Tools,Lessons Learned,and InsightsBuilding Referring Physician Loyaltywith Experience Mapping
AgendaSituation OverviewExperience MappingAction and ResultsQ&A
Situation OverviewCincinnati Children’s Hospital•   Nonprofit pediatric academic medical    center established in 1883, lo...
Previous Experience withPhysician Satisfaction Measures          • Physician Liaison program since 1994             – Loca...
Conventional Wisdom• Referring providers want &  expect updates about the  patients they refer• Understand why referring  ...
But We Still Had Questions…• Do referring specialists expect the same frequency/type  of communication as primary care pro...
Alternatives Considered              Mystery Shopping                                      ?                              ...
Our ChoiceExperience Mapping• Evaluates the entire experience—from the  moment a decision is made to refer to the stage  o...
EXPERIENCE MAPPING
Experience, Culture and Brand                     Experience                       •   Culture and brand promise are linke...
Word-of-Mouth Advertisingis theleast expensiveandmost effectiveform of promotion
How Enchantment is Different          Loyal Physicians                            Enchanted Physicians         Satisfied a...
Difference in DriversFunctional Needs                Emotional Needs             NUMBERS           STORIES  What we do…   ...
Enchantment Cycle    Reinforce the                                                                   Listen to promise and...
Shifting the Perspective“Customer experience is bigger than customerservice in that it is the full, and endexperience. It ...
Experience Mapping:                Fitting it All TogetherExperience Mapping is an in-depth qualitative research technique...
Scope•   Airway Reconstruction and Aerodigestive    & Sleep Center     – 15 current referrers                             ...
Subspecialist Experience Map                                                       Scheduling/                            ...
Imparting the InsightsReferral Stages:                    Ideal Outcome:                                    “Cincinnati Ch...
Communication                                                  Communication         Coordination   Care•   I only refer p...
Communication                                               Communication      Coordination        Care•   I only refer pa...
Communication                                                Communication      Coordination         Care•   I only refer ...
Current     Importance to   Category                Details (Why/What/How)                   Performance     ReferrersEsta...
Coordination                                                Communication      Coordination        Care•   To initiate a r...
Coordination                                                Communication      Coordination        Care•   To initiate a r...
Coordination                                                Communication      Coordination        Care•   To initiate a r...
Coordination                               Communication     Coordination        Care       The scheduling process is easy...
Coordination                               Communication      Coordination        Care       The scheduling process is eas...
Coordination                               Communication     Coordination        Care       The scheduling process is easy...
Coordination                                      Communication   Coordination     Care―It’s always challenging transferri...
Care                                                       Communication      Coordination        Care• Families are anxio...
Care                                                        Communication      Coordination       Care•   Families are anx...
Care                                                         Communication      Coordination        Care•   Families are a...
Care                                                         Communication      Coordination        Care•   Families are a...
Care                                       Communication       Coordination          Care           Functional            ...
Care                                       Communication      Coordination           Care           Functional            ...
Care                                       Communication       Coordination          Care           Functional            ...
Care                                       Communication      Coordination           Care           Functional            ...
Care                                  Communication      Coordination        Care    Emotional     Needs                  ...
Care                                  Communication      Coordination        Care    Emotional     Needs                  ...
Care                                  Communication      Coordination        Care    Emotional     Needs                  ...
Care                                  Communication      Coordination        Care    Emotional     Needs                  ...
Care                                  Communication      Coordination        Care    Emotional     Needs                  ...
Program Summary Program             Awareness                 Need                Scheduling             Treatment        ...
Program Summary Program             Awareness                Need             Scheduling           Treatment            Tr...
Program Summary Program             Awareness                 Need                Scheduling             Treatment        ...
ACTION AND RESULTS
Our Key Take-Aways• Developing direct relationships with  specialists is key• Referring providers want to be included in  ...
Action CategoriesCommunication    Coordination       Care         Awareness and Outreach                     +     Excepti...
