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Physician Leadership

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Dr. Steve Berkowitz presents why we need physician leadership and why

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Physician Leadership

  1. 1. Hospital - Physician Leadership<br />How your hospital can succeed despite what <br />will or willnot happen in Washington<br />Steven M. Berkowitz, MD<br />Chief Medical Officer<br />St. David’s HealthCare<br />Austin, Texas<br />512-415-6095<br />Steve.berkowitz@stdavids.com<br />
  2. 2. Clinical Integration ModelsSame Old Wine in a Brand New Bottle ?<br />
  3. 3. Previous “Deal Killers” in Integration Strategies<br />Risk Contracts /Capitation<br /> Physician Employment<br /> Collective Bargaining (Antitrust)<br />
  4. 4. Previous “Deal Killers” in Integration Strategies<br />Risk Contracts /Capitation<br /> Physician Employment<br /> Collective Bargaining (Antitrust)<br />
  5. 5. “Deal Killers” in Integration Strategies<br />Let’s get back to basics<br />What is the best model for your organization?<br /> Any hand’s a winner…. Any hand’s a loser !!<br />
  6. 6. What can we Learn from the Airline Industry ?<br />Today’s Pilots <br /> A nice, boring flight !!<br /> MUCH safer !!<br /> HIGH reliance on systems and multidisciplinary<br />support<br />
  7. 7. The Health Care Team<br />Medicine is a Team effort….<br /> …..Why do we insist on playing Solo!<br />
  8. 8. Developing physician leadership<br />Techniques for hospital-physician interactions<br />The role of the Board in the quality agenda<br />Delivery Models<br />
  9. 9. Developing physician leadership<br />Techniques for hospital-physician interactions<br />The role of the Board in the quality agenda<br />Delivery Models<br />
  10. 10. Developing physician leadership<br />Techniques for hospital-physician interactions<br />The role of the Board in the quality agenda<br />Delivery Models<br />
  11. 11. Board<br />Board<br />Administration<br />Medical Staff<br />Administration<br />Medical Staff<br />The Interactions of the Leadership Team<br />
  12. 12. Identifying the Physician Leader<br />Being a physician does not automatically make one a leader !<br />
  13. 13. The Physician Leader Overcoming Perceptions<br />Words of Wisdom-- Clifford J. Harris, M.D. 1984:<br />To the practicing physicians you are seen as a *&$#% administrator….. to the administrators, you are seen as a *&$#% physician<br />Even if you are a top notch physician, at best, you will only retain 50% of your credibility with your physician colleagues.<br />
  14. 14. The Physician LeaderOvercoming Perceptions<br />My first lesson in Medical School:<br /> “ “<br />Quote…non physician administrator<br />
  15. 15. Why Choose to Become a Physician Leader?<br />New challenge<br />Personal growth/ achievement<br />Ability to impact total health care team<br />Desire to be part of the decision making process<br />Patient quality advocate<br />
  16. 16. Why NOT to Become a Physician Leader<br />“Burned out” on clinical medicine<br />Get off the call schedule, better life style<br />Looking for a way to ease into retirement<br />Personal agendas/ vendettas<br />
  17. 17. Continuum from Clinician to Physician Leader<br />
  18. 18. Physician Barriers to Change<br />“I’ve always done it this way !!”<br />“Just wait, next month there will be another article telling us to do it the opposite way !!”<br />“In my experience ( of ____ years) , I have found that….”<br />“At our institution we do it this way !!”<br />“No one is going to tell ME how to practice medicine”<br />“Where did you get your MD !!”<br />
  19. 19. Physician Leadership Development Program -- A Hospital System Example<br />1. Identify and Develop Key Physician Leaders<br />Annual Senior Management / MEC Review Process<br />what are the physician leadership needs<br />how to better engage the staff physicians at the facility<br />incorporate existing best practices (internal and external) on how to identify and groom physician leaders<br />identify future physician leaders<br />
  20. 20. Physician Leadership Development Program -- A Hospital System Example<br />2. Medical Leadership Development Plan <br />Quarterly “curriculum” for physician leaders.<br />technical:finance, basic hospital operations, budgeting, medical management, utilization review, data analysis, statistical <br />non-technical:conflict resolution, negotiating skills, problem solving, customer service<br />Annual leadership meeting with prominent national speaker<br />Off site CME conference for key physician leaders.<br />
  21. 21. Leadership Development ProgramA Hospital Example<br />3. Measurement Plan <br />Determine performance measures<br />technical:Length of stay, incorporation of best practices, medical costs, patient satisfaction scores, core measures <br />non-technical:conflict resolution, negotiating skills, problem solving, customer service<br />Incorporation of these performance measurements into the annual evaluation/ compensation of the physician <br />
