Post on 24-Dec-2015
transcript
The Medical Director’s
Role at VUMC:What is it Really All About?
Lynn E. Webb, Ph.D.May 25, 2011
WARNING:The following presentation
contains content which may be considered warm and fuzzy. Viewer attention is advised.
A Little History:1993
“Managed Care Threatens AMC’s”
“Can Academic Medicine be
Competitive in New Environment?”
1. Reduce costs to be competitive
2. Improve service to meet customer expectations
3. (Note: Quality and Safety not invented yet or we assumed it!)
Physicians must participate more actively in leadership at every level of the organization
Create Patient Care Centers that are accountable for achieving goals in Patient Care
VUMC Design Team
The Physician-Administrator Leadership Team - VHVI
“ Attributes of Successful Physician / Administrator Leadership: An Empirical Approach”
___________________________________________________________________________________________________________________________________
Webb, Lynn E. American College of Medical Practice Executives (ACMPE) College Review. Volume 18.Number 1 (Spring 2001): 24-38.
The emergence of the integrated health care delivery system is creating new demands on the physician-administrator relationship. This paper examines the relationship between selected attributes of the physician/administrator leadership (PAL) team and the team’s perceived success in performing its leadership functions.
Cardiovascular Position Descriptions Departmental Leadership Team PositionsManager and Medical Directors
Cardiovascular Patient Care Center Leadership Team
The leadership team of the cardiology services areas will include a Medical Director and a manager. The team is responsible for the creation of a patient focused, high performance, high commitment work team which supports the mission, vision and credo of the Cardiovascular Patient Care Center and the Clinical Enterprise. The leadership team will collaborate to meet the established goals of the Patient Care Center and the Clinical Enterprise of Vanderbilt University Medical Center.
Excerpts for VHVI Medical Director Job Descriptions:
• Develop standards of care
• Manage physician clinical performance and behavior
• Develop annual goals
• Lead improvement initiatives
As a medical director, how do I spend most of my time?
Leading im
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1.Leading improvement initiatives
2.Developing and monitoring annual goals
3.Setting standards of care
4.Dealing with physician performance and behavior
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How do I spend most of my time?
43% 43%
14%
0%
1.Leading improvement initiatives
2.Developing and monitoring annual goals
3.Setting standards of care
4.Dealing with physician performance and behavior
Where do I get my authority?
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1.My job description
2.Dr. Churchwell tells me I have authority.
3.My ability to persuade people to do things.
4.What authority?
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Where do I get my authority?
My j
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Dr. C
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My a
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What a
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33%
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33%33%1.My job description
2.Dr. Churchwell tells me I have authority.
3.My ability to persuade people to do things.
4.What authority?
“Excellence comes from the leadership of those who have the greatest impact on the conduct of others.”
“When physician leaders take active ownership, express support, and lead service and quality efforts, these efforts take on a sense of greater importance”
Steve Beeson, M.D. Engaging Physicians
“ Balancing Systems and Individual Accountability:A Case of the Wrong Blood ”
___________________________________________________________________________________________________________________________________
Gerald B. Hickson, MD, Ilene N. Moore, MD, JD, James W. Pichert, PhD, Manual Benegas, JR., JD.
Healthcare leaders face three challenges in balancing systems and individual accountability. …most importantly, leaders must determine how to create a healthcare enterprise in which systems are least likely to fail and humans hold themselves accountable, that is to say, accept responsibility for their actions in achieving outcomes.
Provide inspiration AND accountability
Demonstrate a value system that always places the interests of patients first.
Effective Physician Leaders:
Achieve excellence primarily through influence, example, and relationships
The “Art of Influencing”
You make choices every time you interact with someone
Consider every interaction an opportunity to influence and have an impact
Your choices make or break the opportunity and the impact it has!
for Having More Influence as a Medical Director (or Quality
Officer!) than You Could Have Ever Imagined
9. Be Present and Engaged
8. Be Authentic AND Humanistic
7. Be Curious, not Judgmental
6. Assume & Respect Separate Realties toward a
Shared Vision
5. Desired Performance Means: Desired Results +
Desired Behavior
4. Provide timely, clear, specific,
and consistent feedback
“Feedback Sandwich”for Formal Feedback
Events“You do these [specific] things very well.”
“You should work on these [specific] items.”
“I know you want to improve because that is the kind of person you are.”
Practice Group Comparison
Provider's Quality of
Care
Provider Explaining
Condition or Treatment
Provider Involving
Pt. in Decision-Making
Provider Spending
Time w/ Pt. during appt.
Provider's Courtesy and Friendliness
Provider's Attention to
What Pt. Had to Say
Likelihood to Recommend
Provider
Overall quality of
care
All Values are % Excellent Scores
81.8% Sellers
81.8% Sellers
84.8% Sellers
90.9% Sellers
87.9% Sellers
84.4% Sellers
87.5% Sellers
87.9% Sellers
73.3%
Whitman
76.5% Grant
82.8%
Whitman
76.7% Whitman
83.3% Whitman
75.9% Whitman
82.4% Grant
80.0% Whitman
70.6%
Grant 72.4%
Whitman70.6%
Grant76.5%
Grant81.8%
Smith70.6%
Grant81.8%
Smith70.6%
Grant
60.6%
Smith69.7%
Smith60.6%
Smith65.5%
Cooper70.6%
Grant69.7%
Smith80.0%
Whitman69.7%
Smith
53.3% Cooper
50.0% Cooper
57.1% Cooper
63.6% Hughes
63.6% Hughes
69.0% Cooper
53.3% Cooper
66.7% Cooper
51.5% Hughes
41.9% Hughes
51.6% Hughes
63.6% Smith
63.3% Cooper
60.6% Hughes
53.1% Hughes
53.1% Hughes
Target for VMG
Providers:88.4% 88.5% 89.6% 87.3% 92.0% 88.4% 90.0% 90.1%
Individual Provider Assessment
Provider's Quality of
Care
Provider Explaining
Condition or Treatment
Provider Involving
Pt. in Decision-Making
Provider Spending
Time w/ Pt. during appt.