Refresh                             Communication   Coordination   Care• Physician liaison materials update• Priority Link...
Physician liaison materials update
Priority Link Program
Hospital transfer information for             parents
Streamline                        Communication   Coordination   Care• Capture referring physician information in EPIC• HI...
New Standards                       Communication   Coordination   Care• Hospital transfer improvement• Coaching with Phys...
Results to Date• Positive engagement with targeted service lines   – Staff now engaged in service recovery with physician ...
Inpatient Discharges          (Regional and National)FY 2000              FY 2005              FY 2010                 Reg...
Inpatient Days     (Regional and National)FY 2000          FY 2005              FY 2010             Regional      National
Short Stay Discharges      (Regional and National)  FY 2000          FY 2005              FY 2010               Regional  ...
Outpatient Visits  (Regional and National)FY 2000         FY 2005              FY 2010           Regional       National
Referrals from WV specialists thatPhysician Services met with* in 2011                        20                        18...
In Our Plans• Further optimize EPIC for  transition of care• Identify ways to improve the  communication process• Other sp...
Lessons Learned• Make sure you have lists ready• Engage the clinical leaders early• Get buy-in from other process owners (...
John McKeever                          Patty BransonPresident                              Sr. Director Physician Services...
Build referring physician loyalty with experience
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  • PB: Share information about Cincinnati Children’s, significant changes over the last 15 years, and why we began this journey of the physician experience.
  • PB: Historically share information about the data collected and the processes for gathering data. What led to our next steps.
  • PB: What we thought we understood and knew
  • PB: Will discuss the work of our group and the decision process
  • We knew we needed market feedback – somehow engaging physicians—PB can address each of theseThe Physician Advisory Board is a distinguished group of independent practicing physicians who provide advice on issues of importance to doctors
  • Why our decision led to working with Gelb
  • Talk about experience starting BEFORE they call you and ends after they leaveFrom the customer perspective – that’s what most important – we often fail to recognize that
  • Comment on length of interviews, discussion format
  • Review the distinctions across each areaWhy this empathy building is key for staff to take action
  • Reference what’s most important
  • Review highlighted comments
  • Review highlighted comments
  • Review highlighted comments
  • Review highlighted comments
  • Review these pieces as a set up for the next section
  • Comment on this framework shaping the way priorities are set
  • Build referring physician loyalty with experience

    1. 1. Tools,Lessons Learned,and InsightsBuilding Referring Physician Loyaltywith Experience Mapping
    2. 2. AgendaSituation OverviewExperience MappingAction and ResultsQ&A
    3. 3. Situation OverviewCincinnati Children’s Hospital• Nonprofit pediatric academic medical center established in 1883, located in the mid-west• 577 Registered Beds• 2nd highest recipient of NIH grants for pediatric research• 1516 active medical staff members, of which 784 are employed• 558 resident/fellows in training• 12654 total employees• Served patients from 50 countries and 48 states in FY11
    4. 4. Previous Experience withPhysician Satisfaction Measures • Physician Liaison program since 1994 – Local market – Primary Care Providers • Surveyed referring physicians (600) bi-annually since 2000 • Survey random specialists annually • Expand Physician Liaison—regional & national
    5. 5. Conventional Wisdom• Referring providers want & expect updates about the patients they refer• Understand why referring providers select Cincinnati Children’s Hospital• Our referral process is straightforward and simple• There are always opportunities to improve the ―physician experience‖ however, not everyone makes this a priority.
