Session 07AB A Practical and Effective Framework for Physician Engagement

Transcription

1 Prepared for the Foundation of the American College of Healthcare Executives Session 07AB A Practical and Effective Framework for Physician Engagement Presented by: John Byrnes, MD Susan Teman

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3 A Practical and Effective Framework for Physician Engagement 07A 10:00 am to 11:30 am 07B 2:15 pm to 3:45 pm Disclosure of Relevant Financial Relationships The following faculty of this continuing education activity have no relevant financial relationships with commercial interests to disclose: John Byrnes Susan Teman 2 1

4 THE GREATEST MYTH 3 THE DOC WHISPERER 4 2

5 What s at Stake? Hospital 11% Physicians Affect >85% of Clinical Quality and Costs Physicians & Hospital 43% Physicians 46% Physicians are the key drivers of clinical quality Across 200 Commonly Reported Indictors Source: The Advisory Board 5 Eliminating COMPLICATIONS $36 Million Study on select conditions through November, 2008; Pediatrics, ICUs, Trauma not included. Source: Spectrum Health Finance 6 3

6 Quality and Safety (and their related process improvements) is the next frontier of cost management. Joseph J. Fifer, FHFMA, CPA President & CEO Healthcare Financial Management Association - HFMA 7 Faculty John Byrnes MD Susan Teman RN 8 4

7 Learning Objectives Discuss how to develop strong, collaborative, highly engaged physician relationships that will contribute to an organization s success. Develop a two-year plan for improving physician engagement. 9 Agenda Common Misconceptions Definition: Physician Engagement The impact of successful engagement A look inside physician culture Two case studies: Inpatient orthopedic surgery Outpatient primary care practice Additional tactics the pyramid 10 5

8 What is Engagement? 11 DYE ENGAGEMENT MODEL 12 6

9 Eight Primary Components of Physician Engagement Dedication Contribution Rewards Involvement Choice Reciprocity Line of sight Emotional commitment 13 ENGAGEMENT IS: 14 7

10 MULTIPLES 5 TIMES Best Clinical Outcomes & The Safest Health System in the Country 15 More than 100 Quality & Safety Awards in 10 years 16 8

11 Flagship Hospital 900+ Beds 17 DVT $180,000 A Quarter Time Physician Leader ARF $820,000 Abcess $75,000 Int. Obstruction $545,000 Acc. Op. Laceration $203,000 Episode of Care: Colon Surgery 7 Preventable Complications Resp. Failure $971,000 Wound Infection $260,000 TOTAL $3,054,000 A small group of physician leaders can remove $ Millions in unnecessary costs 18 9

12 Culture: It s all we talk about, It s everything we do 19 Physician Culture Welfare of patient is number one concern Quality of care is paramount Captain of the ship Independent and autonomous Teamwork is fine, but they re in charge Learned from a master Problem solver Incredibly competitive Love involvement 20 10

13 Physician Culture Do not tolerate embarrassment Taught to be aggressive Strong egos Lively debates Data driven Evidence based Want a functional, efficient workshop Healthcare is a caste system if you re not in the club 21 Leverage the FEW 1. Always Explain the WHY 2. Quality of care is paramount 3. Want a functional, efficient workshop 4. Problem solver 5. Love involvement 6. Incredibly competitive 7. Data driven 8. Evidence based 22 11

14 Source: Byrnes, J., The Quality Playbook Workbook 23 Two Case Studies Orthopedics - Total Joint Surgery Primary Care - HEDIS Quality Measures 12

