KHC Summit on Quality, 2015 October 16, 2015

Transcription

1 Seventh Annual Summit on Quality Quint Studer Friday, October 16, 2015 Outcomes Compliance Physician Burnout 1

2 Two Brave Women The Original Firestarter Quinton D. Studer Top Barriers to Success and Achieving Desired Outcomes Lack of will Lack of skill Denial Blame Rationalization 6 2

3 The silent killer of execution is rationalization. Quint Studer 9/11/15 Why Organizations Fail 1. Dots are not connected consistently to purpose, worthwhile work and making a difference 2. Do not achieve critical mass - Lack of balanced approach 3. Absence of an objective accountability system 4. Leaders do not have the training to be successful Source: Studer Group. Organizational Change Processes In High Performing Organizations: In-Depth Case Studies with Health Care Facilities. Alliance for Healthcare Research Too many new behaviors introduced at once need of sequenced approach 6. No process in place to rerecruit the high and middle performers and address low performers 7. Inability to take best practices and standardize across organization 8. Failure to have leaders always do desired behaviors Often less activities with greater focus achieves better results. Quint Studer 9 3

4 Nurse Knowledge Exchange (NKE) Full Bundle Impact Survey Questions: 1. The nursing staff asked me for input about my daily care. 2. When nurses changed shift, the nurse caring for me introduced me to the new nurse. 3. The nurse reviewed my daily care with me in a way that I could understand. 4. The care board in my room was always updated with my new caregivers names and my plan HCAHPS Results Data Source: Kaiser Permanente Program wide All IP combined average results (Jan 2010 Aug 2011) National 75 th percentile for Rate Hospital is 73% and for Nurse Communication is 80% (CMS 2010Q1 Q4) Nurse Leader Rounding Custom Questions Nurse Leader Rounding Did someone from Nursing Leadership visit with you during your stay? Post-Visit Call Did you receive a phone call from a hospital staff member regarding your stay? Hourly Rounding How often did nursing staff come into your room to check on you during the day? Would you say every hour, every two hours, every few hours, or a couple of times a day? Bedside Shift Report During your change of shift, did the nurses include you in their conversation regarding your plan of care. 11 Nurse Leader Rounding 12 4

5 Unsettling occurs when a culture of optionality changes to a culture of accountability. Quint Studer 13 People wish to be settled; but only as far as they are unsettled, is there any hope for them. Ralph Waldo Emerson 14 Even if we don t want to unsettle, we have no choice. The external environment is creating unsettling. Quint Studer 15 5

6 Market Will Demand 20 40% Improvement Compelling Need to Develop a Multi-Pronged Approach Performance Improvement 8-12% Total Improvement Clinical Transformation 6-14% Total Improvement Market Drivers: Payment Reform Cost Pressures Information Boom Improved Care Asset Rationalization 3-6% Total Improvement Scale & Integration 4-8% Total Improvement Source: 2012 Huron Consulting Group. All rights reserved. Must Haves for Every System Volume Quality Cost Service Access Flow Compliance Consistency (Standardization) Efficiency (Right Tool and Right Process) Effectiveness (Right People) Vision without execution is hallucination. Thomas Edison 6

7 Healthcare Flywheel WHY Dashrath Manjhi The Man who moved a mountain.. Dashrat Manjhi worked 22 years to carve a 360 foot tunnel through a mountain after his wife died because medical attention could not be brought to her in time. He did not want anyone else to suffer the same fate as his wife. Impact on Operational Outcomes Quality VBP: improved HCAHPS VBP: improved overall core measures Decreased preventable readmissions Increased surgical care improvement Decreased healthcareassociated infections Reduced LOS Improved mortality index Decreased med errors People Finance $ Service Growth Community Increased Maximized Improved Increased Increased employee reimbursement patient volume philanthropy Improved perception of engagement Increased operating care Reduced revenue income Increased turnover Decreased Decreased cost CGCAHPS left without Reduced per adjusted Reduced treatment vacancies discharge claims Reduced noshows Reduced Improved Reduced agency costs collections malpractice Increased Reduced Reduced expense physician overtime accounts Increased engagement Reduced receivable days physician physicals Reduced engagement and cost to advertising orient costs Decreased legal fees 21 7

