Leading the CME Enterprise: Educators as Leaders

Transcription

1 Leading the CME Enterprise: Educators as Leaders Ronald B. Goodspeed, M.D., MPH, FACP -Harvard School of Public Health -Coalition for the Prevention of Medical Errors Retired President & CEO Southcoast Hospitals Group & Southcoast Physician Services Lessons for today What is Leadership..No, what is it really? Physicians as Leaders Educators as Leaders Leading from Anywhere with examples Leading as an Educator with examples Resources and Opportunities including the six Core Competencies 1

2 Leadership is: The influence of people to achieve goals, movement, direction, change. (Education?) Education is: The influence of people to achieve goals, movement, direction, change. (Education?) 2

3 About Leadership Rare skill Born, not made Leaders are all charismatic. Leadership is only at the top. Leaders control, direct, prod, & manipulate. Myths about Leadership Rare skill Born, not made Leaders are all charismatic. Leadership is only at the top. Leaders control, direct, prod, & manipulate. 3

4 Goleman on Leadership Self-awareness Self-regulation Motivation and Commitment beyond personal gain or recognition Managing relationships Finding common ground Drucker Ask what is right for the enterprise (what are the goals specific measureable) Develop action plans Take responsibility for Decisions Take responsibility for communicating (clarity, accountability) Focus on Opportunities not problems Run productive meetings (goals for the meeting, your approach to the meeting) Listen First, speak last Think and say We not I 4

5 Key Strategies for Leaders Attention through Vision- create focus; don t waste their time; results oriented Meaning through Communication- Clarity; compelling vision of desired results Trust through positioning- accountability, reliability, predictability, Deployment of self through positive self-regard and self-management emotional intelligence *adapted from Bennis & Nanus, 1985 Key Skills (emotional wisdom) Accept people as they are. Treat those close to you with the same respect you would guests. Work in the present, not in the past. Trust others even if the risk is great. Do without constant approval or recognition. 5

6 Influencing Others Know yourself thoroughly Manage yourself Keep promises you make. Choose your course, not reacting to bad events. Refrain from saying the unkind thing. Speak the languages of logic and passion Influencing Others Go one on one. Step to the other side. If offended, take the initiative to clear it up. Admit your mistakes, apologize, and move on. Know the situation & the people around you Managing Upward is key 6

7 Swimming Upstream: Oxymoron? Experience is in the wrong direction Inappropriate education Trained not to Trust No training in teamwork Trained that we must have the answer It s not about problem solving It s not about you But, DME should be a Physician MMS CAR recently unanimously voted to affirm the requirement that DME be a physician Identifies practice gaps within the organization Conduit to upper management and the Medical Staff Writes learning objectives for CME activities Vets content for CME activities Leads the overall CME program evaluation Influences the value and perception of the CME program within the organization 7

8 DME as Leader Know the goals for your overall program (are they specific and measureable?) Know the goals of each component Be relentless Identify your allies Align goals; education, quality, safety, finance, public relations Show specific objective results You Can Lead from Anywhere! Consistently, be what you believe in. Be the Source: info, answers, actions, results. Find key allies & work with them. Seize every opportunity. Manage upward. Make em look good. The worst decisions and actions you will take and the issues you make no progress on, will be those wherein you forgot, it s not about you. 8

9 Who are your Allies? Chief Medical Officer Chief Quality person Chief Patient Safety person Department Chairs Chief Financial Officer Chief Operating Officer Approaches to Winning Over those Allies Saving Lives Saving Money Advent of non-payment Public Reporting Public Expectation 9

10 Hospital-Acquired Infections Saving Lives Estimated 2 million hospital patients per year 4.5% of discharges 9.3 per 1,000 patient days 90,000 deaths per year Cost: Massachusetts $200 million/yr 88% of costs from Surgical, Blood Stream, Pneumonia Ventilator Associated Pneumonia (VAP) Rate Lower is better GOAL: Eliminate VAP Trend Period 12 Months SHG Vent Pneumonia (VAP) Rate per 1000 Device Days FY05 Q3 FY05 Q4 Incidence Rate FY 06 Q1 FY 06 Q2 FY 06 Q3 FY 06 Q4 Linear (Incidence Rate) FY 07 Q1 FY 07 Q2 FY 07 Q3 FY 07 Q4 Current Trend Current Goal Benchmark (average) Source Last Revised 2.15 per 1000 device days 0 cases by 9/31/ per 1000 device days NHSN: /2007 Most recent data point 0 infections over 1037 device days = 0.00/

