Operations Efficiency through Physician EngagementGHS Leadership Team Kevin Gilroy, MDMeeting Internal Medicine, Lead HospitalistMarch 16, 2011 Associate Program Director, Internal Medicine Residency Program
The Culture of Engagement • Department of Medicine DRG Project: – Goals: • Improve Operational Efficiency • Cost Reduction – Via: • Standardized Care • Evidence-based focus • Identification of Process barriers • Physician Engagement and Ownership
The Culture of Engagement • Top 12 DRGs identified for cost savings opportunity – Congestive Heart Failure – Sepsis – Pneumonia – Renal Failure – Stroke – Acute Pancreatitis – Urinary Tract Infection – GI Bleed – Diabetes – Overdose – Respiratory Failure with Tracheostomy – Acute Leukemia
The Culture of Engagement • Multidisciplinary Physician Team created for each DRG – Hospitalist with Subspecialist(s) • Physician owned / affiliated (majority) • Private (GI, Hem/Onc, Nephrology) • Individual DRG Team education, data overview, goal setting • Random sample of 25 charts reviewed by each team • Business Intelligence utilized for further data drill down • Opportunities identified; Action plans later created
The Culture of Engagement• DRG Team Review: – Physician opportunity / ownership issues identified: Prime Focus! • “Taking care of our own backyard” drilled home – Non-Physician opportunities identified: Secondary• DRG specific and common themes identified• Action Plans created to address major issues identified – Physician-specific opportunities - Priority – System specific opportunity recommendations – Timelines created – Follow-up data reviewed
The Culture of Engagement• Physician ownership issues (examples): – Documentation integrity opportunities • Physician lack of understanding coding world – Sepsis management delays – Plavix procedural delays – Lack of aggressive management / resuscitation: • Pancreatitis • Sepsis – Lack of antibiotic stewardship – Lack of evidence-based standardization for • Pancreatitis • Sepsis • PNM • CVA • CHF
The Culture of Engagement• Non-Physician issues (examples): – Reactive Case Management / Social Work – Coding discrepancies / Separation from clinical world – Sepsis management delays • Nursing education and training in ER • Transport delays • ICU bed availability – Contaminated blood culture results – Data management • Lack of Physician-specific utilization • Lack of Service-focused patient / data assignment – Limited Behavioral Patient Bed access / State resources – Lack of coordinated post acute care assessment / transition
The Culture of Engagement• Benefits outside of cost savings – Transparent focus on Physician Improvement / practice opportunities – Highlighting “our” unexplained Physician practice variation • Acceptance of its existence and detriment to our Patients and System • Taking ownership to create the solutions – Linking a strong bottom line to enhancing Physician support for patient care – Physician access and education on Data management and capability – Shared focus / unified goal of the Department • Relationship building between Divisions • Fostering a “Team” atmosphere – Physician education regarding System operations / processes of care – Physician education regarding Payment methods and System solvency – Highlighting Physician responsibility and ownership for financial success • Equal / equivalent to Quality care • Everyday practice focus among Divisions – Fostering Physician creativity in streamlining / maximizing operational efficiency – Physicians and System = One in the same!
The Culture of Engagement• Reasons for success – Administrative support of Physician-led System • An organizational culture change • Physician buy-in increasing – Administrative Leadership • Transparent, accountable, engaged, accessible, workforce Leadership and development – Physician owned / aligned Medical Staff (majority) – Administrative resource support behind project • Business Intelligence: Janet Thompson and Renee Tollison (phenomenal) – Department Chair Leadership and Focus • IM Leadership biweekly Meetings / Education – Economic downturn – Local Competition – Clarity of Healthcare Reform landscape: Keys to survival and success
The Culture of Engagement• Future opportunities / needs assessment – Improved data collection and management • Transparent Physician performance with real-time feedback • Access to office based EMRs – Clinical IT decisional support systems • Gains to date based on Education / awareness alone: short half-life – Case Management development – More nimble Pharmacy and Therapeutics committee • More real-time Formulary efficacy and cost evaluation / adjustment – Antibiotic stewardship development / growth • High cost / Highly utilized medications • LOS opportunity – Continued Medical Staff involvement / engagement / ownership
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