8 Execution Framework Evidence-Based Leadership SM Evidenced-Based System Behavior and Performance Management Goals and Skills Process and Technology Why is leadership so hard? Because we are leading people... and there is no such thing as soft skills. Quint Studer 24 8

9 Compliance 25 Compliance When do people comply? When they WANT to OR When they HAVE to 26 Connecting Heart and Mind H E A R T M I N D 9

10 Compliance People WANT to comply when... It fits their values (The Why) It improves operations It improves clinical outcomes It makes their life better Compliance People HAVE to comply when... The outcome of not changing behavior is worse than the discomfort of changing behavior Even though a person may not feel they have the skill set or the desire to be successful, they know that their compliance will be validated What does this mean? 30 10

11 Tips Don t assume that a person knows how to do this If at this time an organization s results are not where they need to be, it is either a will or a skill issue There are bright spots in the organization, therefore, it is not geography, skill, facilities, compensation, or corporate It rests in the heart and minds of individual leaders Physician Burnout 32 Healing Physician Burnout Diagnosing, Preventing and Treating 33 11

12 Website 34 Now is the Time to engage and partner with physicians EXTERNAL ENVIRONMENT W H Y? Change in Payment System Change in Technology Change in Employment 35 The biggest and most profound challenge we ve had to deal with is our industry s move from episodic change to continuous change. Quint Studer 12

13 No one is experiencing more change than physicians. Individual Change Unconsciously unskilled Consciously unskilled Consciously skilled Unconsciously skilled Source: Abraham Maslow; 1940; Four Stages for Learning Any New Skill ; Gordon Training International by Noel Burch; 1970 That is why it is so hard... 13

14 Burnout - Definition Progressive loss of idealism, energy, and purpose. Physician Misery Index Survey, Geneia, March 5, 2015, 40 Does Burnout Matter? Medical Errors Williams ES et al, Health Care Manage Rev. 2007;32: Firth Cozens J & Greenhalgh J. Soc Sci Med. 1997; 44: Shanafelt TD et al. Ann Intern Med. 2002;136: Patient Compliance DiMatteo MR et al. Health Psychol. 1993; 12: Medical Malpractice Suits Jones JW et al. J Appl Psychol, 1988; 73: Patient Satisfaction Linn LS et al. Med Care. 1985; Haas JS et al. J Gen Intern Med. 2000;15: Choosing Resilience; Wayne M. Sotile, Ph.D.; Founder of Center for 41 Physician Resilience, Davidson, NC Burnout Rates by Specialty Critical Care Emergency Medicine Family Medicine Internal Medicine General Surgery HIV/Infectious Diseases Radiology OB/Gyn & Women's Health Neurology Urology Pulmonary Medicine Cardiology Diabetes & Endocrinology Orthopedics Nephrology Plastic Surgery Pediatrics Oncology Anesthesiology Rheumatology Allergy & Clinical Immunology Ophthalmology Gastroentrerology Pathology Psychiatry & Mental Health Dermatology The 2015 Medscape survey results reflect the highest burnout rates found in critical care (53%) and emergency medicine (52%), and with half of all family physicians, internists, and general surgeons reporting burnout 53% 52% 50% 50% 50% 50% 49% 49% 49% 48% 47% 46% 45% 45% 45% 45% 44% 44% 44% 43% 43% 41% 41% 39% 38% 37% Peckham, C., Physician Burnout: It Just Keeps Getting Worse, Medscape Physician Lifestyle Report January 26,

15 Maslach Burnout Index (MBI) 3 Dimensions of Burnout Emotional Exhaustion: Sense of being emotionally drained while working with other people and the dread that accompanies thoughts of having to go to work. Cynicism: Expressed as depersonalization, withdrawal, and compassion fatigue. Ineffectiveness / Lack of Efficacy: Loss of desire to accomplish great goals and make the world a better place. To access the MBI, visit 43 Re-think Balance Working fewer hours in a job you re not engaged in will resolve none of your work/life balance issues. Engagement is the key. Choosing Resilience; Wayne M. Sotile, Ph.D.; Founder of Center for 44 Physician Resilience, Davidson, NC What Drives Provider Satisfaction? Choosing Resilience; Wayne M. Sotile, Ph.D.; Founder of Center for 45 Physician Resilience, Davidson, NC 15

