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The Doctor’s Orders for Engaging Physicians to Drive Improvements

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The Doctor’s Orders for Engaging Physicians to Drive Improvements

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Physicians drive the majority of all quality and cost decisions, yet reimbursement pressures, competing time pressures, misaligned incentives, and a lack of credible data often make engaging clinicians in improvement work one of the biggest challenges in healthcare.

David Wild, MD, MBA, and Jack Beal, JD, explore how to spread data to the edges of the organization and engage physicians in leading a continuum of improvement across an entire organization.

During this webinar, our presenters:
• Identify the levels of physician leadership in your organization you can engage to drive improvement.
• Pinpoint the types of data and information of most interest to physician leaders.
• Propose several ways data to use data to engage physicians in leading improvement work.
• Help you develop at least one mechanism you can use to better engage physicians in improvement work at your organization.

Physicians drive the majority of all quality and cost decisions, yet reimbursement pressures, competing time pressures, misaligned incentives, and a lack of credible data often make engaging clinicians in improvement work one of the biggest challenges in healthcare.

David Wild, MD, MBA, and Jack Beal, JD, explore how to spread data to the edges of the organization and engage physicians in leading a continuum of improvement across an entire organization.

During this webinar, our presenters:
• Identify the levels of physician leadership in your organization you can engage to drive improvement.
• Pinpoint the types of data and information of most interest to physician leaders.
• Propose several ways data to use data to engage physicians in leading improvement work.
• Help you develop at least one mechanism you can use to better engage physicians in improvement work at your organization.

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The Doctor’s Orders for Engaging Physicians to Drive Improvements

