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  • Hospital Impact - The what and how of physician engagement
    trust and mutual respect The authors likened progressing through these changes to progressing through Elizabeth Kubler Ross s stages of grief denial anger bargaining depression and acceptance They have done a masterful job of outlining the what of healthcare transformation To address the how of healthcare transformation I turn to my internal source the Zen of Physician Engagement which I define as the natural essence as told through parables Physicians can engage in transforming care through bottom up activities such as negotiating compacts and clinical priority setting with hospital leaders Regarding compacts a mid Western physician said My initial thoughts were filled with skepticism as I did not understand the purpose of it However after reading through it I think it is a great outline of the commitment expectations and goals of the organization If we see this organization as physician led then the foundation needs to be laid down The compact is a great place to start in addressing the mission and the goals of the organization Also the philosophy and expectations of the organization are spelled out to the physicians staff and patients The compact makes expectations crystal clear in my mind Regarding clinical priority setting a West coast physician wrote I enjoyed the data driven presentations in which physicians from all major clinical areas discussed strengths weaknesses opportunities and threats that they faced and proposed recommendations to improve care and to enhance physician physician and physician hospital communication We evolved from a self interested view of what the hospital should do for us as physicians to a more empowered view of how the hospital could employ limited resources to improve care for our community Through the process of discovery we began to think and act more as long term partners and co owners than short term customers and renters That clinicians who prided themselves on patient care could come to consensus on long term priorities gave the Board and hospital administration the confidence to accept their recommendations Healthy competition can create urgency for change As a New England cardiologist said None of us wanted to be an outlier except on the positive side I hope that this post gives credence to my belief that the optimal way to build a more collaborative culture is to give physicians a role in shaping it Ken is a practicing general surgeon MBA and CEO of HealthcareCollaboration com who divides his time between providing general surgical coverage and working with organizations that want to engage physicians to improve clinical and financial performance Leave a comment Please enable JavaScript to view the comments powered by Disqus Enter your search terms Submit search form Web www hospitalimpact org Get Hospital Impact in your inbox Healthcare Industry news Final Obama budget takes aim at opioid addiction superbugs Zika outbreak White House seeks 1 8B to respond to virus More hospitals replace nurseries with rooming in with moms Hospitals must train millennial nurse leaders in empathy frontline engagement St Louis hospital creates unit to improve

    Original URL path: http://www.hospitalimpact.org/index.php/2013/04/24/the_what_and_how_of_physician_engagement (2016-02-10)
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  • Hospital Impact - Informal doc leaders: A help or hindrance?
    on this project Dr Earnest informs Dr Yoda that Dr Clout did not seem interested in participating and Dr Yoda suggests Dr Earnest consider supporting Dr Clout to potentially lead the project and leaves Dr Earnest with much to think about Alone is his office Dr Earnest recalls a famous quote by the former CEO of Coca Cola Bob Woodruff There is no limit to what a man can achieve as long as he doesn t care who gets the credit Dr Earnest realizes he had gone about this all wrong he made this a management initiative and thus doomed it to failure The key is Dr Clout and Dr Earnest s proper role is facilitator and unobtrusive coach So Dr Earnest discusses his plans with the CEO and at her suggestion invites Dr Clout to a private dinner meeting with the two of them At the dinner the CEO showers Dr Clout with respect and informs Dr Earnest of Dr Clout s long and distinguished career with the organization and how he built the medical staff up from scratch years ago when few were interested in practicing medicine outside of the academic setting She further extols Dr Clout s willingness to embrace new practices as they emerge and provide effective informal leadership to medical staff management and the board Dr Earnest tells Dr Clout the board and management would be honored if he would consider designing and leading the service line initiative noting he would be compensated fair market value for his leadership time and services and would become a member of the executive team as associate chief medical officer and medical director of the Service Line Services Several days later Dr Clout returns with terms that he feels comfortable with and he and Dr Earnest negotiate a personal services agreement PSA contract to cover his leadership services Dr Earnest suggests Dr Clout put together an advisory council to provide specialty specific input