  22. 22. Key Attributes of the Successful Physician Leader<br />Maximizes credibilitywith both physicians and administrators<br />Equallycomfortable with technical skills and business skills<br />Maintains a passionfor clinical medicine<br />Maintains allegiance to the BIGpicture, not simply a physician advocate<br />
  23. 23. Developing physician leadership<br />Techniques for hospital-physician interactions<br />The role of the Board in the quality agenda<br />Delivery Models<br />
  24. 24. Board<br />Board<br />Administration<br />Medical Staff<br />Administration<br />Medical Staff<br />Examples of Interactive Models<br />
  25. 25. Power<br />versus<br />Influence<br />The Interactions of a Multidisciplinary Team<br />
  26. 26. The Physician as Part of a Multidisciplinary Team<br />The historical interactive style:<br />
  27. 27. The Administrator as Part of a Multidisciplinary Team<br />The historical interactive style:<br />
  28. 28. The Physician as Part of a Multidisciplinary Team<br />The better approach:<br />
  29. 29. The Administrator as Part of a Multidisciplinary Team<br />The better approach:<br />
  30. 30. Hospital / Physician Integration Strategies<br />-<br />HOSPITAL<br />+<br />-<br />+<br />PHYSICIANS<br />
  31. 31. Brief Digression….<br />….The Revolutionary Model of Copernicus<br />The sun, NOT the earth as the center of the solar system<br />
  32. 32. Two Dysfunctional Models <br />That Typically Exist in Health Care<br />
  33. 33. A Third Dysfunctional Model<br />That Exists in Health Care<br />
  34. 34. The Consumer-Centric Model<br />
  35. 35. Hospital / Physician Integration StrategiesBottom Line:<br />In the minds of many physicians, the taking care of the patient has now taken a backseat to the increasing hassles of non-patient care !!<br />
  36. 36. Hospital / Physician Integration StrategiesBottom Line:<br />Most of the time, administrators come to the medical staff with “solutions”….<br />Wouldn’t it be much better if they came to us with “problems” and we worked together to come up with solutions…<br />A Physician<br />
  37. 37. Value Enhancement for Both Physician and the Hospital<br />Value to the physician(timeismoney)<br /><ul><li>improvement in patient care
  38. 38. improvement of logistical hassles</li></ul>orders/ forms/ medical records--- admin time per patient<br />transfers<br />Value to the hospital<br /><ul><li>care improvement
  39. 39. cost reduction
  40. 40. patient satisfaction</li></li></ul><li>Characteristics of Physician/ Administrator Interactions<br />Both physicians and administrators want an invitation to the party, but neither may really want to attend.<br />Administrators have a tendency to control; Physicians have a tendency toward arrogance.<br />Both parties have photographic memories.<br />Once trust is established, long term relationships tend to be very successful.<br />Decisions should be made on sound business principles for the benefit of both sides and in the advocacy of patient care.<br />
  41. 41. Some Lessons from History…..Consensus vs. Science<br />Consensus is a political process<br /> Science is an evidentiary process<br />
  42. 42. Consensus 1492<br />It was the unanimous consensus of the court that the earth is flat !<br />
  43. 43. If you lead by simply promoting the consensus, you are FOLLOWING, not LEADING.<br />
  44. 44. Another Brief Digression…. <br /> 1620- Somewhere in the Atlantic.…<br />
  45. 45. Physician Hospital RelationsA Physician- Hospital Compact<br />Competent Leadership<br />Shared Goals<br />Mutual Sustained Success<br />“for our better Ordering and Preservation, <br /> and Furtherance of the Ends…”<br />
  46. 46. Leadership<br />Management is doing things right; <br /> Leadership is doing the right things. <br /> Peter F. Drucker<br />Change<br />
  47. 47. Developing physician leadership<br />Techniques for hospital-physician interactions<br />The role of the Board in the quality agenda<br />Delivery Models<br />
  48. 48. Board<br />Board<br />Administration<br />Medical Staff<br />Administration<br />Medical Staff<br />Advancing the Quality Agenda<br />
  49. 49. What Does the Evidence Tell Us?<br />Five Tips for the Board:<br />Define the Board’s role in quality<br />Quality is more than regulations<br />Find quality champions<br />Incorporate quality into the mission<br />Bring theory into reality<br />Dlugacz, Krasnoff Quality Management Inst., 2007<br />
  50. 50. Recommendations from IHI“Getting the Boards on Board”<br />The Goal:<br />Boards in all hospitals will spend at least 25% of their meeting time on quality and safety issues.<br />Boards will have a conversation with at least one patient (or family member of a patient) who sustained serious harm at their institution within the last year.<br />
