%.
Morehead research Morehead has found some association between high-performing hospitals and physician engagement. “Typically, when we see physician engagement move, we see other important metrics move,” Morton said. “Physician engagement is the lynchpin of many strategies in the organization, and without it, [those strategies] will not happen.” Morehead reported a shift in balance, with physicians treated less as customers and more like partners in patient care.
Will I know it when I “feel” it? How do you know an “engaged” physician from a “fully” engaged physician? Is it shifting or constant? Is it situational? Do they have linguistic or body language that tells you? Will you know what to look for? How to feel it?
How are you engaging with your physicians? Share with us some of the ways you might be building an engagement strategy today? What kinds of experiences? Communications strategies? “Feeling” opportunities? By whom?
This is work!WHY IS “ENGAGEMENT”SO CHALLENGING?
All about our Brain and our Culture Brain Hates Culture Binds Change You Together 23
When you are getting “engaged” It is like a new role you must play Think about what you will: Do more of? Do less of? Start? Stop? Never Change?
Models and Methods Physician arrangements Choosing the modelUnderstanding cause and effect
Business Imperatives Yesterday & Tomorrow■ Yesterday (FFS) – Aligned Physicians (heart-strings) • Referrals to hospital & ancillary services • Referrals to aligned specialists■ Tomorrow (Value-based reimbursement) – Aligned Physician Network (business rationale) • Principally primary care • Shared savings
High Splitters 1,200 docs • Brian, add your slides here to address the he physician arrangements and business strategies100% Alignedat alignment Private Practice aimed • Management Services Business models and degree of800 docs alignment risk Agreement physician and the hospital for the CCIA Lease EmploymentLow High Low
PHYSICIAN ENGAGEMENT – CHANGE IN CULTUREHospital – Centered → Physician - centric• Redefined Senior Team’s Focus to Physician Based Initiatives• Redefined mid-level interactions• Restructured physician liaison focus• Changed leadership structure to focus on physician intel and alignment priorities
Structured for Organizational Success• Leadership Goals established • Growth Council • Growth Reports • Service lines established • Physician leaders created • Physician sales retrained and expanded
Tracking Physician Engagement E ATIV NTITQUA Target List: Physician loyalty trending • Volume • Revenue • Payor Mix • Surgery vs. Medicine (or desired case types) • Elective vs. ED • Quality Order Set compliance; Morbidity/Mortality; Infection Rate; ED Call coverage • Efficiencies/”Workshop” Improvements CMI; Cost per Case; Supply Compliance; On-time Starts • Hospitalist &/or Specialist referrals • Ancillary utilization • Program participation/Leadership roles • Competitor share (splitting)
Let’ s take a look: Case StudyHow Doctors Engage & Howto Engage Doctors
Situation Hurley Medical Center in Flint, MI Opportunity to build a physician services approach to engage physicians from a region in the growth of a hospital. Two competitors in the local area: Genesys and McLaren And, not far away, many major medical centers intent on drawing patients from the region.
First We went Exploring Listened to their Stories Ethnographic approach Narratives tell you what surveys cannot And building it from the doctor backward, not the hospital outward.
What did we hear? Stories about how the other hospitals treated them. How the other PHO made it a financial “sin” to refer elsewhere. How they were closely tied to the other hospital and thought it was unnecessary to go elsewhere. Had self-selected to belong to the other institutions.
On the other hand… For Hurley, we had to listen better! This hospitals treated the doctors differently, in the voice of the doctors. Hurley had to work on service issues and concerns with the future investments of the hospital. IT Medical Records / Patient Charts Transcription Services Nursing Equipment/Technology
What were we going to do? Engage! Bring the doctors into the hospital differently. What could we do to help them? Not us!
Emotions matter Shared values, beliefs and behaviors create active culture—which makes us humans. We buy with emotions and justify with logic. This was a great deal about how the doctors “Felt.” The problems seemed functional. The reality was very emotional.
Functional changes CEO visits New technology and a new Emergency Department New Electronic Medical Records, Heavy Physician involvement. Physician Leadership engaged Engagement in the Strategic Process
Emotional Changes Launched a new physician services program to change the way it felt to be part of the hospital. Shifting from service recovery approach to a support and practice development approach. Key: “what do you, doctor, need and how do we help you?” What will enhance your reputation? TISP: Trusted, Important, Special and Pleased
Marketing What can you do to help them grow their practices and in turn, your services? What can you hold in their offices or for their patients? How can you attract more patients with and for them? How do they help tell your story and how does it help them tell theirs? All within regulatory environment? Then we Measured.
