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

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1.Leading improvement initiatives

2.Developing and monitoring annual goals

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4.Dealing with physician performance and behavior

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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

Where do I get my authority?

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2.Dr. Churchwell tells me I have authority.

3.My ability to persuade people to do things.

4.What authority?

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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

10. This is about you, not “them”

Video

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