  1. 1. The Doctor’s Orders for Engaging Physicians to Drive Improvements Jack Beal, JD Vice President, Performance Improvement and Deputy General Counsel, The University of Kansas Health System February 12, 2020 David Wild, MD, MBA Vice President, Performance Improvement, Assistant Professor, Department of Anesthesiology, The University of Kansas Hospital
  2. 2. Share background information about The University of Kansas Health System. Discuss the value of data to drive improvement. Review how to determine if a problem is technical or adaptive. Explore the three levels The University of Kansas Health System uses to engage physicians in leading improvement work. Share conclusions about physician engagement. Agenda
  3. 3. © 2020 Health Catalyst Verbalize several ways data can be used to engage physicians in leading improvement work. Identify the levels of physician leadership in your organization that can be engaged to drive improvement. Become familiar with the types of data and information of most interest to physician leaders. Develop at least one mechanism that can be used to better engage physicians in improvement work. Learning Objectives 3
  4. 4. © 2020 Health Catalyst On a scale of 1-4, how would you rate your organization’s effectiveness in engaging physicians in improvement work? 1. Not at all effective – 10% 2. Somewhat effective – 34% 3. Moderately effective – 31% 4. Extremely effective – 2% 5. Unsure or not applicable – 23% Poll Question #1 4
  5. 5. © 2020 Health Catalyst Building on a legacy of patient care that began in 1906, The University of Kansas Health System, based in Kansas City, Kansas, is a world-class academic medical center and destination for complex care and diagnosis. 900-bed general medical and surgical facility. FY18 Volumes • 41,952 discharges • 29,073 surgeries • 60,207 ED visits • 1,726,674 ambulatory encounters The University of Kansas Physicians (UKP), the largest multi-specialty group practice in Kansas, are researchers and educators expanding the boundaries of medical knowledge. The University of Kansas Health System 5
  6. 6. © 2020 Health Catalyst Our Teams Performance Improvement Business Intelligence Solutions Applied Analytics Lean Promotion Office 6
  7. 7. © 2020 Health Catalyst The Problem Clinical or Business Event Data Collected Analysis Complete Action Taken TIME VALUE 7
  8. 8. © 2020 Health Catalyst Improvement work is hard enough, and doctors can be… Different. Challenging. Disengaged. Special. The Problem Continued 8
  9. 9. © 2020 Health Catalyst “The improvisational ability to lead adaptively relies on responding to the present situation rather than importing the past into the present and laying it on the current situation like an imperfect template.” -Ronald Heifetz 9
  10. 10. © 2020 Health Catalyst Clinical departments vary in their support for and mechanism of improvement work. “Us vs. them” mentality is common among physicians following the merger of the hospital and physician practices. Legacy medical director program is a primary mechanism for clinical improvement work. Physician compensation is mainly based on productivity, with occasional, small components based on quality or value. Condition of Clinical Improvement Work, May 2017 10
  11. 11. © 2020 Health Catalyst Defining the Future State Our improvement work must be aligned in all aspects. Problems and improvement ideas must be identified at the local level, even for physicians. Our physicians must be engaged in improving quality and reducing cost. 11
  12. 12. © 2020 Health Catalyst How frequently does your organization share departmental performance information with clinical departments? 1. Annually – 3% 2. Quarterly – 27% 3. Monthly – 22% 4. Weekly or more frequently – 9% 5. Unsure or not applicable – 39% Poll Question #2 12
  13. 13. © 2020 Health Catalyst Enhancing Physician Engagement in Improvement Work Care Connections Program. Updated, physician-led, local improvement program. Value-Based Performance. New department, or division-level, gain sharing program. Department Finance and Planning Sessions. Engagement of physician leadership in strategy and planning for growth and improvement. 13
  14. 14. © 2020 Health Catalyst Foundational support for each project with data, measurement, and analytics resources. Care Connections Program Key Features Move from paying for time, to paying for project completion. Encourage practicing physicians and their teams to generate improvement ideas. Ensure organizational alignment by providing executive oversight and coaching for project, measure and outcome selection. Improve academic productivity by requiring physicians to present and publish their work. 14
  15. 15. © 2020 Health Catalyst Care Connections Program Care Advancement Improvement topics are suggested by the health system in a “Request for Proposal” announcement. Physicians with interest in a topic submit a proposal with the hypothesis, proposed project, and proposed measures. The executive steering committee reviews all project submissions and approves funding for project time. 15 Care Transformation • Designed to support great ideas from physicians, and the teams they work with, even if the project was not identified by leadership. • Projects are submitted for review, approval, and funding by the executive steering committee.
  16. 16. © 2020 Health Catalyst Departmental Finance and Planning Sessions Information packets produced. Office hours with analytics leadership. Planning meeting with senior leadership. Annual improvement plan developed. 16
  17. 17. © 2020 Health Catalyst Value-Based Performance Value-Based Performance1. Find Improvements. 2. Support the physician department or division. 3. Remove barriers and support. 4. Generate and share value. 17
  18. 18. © 2020 Health Catalyst Departmental Finance and Planning Sessions Internal Medicine 18
  19. 19. © 2020 Health Catalyst Departmental Finance and Planning Sessions Provider wRVUs and Patient Satisfaction v 19
  20. 20. © 2020 Health Catalyst Departmental Finance and Planning Sessions Growth and Access 20
  21. 21. © 2020 Health Catalyst Departmental Finance and Planning Sessions Market Analysis 21
  22. 22. © 2020 Health Catalyst “Your goal should be to keep the temperature within what we call the productive zone of disequilibrium (PZD): enough heat generated by your intervention to gain attention, engagement, and forward motion, but not so much that the organization (or your part of it) explodes.” -Ronald A. Heifetz 22
  23. 23. © 2020 Health Catalyst Results Care connections 37 projects approved. 17 of 21 clinical departments represented. 1st quarter results were reported in November 2019. Value-Based Performance. Measurable improvement and savings in 80% of the projects in the first month. Savings from the first 6 months of the measurement period were approximately $400,000. Process (intervention) outcomes All 21 clinical departments have annual growth and improvement plans in place. More than 100 additional projects/ideas are either complete, in the vetting phase, or are beings sized, all the direct result of this work. 23
  24. 24. © 2020 Health Catalyst Value-Based Performance COPD Readmission Rate 24
  25. 25. © 2020 Health Catalyst Value-Based Performance Acetaminophen Substitution 25
  26. 26. © 2020 Health Catalyst Value-Based Performance Average Antibiotic Direct Cost 26
  27. 27. © 2020 Health Catalyst Departmental Finance and Planning Orthopedic Surgery 27
  28. 28. © 2020 Health Catalyst Key Learnings and Recommendations Engaging physicians in improvement must be done at multiple levels, including at the leadership, departmental, and individual levels. It is worth the investment of time to explain and socialize the data and information required for prioritization and measurement. Physicians (and those doing the work every day) have good ideas about what needs to improve, and ideas about how to improve. Listen to them. Aligned, not dictated, improvement efforts generate physician engagement. 28
  29. 29. Q&A 29 David Wild, MD, MBA Vice President, Performance Improvement, Assistant Professor, Department of Anesthesiology, The University of Kansas Hospital Jack Beal, JD Vice President, Performance Improvement and Deputy General Counsel, The University of Kansas Health System
  30. 30. © 2020 Health Catalyst New Ways to Improve Hospital Flow with Predictive Analytics Improving hospital-wide patient flow requires an appreciation of the hospital as an interconnected, interdependent system of care. Learn how supervised machine learning was used at Cedars-Sinai to create predictive models for length of stay, emergency department (ED) arrival, ED admissions, aggregate discharges, and total bed census to reduce patient wait times, reduce staff overtime, improve patient outcomes, and improve patient and clinician satisfaction. Wednesday, March 18 1:00 - 2:00 PM ET In this webinar you can expect to: • Discover how Cedars-Sinai framed the real question that needed to be answered. • Discuss how Cedars-Sinai engaged leaders up front – with the goal of operationalizing our analytics. • Summarize the types of machine learning (ML) methods Cedars-Sinai employed. • Show how Cedars-Sinai operationalized the results. Michael Thompson, MS Predictive Analytics Executive Director, Enterprise Data Intelligence, Cedars-Sinai Medical Center
  31. 31. Thank you!

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