All about “Beliefs” What you “Believe is What you Will See!” 46
What Does it Mean for Me? Obligation Implementation What works, what doesn’t
Successful Engaged Organization of the Future• Move to greater integration of physician leadership in governance • Physician Enterprise • Employed Physicians • Independent Physicians • Align Financial & Strategic Interests • Focused on Meeting needs of Population, Local Businesses & Payors
Successful Engaged Organization of the Future• Collaboration & Integrated Decision Making• Elevate Physician Leadership in organizational Role to • Improve Quality & Safety • Improve Efficiency • Redesign Patient Processes of care across continuum
Change In Leadership Expectations• Leadership Development of Physicians• Greater Integration of Physicians in Designing & Managing “Second Curve” of Health Care• Sharing of Leadership• Change in Focus on Value • Cost • Quality • Convenience • Service
Tactical Organizational Commitments■ Dedicated resources – MOST Liaisons IMPORTANT: – Clout (VP) Know the vision for your – Physician leadership organization and what it needs to – Market intelligence accomplish with its physician – Business analysts base. – Relationship with finance
Revenue Outlook Operating Margins will suffer Risk Based RevenueTODAY TOMORROW
Volume-to-Value■ “Pay-per-Click / Hamster wheel Transactionism moves to Population Health and Payment for Outcomes” Decades of (perverse) FFS incentives leave hospitals and physicians ill-prepared for a necessary economic/reimbursement paradigm shift Quality (Q) Value (V) = Cost (C)
Accountability – theremust be a goodpolitical solution NOT !
Balancing Relationships Engaging physicians as “vital partners” These are changing times. Can we partner our way forward?
Physician Services and Marketing“4 I’s”1.Insight: Come from listening to our physicians andtheir customers?2.Innovation: Add value in innovative ways.3.Integrating: Let’s not sell the factory. Let’s integratewith our physicians and our customers so together wedo better.4.Implementation: Execution wins!
Tactically that means… Different ways to listen and act together. Leadership involvement and broader empowerment. Outreach Program/Coordinators transformed from liaisons and problem solvers to relationship builders. What do the physicians need, not what can we sell them?
Tactical Plans cont’d. How do we help them by sharing and educating on changes. Communications are changing, have we changed ours—while sustaining those for older physicians and using new ones for younger ones. Text versus fax? How does social media and mobile applications tie us together. Data. Who has it? How do we use it? How do we think about it?
Model might look like this… Physician Services Outreach Programs Physician Needs andHospital Needs and PrioritiesPriorities •More Patients•More Patients •More Revenue•More Revenue Patient •More Collaboration•More cross-selling Relationships •More Hospital and Referralsof services•More Quality Satisfaction •More Resources•More Referrals Increase •More Back Office•More Services Support•More Technology •More Technology More Revenue for Both Doctors and Hospitals
Growing What You NeedHave a plan: Recruitment and Retention•You can’t wait and don’t always want those that come to you.•Onboarding is your chance to learn their expectations ofengagement•Don’t wait until they arrive. Plan and define the handoff. It iseasier to keep business than to grow new. Tend to your mostloyal. – Remember they love you enough to whine – Respect their level of connection
Physician Relations• Think outside the hospital• Seek new information• Internal obligation to define the physician business strategy – Market softening – Validation – Pure intelligence – Optimal experience – Earned growth in clinical area
What Credentials Do Doctors Find MostImportant in a Physician Relations Rep?
The Right Level of Impact• What do doctors want? – How do you earn value? – How do you reinforce this?• What do leaders want?• What do you want?
How Helpful Do Doctors Find the Topics thePhysician Liaison Discusses With Them?
Vision • Can’t live in limbo • Create the vision for today and follow with a plan, but be nimble • Talk about their vision
Engaged and at Your Peak• What does “engaged performance ”look like?• What did you do within the last week that demonstrated your work to better engage your medical staff? – Qualitative – Quantitative• What can you do to achieve this level with more consistency?
Your Observations and Questions • Surprises? • Obligations • Topics still open • Comments
“Peak performers develop powerful mental images of the behaviorthat will lead to the desired results. They see in their mind’s eye the result they want, and the actions leading to it.” - Charles A. Garfield
Thanks!Jeff, Brian, Andi and Kriss Kriss Barlow RN, MBA Principal 651 Old Hwy 35 South Hudson, WI 54016 (715) 381-1171 firstname.lastname@example.org