and notes that he is happy to serve as secretary of the council take minutes and ensure that Dr Clout has the necessary resources to execute his plan It is like magic All of the heavy hitters on the staff want to be on the advisory council and Dr Clout cuts through political barriers like butter At the suggestion of Dr Earnest Dr Clout presents his plan to the medical staff it gets approved unanimously and moves through the MEC for board approval The service line flourishes Dr Clout receives public praise for his outstanding leadership and the CEO quietly provides her new CMO with private acknowledgement for his role in facilitating the process so adeptly Informal leaders provide the key to management s success or failure and it is up to leaders to understand where true power lies leverage the positive energy behind that power and leave the accolades to others only then will management and the organization succeed Jonathan H Burroughs MD MBA FACHE FACPE is a certified physician executive and a fellow of

    Original URL path: http://www.hospitalimpact.org/index.php/2013/08/05/informal_doc_leaders_a_boon_or_bust (2016-02-10)
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  • Hospital Impact - Physician engagement must-dos
    it now seems reasonable to create eligibility criteria for each specialty based upon demographic need specific skill set willingness to be employed or under contract and professional and personal values PRM derives from customer relationship management coined and described in the 1980s by Christan Granroos Evert Gummesson and Theodore Levitt They realized not all customers should be treated the same and thus began the implementation of segmented marketing by separating customers according to their value to the organization Recently this approach has been applied successfully to physicians and requires that a senior management take responsibility for a number of key physician relationships based upon quantitative e g revenue and qualitative e g opinion leader quality clinician etc criteria Quarterly management meets with the physicians and determines his her interest in partnering with the organization around initiatives of mutual benefit The benefit of this approach is that it explores ways in which an organization can leverage a physician s unique qualities to pursue goals objectives that require physician commitment and control This program demonstrates a high return on investment For example St Ann s Hospital in Westerville Ohio implemented such a program in 2007 and in three years saw a net income increase from 14 million to 24 million case mix adjusted length of stay decrease from 3 6 days to 3 3 days inpatient would recommend HCAHPS ratings increase from 50 percent to 80 percent and adjusted discharges increase by 3 000 HCA Presbyterian Hospital in Oklahoma City did the same and benefited in a three year period by volume increasing 12 percent monthly inpatient revenue increasing 15 percent inpatient ratings increasing 23 percent and most startling experiencing a 40 percent positive shift of the cardiology market share For both organizations this represented a ROI of between 400 percent and500 percent 2 Determine the type of economic relationship to create Many contractual arrangements provide an effective means for physicians to work successfully with organizations These include exclusive agreements personal services agreements leasing arrangements co management agreements joint venture and enterprise arrangements to name a few Many of these contractual entities permit the organization to compensate physicians based upon fair market value FMV and provide corporate benefits based upon state law and HR policy More importantly these arrangements create an effective economic and political bridge to work together in a more unified way that may segue into eventual employment The range of potential economic relationships is only limited by state law legal counsel s recommendation and the strategic interests of the organization to successfully partner with physicians 3 Pursue shared goals objectives The obvious quid pro quo is that in exchange for a mutually beneficial economic relationship both parties need to work together to create shared quality safety service and cost goals and objectives The operative word is together and as was pointed out in the previous article physicians will be deeply offended if they are not a key part of the initial discussions to create the organization s strategic pathway

    Original URL path: http://www.hospitalimpact.org/index.php/2013/07/10/physician_engagement_must_dos (2016-02-10)
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  • Hospital Impact - Physician engagement: What not to do
