Creating A Cohesive Physician Culture:
Action Plans for Accountability
American College of Physician Executives
April 25, ...
Agenda
I. Three Keys To A Cohesive Physician Culture
1) Clear work expectations
2) Process for monitoring performance
3) A...
Organization Tools for Change
3Source: Forbes Steve Denning – Leadership 7/2011
Keys to Successful Culture Change
 DO introduce and consistently reinforce the
values of radical transparency and
continu...
Critical Elements to Support Change
• Clear & Timely Communication
– You can’t over communicate!
– Listen too!
• Strong En...
© 2014 Huron Consulting Group Inc. All Rights Reserved. Proprietary & Confidential.
Trinity Mother Frances Health
System C...
Profile of Trinity Clinic – 2012
• Multispecialty clinic, 250 physicians / 100 APP’s in East
Texas, part of Trinity Mother...
Climate for Change – 2012
• Financial crisis late 2012, caused by declining volumes, EHR
implementation, opening of new He...
Setting the Stage
• “Never waste the opportunities offered by a good crisis” The
Prince, Machiavelli, 1532
• Clinic leader...
Action Plans
• Analysis revealed significant performance gaps in physician
productivity and access
• Created physician-led...
Productivity Approach: Throughput Analysis
11
Physician Productivity Policy - 12/4/12
• WHEREAS, the Trinity Clinic is a not-for-profit, physician corporation and an af...
Action Plans
• 30, 60, 90 day meetings with providers to promote accountability,
with focused meetings as needed thereafte...
Provider Capacity Tracking Report (WRVUs)
InternalMedicine
14
FamilyMedicine
0
100
200
300
400
500
600
700
800
900
Jul Aug...
Provider Capacity Tracking Report (cont)
15
Cardiology
0
200
400
600
800
1,000
1,200
1,400
1,600
Jul Aug Sept Oct Nov Dec ...
Operating Revenues
16
System Consolidated Financials
Operating Revenues
(In Thousands)
Net Oper. Rev.
Productivity Project...
Trinity Clinic WRVU Trend
17
Hospitalists are excluded in this data
37,000
39,000
41,000
43,000
45,000
47,000
49,000
51,00...
Access Improvements:
Clinical Call Volume
Goal:
• Improve response time to patients on clinical
questions and inquires
• M...
Access Improvements:
Centralized Scheduling Customer Experience
Goal:
• Improve overall customer experience rating for
Cen...
Lessons Learned
• A crisis provides a unique opportunity to create transformative
change in your organization
• Using exis...
Summary
• Changing performance requires diligent attention to changing
the culture
• Three keys to developing a cohesive p...
© 2014 Huron Consulting Group Inc. All Rights Reserved. Proprietary & Confidential.
Questions?
22
Presenter Contact Information
23
Steven P. Keuer, M.D.
President, Chief Medical Officer
Trinity Mother Frances Health Syst...
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Creating a Cohesive Physician Culture: Action Plans for Accountability

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Huron Healthcare’s Andy Ziskind presents on building a cohesive physician culture, using a recent case study to distill insights for effective change.

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  • [Andy]
  • [Andy]
  • [Andy]
    Frequent mistakes in trying to change culture include:
    Overuse of the power tools of coercion and underuse of leadership tools.
    Beginning with a vision or story, but failing to put in place the management tools that will cement the behavioral changes in place.
    Beginning with power tools even before a clear vision or story of the future is in place.
  • [Andy]
  • [Andy – transition to Steven]

    Clear & Timely Communication Models
    Frequent large and small group communications around the goals, objectives and the unifying vision of the group are critical.
    Being careful in these settings to listen and respond in a timely and effective manner and in a respectful and direct way is the foundation for a strong culture of collegiality and respect
    Strong Engagement Models
    Along with communication, providing vehicles where physicians have direct input and responsibility for results around clinical and administrative activities. Inclusion and shared-decision making are key contributors to high satisfaction among medical group members
    Flexible Participation Models
    Structure and hierarchy have to be carefully balanced against the need to be “sure of foot” and able to react to the environment.
    Participation models – i.e., group membership, compensation and other contracting arrangements have to be structured such that there is the ability to balance and align individual goals with that of the organization in a meaningful way that can be adjusted as market realities impact the group
    Supportive of Mistakes
    Ability to recognize mistakes quickly but resolve them respectfully and in a supportive manner
    Ability to implement change quickly but also to monitor and adapt quickly as mistakes are recognized and resolved
  • [Steven]
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  • [Steven]
  • [Steven]
  • [Steven]
  • [Steven]
  • [Steven]
  • [Steven]
  • [Steven]
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  • [Steven]
  • [Steven]
  • [Steven]
  • [Steven]
  • [Steven – transition to Andy]
  • [Andy] Comment on the burning platform in the communication section.
  • Creating a Cohesive Physician Culture: Action Plans for Accountability