    6. 6. But We Still Had Questions…• Do referring specialists expect the same frequency/type of communication as primary care providers?• How do specialists learn about our services and what factors determine repeat business?• What process do specialists use to refer their patients? What are the barriers to that process?• How can we improve the physician experience and which division(s) will be our ―test of change‖
    7. 7. Alternatives Considered Mystery Shopping ? Best GuessPhysician Survey Patient Survey Physician Advisory Board
    8. 8. Our ChoiceExperience Mapping• Evaluates the entire experience—from the moment a decision is made to refer to the stage of transitioning care back to the referring provider• Creates the framework for an action plan• Assigns accountability for each area
    9. 9. EXPERIENCE MAPPING
    10. 10. Experience, Culture and Brand Experience • Culture and brand promise are linked through the experience delivered, supported by leadership Deliver Ideal Experience Exceptional Experience • Leaders translate customer expectations through the brand and Internal Brand desired experience into employee Culture Promise behaviorDesired Employee Behaviors Physician Expectations • This alignment creates an exceptional experience and a sustainable competitive advantage Leadership • We call this desired state ―enchantment‖
    11. 11. Word-of-Mouth Advertisingis theleast expensiveandmost effectiveform of promotion
    12. 12. How Enchantment is Different Loyal Physicians Enchanted Physicians Satisfied and refer again Raving fans and spread the word• Will recommend you if asked • Go out of their way to recommend you• But won’t give you a second chance • They forgive you for missteps• Have minimum investment in your future • Demonstrate a strong commitment• See you as a choice among many • They are part of your future
    13. 13. Difference in DriversFunctional Needs Emotional Needs NUMBERS STORIES What we do… How we do it… – Services offered – Inclusion in treatment – Clinical outcomes – ―Feel‖ of the interactions – Transfer efficiency – Subjective quality judgments – Scheduling delays – Feeling valued
    14. 14. Enchantment Cycle Reinforce the Listen to promise and deliver Reinforce Listen customers, theirin all communications influencers and other & interactions stakeholders Physician Deliver Define Define how yourDeliver flawlessly on organization will meet the Promise or exceed needs Promise Communicate a resonant Promise
    15. 15. Shifting the Perspective“Customer experience is bigger than customerservice in that it is the full, and endexperience. It starts when you first hear aboutAmazon from a friend and ends when you getthe package in the mail and open it.” -Jeff Bezos, CEO, Amazon.com
    16. 16. Experience Mapping: Fitting it All TogetherExperience Mapping is an in-depth qualitative research technique thatutilizes a visual cue (the experience map) to help patients, staff, and otherinfluencers recall specific episodes in their journey. It provides:Assessment of the total experience• Expectations- before first encounter• Activities and Touchpoints• Changes in attitudes, if anyFramework for action• Experience stewards who are responsible for delivery• Steward can appreciate the relationship of their actions to the rest of the journey• Interactions or “touchpoints” are categorized at each step
    17. 17. Scope• Airway Reconstruction and Aerodigestive & Sleep Center – 15 current referrers An interviewee is designated as a current – 3 non-referrers referrer if he/she has currently or previously referred a patient to Cincinnati Children’s; non-referrers have never referred a patient to• Perinatal Institute Cincinnati Children’s OR have never referred to the respective program. – 20 Current Referrers• Gastroenterology, Hepatology & Nutrition Center – 15 current referrers – 3 non referrers 17
    18. 18. Subspecialist Experience Map Scheduling/ Transition of Awareness Need Treatment Transfer CarePerceptions of Diagnosis Initial contact with Coordination of care Discharge summaryCincinnati Children’s referral facility with Cincinnati Evaluation and Coordination of Children’s specialistKnowledge about selection of treatment Scheduling/transfer on-going careCincinnati Children’s providers process Progress notes and Ongoing patient methods ofMarketing or Discussion with Timing and ease of care/support communicationeducational resources patients process Call-backs forfrom Cincinnati (diagnosis, referral Family feedback about Managing insurance assistanceChildren’s options) their clinical requirements, experienceIdeal relationship with Preparing patients for accommodations orCincinnati Children’s what to expect travel for families Support offered to family Methods of Communication (In each phase)