    treating a CEO as a regular employee Technically a CEO is an employee of the board with an employment agreement however s he is also a strategic partner leader confidant ambassador and more Similarly a physician is trained to be a clinical expert interdisciplinary leader strategic advisor supervisor mentor and colleague Thus to expect a physician to follow operational command without input participation or active involvement will ensure psychological detachment alienation and a deep sense of professional betrayal disrespect and anger Frankly this principle applies to any employee however not tapping in to all that a physician offers ensures the organization will fail to realize that physician s full potential and may even bring out the worst Create a one size fits all approach for physician engagement No single successful engagement approach will benefit physicians Not every physician seeks employment joint venture service line medical staff leadership investment opportunities or part time status Each physician has unique needs and wants and requires a customized approach Thus a one size fits all approach will neither be appropriate nor relevant to most physicians and will ensure the perception that management is not interested or concerned Tell physicians what the organization expects of them A physician spends a great deal of effort to defend his or her right to make autonomous decisions When management inadvertently takes away that source of professional pride and dignity resistance resentment and bitter acrimony is almost always the result Physicians make personal sacrifices to lead a performance initiative they believe to be important to their patients and to their professional standing but will artfully evade elude or sabotage an initiative they believe did not receive due consideration or approval from peers and colleagues Ideally physicians should take full ownership of performance initiatives and when management inadvertently eliminates that ownership they also remove any motivation to ensure the investment of resources and effort Make performance expectations nonnegotiable The only performance expectations a physician defines as nonnegotiable are those s he takes full ownership of For instance the University of Virginia recently modified its medical staff bylaws to inform all potential applicants that the practice of evidence based medicine is no longer optional for those seeking appointment or reappointment to its staff This occurred only because the medical staff took full responsibility for quality and decided to raise its own bar and demonstrate its commitment to evidence based practice One vice president of medical affairs put it succinctly If physicians commit to a higher purpose that has deep personal meaning they will drive it further than you can imagine however if an issue is forced upon them without input or discussion they will not budge an inch Disregard informal physician leaders Just because a physician lacks a formal political title doesn t mean s he doesn t wield enormous political and economic clout Traditionally the medical staff was controlled and led by informal leaders without titles who quietly and expertly orchestrated medical staff and physician initiatives from the sidelines without

    Original URL path: http://www.hospitalimpact.org/index.php/2013/06/24/doc_engagement_what_not_to_do (2016-02-10)
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  • Hospital Impact - Just what is healthcare reform anyway?
    by its associates These centers include 1 Cleveland Clinic Ohio 2 Geisinger Medical Center in Danville Pa 3 Mayo Clinic in Rochester Minn Scottsdale Ariz and Jacksonville Fla 4 Mercy Hospital Springfield Mo 5 Scott and White Memorial Hospital in Temple Texas 6 Virginia Mason Medical Center in Seattle Wal Mart will pay all costs for its associates to go to one of these centers and will pay a spouse or significant other to join them for support If an associate chooses to go anywhere else including the closest qualified facility to him her the associate is responsible for all deductibles and co payments as well as any cost for their significant other Wal Mart claims it has saved tens of millions of dollars in healthcare costs with this strategy and other major employers are taking notice Third party payers are moving forward as well When a group of highly motivated physicians formed the Memorial Hermann MD Clinical Integration Program in Houston and standardized hundreds of clinical and functional pathways to evidence based practices through creation of clinical practice committees CPCs the results were remarkable Hospital acquired infections dropped by 91 percent general complications dropped 66 percent 30 day readmissions fell 43 percent and mortality dropped 23 percent Aetna one of the three major insurance carriers in the market came to the group offered to renegotiate their contract at a higher rate with a significant bonus to divert patients to the integrated group and offered to market the group to compete against United and Blue Cross Blue Shield in the Houston market Aetna realized this integrated group could increase quality margin and return to stockholders investors and joined an increasing number of third party payers to create a tiered network to preferentially incentivize patients to go to high quality low cost providers and groups Discriminating patients are doing the same For instance Healthgrades s website gets more than 11 million hits a month and the Centers for Medicare Medicaid Services Hospital Compare website gets more than 14 million hits per month This represents only 8 percent of patients however this group represents highly educated individuals with disposable income who want to make discriminating high quality low cost healthcare choices for their loved ones Healthcare reform is not a political issue We have inadvertently allowed our healthcare system to fail by reverting to a supplier based reimbursement system that rewards organizations that perform high numbers of procedures and ancillary studies half of which according to the RAND Corporation are unnecessary Also because of a reimbursement system based upon return on investment ROI to stockholders investors and not based on healthcare outcomes half of the services that patients need have no meaningful reimbursement e g chronic disease management particularly in the outpatient setting Healthcare transformation requires an overhaul of our system so we can provide world class quality safety and service at a cost structure below that of most of our international competitors delivering the kind of healthcare we deserve and compelling

