Rx for a Great Future *** Engagement, Alignment, & Leadership

Transcription

1 Rx for a Great Future *** Engagement, Alignment, & Leadership Jay Kaplan, MD, FACEP Medical Director, Studer Group Practicing Clinician and Director, Service/Operational Excellence, CEP America The future viability of our organization will be dependent on our ability to deliver Service Excellence. Mayo Clinic And importantly... A Commitment to Excellence will not manifest without the leadership, support and example set by physicians. How We Need to Feel Jay Kaplan, M.D.

2 Lessons Learned Blame Nobody, Expect Nothing, Do Something (Bill Parcells, NY Post 1999) Change starts at home first me, then thee (Leadership) It s not the ideas, it s the implementation (Accountability) Perception is all there is (Almost) Why is this important? #1 - Reimbursement Here you go thought you might like this Attracting Patients Through Service Jay Kaplan, M.D.

3 #2 Workforce Shortage - Nurses Physician Workforce Shortage Reason #3 - Malpractice Jay Kaplan, M.D.

4 Malpractice Litigation-Cited Reasons Didn t listen Didn t return phone calls Showed little concern or respect for patient condition Rude Didn't spend enough time Didn t answer questions adequately Patient Complaints and Malpractice Risk, JAMA 2002 Relationship between patient satisfaction, complaints and lawsuits Physicians with lower patient satisfaction results are more likely to have patient complaints (RR 1.79;95% CI ; p<.001) Each one point decrement in patient satisfaction scores is associated with a 6% increase in complaints (RR 1.06, 95% CI ;p<.0001) 0001) 5% increase in risk management episodes (RR 1.05, 95% CcI ;p<.008) Lower performing physicians were at greater risks for lawsuits (RR = 2.10;p 95% CI ; p<.019) 75% of complaints were related to communication issues Stelfox HT, et al, The American Journal of Medicine 2005; 118: Reason #4 The Transparent Environment Quality On-Line Jay Kaplan, M.D.

5 Patient Satisfaction Measurement On-Line: HCAHPS During your hospital stay, how often did doctors/nurses: treat you with courtesy and respect? listen carefully to you? explain things in a way you could understand? Never/Sometimes/ Usually/ Always Pay for Performance Coming to Your Neighborhood Soon... Value-Based Purchasing(VBP) = a specified percentage of hospital payment (5-15%) would be conditional on performance Reimbursement currently: 100% public reporting Reimbursement FY 2011: 50% performance 50%public reporting Reimbursement FY 2012: 100% performance Calculating Reimbursement Will need to either be at 50%ile or show improvement from previous score to earn points for that dimension The New Paradigm Outcome = Income Jay Kaplan, M.D.

6 Definitions Clinical Quality delivering clinical care that is measurably superior by recognized standards. Service Excellence - meeting the needs and fulfilling the expectations of patients and staff and colleagues (all with whom you work). Operational Efficiency doing both of the above efficiently without time/resource waste. Communication = Compliance = Quality Physician communication correlates STRONGLY with adherence rates by patients in acute and chronic disease. There are now over 100 observational and 20+ experimental studies published demonstrating the correlation of communication (patient satisfaction) with compliance. Compliance with treatment regiments has significant influence on quality measures in chronic disease and outcomes. Medical Care: August Volume 47 - Issue 8 - pp 826 Simple Truth #1: We Live in a Service Economy Jay Kaplan, M.D.

7 Key Words for Us Satisfy to please, to be adequate to an end in view, to meet an obligation Astonish to strike with sudden and usually great wonder or surprise Memorable worth remembering What Can You Do to Astonish... Every Patient... Every Employee... Every Physician... Every Time? Simple Truth #2: We All Believe We Give Great Service We assume Patient = = Satisfaction Employee Satisfaction Jay Kaplan, M.D.

8 Simple Truth #3: It Just Isn t So... How Is It Really, With Our Patients? 74% of patients are interrupted by physicians giving the initial history, average time of interruption: 16.5 seconds The Effect of Physician Solicitation Approaches on Ability to Identify Patient Concerns. J Gen Intern Med March; 20(3): In clinical encounters that lasted on average 16.5 minutes, patients spent an average of 8 seconds asking questions of their physicians. Although physicians believed they spent on average 9 minutes providing information to patients, in fact, they spent less than 40 seconds. Howard Waitzkin, At The Front Lines of Medicine, Rowman & Littlefield, 2001 Simple Truth #4: No Rest For The... If the other guy s getting better, then you d better be getting better faster than that other guy s getting better... or you re getting worse. -- Tom Peters The Circle of Innovation Jay Kaplan, M.D.

9 It s Getting Harder to be Great... Press, Ganey Associates Hospital Pulse Report 2007 Physicians offices must continue to improve the patient care experience if they are to remain competitive. Simple Truth #5: The Best Definition of Madness is To keep doing things the same way and expect different results Jay Kaplan, M.D.

10 Leaders Align All Around Our Most Difficult Task: Philosophy Goals Passion Commitment must be shared by everyone... Definitions Leader: A person who guides on a way especially by going in advance, who directs on a course. Merriam Webster Leaders are visionaries with a poorly developed sense of fear and no concepts of the odds against them. Robert Jarvik, M.D. A leader is a dealer in hope Napoleon Jay Kaplan, M.D.