    19. 19. Imparting the InsightsReferral Stages: Ideal Outcome: “Cincinnati Children’s is my best resource.” Day in the Life: • Cincinnati Children’s provides the best care possible for my patients and their familiesTouchpoint Performance: • Cincinnati Children’s provides great care to patients, but does not keep me informedElectronic communications,telephone communications, • I prefer to refer patients to other facilitiesfacility, written communications, because of bad experiences with Cincinnatiinterpersonal communications Children’s 19
    20. 20. Communication Communication Coordination Care• I only refer patients out of state if there is no way to provide care locally; a major hurdle is overcoming insurances restrictions as certain providers will not cover care provided out of state (although Cincinnati Children’s accepts more types of insurance than other facilities that I have worked with and helps with the paperwork) 21
    21. 21. Communication Communication Coordination Care• I only refer patients out of state if there is no way to provide care locally; a major hurdle is overcoming insurances restrictions as certain providers will not cover care provided out of state (although Cincinnati Children’s accepts more types of insurance than other facilities that I have worked with and helps with the paperwork)• I am confident in using Cincinnati Children’s for certain diagnoses (such as airway, cardiovascular or GI), but I may pick another facility for other issues (such as hearing problems or general as I am unsure what unique benefits Cincinnati prematurity), Children’s would offer my patients compared to a facility closer to home 22
    22. 22. Communication Communication Coordination Care• I only refer patients out of state if there is no way to provide care locally; a major hurdle is overcoming insurances restrictions as certain providers will not cover care provided out of state (although Cincinnati Children’s accepts more types of insurance than other facilities that I have worked with and helps with the paperwork)• I am confident in using Cincinnati Children’s for certain diagnoses (such as airway, cardiovascular or GI), but I may pick another facility for other issues (such as hearing problems or general prematurity), as I am unsure what unique benefits Cincinnati Children’s would offer my patients compared to a facility closer to home• I receive mailed information from many pediatric facilities, and feel that Cincinnati Children’s is equal I particularly appreciate information to, or better than, others; about their referral process, outcomes and unique research/clinical techniques 23
    23. 23. Current Importance to Category Details (Why/What/How) Performance ReferrersEstablishing Continue CME offerings , conferences, High 1Expertise distribution of outcomes and research updates Visit referring physician offices or host GrandOutreach High 2 Rounds at their facility Program-specific mailed resources, includingResources contacts for initiating a referral, include Moderate 3 messaging “we make it easy for you to refer”Out-of-state Promote resources that provide help with Low 4challenges insurance restrictions and travel resources Provide resources that outline array of servicesResources offered and focus on benefits for patients ; focus Moderate 5 on “Why Choose Cincinnati Children’s?” 24
    24. 24. Coordination Communication Coordination Care• To initiate a referral, I find the phone number on the Web site, in a mailed newsletter, or have been I call the physician or given a direct number to one of the physicians; department coordinator and they take care of everything from that point, which is exactly what I want – it is easy 26
    25. 25. Coordination Communication Coordination Care• To initiate a referral, I find the phone number on the Web site, in a mailed newsletter, or have been given a direct number to one of the physicians; I call the physician or department coordinator and they take care of everything from that point, which is exactly what I want – it is easy• I’m never Even though I trust the patient’s appointment has been appropriately scheduled, really sure when their appointment is and would like an appointment confirmation; this confirmation could also include contact information so that everyone involved knows who to contact with questions 27
    26. 26. Coordination Communication Coordination Care• To initiate a referral, I find the phone number on the Web site, in a mailed newsletter, or have been given a direct number to one of the physicians; I call the physician or department coordinator and they take care of everything from that point, which is exactly what I want – it is easy• Even though I trust the patient’s appointment has been appropriately scheduled, I’m never really sure when their appointment is and would like an appointment confirmation; this confirmation could also include contact information so that everyone involved knows who to contact with questions• The post-treatment communication is critical to me and a determiner of whether or not my referring experience is a positive one; I sometimes receive communication from Cincinnati Children’s, but it is inconsistent (and I wonder if it is being sent to another doctor) and sometimes arrives too late (after I have already seen the patient) 28