    Original URL path: http://www.hospitalimpact.org/index.php/2013/05/20/just_what_is_healthcare_reform_anyway (2016-02-10)
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  • Hospital Impact - How to handle medical professional conduct violations
    misconduct intoxication while caring for sick patients significant destruction to property or equipment etc Like a just culture the approach to violations varies significantly for each type of conduct offender 1 Rare and episodic Counseling with attentive listening to identify system issues and obstructions that inadvertently interfere with good patient care Part of the discussion tests for the physician s level of insight and understanding into the role of good communication in optimum patient care Typically this meeting is documented with an opportunity for the physician to agree to a high level of professionalism and conduct going forward 2 Established pattern This is a more complex group as the steps taken for group 1 obviously have not worked Attempting another half dozen rounds of meetings serves no purpose for these doctors and every attempt should be made to understand the root of the behavior the existence of any concomitant and treatable impairment that may trigger the behavior and the physician s willingness or not to seek help voluntarily Best practices for this group include having a behavioral evaluation and review committee made up of behavioral experts e g psychiatrists psychologists psychiatric social workers addiction specialists meet with the practitioner and determine whether s he requires referral for a fitness for work evaluation to identify specific psychiatric cognitive or organic medical issues that may be amenable to treatment Following a comprehensive evaluation a performance contract should be drawn up to define the level of measurable improvement that is expected the time frame within which this must take place and any positive or negative consequences based upon the successful or unsuccessful execution of this agreement Both the physician and a physician leader should be accountable for the outcome and the plan should be approved by the medical executive committee and governing board These physicians have a choice of self awareness reinvention or voluntary withdrawal from the medical staff if they cannot or will not make the necessary changes 3 Egregious Some form of progressive discipline and corrective action up to and including reduction in membership and privileges should take place immediately for both the sake of patients and the morale of the organization Professional conduct that involves some form of criminal activity significant destruction or recklessness puts everyone at risk and enabling such activity sends a destructive and contradictory message to the staff and community at large This rare activity tests the character and discipline of both physician and organizational leaders particularly when economic and political stakes are high In all instances the code of conduct should clearly state voluntary cooperation with medical staff leadership is essential and failure to cooperate will be considered a breach of the medical staff bylaws and thus require a voluntary withdrawal of membership of privileges This approach enables the medical staff to treat most physicians with care consideration and support in a positive and constructive manner while system impediments are addressed Only in the rare chronic or egregious incidents does the medical staff take a more

    Original URL path: http://www.hospitalimpact.org/index.php/2013/03/27/creating_a_just_culture_for_medical_prof (2016-02-10)
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  • Hospital Impact
    capita personal income X 0 45 Read more Leave a comment Is there life for docs after a Data Bank report December 17th 2012 by Jonathan H Burroughs In 1986 Congress passed the Healthcare Quality Improvement Act designed to provide federal immunity and protection for healthcare organizations and entities that provide good faith peer review to physicians and dentists The quid pro quo was the creation of the National Practitioner Data Bank NPDB to restrict the ability of incompetent physicians to move from State to State without disclosure or discovery of the physician s previous damaging or incompetent performance The NPDB has not been optimally effective It received a high of 830 reports in 1991 and a low of 532 in 2006 or approximately 10 percent of the number as estimated by the Public Health Service 5 000 and the American Medical Association 10 000 according to Public Citizen s Health Research Group Report 2009 Read more Leave a comment Revisiting