Provider's Courtesy and Friendliness
Provider's Attention to
What Pt. Had to Say
Likelihood to Recommend
Provider
Overall quality of
care
All Values are % Excellent Scores
81.8% 81.8% 84.8% 90.9% 87.9% 84.4% 87.5% 87.9%
73.3% 76.5% 82.8% 76.7% 83.3% 75.9% 82.4% 80.0%
70.6% 72.4% 70.6% 76.5% 81.8% 70.6% 81.8% 70.6%
60.6% 69.7% 60.6% 65.5% 70.6% 69.7% 80.0% 69.7%
53.3% 50.0% 57.1%63.6%
Hughes63.6%
Hughes69.0 53.3% 66.7%
51.5% Hughes
41.9% Hughes
51.6% Hughes
63.6% 63.3%60.6% Hughes
53.1% Hughes
53.1% Hughes
Target for VMG
Providers:88.4% 88.5% 89.6% 87.3% 92.0% 88.4% 90.0% 90.1%
Inpatient Physician Feedback
Physician Average
Goal Physician
Beta Blocker at Discharge for AMI
94% 98% 93%
Involved Patient in Decision Making
70% 80% 75%
DC Summary sent to PCP
78% 90% 91%
30 Day Re-Admit Rate
12% 8% 16%
Feedback Can Get Results
Pre-Feedback Post-Feedback
6 Month Percent (%) Excellent Scores
Cardiac Surgeon A 84% 89%
Cardiac Surgeon B 76% 85%
Cardiac Surgeon C 72% 84%
Orthopaedist A 73% 83%
Orthopaedist B 52% 76%
3. Have Purposeful Conversations
ABCD For “Purposeful” Conversations
A Affect (Mine)“I’m concerned”“I’m surprised”“I’m frustrated”
B Behavior “That you raised your voice”“That you were late for clinic”
C Consequence “The employee feels he/she is not respected”“As a result, many patients had to wait”
D Desired Behavior
“You should remain professional in your conversations”“The expectation is to arrive on time”
2. It’s so hard when I have to,And so easy when I want to.
- Annie Gottlier
It’s About Culture
1. Be a COACH, rather than an ENFORCER.
To Accomplish Vision VHVI Must Be:
•Best place to receive care for patients•Best place to practice medicine for physicians•Best place to work for employees
Led by:
•Highly Effective Physician-Administrator Team
CASE #1: Process change required
At a management team meeting, there is an agreement for a necessary process or system change that will require all team members, including physicians, to make considerable
changes to work flow.
What is the medical director’s responsibility in this change process?
Clarity of roles
What Impacts the Management Team?
Trust
Administrative leaders become more effective when they are supported by visible, engaged, and participatory physician leaders.
Transparent and Frequent Communication
Unity on Major Goals
“Rules of Engagement” for Decision Making
Perceived as a Unified Team
CASE #2
Two physicians have expressed concerns to you about perceived low morale of
unit/clinic staff and that staff just seem to be “going through the motions”. They feel it is impacting patient satisfaction
as well as clinic efficiency.
What action should you take?
Clear expectations and individual feedback (positive and constructive).
What Impacts Employees?
Constant reminder of mission (i.e. what is important).
A highly supportive and respectful environment.
Physicians model how employees should interact with patients.
CASE #3
The manager approaches you that Dr. _________ consistently
fails to respond to pages and phone calls in a timely fashion. Something must be
done.
What action should you take?
Establishing trust is a precursor to any durable and meaningful partnerships with physicians.
What Impacts Physician Colleagues?
Communicating clear standards and expected behaviors to improving performance.
Feedback of objective performance data is highly motivating.
Modeling exceptional performance is a must.
Sustained change happens when physicians consider that, while treatment isn’t always effective, we can still make a positive
difference with every patient every time.
Change happens when physicians step away from the intensity of the day and
look at care through the eyes of patients.
Impact on Patients
Hippocratic Oath:
Vanderbilt Class of 2011 Oath:
I will never do harm to anyone.
I will work diligently for the best interest of all patients… and will strive to improve the practice of
medicine.
Medical Directors and Quality Officers at VUMC
“Working hard with people you like
to do something that matters for someone else.”
e l e v a t e
References:
Beeson, Stephen C. (2009). Engaging Physicians: A Manual to Physician Partnership. Florida: Fire Starter Publishing.
Lee, Fred. (2004). If Disney Ran Your Hospital: 9 ½ Things You Would Do Differently. Montana: Second River Healthcare Press.
Sasscar, Mark & North, Susan. “The Choice is Yours: Ten Principles of Personal Leaderhip”. LeadQuest Consulting, Inc. http://leadquestllc.com/PDFs/10PrincArtLeaderChoiceisYours11.08.pdf