    27. 27. Coordination Communication Coordination Care The scheduling process is easy and timely, which is ideal for referrers. To their knowledge, patients typically receive appointments in a appropriate time frame; if the patient expresses concern about the timing, the referrer is able to call to obtain an earlier appointment. 30
    28. 28. Coordination Communication Coordination Care The scheduling process is easy and timely, which is ideal for referrers. To their knowledge, patients typically receive appointments in a appropriate time frame; if the patient expresses concern about the timing, the referrer is able to call to obtain an earlier appointment. Many do not receive any updates during treatment and would like notes after Discharge summaries are important milestones. critical for on-going care, sometimes received after the referrer has already seen the patient – or not at all. Electronic (or telephone) updates are preferred for speed; mailed for formal record-keeping. Referrers also suggest appointment confirmations (faxed or electronically) that include the day/time of the appointment, who to contact with questions and the name of the patient’s doctor; this would be helpful for them to stay updated about their patient’s care and to answer questions the family may have. 31
    29. 29. Coordination Communication Coordination Care The scheduling process is easy and timely, which is ideal for referrers. To their knowledge, patients typically receive appointments in a appropriate time frame; if the patient expresses concern about the timing, the referrer is able to call to obtain an earlier appointment. Many do not receive any updates during treatment and would like notes after important milestones. Discharge summaries are critical for on-going care, sometimes received after the referrer has already seen the patient – or not at all. Electronic (or telephone) updates are preferred for speed; mailed for formal record-keeping. Referrers also suggest appointment confirmations (faxed or electronically) that include the day/time of the appointment, who to contact with questions and the name of the patient’s doctor; this would be helpful for them to stay updated about their patient’s care and to answer questions the family may have. 32
    30. 30. Coordination Communication Coordination Care―It’s always challenging transferring someoneout of state because there’s a lot that goes ―I get practically nothing frominto it. There are some things that help, such Cincinnati Children’s after theas knowing that I can pick up the phone and baby has gone to thetalk to someone at Cincinnati.‖ NICU, and this is similar to-- ENT Current Referrer other places that I refer babies to…I won’t give anyone I work with higher than a C for―I don’t like the way the NICU attending never communication. It tends to fallcalls me back, but I have no choice. Fair off into a black hole and if Iwarning -if another group comes into town, I want to know any specifics, Iwill be calling them instead…it’s only a matter have to call and extract theof time because we get more competition in information from them.‖this area.‖ -- Perinatal Referring Physician-- Perinatal Referring Physician 33
    31. 31. Care Communication Coordination Care• Families are anxious about going to a large hospital, especially if it is out of state, so directing me to resources such as maps, a list of travel resources, contact numbers for families to call, and information about what they can expect would be helpful 35
    32. 32. Care Communication Coordination Care• Families are anxious about going to a large hospital, especially if it is out of state, so directing me to resources such as maps, a list of travel resources, contact numbers for families to call, and information about what they can expect would be helpful• I want to feel respected as a fellow expert – after all, I am a specialist and not a general family doctor – so I expect them to always accept patient transfers, give my patients appointments within an timeline that I deem appropriate, and listen to the background information that I can offer 36
    33. 33. Care Communication Coordination Care• Families are anxious about going to a large hospital, especially if it is out of state, so directing me to resources such as maps, a list of travel resources, contact numbers for families to call, and information about what they can expect would be helpful• I want to feel respected as a fellow expert – after all, I am a specialist and not a general family doctor – so I expect them to always accept patient transfers, give my patients appointments within an timeline that I deem appropriate, and listen to the background information that I can offer• I know it’s difficult for Cincinnati Children’s physicians to call me as they are busy, but if I really want to get in touch with them, I often don’t know who to call and would like a means to contact my ideally, they would initiate a call to me patient’s care team – and for urgent situations 37