16 To Heal Physician Burnout Physician Burnout Organizational Responsibility Individual Responsibility Engagement Physician Drivers What Do Physicians Want? Physicians want to know their patients are receiving QUALITY quality care and a great patient experience. Physicians want to work with team members who have the information needed at hand to discuss their EFFICIENCY patients. Over the course of a day this efficiency will save the physician 30 minutes or more. Physicians need a seat at the table to provide input when decisions are being made that affect clinical INPUT outcomes. Round on physicians and consistently ask them, Do you have everything you need to provide excellent care to your patient? APPRECIATION Physicians value a thank you and acknowledgment when things are going well. They also want to see follow up on their input in the form of tangible change. 47 Healing Physician Burnout Tactics Organizational Responsibility 16

17 Resilience Strategy Need a Boost Leading, Coaching and Coping During Uncontrollable times Boost actual and/or perceived support and control Choosing Resilience; Wayne M. Sotile, Ph.D.; Founder of Center for Physician Resilience, Davidson, NC Tools and Tactics for Reducing Burnout Diagnostic Measurement Treatment Out of the Box Focus Groups Physician Engagement Survey Physician Quadrants Day in the Life Provider Feedback System Stoplight Reports Administrative Dashboard Physician Selection and Retention Rounding on Physicians Focus, Fix and Follow up Reward and Recognition Patient Call Backs Physician Preference Card Simulation Lab Physician Health and Wellness Physician Support Groups Professional Development Feedback Systems Opportunities for Physician Collegiality Healing Physician Burnout: Diagnosing, Preventing and Treating; Page 99 Tactics and Outcomes Physician Quadrants Provider Feedback System SM Stoplight Report Rounding Focus Fix and Follow up Effectiveness and Efficiency Alignment, Input, Feedback, Development and Reward & Recognition Effectiveness and Efficiency 17

18 Diagnostic: Physician Quadrants Assessing Alignment Quadrant 1 Quadrant 2 Quadrant 3 Quadrant 4 Loyal Want to be aligned Skeptical Naysayer (Always) (Usually) (Sometimes) (Never) Healing Physician Burnout: Diagnosing, Preventing and Treating; Page Physician Quadrant Exercise Physician Name Quadrants Notes Healing Physician Burnout: Diagnosing, Preventing and Treating; Page 117 Measurement: Provider Feedback System Peer to Peer Comparison Baseline Performance Monthly, Quarterly, Yearly Healing Physician Burnout: Diagnosing, Preventing and Treating; Page

19 Measurement: Stoplight Report Completed (Green) AIDET training for physicians is requested. Online training module was created and link sent to all medical staff as well as a 60 minute session will be presented at the medical staff meeting OB Doppler requested by Dr. S. purchased and delivered. Dual Monitors purchased and installed for all providers On line printer for LeAnn M. s office ordered and installed for use for 1E More chairs needed for physicians to sit when visiting patients in patient rooms. Provided one marked chair per room Scribes requested in ED, 2 hired for pilot project In Progress (Yellow) Sound barrier at Dr. G. nursing pods requested P. Little Additional Ortho mid level provider needed (Recruitment has begun) Laser Equipment for pigmented skin and tattoo removal requested by Dr. B. (Will be considered in the next budget process that begins in October) More staffing in OR requested (Continuing outreach and training of internal candidates, Expected to be fully staffed in less than one month) Can t Complete At This Time and Here s Why (Red) Overhead storage cabinet for S. Hicks, FNP (Due to cost this project cannot be completed at this time) Peds physicians do not feel expansion to level 2 nursery was enough (No capital resources at this time. Will target for consideration within 5 year strategic plan) OB physicians requesting higher pay for PA s (Conducted a salary and benefits comp study. No changes at this time as we are within competitive range) Healing Physician Burnout: Diagnosing, Preventing and Treating; Page 130 Treatment: Rounding for Outcomes % favorable Recommend for Work 100% 80% 60% 40% 20% 0% Impact of Rounding on Willingness to Impact of Rounding on Willingness to Recommend KPNW as a Recommend Place as to a Work Place to Work 50.2% Never 55.6% Rarely (Couple times a year) 79.3% Often (At least quarterly) 87.4% Tactic and Tool Implemented: Leader Rounding on Staff and Physicians Frequently (At least Monthly) Frequency of Rounding Oregon Integrated Health System; 8700 employees * Results are one year following implementation of Leader Rounding on Staff and Physicians; Staff and physicians rounded on at least monthly had the highest satisfaction levels. Other Industries How do other industries treat elite performers? 19