15 Physician Level Report Lower Body Joint Replacement Disease Study 1/1/02 through 12/31/02 = Unfavorable Sev. Adj. Variance at 95 % Confidence Level = Neither Favorable nor Unfavorable at 95 % Confidence Level = Favorable Sev. Adj. Variance at 95 % Confidence Level Note: Observed Values Displayed Clinical Issues Quality Issues Phys ID Name Spec Avg. No. of Blood Product Revisn Knee Hip Replace Hemorr from Iatrogenic Phlebitis Sev Pat Given? Replacmt Revision Comp Complications DVT Readmit31 ORT % 2.9% 5.8% 1.0% 5.8% 0.0% 5.8% ORT % 1.5% 1.5% 0.0% 4.5% 0.0% 0.0% ORT % 16.7% 16.7% VARIATION 0.0% 0.0% 0.0% 8.3% ORT % 8.9% 0.0% 0.0% 0.0% 0.0% 8.9% ORT % 10.2% 10.2% 9.7% 2.0% to 82.5% 4.1% 0.0% 4.1% ORT % 6.3% 0.0% 0.0% 6.3% 0.0% 0.0% ORT % 0.0% 1.4% 21 Orthopedic 1.4% Surgeons 1.4% 0.0% 0.0% ORT % 7.5% 10.0% 1.3% 5.6% 0.6% 6.3% ORT % 0.0% 0.0% 0.0% 10.0% 0.0% 0.0% ORT % 1.1% 0.0% 2.3% 3.4% 2.3% 3.4% ORT % 9.1% 0.0% 0.0% 0.0% 0.0% 0.0% ORT % 0.0% 0.0% 0.0% 30.0% 0.0% 10.0% ORT % 9.0% 14.8% 0.0% 3.9% 0.0% 3.3% Other % 7.7% 0.0% 0.0% 0.0% 0.0% 2.6% ORT % 13.0% 14.8% 1.9% 1.9% 0.0% 14.8% ORT % 8.0% 2.7% 0.0% 1.8% 0.0% 5.3% ORT % 5.1% 4.0% 0.0% 3.0% 0.0% 3.0% ORT % 0.0% 2.3% 0.0% 4.7% 0.0% 11.6% ORT % 11.8% 6.5% 0.0% 2.2% 0.0% 3.2% Blood product given does not appear to be related to revision volume or LMWH use 25 Knee Replacement Blood Transfusion Before 31% After 13.5% 26 13

16 KR Autologous Blood Collected Before 41% After 14.5% 27 Rates Continue to Decrease After 5.6% Currently at 2.6% 28 14

17 Prevention of DVT & PE Lower Body Joint Replacement Disease Study 1/1/02 through 12/31/02 = Unfavorable Sev. Adj. Variance at 95 % Confidence Level Through 10/06 = Neither Favorable nor Unfavorable at 95 % Confidence Level = Favorable Sev. Adj. Variance at 95 % Confidence Level Note: Observed Values Displayed Clinical Issues Quality Issues Phys ID Name Spec Avg. No. of Blood Product Ceph 1st Hemorr from Phlebitis Vanco LMWHeparin Sev Pat Given? Generatn Comp DVT Readmit31 Larry ORT % 79.6% 25.8% 3.2% 0.0% 0.0% 3.2% Moe ORT % 82.5% 3.9% 5.8% 1.0% 0.0% 5.8% Curly ORT % 88.5% 1.8% 6.2% 0.0% 0.0% 5.3% Pat ORT 1.57 VARIATION % 97.0% 3.0% 7.1% 0.0% 0.0% 3.0% Larry ORT % 91.7% 16.7% 8.3% 0.0% 0.0% 8.3% Jennie ORT % 81.5% 9.3% 9.3% 1.9% 0.0% 14.8% 3.2% to 100% Deb ORT % 91.4% 0.0% 14.3% 1.4% 0.0% 0.0% Clarice ORT 21 Orthopedic Surgeons 57.1% 89.3% 5.4% 21.4% 0.0% 0.0% 8.9% Joe Other % 82.1% 7.7% 23.1% 0.0% 0.0% 2.6% Mandy ORT % 89.8% 2.3% 25.0% 2.3% 2.3% 3.4% Lori ORT % 81.6% 0.0% 28.6% 2.0% 0.0% 4.1% Lowell ORT % 79.4% 26.3% 28.8% 1.3% 0.6% 6.3% John ORT % 75.0% 5.0% 35.0% 0.0% 0.0% 0.0% Matt ORT % 90.0% 10.0% 60.0% 0.0% 0.0% 10.0% Shawn ORT % 81.8% 0.0% 90.9% 0.0% 0.0% 0.0% Kathy ORT % 86.0% 7.0% 95.3% 0.0% 0.0% 11.6% Bud ORT % 83.4% 17.8% 97.6% 0.0% 0.0% 3.3% Bob ORT % 89.4% 3.0% 98.5% 0.0% 0.0% 0.0% Eric ORT % 87.5% 6.3% 100.0% 0.0% 0.0% 0.0% 29 What Strategies Were Used to Drive This Improvement? Insight into Culture of Orthopedic Department Medical Director Data Information EBM Discussion & Agreement One on one detailing with outliers 30 15