11 Saving Money Ventilator Associated Pneumonia Costs Average cost (not charge)/case Vented patient without VAP $26,813 Vented patient with VAP $60,310 Excess cost $33,497 FY03/FY04 total cases 54 Total cost savings potential (2 years) $1,808,838 ($904,419 per year) Other cost examples Other reported excess costs from the literature: Surgical site infections: $27,000 Central Line BSI: $27,000 MRSA: $20,000 VAP: $24, % HAI rate, $15,000 excess cost, 20,000 admissions: ~$13.5 million in excess costs per year (HCAB) Cincinnati Children s $11 million so far. 11

12 Approaches to Winning Over those Allies Saving Lives Saving Money Advent of non-payment Public Reporting Public Expectation Public Reporting in Massachusetts Health Care Quality & Cost Council hospitals are required to: Enroll in National Healthcare Safety Network (database on hospital-acquired infections) HCQCC will report to the Public hospital-specific (10/09) 1. Central Line Blood Stream Infections in the ICU 2. Surgical Site Infection Hip & Knee 3. Flu vaccination of employees Report to DPH(DPH will survey all HAI practices too): 1 & 2 VAP prevention processes MRSA point prevalence Report within hospital: Central Line BSI outside the ICU VAP rates 12

13 From Southcoast Website Remember! You Can Lead from Anywhere! Consistently, be what you believe in. Be the Source: info, answers, actions, results. Find key allies & work with them. Seize every opportunity. Manage upward. Make em look good. The worst decisions and actions you will take and the issues you make no progress on, will be those wherein you forgot, it s not about you. 13

14 CME can be a Strategic Asset for your Organization if: The CME is focused on a topic in need of improvement The need has been identified using data The target audience has been specifically identified The target audience has been primed with data from current performance measures The education is evidenced-based You are saving lives & saving money Key Practicalities Economic environment requires efficiencies Choose high priority areas, e.g. high volume, high cost Choose areas that are easily measured Target multiple birds with one stone (saving lives & saving money) You are not doing randomized, double-blind, controlled trials Some examples. 14

15 Pneumonia Care FY04Q1 FY04Q2 FY04Q3 FY04Q4 FY05Q1 FY05Q2 FY05Q3 FY05Q4 FY06Q1 FY06Q2 FY06Q3 CME SHG Top Decile 2nd Decile CME Heart Failure Care FY04Q1 FY04Q2 FY04Q3 FY04Q4 FY05Q1 FY05Q2 FY05Q3 FY05Q4 FY06Q1 FY06Q2 FY06Q3 CME SHG Top Decile 2nd Decile 15

16 Another Example Measure: Incidence of Pulmonary Emboli and Deep Vein Thrombosis in surgical patients. CME: Focused presentation on Anticoagulation Therapies for Surgical Patients, managing the risk. Target audience: Invited surgeons, internists and cardiologists Result: A 33% reduction in the incidence of PE & DVT (saving lives & saving money) Resources Massachusetts Department of Public Health Massachusetts Board of Registration in Medicine MassPro National Quality Forum National Committee for Quality Assurance 16

17 Sources of Evidence-based Clinical Guidelines Specialty societies Agency for Healthcare Research and Quality (AHRQ) National Guideline Clearinghouse US Preventive Services Task Force (available on the AHRQ website Guidelines for Competency-based Hospital Credentialing from the MA Board of Registration in Medicine As stated by the ABMS,..member Boards realized that, in addition to medical knowledge, other skills and competencies are necessary for doctors to close the quality gap in the practice of specialty medicine and surgery in the 21st century. Enter the Maintenance of Certification (MOC) process. MOC defines a process through which specialty board certified physicians can maintain their board certificate by demonstrating specific competencies. In response to this deficiency, the ABMS, American Council on Graduate Medical Education (ACGME) and the Joint Commission have embraced a series of six core competencies. Together with the Federation of State Medical Boards (FSMB), these groups are seeking to establish standardized, comprehensive, and continuing methods for assessing physician competencies, both for physicians in training and, at the hospital level, for physicians in practice. 17

18 Core Competencies Definition: Competence is the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values and reflection in daily practice for the benefit of the individual and community being served. Core Competencies 1. Patient Care -Practitioners are expected to provide patient care that is compassionate, appropriate and effective for the promotion of health, prevention of illness, treatment of disease and care at the end of life. 2. Medical Knowledge -Practitioners are expected to demonstrate knowledge of established and evolving biomedical, clinical, and social sciences, and the application of their knowledge to patient care and the education of others. -This is accomplished by demonstrating an investigatory and analytic thinking approach to clinical situations. Clinicians are expected to know and apply the basic and clinically supportive sciences which are appropriate to their discipline. -Keeping up to date with new advances is accomplished through continuous certification by engaging in CME/Continuing Professional Development (CPD). Knowledge acquisition is measured by accessing and evaluating information and by mastery of practice specific competencies. Clinicians must be aware of best practices, guidelines, consensus documents in specific areas of practice and understand limits of knowledge. 18

