Leadership Team Gilroy, MD -3-16-11
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Transcript of Leadership Team Gilroy, MD -3-16-11
Operations Efficiency through
Physician Engagement
Kevin Gilroy, MD Internal Medicine, Lead Hospitalist Associate Program Director, Internal Medicine Residency Program
GHS Leadership Team Meeting March 16, 2011
• Department of Medicine DRG Project: – Goals:
• Improve Operational Efficiency • Cost Reduction
– Via: • Standardized Care • Evidence-based focus • Identification of Process barriers • Physician Engagement and Ownership
The Culture of Engagement
• Top 12 DRGs identified for cost savings opportunity – Congestive Heart Failure – Sepsis – Pneumonia – Renal Failure – Stroke – Acute Pancreatitis – Urinary Tract Infection – GI Bleed – Diabetes – Overdose – Respiratory Failure with Tracheostomy – Acute Leukemia
The Culture of Engagement
• Multidisciplinary Physician Team created for each DRG – Hospitalist with Subspecialist(s)
• Physician owned / affiliated (majority) • Private (GI, Hem/Onc, Nephrology)
• Individual DRG Team education, data overview, goal setting
• Random sample of 25 charts reviewed by each team • Business Intelligence utilized for further data drill down • Opportunities identified; Action plans later created
The Culture of Engagement
• DRG Team Review: – Physician opportunity / ownership issues identified: Prime Focus!
• “Taking care of our own backyard” drilled home – Non-Physician opportunities identified: Secondary
• DRG specific and common themes identified
• Action Plans created to address major issues identified – Physician-specific opportunities - Priority – System specific opportunity recommendations – Timelines created – Follow-up data reviewed
The Culture of Engagement
• Physician ownership issues (examples): – Documentation integrity opportunities
• Physician lack of understanding coding world
– Sepsis management delays – Plavix procedural delays – Lack of aggressive management / resuscitation:
• Pancreatitis • Sepsis
– Lack of antibiotic stewardship – Lack of evidence-based standardization for
• Pancreatitis • Sepsis • PNM • CVA • CHF
The Culture of Engagement
• Non-Physician issues (examples): – Reactive Case Management / Social Work – Coding discrepancies / Separation from clinical world – Sepsis management delays
• Nursing education and training in ER • Transport delays • ICU bed availability
– Contaminated blood culture results – Data management
• Lack of Physician-specific utilization • Lack of Service-focused patient / data assignment
– Limited Behavioral Patient Bed access / State resources – Lack of coordinated post acute care assessment / transition
The Culture of Engagement
The Culture of Engagement
The Culture of Engagement
• Benefits outside of cost savings – Transparent focus on Physician Improvement / practice opportunities – Highlighting “our” unexplained Physician practice variation
• Acceptance of its existence and detriment to our Patients and System • Taking ownership to create the solutions
– Linking a strong bottom line to enhancing Physician support for patient care – Physician access and education on Data management and capability – Shared focus / unified goal of the Department
• Relationship building between Divisions • Fostering a “Team” atmosphere
– Physician education regarding System operations / processes of care – Physician education regarding Payment methods and System solvency – Highlighting Physician responsibility and ownership for financial success
• Equal / equivalent to Quality care • Everyday practice focus among Divisions
– Fostering Physician creativity in streamlining / maximizing operational efficiency
– Physicians and System = One in the same!
The Culture of Engagement
• Reasons for success – Administrative support of Physician-led System
• An organizational culture change • Physician buy-in increasing
– Administrative Leadership • Transparent, accountable, engaged, accessible, workforce Leadership and
development
– Physician owned / aligned Medical Staff (majority) – Administrative resource support behind project
• Business Intelligence: Janet Thompson and Renee Tollison (phenomenal)
– Department Chair Leadership and Focus • IM Leadership biweekly Meetings / Education
– Economic downturn – Local Competition – Clarity of Healthcare Reform landscape: Keys to survival and
success
The Culture of Engagement
• Future opportunities / needs assessment – Improved data collection and management
• Transparent Physician performance with real-time feedback • Access to office based EMRs
– Clinical IT decisional support systems • Gains to date based on Education / awareness alone: short half-life
– Case Management development – More nimble Pharmacy and Therapeutics committee
• More real-time Formulary efficacy and cost evaluation / adjustment
– Antibiotic stewardship development / growth • High cost / Highly utilized medications • LOS opportunity
– Continued Medical Staff involvement / engagement / ownership
The Culture of Engagement