    34. 34. Care Communication Coordination Care• Families are anxious about going to a large hospital, especially if it is out of state, so directing me to resources such as maps, a list of travel resources, contact numbers for families to call, and information about what they can expect would be helpful• I want to feel respected as a fellow expert – after all, I am a specialist and not a general family doctor – so I expect them to always accept patient transfers, give my patients appointments within an timeline that I deem appropriate, and listen to the background information that I can offer• I know it’s difficult for Cincinnati Children’s physicians to call me as they are busy, but if I really want to get in touch with them, I often don’t know who to call and would like a means to contact my patient’s care team – and ideally, they would initiate a call to me for urgent situations• I want to have a relationship with someone there who knows my name and can help me navigate the system, and I appreciate being part of outreaches and offered opportunities to strengthen my skills (through CMEs and the specialist’s willingness to explain things to me and answer my questions) 38
    35. 35. Care Communication Coordination Care Functional Needs How these needs are met… I am confident in their clinical Conferences, journals, hosting CME, care and outcomes mailed updates, publishing outcomes I can quickly access them and Priority Link, minimal hold times, quick initiate a referral/transfer transfer process I receive a discharge Immediate summary upon summary and on-going care discharge, clear plan for next plan steps, ability to contact specialist for questions I am updated throughout the Updates post-admission and weekly process 40
    36. 36. Care Communication Coordination Care Functional Needs How these needs are met… I am confident in their clinical Conferences, journals, hosting care and outcomes CME, mailed updates, publishing outcomes I can quickly access them and Priority Link, minimal hold times, quick initiate a referral/transfer transfer process I receive a discharge Immediate summary upon discharge, summary and on-going care clear plan for next steps, ability to plan contact specialist for questions I am updated throughout the Updates post-admission and weekly process 41
    37. 37. Care Communication Coordination Care Functional Needs How these needs are met… I am confident in their clinical Conferences, journals, hosting CME, care and outcomes mailed updates, publishing outcomes I can quickly access them and Priority Link, minimal hold times, quick initiate a referral/transfer transfer process I receive a discharge Immediate summary upon summary and on-going care discharge, clear plan for next plan steps, ability to contact specialist for questions I am updated throughout the Updates post-admission and weekly process 42
    38. 38. Care Communication Coordination Care Functional Needs How these needs are met… I am confident in their clinical Conferences, journals, hosting care and outcomes CME, mailed updates, publishing outcomes I can quickly access them and Priority Link, minimal hold times, quick initiate a referral/transfer transfer process I receive a discharge Immediate summary upon discharge, summary and on-going care clear plan for next steps, ability to plan contact specialist for questions I am updated throughout the Updates post-admission and weekly process 43
    39. 39. Care Communication Coordination Care Emotional Needs Don’t question necessity of transfers, ask I am respected questions and respect medical opinion, call to discuss updates, assure they did a good job caring for the baby I am included in the process Updates and discharge summaries, communication with transfer team They appreciate my Explicit “thank you” and “how can we do better?,” referrals outreach, resources to make it easy to initiate a referral They make me look good to Inclusion in on-going care plan, reverse transfer families when possible I can develop my Educational outreach, allowing them to ask professional expertise questions about specific patients 45
    40. 40. Care Communication Coordination Care Emotional Needs Don’t question necessity of transfers, ask I am respected questions and respect medical opinion, call to discuss updates, assure they did a good job caring for the baby I am included in the process Updates and discharge summaries, communication with transfer team They appreciate my Explicit “thank you” and “how can we do better?,” referrals outreach, resources to make it easy to initiate a referral They make me look good to Inclusion in on-going care plan, reverse transfer families when possible I can develop my Educational outreach, allowing them to ask professional expertise questions about specific patients 46