20 One Example... Jesse Winker #23 LF Pensacola Blue Wahoos Will play about 130 games Each game lasts about 2 hours and 45 minutes Might have 6 balls hit to him during a game Will be at bat about 4 times per game Johnny Cueto #47 SP Kansas City Royals Will perform once every 5 days 162 games per season Will pitch in about games per year Will pitch on average 7 innings per game 20

21 Healing Physician Burnout Tactics Individual Responsibility Dealing with the them mentality... Even if they are 90% of the problem, what 10% are you willing to own? 62 Physician Heal Thyself A physician s individual coping style also has a significant impact of job performance, well-being, patient outcomes and likelihood of burnout. Howlett M. et al., Burnout in Emergency Department Healthcare Professionals is Associated with Coping Style: A Cross-Sectional Survey, Emergency Medicine Journal, 2015, 0:

22 Suicide Lifeline National Suicide Prevention Lifeline WORK: Tactics to Apply Chapter 12 - Physician Heal Thyself (1 of 4) Talk about what you are feeling and experiencing. Physicians often feel compelled to project physical, mental and emotional capabilities beyond what they actually possess. (New York Times, 2014) Speak up if you think you need help. Seeking professional help outside of the hospital. (spiritual counselor, therapist, career coach, etc.) 65 WORK: Tactics to Apply Chapter 12 - Physician Heal Thyself (2 of 4) Allow yourself to take regular vacations. 36% of burned-out physicians take < 2 weeks vacation per year, and 5% take no vacation at all (Medscape 2015 Physician Lifestyle Report) Try to find a healthy work-life balance. Physicians reported that knowing and setting limits, which included changing and restricting their practices, helped them achieve balance. (Jenson, Can Fam Physician, May 2008) 66 22

23 WORK: Tactics to Apply Chapter 12 - Physician Heal Thyself (3 of 4) Take responsibility for your own training and development. A common indicator of burnout is a feeling of powerlessness over environment. Seek a collaborative, engaged relationship with administrators. Eliminate we/they relationship between physicians and organizational leaders. 67 WORK: Tactics to Apply (4 of 4) Chapter 12 - Physician Heal Thyself Give credit where it s due. Staff turnover has a huge impact on physicians stress levels and morale. Think of patients as partners. Non-compliance is a stress source for physicians. Give patients a stronger sense of ownership and help improve compliance. 68 PERSONAL LIFE: Tactics to Apply Chapter 12 - Physician Heal Thyself (1 of 3) Exercise regularly. Physical well-being helps you cope with stress. Give back to others off the clock. Volunteering found to improve health and happiness levels, lower depression rates and make practitioners feel as though they have more time. (Forbes, March 2015) 69 23

24 PERSONAL LIFE: Tactics to Apply Chapter 12 - Physician Heal Thyself (2 of 3) Cultivate meaningful interest outside of work. Actively engaging in fulfilling interests outside of work. (Hobbies and Interests) Find a healthy financial balance. 39% of burned-out physicians consider themselves to have a minimal savings to unmanageable debt. Only 56% of burned out physicians believe that they have adequate savings or more. (Medscape, January 2015) 70 PERSONAL LIFE: Tactics to Apply Chapter 12 - Physician Heal Thyself (3 of 3) Focus on nurturing, not managing your relationships. Take a fresh look at your relationships outside of work. Are you bringing stress home? 71 Mental Resources to Develop Chapter 12 - Physician Heal Thyself (1 of 2) Be aware of the benefits of stress. In manageable amounts, challenges and pressure can help build your resilience, knowledge, and stamina. Maintain emotional self-awareness. Burnout does not happen overnight; it builds over a long period of time. Assess how you are feeling regularly

25 Mental Resources to Develop Chapter 12 - Physician Heal Thyself (2 of 2) Practice mindfulness techniques. Paying attention in the present moment in a purposeful and non-judgmental way, to create a sense of objectivity in the face of frustration. (Ex: Meditation, breathing exercises, massage, yoga, etc.) 73 If we don't recapture the physicians' hearts there will be no healthcare as we know it. Quint Studer Morning Joe Show 9/10/15 Back to

26 Always bring it back to values... Quint Studer Never Underestimate the Difference You Can Make Quint Studer 26