  51. 51. I don’t know anything about Relativity...<br /> …but I do know Albert, and you can trust him.<br /> Mrs. Albert Einstein<br />Change<br />
  52. 52. Trust, but verify.<br />Michail Gorbachov<br /> Ronald Reagan<br />Change<br />
  53. 53. Variance Analysis-- The Keys:<br />Share the Data !<br />Decreasethe Variance !<br />
  54. 54. The Performance Improvement Process<br />Data, not an Indictment !!<br />Data isNOTDiagnostic !!<br />Sed Rate Analogy<br />
  55. 55. The Inverse Relationship between Quality and Spending<br />Baickeret al. Health Affairs web exclusives, October 7, 2004<br />
  56. 56. The Five Stages of Death and Dying(and Data !!)<br />Denial !!<br />Anger<br />Bargaining<br />Depression<br />Acceptance !!<br /> Adapted from Kubler-Ross<br />
  57. 57. Variance Analysis and Intervention<br />Large clinical variances continue to exist amongst physicians and hospitals<br />Variances can and do lead to differences in management, treatment, and outcomesfor the patient<br />
  58. 58. Variance Analysis and Intervention<br />A process must be developed to investigate these variances in an objective, non-judgmental manner<br />An identified variance is not necessarily good or bad-- it is simply an observation<br />Physicians must assume a leadership role in the data evaluation and management team<br />
  59. 59. Bottom Line……...<br />Unexplainedvariance is the Basis of the Quality Improvement Process !!<br />
  60. 60. Variance Analysis and Intervention<br />The great majority of “outlying” physicians are good physicians who have developed a particular style of practice which can be madeevenbetter!<br />
  61. 61. Leadership<br />Hell, there are no rules here– <br />We're trying to accomplish something. Thomas A. Edison<br />Change<br />
  62. 62. Working Together to Move the Quality Agenda<br />A Proven Methodology to Improve Clinical Outcomes<br />
  63. 63. The Clinical Improvement Process<br />1. Verify that the problem is significant<br />Potential impact on patients<br />Opportunity for improvement<br />2. Incorporate the evidence-based processes<br />Education- physicians, medical team<br />Adoption- treatment modifications or new guidelines<br />3. Determine what outcomes should be tracked<br />Identify and measure the few key outcomes<br />Provide ongoing feedback to the medical team<br />4. Respect the data– Take it to the next level<br />Pursue outliers and new opportunities to further improve<br />
  64. 64. Developing physician leadership<br />Models for hospital-physician interactions<br />The role of the Board in advancing the quality agenda<br />
  65. 65. Change<br />Just the facts !<br />Detective Sgt. Joe Friday<br />
  66. 66. Change<br />If the other guy’s getting better, then you’d better be getting better faster than that other guy’s getting better…<br /> …Or you’re getting worse. <br /> Tom Peters<br />Change<br />
  67. 67. Developing physician leadership<br />Techniques for hospital-physician interactions<br />The role of the Board in the quality agenda<br />Delivery Models<br />
  68. 68. Clinical Integration ModelsSame Old Wine in a Brand New Bottle ?<br />
  69. 69. Clinical Integration ModelsSame Old Wine in a Brand New Bottle ?<br />
  70. 70. Accountable Care Organizations<br />Definition:<br />An ACO is a health care provider organization that is accountable for meeting the health needs of a defined population, including the total cost of care and the quality and effectiveness of services.<br />
  71. 71. Accountable Care Organizations<br />Structurally, ACOs will look different, but would share Three Guiding Principles:<br />1. Local accountability for a defined population of patients<br />2. Payment reform based on shared savings<br />3. Performance and outcome measurement<br />
  72. 72. Accountable Care Organizations<br />Functional Capacity Categories:<br />Manage the full continuum of care starting with the concept of a medical home<br />Financially integrated with both commercial and public payers<br />An IT platform for proactive patient management<br />A physician and hospital leadership team<br />Process improvement capabilities<br />
  73. 73. Accountable Care Organizations<br />How do we get there:<br />Understand the difference between Market and Mandate<br />Specifically define your core business<br />Develop a methodology to get better and more efficient at that business<br />Recognize your stakeholders<br />Then….. Work with your stakeholders to develop an infrastructure that satisfies the criteria of an ACO<br />
  74. 74. Developing physician leadership<br />Techniques for hospital-physician interactions<br />The role of the Board in the quality agenda<br />Delivery Models<br />
  75. 75. Change<br />Change<br />To the world you may be just one person,<br />But to one person you may just be the world.Unknown <br />Change<br />

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