    41. 41. Care Communication Coordination Care Emotional Needs Don’t question necessity of transfers, ask I am respected questions and respect medical opinion, call to discuss updates, assure they did a good job caring for the baby I am included in the process Updates and discharge summaries, communication with transfer team They appreciate my Explicit “thank you” and “how can we do better?,” referrals outreach, resources to make it easy to initiate a referral They make me look good to Inclusion in on-going care plan, reverse transfer families when possible I can develop my Educational outreach, allowing them to ask professional expertise questions about specific patients 47
    42. 42. Care Communication Coordination Care Emotional Needs Don’t question necessity of transfers, ask I am respected questions and respect medical opinion, call to discuss updates, assure they did a good job caring for the baby I am included in the process Updates and discharge summaries, communication with transfer team They appreciate my Explicit “thank you” and “how can we do better?,” referrals outreach, resources to make it easy to initiate a referral They make me look good to Inclusion in on-going care plan, reverse transfer families when possible I can develop my Educational outreach, allowing them to ask professional expertise questions about specific patients 48
    43. 43. Care Communication Coordination Care Emotional Needs Don’t question necessity of transfers, ask I am respected questions and respect medical opinion, call to discuss updates, assure they did a good job caring for the baby I am included in the process Updates and discharge summaries, communication with transfer team They appreciate my Explicit “thank you” and “how can we do better?,” referrals outreach, resources to make it easy to initiate a referral They make me look good to Inclusion in on-going care plan, reverse transfer families when possible I can develop my Educational outreach, allowing them to ask professional expertise questions about specific patients 49
    44. 44. Program Summary Program Awareness Need Scheduling Treatment TransitionPerinatal Program is well- Common to split Transfer process is Few receive DischargeInstitute known, but other referrals, and send efficient, but treatment updates, summaries are options are closer to you only complex physicians don’t some track down received home; building cases always feel included doctor themselves inconsistently, but relationships via needed for ongoing outreach is crucial careAirway Re- Capabilities and Top referral choice Scheduling Patients are well- Some receive ampleconstruction specialists are for airway , but split process is easy; cared for, but follow-up, butand Aero- well-known; most referrals for other seek progress reports are others receive nonedigestive and receive mailed issues; insurance is a appointment inconsistent and are unsure why major hurdleSleep Center information confirmation and patient resourcesGastro- Most have heard Expertise is well- The process is easy Generally happy Most receive follow-enterology, of program and known, but local and efficient, but with updates; need up communicationHepatology receive mailed care is preferred and appointment contact #s when but it’s often late –& Nutrition information; CME few know about confirmations are questions arise after follow-up visit travel resources suggestedCenter in Aspen is popular High Performance Moderate Performance Low Performance 51
    45. 45. Program Summary Program Awareness Need Scheduling Treatment TransitionPerinatal Program is well- Common to split Transfer Few receive DischargeInstitute known, but other referrals, and process is treatment updates, summaries are options are closer send you only efficient, but some track down received to home; building complex cases physicians don’t doctor themselves inconsistently, but needed for ongoing relationships via always feel care outreach is crucial includedAirway Re- Capabilities and Top referral Scheduling process Patients are Some receiveconstruction specialists are well- choice for is easy; seek well-cared for, ample follow-and Aero- known; most receive airway, but split appointment but progress up, but othersdigestive and mailed information referrals for confirmation and reports are receive none patient resourcesSleep Center other issues; inconsistent and are unsure insurance is a why major hurdleGastro- Most have heard of Expertise is well- The process is Generally happy Most receiveenterology, program and receive known, but local easy and with updates; follow-upHepatology mailed information; care is preferred efficient, but need contact communication& Nutrition CME in Aspen is and few know appointment #s when but it’s often popularCenter about travel confirmations questions arise late – after resources are suggested follow-up visit High Performance Moderate Performance Low Performance 52