19 Core Competencies 3. Practice Based Learning and Improvement -Practitioners are expected to be able to use scientific evidence and methods to investigate, evaluate and improve patient care practice. -This takes place through analyzing practice experiences and performing practice-based improvement activities using systematic methodologies. Specifically, the clinician must locate, appraise, and assimilate evidence from scientific studies related to their patients health problems. 4. Interpersonal and Communication Skills -Practitioners are expected to demonstrate interpersonal and communication skills that enable them to establish and maintain professional relationships with patients, families, non-physician coworkers, physician colleagues and others. -This is realized by creating and sustaining a respectful, therapeutic and ethically sound relationship with patients using effective listening skills and eliciting and providing information using effective nonverbal, explanatory, questioning, and writing skills. Core Competencies 5. Professionalism -Practitioners are expected to demonstrate integrity with behaviors that reflect a commitment to continuous professional development, personal health, ethical practice, an understanding and sensitivity to diversity, and a responsible attitude toward their patients, their profession and society. -Professionalism is evidenced by a commitment to clinical excellence, self-awareness, and diligence with respect to personal physical and emotional health. 6. Systems-Based Practice -Practitioners are expected to demonstrate both an understanding of the contexts and systems in which health care is provided, as well as the ability to apply this knowledge to improve and optimize health care and patient safety. 19

20 Measures Applicable to Assessment of Clinical Competence 1. ABMS Specialty Board certification, re-certification and/or MOC 2. Malpractice Claims 3. Co-worker or peer recognition of excellence or complaints 4. Academic recognition of excellence or complaints 5. Professional society recognition of excellence or complaints 6. Patient/Family recognition of excellence or complaints 7. Outcomes analysis a. Deaths b. Complications c. Readmissions 8. Portfolio analysis of outcome data and 360 reviews for performance improvement 9. Appropriateness analysis (unnecessary surgery, imaging, etc.) 10. Process indicators (core measures, e.g., eye exams, B- blockers, etc) 11. Peer review record (American Board of Internal Medicine [ABIM] tool, etc.) 12. Retrospective record review 13. Communication assessment (Kalamazoo and other instruments) 14. Observation assessment of a standardized patient Measures Applicable to Assessment of Clinical Competence 15. Observation of a video or CD of actual case and presentation to experts 16. Participation, observation and assessment in high fidelity simulation 17. Multisource (360) evaluation 18. Department chairman assessment 19. Reports to Risk Management 20. Attendance and participation in departmental meetings and conferences 20

21 Suggested Form for Use EVALUATION FOR MEDICAL STAFF APPOINTMENT Assessment of Current Clinical Competence Applicant s Name Evaluating Institution Current Status Active Affiliate Fellow Resident Dates of Appointment From To Competency Characteristic Measures used: Excellent, Good, Fair, Poor, Unknown 1. Patient Care: a. Access b. Assessment c. Diagnosis d. Treatment e. Coordination of care f. Referral Record keeping 2. Medical Knowledge: a. Aware of best practices b. Keeps up to date 3. Practice-Based Learning And Improvement: a. Learning and investigation b. Evaluation/Improvement Suggested Form for Use 4. Interpersonal and Communication Skills: a. Communicates effectively with patients and families b. Involves patients in care c. Communicates honestly and openly when things go wrong d. Communicates effectively with non-physician coworkers e. Communicates effectively with physician colleagues 5. Professionalism: a. Demonstrates personal integrity b. Maintains personal competence c. Places patients interests first d. Ensures competency and professionalism of colleagues 6. Systems-Based Practice: a. Understands systems of care b. Participates in quality audits c. Partners with others to redesign systems as needed d. Practices cost-effective care Goals /Objectives for Next Year: Signature of Evaluator Signature of Applicant 21

22 Is there an opportunity or two here? SIX Core Competencies 20 Possible Measurable 24 items from a suggested form to use Remember: You Can Lead from Anywhere! Consistently, be what you believe in. Be the Source: info, answers, actions, results. Find key allies & work with them. Incessantly demonstrate that high quality and patient safety are lower cost, sell well to the public and the oversight agencies Seize every opportunity. Manage upward. Make em look good. The worst decisions and actions you will take and the issues you make no progress on, will be those wherein you forgot, it s not about you. 22