11 Definitions Engage to attract and hold by influence or power; to pledge oneself; to begin and carry on an enterprise or activity Align to get or fall into line; to be in or come into precise adjustment or correct relative position What I Want to Be Known For I am known for (1-2 items); by next year at this time, I plan also to be known for (1 additional item): 2. My current work is provocative and challenging to me in the following (1 way): 3. New learnings in the last 90 days that have excited me consist of (1 item): 4. We (our department, business) are known for (1-2 items); by next year at this time, we plan also to be known for (1 additional item): Jay Kaplan, M.D.

12 Jay Kaplan, M.D.

13 Have the Conversation: What Do We Want To Be Known For? What is it that you are known for now? What do you want to be known for? Exceptional Care, Extraordinary Service in a Safe & Efficient Environment Leader Rounding: How to Get Everyone On Board Harvest Wins: Are there any staff or physicians you would like me to compliment or recognize? Focus on the Positive: What is going well today? Identify Process Improvement Areas: What systems could be working better? Repair and Monitor Systems Do you have the tools, equipment and assistance to care for your patients well? Coach on New Behaviors We re trying to improve our patients experience. One way to do that is... Align to What: Effective Standards are Specific and Observable Always ask, What does it look like? The answer is your Standard Friendly is not specific or observable. What does friendly look like? Makes eye contact with patients and coworkers Escorts visitors to their destinations Jay Kaplan, M.D.

14 Have you ever worked with? CAVE people Consistently Against Virtually Everything ROAD warriors Retired On Active Duty Accountability Everyone has to get on board. If you permit it, you promote it Jay Kaplan, M.D.

15 The Different Roles Physicians Now Have Craftsman: caring for the individual patient. Team player: being a part of the team which delivers that care in a coordinated and supportive manner. Manager: managing the process by which that care is delivered. Leader: creating the vision what that care should look and feel like. For which role(s) do they receive training? Hospitals Want Physicians Who... Have great bedside manner. The nurses and staff love to work with. Are willing to do more than just see patients. Understand their importance in terms of setting the tone in the work environment Jay Kaplan, M.D.

16 The Role of Craftsman/Healer: Think Bakery What Do Our Patients Feel? Sit Down To Sit or Not to Sit? (Annals Emerg Med 2007)) Sitting: time overestimated 15% Standing: time underestimated 7% Providers overestimated time 6% Jay Kaplan, M.D.

17 What Do Our Patients Hear? People (Patients) will not hear all of your words... Use Key Words or Phrases to express your caring. Use Key Words We re going to do our best to keep you comfortable and informed. We ve got more pain medicine than you have pain. You will be involved in the decisions made about your treatment. Do you have any questions? Is there anything I can do for you right now? Think Baseball - Touching All the Bases Five Fundamentals of Communication A I D E T Acknowledge Introduce Duration Explanation Thank You Jay Kaplan, M.D.

18 A I D E T Acknowledge patient and family, use a greeting, adjust covers, smile, eye contact Contact Introduce self with title, Manage Up, service recovery if needed (Thank/Apologize and Commit) Explain how long evaluation and diagnostic work-up will take, use key words for keeping patient informed, Under-Promise and Over-Deliver Explain the plan of care, what tests and treatments are to be accomplished, and what you feel is going on, Use Key Words Say Good-bye to the patient Closure Follow Up Phone Calls - Quality Nearly 1 in 5 patients * 400 patients surveyed 76 (19%) had adverse events after discharge Type of Adverse Events Other Fall 13% Nosocomial 4% Infection 5% Procedure Related 16% 62% Adverse Drug Event * 81 events occurred in 76 patients * Adverse Events After Discharge from Hospital, Annals of Internal Medicine, February 2003 Outcome: Post Visit Calls Inpatient k Percentile Rank Likelihood of Recommending No No No No No No No Call Call Call Call Call Call Call Call Call Call Call Call Call Call 0 3Q06 4Q06 1Q07 2Q07 3Q07 4Q07 1Q08 Source: New Jersey Hospital, Inpatient No Call Call admissions=75,065, Total beds = Jay Kaplan, M.D.

19 The Role of Team Player Our Most Difficult Task: Philosophy Goals Passion Commitment must be shared by everyone... Create the Team Think Football If on a football team, what position do you play? Do quarterbacks win games? Colleague as Customer What can I do to help you have a great day in working with me today? Jay Kaplan, M.D.

20 Say Thank You More The Simplest Recognition: Saying Thank you at the end of the day (shift) The Role of Manager Process Systems Outcomes Staff Physicians People Patients Systems - Think Bowling... Set up the pins Aim & follow through Keep score Determine metrics Define baselines/goals Create action plans Jay Kaplan, M.D.

21 Hospitals Want Physicians Who... Are willing to see measurement as an educational opportunity rather than as criticism. Will participate in performance improvement processes. Recognize that it takes time to make processes better and that it won t happen without physician participation. Performance Measurement Measurement drives performance in the absence of any other intervention Dissemination of comparative data to physicians i is more compelling than raw data Transparent data is more compelling than veiled data Where s There s No Gardener, There s No Garden No one is going to create a great place for us to work or for our patients to receive care unless we participate Jay Kaplan, M.D.

22 Summary We live in an experience economy. Satisfy is not enough. If the other guy s getting better... Quality gets you in the game. Service helps you win. Thank you. Jay Kaplan MD, FACEP jay@jaykaplanmd.com Jay Kaplan, M.D.