    46. 46. Program Summary Program Awareness Need Scheduling Treatment TransitionPerinatal Program is well- Common to split Transfer process is Few receive DischargeInstitute known, but other referrals, and send efficient, but treatment summaries are options are closer to you only complex physicians don’t updates, some received home; building cases always feel included track down inconsistently, relationships via doctor but needed for outreach is crucial themselves ongoing careAirway Re- Capabilities and Top referral choice Scheduling process Patients are well- Some receive ampleconstruction specialists are well- for airway , but split is easy; seek cared for, but follow-up, butand Aero- known; most receive referrals for other appointment progress reports are others receive nonedigestive and mailed information issues; insurance is a confirmation and inconsistent and are unsure why major hurdle patient resourcesSleep CenterGastro- Most have heard of Expertise is well- The process is easy Generally happy Most receive follow-enterology, program and receive known, but local and efficient, but with updates; need up communicationHepatology mailed information; care is preferred and appointment contact #s when but it’s often late –& Nutrition CME in Aspen is few know about confirmations are questions arise after follow-up visit popular travel resources suggestedCenter High Performance Moderate Performance Low Performance 53
    47. 47. ACTION AND RESULTS
    48. 48. Our Key Take-Aways• Developing direct relationships with specialists is key• Referring providers want to be included in the team and expected updated communication• Communication is sporadic and inconsistent• Challenges exist with the referral process• Referring providers want to learn about ―other services‖ available• Coordination of transition care could improve
    49. 49. Action CategoriesCommunication Coordination Care Awareness and Outreach + Exceptional Referral Coordination = Lasting relationships
    50. 50. Refresh Communication Coordination Care• Physician liaison materials update• Priority Link promotion• Sub-specialist web pages• First appointment notifications• Hospital transfer information for parents
    51. 51. Physician liaison materials update
    52. 52. Priority Link Program
    53. 53. Hospital transfer information for parents
    54. 54. Streamline Communication Coordination Care• Capture referring physician information in EPIC• HIPAA guidelines and second opinions• EPIC access for specialists• Discharge summary for next steps in on-going care• Integration between CRM and EPIC
    55. 55. New Standards Communication Coordination Care• Hospital transfer improvement• Coaching with Physician Priority Link staff• Perinatal inpatient care nurse liaison
    56. 56. Results to Date• Positive engagement with targeted service lines – Staff now engaged in service recovery with physician liaisons – Reviews of reports with faculty• Expansion to national scope – FTEs plus travel budget increases – Marketing creating national campaign• Activity increases – Registrants to physician portal – Volume
    57. 57. Inpatient Discharges (Regional and National)FY 2000 FY 2005 FY 2010 Regional National
    58. 58. Inpatient Days (Regional and National)FY 2000 FY 2005 FY 2010 Regional National
    59. 59. Short Stay Discharges (Regional and National) FY 2000 FY 2005 FY 2010 Regional National
    60. 60. Outpatient Visits (Regional and National)FY 2000 FY 2005 FY 2010 Regional National
    61. 61. Referrals from WV specialists thatPhysician Services met with* in 2011 20 18 16 14 Number of Referrals 12 10 8 IP Referrals 6 OP Referrals 4 2 0 ENT Cardio Hem/Onc Neuro Endo Plastics Rheum Divisions receiving referrals *Specialists from ENT, Hem/Onc and Cardio
    62. 62. In Our Plans• Further optimize EPIC for transition of care• Identify ways to improve the communication process• Other specialty programs are seeking our assistance• CME department now working with divisions to heighten awareness
    63. 63. Lessons Learned• Make sure you have lists ready• Engage the clinical leaders early• Get buy-in from other process owners (e.g., IT)• Ensure alignment on deliverables and action
    64. 64. John McKeever Patty BransonPresident Sr. Director Physician ServicesGelb, An Endeavor Management Company Cincinnati Children’s Hospital1011 Highway 6 South, Suite 120 3333 Burnet AvenueHouston, TX 77077 MLC 5002 Cincinnati, OH 45229-3039281-759-3600 513-636-6033 (office)www.endeavormgmt.com 513-636-7431 (Fax)jmckeever@endeavormgmt.com Patty.Branson@cchmc.org

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