the key components of the Affordable Care Act November 27th 2012 by Jonathan H Burroughs Since the U S Supreme Court s landmark decision in June and Obama s re election this month it is clear that for at least the next four years the provisions of the Patient Protection and Affordable Care Act will stand with the exception of the mandate to expand Medicaid to 133 percent of the federal poverty level FPL in 2014 This article outlines the fundamental components of the ACA and the affect they will likely have over the next four years I Insurance Reform At the heart of this law is insurance reform as of all the industrialized nations we have the largest private sector third party coverage of any healthcare system in the world This is a historic federalism versus state rights conflict that has defined our nation throughout our entire history and continues to divide us politically as evidenced in the recent presidential election Read more Leave a comment What if 2 post election scenarios for healthcare October 24th 2012 by Jonathan H Burroughs As a political independent in a staunchly independent state New Hampshire I am disappointed in both political parties attempted efforts to fix our healthcare system which spends almost twice that of any industrialized nation and ranks 37th in the world according to many agreed upon quality metrics Since the recently upheld Patient Protection and Accountable Care Act is the law of the land we can assume that if President Obama win a second term and absent a 60 percent filibuster free Republican majority in both houses of Congress the law will remain largely untouched Thus this article looks at the likely impact on healthcare if Gov Romney is elected president and what a re elected Obama must do to solve the inherent failings of the ACA to ensure continued progress towards fixing a broken healthcare system Read more Leave a comment Previous Page Next Page Enter your search terms Submit search form Web www hospitalimpact org Get

    Original URL path: http://www.hospitalimpact.org/index.php?blog=1&s=Jonathan%20Burroughs&page=1&disp=posts&paged=7 (2016-02-10)
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  • Hospital Impact - Continuity leads to relationship, trust and better care
    appointment to discuss his previous heart attack Jim shared with me that from the time he heard the news about his heart attack until the time of his follow up appointment with his personal physician he experienced chest pain pain in his jaw arm numbness etc And each time he thought is this another heart attack am I going to die Finally Jim saw his personal doctor who spent a great deal of time doing an appropriate assessment reviewing the notes and test outcomes associated with the EKG and previous exam as well as talking and listening to Jim He then said Jim you did not have a heart attack The other physician had misinterpreted the results You are fine Don t worry See this and this and this you are fine No need to be worried Although Jim s physician shared a lot more information once he heard no heart attack he was so elated much after that was a blur Jim said he was truly thrown for a loop with the original declaration that he definitely had had a heart attack and the emotional rollercoaster he and his young family experienced really impacted them all In the end Jim realized how grateful he is for HIS physician the physician with whom he has a trusting relationship the physician who truly knows and understands him the physician who shared empathy and time and wisdom with Jim and who of course provided such GREAT news It still amazes me how important time relationship caring continuity trust and empathy are to healing AND how consistently the healthcare system considers these items as afterthoughts and or positions them as unimportant or worse sets them aside to ensure productivity and revenue generation At least half of all medicine lacks scientific validity according to the Institute of Medicine Much of all clinical research is wrong according the work of Dr John Ioannidis and his team Bias and conflicts of interest run rampant in mainstream medicine and lead to patients being placed in danger See Medical societies are financially tied to drugmakers and Overtreated by Shannon Brownlee And yet the tried and true healing powers of time relationship caring continuity trust and empathy are pushed aside and indeed mocked in certain industry circles This is just one example that fortunately had a positive ending How many are out there that do not Thomas H Dahlborg M S M is executive director of the physician practice True North Health Center where he focuses on improving growth while ensuring access for the uninsured and the elderly He has 21 years of experience creating competitive advantages analyzing customer expectations and developing and implementing focused and aligned strategic deployment plans Formerly he served as the chief business strategy officer at Network Health a comprehensive Medicaid health plan based in Cambridge Mass and was COO of the U S Family Health Plan at Martin s Point Health Care in Portland Maine Leave a comment Please enable JavaScript to view the

    Original URL path: http://www.hospitalimpact.org/index.php/2011/05/18/continuity_leads_to_relationship_trust_a (2016-02-10)
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