    1. 1. Creating A Cohesive Physician Culture: Action Plans for Accountability American College of Physician Executives April 25, 2014 1 Steven P. Keuer, M.D. President, Chief Medical Officer Trinity Mother Frances Health System Andy Ziskind, M.D. Managing Director, Clinical Solutions Huron Healthcare
    2. 2. Agenda I. Three Keys To A Cohesive Physician Culture 1) Clear work expectations 2) Process for monitoring performance 3) Action plans to increase accountability and productivity II. Trinity Mother Frances Health System Case Study III. Commentary IV. Questions and Discussion 2
    3. 3. Organization Tools for Change 3Source: Forbes Steve Denning – Leadership 7/2011
    4. 4. Keys to Successful Culture Change  DO introduce and consistently reinforce the values of radical transparency and continuous improvement.  DO communicate horizontally in conversations and stories, not through top- down commands. x DON’T start by reorganizing. First clarify the vision and put in place the management roles and systems that will reinforce the vision. x DON’T parachute in a new team of top managers. Work with the existing managers and draw on people who share your vision. 4Source: Forbes Steve Denning – Leadership 7/2011  DO come with a clear vision of where you want the organization to go and promulgate that vision rapidly and forcefully with leadership storytelling.  DO identify the core stakeholders of the new vision and drive the organization to be continuously and systematically responsive to those stakeholders.  DO define the role of managers as enablers of self-organizing teams and draw on the full capabilities of the talented staff.  DO quickly develop and put in place new systems and processes that support and reinforce this vision of the future, drawing on the practices of dynamic linking.
    5. 5. Critical Elements to Support Change • Clear & Timely Communication – You can’t over communicate! – Listen too! • Strong Engagement Models – Give physicians opportunity to have direct input and responsibility for clinical and administrative results – Inclusion and shared decision-making improve satisfaction • Flexible Participation Models – Balance structure and hierarchy vs. agility – Make sure contract structure and financial incentives align individual goals with the organizational goals – and be prepared to adjust as the market changes • Be Supportive of Taking Risk and Making Mistakes – Recognize mistakes quickly and resolve them in a respectful and supportive manner – Implement change quickly, but also to monitor and adapt quickly as mistakes are recognized and resolved 5
    6. 6. © 2014 Huron Consulting Group Inc. All Rights Reserved. Proprietary & Confidential. Trinity Mother Frances Health System Case Study 6
    7. 7. Profile of Trinity Clinic – 2012 • Multispecialty clinic, 250 physicians / 100 APP’s in East Texas, part of Trinity Mother Frances Health System • Governed by a 501(a) all-physician board, clinical leadership led by system wide Chiefs of Service who lead eight Institutes • Culture characterized by group loyalty, passion for quality, physician-centric focus, ambivalence to service and access issues, variable productivity, with few practice standards • New President and new Chief Administrative Officer in 2012 • Clinic losses were covered by a System mission grant 7
    8. 8. Climate for Change – 2012 • Financial crisis late 2012, caused by declining volumes, EHR implementation, opening of new Heart Hospital • Comprehensive System cost reduction strategies implemented, including Trinity Clinic • Intense focus on Clinic operations, productivity, financial improvement • Private discussions began about sustainability of our integrated model 8
    9. 9. Setting the Stage • “Never waste the opportunities offered by a good crisis” The Prince, Machiavelli, 1532 • Clinic leadership created a new vision for change, a commitment to not only clinical but also financial and operational excellence • Consensus developed among Clinic Board Executive Committee • Restructured physician leadership to effectively lead new initiatives • Executed a new management structure to support action plans (including data analytic support) 9
    10. 10. Action Plans • Analysis revealed significant performance gaps in physician productivity and access • Created physician-led multidisciplinary teams to lead each project • Clinic Board (1) approved a target of 65-75% specialty-specific MGMA WRVU’s for physician productivity, (2) approved centralized scheduling for the entire Clinic, and (3) mandated that all Clinic physicians would see new patients • Data analytics developed individual physician productivity reports produced monthly • Chiefs of Service and administrative leaders met with small groups of physicians initially, then individually with low performers 10
    11. 11. Productivity Approach: Throughput Analysis 11
    12. 12. Physician Productivity Policy - 12/4/12 • WHEREAS, the Trinity Clinic is a not-for-profit, physician corporation and an affiliate of Trinity Mother Frances Hospitals and Clinics, an integrated health care delivery system consisting of, among others, acute care facilities, outpatient facilities, community practices and critical access hospitals (the “System”); • WHEREAS, the Trinity Clinic desires to create fair and reasonable productivity targets that take into account: (1) physician work effort measured predominantly by a metric know as a work relative value unit (“WRVU”); as well as, (2) the System and Clinic’s overarching strategic vision and goal of improving quality and efficiency through innovation, integration and coordination of care; and • WHEREAS, the Trinity Clinic further desires to create and maintain a provider workforce that is predictable and financially sustainable and yet flexible enough to meet the upcoming federal health care overhaul measures which will include provider accountability for quality, efficiency and outcomes; • ACCORDINGLY, the Trinity Clinic Board hereby adopts the following as its Physician Productivity Policy effective December 4, 2012. • The minimum target range for physician productivity for a full time Trinity Clinic physician shall be between the 65th and 75th percentile WRVUs, based on the most recent Medical Group Management Association (“MGMA”) data. • The Board authorizes management to use appropriate actions to assist physicians in reaching this target range. 12