18 2 nd Case Study Orthopedics - Total Joint Surgery Primary Care - HEDIS Quality Measures HbA1c < 7% in Primary Care Doctor 1 Doctor 2 PCP Office #8 Target 90 th %tile Doctor 3 Doctor 4 Doctor 5 Doctor

19 Best in PC Department Doctor 1 Doctor 2 PCP Office #8 Target 90 th %tile Doctor 3 Doctor 4 Doctor 5 Doctor 6 33 Worst in PC Department Doctor 1 Doctor 2 PCP Office #8 Target 90 th %tile Doctor 3 Doctor 4 Doctor 5 Doctor

20 Overall Office Performance Doctor 1 Doctor 2 PCP Office #8 Target 90 th %tile Doctor 3 Doctor 4 Doctor 5 Doctor 6 35 Green Exceeds 90 th %tile Doctor 1 Doctor 2 PCP Office #8 Target 90 th %tile Doctor 3 Doctor 4 Doctor 5 Doctor

21 Red = Below Target Doctor 1 Doctor 2 PCP Office #8 Target 90 th %tile Doctor 3 Doctor 4 Doctor 5 Doctor 6 37 Office Bulletin Boards Doctor 21 Doctor 43 Doctor 56 Doctor 21 Doctor 43 Doctor 65 Doctor 21 Doctor 43 Doctor 56 Doctor 21 Doctor 43 Doctor 56 Doctor 21 Doctor 43 Doctor 56 Doctor 21 Doctor 43 Doctor 65 Doctor 21 Doctor 43 Doctor 65 Doctor 21 Doctor 43 Doctor 56 Message from Medical Director Is placed here 38 19

22 What Strategies Were Used to Drive This Improvement? Insight into Culture of Primary Care Department Medical Director Data Information EBM Discussion & Agreement Academic Detailing and Peer Pressure Public Display of Unblinded Data 5 Figure P4P Bonus Potential 39 Medical Director Role Chief, Medical Director Colleagues 40 20

23 How Many Physician Leaders? Your Quality Improvement Army Faculty Biography & Contact Info John Byrnes MD is a nationally recognized expert in healthcare quality and safety. He has over 20 years of experience leading, designing, and implementing quality and safety programs throughout the United States and Europe. During his recent eleven-year tenure as Chief Quality Officer at Spectrum Health, the organization received over 100 quality awards, was ranked three times as one of the nation s 15 Top health systems, and received multiple 50 and 100 Top hospital designations. Dr. Byrnes is a popular speaker at regional and national conferences including the annual meetings of HFMA and ACHE. He is a member of the national faculty for AAPL, serves on their Board s Faculty Advisory Council, and teaches at the AAPL Institutes. He also serves on the national Board of Directors for the Healthcare Financial Management Association and has served on Board Quality Committees for large hospital systems, multi-specialty medical groups, integrated healthcare systems, and health plans. Dr. Byrnes is Clinical Associate Professor at Michigan State University College of Human Medicine. Contact: John Byrnes MD Byrnes Group LLC john@johnbyrnesmd.org 42 21

24 Faculty Biography & Contact Info Susan Teman, BSN, RN, CPPS has 30 years of experience in healthcare leadership, quality, patient safety and risk management. She previously served as the Director of Patient Safety for Children s National Health System in Washington, DC. She led the safety culture transformation at Helen DeVos Children s hospital which went on to be recognized by the Lucien Leape Foundation, National Patient Safety Foundation, Michigan Hospital Association and outlined in numerous publications. She is a national speaker on patient safety for the Children s Hospital Association, Solutions for Patient Safety and Association for Healthcare Risk Management. Contact: Sue Teman RN Simulation Specialist Helen DeVos Children s Hospital susan.teman@spectrumhealth.org 43 Good Resources 44 22

25 Winter 2017 Health Administration Press 45 More resources Multiple chapters on physician engagement and physician leadership structures 46 23