Physician Led Patient Care Improvement: Key Success Factors

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1 Physician Led Patient Care Improvement: Key Success Factors Ronald Copeland, M.D. President & Executive Medical Director Lydia A. Cook, M.D. FAAP Assistant Medical Director of Primary Care Ohio Permanente Medical Group

2 Disclosure Presenters reported no financial interest relevant to this presentation

3 Objectives 1. Define and clarify the leadership role that a physician must embrace in order to create truly "patient centered" cultures, systems and experiences. 2. Identify and discuss effective methods and approaches to developing performance driven and accountable physician leaders. 3. Clarify, through group discussion of specific scenarios, the critical success factors essential to leading care teams through successful, strategic and operational, performance improvement implementation.

4 The Care for Physician Leadership

5 Critical Confluence Affordability Nursing and other health care worker shortages Supply and sustainability of primary care physicians More patient focus/inclusion Essential major investments in technology and systems (including EMRs) Government and public policy probing for answers Baby Boomers entering Medicare Worst economic crisis in decades Keys to solutions will be health care led by clinicians, integrated with functional IT systems, and staffed with innovative, enthusiastic, computerenabled health care teams.

6 Institute of Medicine s Six Aims for 21 st Century Health Care SAFE avoid injuries EFFECTIVE Evidence-based, avoid misuse, overuse and underuse PATIENT-CENTERED Customized for patient value, preference and choice TIMELY Reducing waits and harmful delays EFFICIENT Avoid waste (time, money, energy, supplies, etc.) EQUITABLE (equal access to equal, quality treatment despite age, gender, ethnicity or socio-economic status)

7 Growing Consensus About Ideal Care Providers need to become accountable for the overall quality and cost of care for the populations they serve * Accountable Care Organizations: A group of providers accepting responsibility for the quality and cost of care for a population of patients Key Characteristics: Provides care for and manages patients across the continuum of care and as a real or virtually integrated local delivery system Sufficient size to support comprehensive, valid, and reliable performance measurement data Financial rewards are linked to accountability for quality and efficiency *Source: Fisher ES, McClellan MB et al. Fostering accountable health care: moving forward in Medicare. Health Affairs 2009 Mar-Apr; 28(1):

8 ACO Essential Features Total Health/ Primary Care Physician Leadership Culture and Mission Aligned Incentives Teams Coordination Information Technology Clinical Guidelines Focus on primary care and total health Physician Leadership Aligned culture and mission Aligned incentives Integration, care coordination, and population management Integrated information technology, performance improvement, and reporting Clinical guidelines and evidence-based medicine

9 The Case for Service People place more importance on doctors interpersonal skills than their medical judgment or experience, and doctors failings in these areas are the overwhelming factor that drives patients to switch doctors. Stephen C. Beeson, M.D.

10 Nine Principles of Service and Operational Excellence 1. Commit to Excellence 2. Measure the Important Things 3. Build a Culture around Service 4. Create and Develop Leaders 5. Focus on Employee Satisfaction 6. Build Individual Accountability 7. Align Behaviors with Goals and Values 8. Communicate at All Levels 9. Recognize and Reward Success -Quint Studer

11 Quotes: The Physician as Solution As it is organized today, health care is approaching its end game. The business of medicine is uncoupled from the responsibility for the quality of its product. We have now reached a crossroad. If cost remains the only measure of health care s relative value, its ultimate weight will destroy our worth. Bureaucrats are all too willing to fill the void. The future is in our hands. (Taylor Dickinson, M.D.)

12 Traditional Physician Compact GIVE Treat Patients Provide Quality Care GET Autonomy Protection Entitlement

13 Clash of Promise and Imperatives Traditional Promise Autonomy Protection Entitlement Imperatives Improve safety/quality Provide service Be patientfocused Improve access Improve efficiency

14 Formulate a New Compact Physicians give what the organization needs to meet clear and real imperatives GIVE Physicians get: What is important to them What supports them to meet organization s needs A promise that is sustainable (for the foreseeable future) GET

15 Physician Role Changes Industrial Age Model of Care Marcus Welby, MD One patient at a time Only know about patients who appear in your office No use of IT Limited use of Extenders Information Age Model of Care Marcia Welbyte, MD Accountability for panel/population Transparency Use of EMR, registries, internet Team Care (including patient) Moving care out of the doctor s office

16 Can Physicians Manage the Quality and Costs of Health Care? The Story of The Permanente Medical Group John G. Smillie, M.D.