    13. 13. Action Plans • 30, 60, 90 day meetings with providers to promote accountability, with focused meetings as needed thereafter • Improved physician effort, re-locating providers, improving office efficiency, marketing certain services lines, and in rare cases elimination of positions were required to right size each site • Access dashboards were produced weekly, physician scheduling templates were simplified • Centralized scheduling has been implemented in over 50% of clinics, with anticipation of 100% of clinics completed by calendar year end • Significant returns in service, access, productivity, compensation, and financial performance have resulted 13
    14. 14. Provider Capacity Tracking Report (WRVUs) InternalMedicine 14 FamilyMedicine 0 100 200 300 400 500 600 700 800 900 Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun 2012-2013 2013-2014 65th %tile 75th %tile 0 100 200 300 400 500 600 Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun 2012-2013 2013-2014 65th %tile 75th %tile
    15. 15. Provider Capacity Tracking Report (cont) 15 Cardiology 0 200 400 600 800 1,000 1,200 1,400 1,600 Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun 2012-2013 2013-2014 65th %tile 75th %tile
    16. 16. Operating Revenues 16 System Consolidated Financials Operating Revenues (In Thousands) Net Oper. Rev. Productivity Project Started
    17. 17. Trinity Clinic WRVU Trend 17 Hospitalists are excluded in this data 37,000 39,000 41,000 43,000 45,000 47,000 49,000 51,000 53,000 PRIMARY CARE - PHYS. & APP MONTHLY WRVUs PCP WRVU - ACTUAL MGMA 65%ile 2013 Report MGMA 75%ile 2013 Report Data excludes Hospital based physicians such as Anesthesia, ER, Critical Care, etc 55,000 60,000 65,000 70,000 75,000 80,000 85,000 90,000 95,000 100,000 SPECIALIST PHYSICIANS (EXCLUDES HOSPITAL BASED PROVIDERS) MONTHLY WRVUs WRVU - Actual MGMA 65%ile 2013 Report MGMA 75%ile 2013 Report
    18. 18. Access Improvements: Clinical Call Volume Goal: • Improve response time to patients on clinical questions and inquires • Mitigate incoming call volume related to clinical questions and inquires to improve overall customer experience for patients at POS Tactic: • Utilize centralized call center management to filter all front end telephony and isolate clinical calls and inquiries • Use of EMR In-basket messaging to allow for instant visibility to clinical question and inquires by type and improve response time in hierarchy of clinical importance 18 Result: • 25% reduction in front end clinic call volume • 89% reduction in response time to patients
    19. 19. Access Improvements: Centralized Scheduling Customer Experience Goal: • Improve overall customer experience rating for Centralized Scheduling, Insurance Verification, and Pre-Registration components of the system • Achieve Service Industry best-in-class rating of 92% or better Tactic: • Comprehensive SWOT analysis of all aspects of provisioning and general telephony customer experience skills • Comprehensive tailored training program isolated by functionality by business unit • Comprehensive ongoing Quality Assurance process inclusive of measurement, management, and training by representative • Calibration and On-going Secret Shop Evaluations 19 Result: • Customer Experience Scores improved from baseline of 71.5% to 93.1% • Improved Access Experience and Efficiencies
    20. 20. Lessons Learned • A crisis provides a unique opportunity to create transformative change in your organization • Using existing governance of Clinic Board and Chiefs of Service created project champions, and greatly facilitated cultural change and project success • Changing Clinic culture from a physician-centric to a patient- centric focus, with clinical, operational, and financial excellence requires vision, planning, and clear accountabilities. For leaders it requires courage, for resistance to change will be great. • A key to our project was accurate data in a user-friendly format consistently presented to physicians in a small group setting 20
    21. 21. Summary • Changing performance requires diligent attention to changing the culture • Three keys to developing a cohesive physician culture – Clear work expectations – Processes for monitoring performance – Action plans to increase accountability and productivity • Pay close attention to – Communication – Engagement and meaningful physician participation – Using data well – Aligning incentives – Taking risks and celebrating successes! 21
    22. 22. © 2014 Huron Consulting Group Inc. All Rights Reserved. Proprietary & Confidential. Questions? 22
    23. 23. Presenter Contact Information 23 Steven P. Keuer, M.D. President, Chief Medical Officer Trinity Mother Frances Health System KEUERS@tmfhs.org 903-531-4445 Andy Ziskind, M.D. Managing Director Huron Healthcare aziskind@huronconsultinggroup.com 312-405-7298

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