17 Definitions of Principles It is our hope that these six principles provide a framework to assist Permanente physicians in defining the physician identity and practice style that we call Permanente Medicine Group Responsibility Self-Governance Self-Management Quality Medicine Permanente/ Patient Relationship Resource Management Physicians sharing a group ethic that promotes shared responsibility and accountability for the care of individual patients and an entire member population in a capitated environment Physicians determine Medical Group policy through elected representative physician leadership Physicians direct all clinical decisions and the design and operations of the care delivery system Health care experiences and outcomes that set the quality standards for American healthcare Patients, physicians, health care practitioners, and staff work as a team to make care decisions and meet the patient s needs Physicians determine appropriate use of members resources across multiple care settings to improve the health outcomes of our membership and ensure affordable health care

18 Credo We will be patient-centered while focused on coordination and population-based care We will develop and maintain a culture of accountability for continuous improvement and resource stewardship We will improve care delivery by: Elevating the importance of a strong primary care base Improving the integration between primary and specialty care for out patients Expanding new models of care delivery to meet the needs of our members We will use metrics to improve our performance and demonstrate our value to all our partners We will create the best place to work where physicians are engaged in executing our strategic objectives while fulfilling their career aspirations

19 Our Values Integrity Excellence Courage Trust Compassion Enjoyment Personal Accountability Respect

20 Physician Leaders Role Leader Teams/Systems Partner Management Community Expert Science/Evidence Based Advocate (Patient) (Community)

21 Range of Impact of the Fully Accountable Physician Clinical Quality Resource Stewardship Information Technology Systems Development and Deployment Drug Formulary Research Public Policy

22 Effective Physician Leaders Patient Centric Values Progressive and Proactive Thinkers Ability to Articulate Strategy Capacity to Create Consensus Promote System Based Care Ability to take a Stand on Principle Driven by Passion for Excellence

23 WHEN ONE LEADS WITH VISION, PERSONAL CHARACTER, AND COURAGE, THERE IS NO CHALLENGE THAT CANNOT BE MET.

24 Dr. Sidney Garfield s Vision

25 Dr. Sidney Garfield s Vision "One can envision a new health care system of the future, which will begin with a basic comprehensive health evaluation for each individual. The result of that evaluation will chart each individual's personal pathway through our health care resources toward optimal health. Periodic updating of health evaluation profiles will monitor the homeostasis of vital body systems and significant deviations will trigger computerized warnings and corrective instructions. Health education will alert and advise measures to be taken against individual predictive risks be they lifestyle, hereditary, environmental or age/sex linked through time. Such individualized continuing healthcare would greatly reduce patient uncertainty and could, in large part, replace today's chaotic, random-entry demand with a smooth regulated use of appropriate resources that would not only be cost-effective but also would optimize the health of each individual through his lifetime... Supplementing today's sick care services with this new system and providing the accessibility it makes possible can raise the quality and distribution of U.S. medicine to a level unparalleled in the world. That is the great promise of this new delivery system for medicine of the future."

26 Effective methods and approaches to developing performance driven and accountable physician leaders Effectiveness is a function of how quickly and smoothly physician leaders can mobilize colleagues and staff that the physician may not control) to accomplish initiatives that cannot be developed by a single professional.

27 Physician Leadership Research shows that over 85 percent of Physician Leadership is applied to accomplish practical outcomes in 12 domains: 1) Design new care models 2) Recruit new physicians 3) Secure better payer contract terms 4) Secure more resources 5) Design new facilities 6) Grow practices 7) Correct inappropriate physician or staff behavior

28 Physician Leadership cont. 8) Implement new protocols/guidelines to enhance outcomes and safety 9) Improve staff morale to avoid expensive turnover 10) Implement patient centered care innovations 11) Improve patient compliance 12) Expand health promotion programming

29 Physician Led Patient Care Improvement: Key Success Factors Visioning Communication Team Building Emotional Intelligence Empowering Coaching Approach Performance, processes and systems thinking Personnel Management

30 Developing Physician Leaders Patient Centered Medical Home Element A new Team System within the clinic that expands the roles of every member of the team and links each person s contribution to patient experience and outcomes; physician becomes physicianleader, nurse becomes nurse-educator, medical assistant becomes patient-advocate etc.

31 Effective methods and approaches to developing performance driven and accountable physician leaders The large multi-specialty group practice can meet the challenge of physician leadership by investment in educating and training the physician leaders and the staff. The creative and strategic approach includes: Ongoing education Leadership training Team meetings Roles and responsibilities that are stimulating and rewarding Shared vision and responsibility for quality of care Value for the contributions of all individuals

32 Physician Leaders Leadership is a learned skill. It requires discipline in execution. Effective Leadership is inspirationaltransforming a culture and work environment.

33 Thank You Insights

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