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Disclosure / Unlabeled Disclosure / Unlabeled Uses DisclosureUses Disclosure
Speakers Faculty Disclosure Speakers Faculty Disclosure
Unlabeled Uses DisclosureUnlabeled Uses Disclosure
Coy Irvin, MDCoy Irvin, MD No relevant financial relationshipsNo relevant financial relationships
Does not anticipate discussing unlabeled uses Does not anticipate discussing unlabeled uses of any commercial products.of any commercial products.
Does not anticipate discussing any Does not anticipate discussing any investigational products investigational products
Copyright BLI 2003Copyright BLI 2003
Why is it Important to Why is it Important to talk about talk about
SERVICE EXCELLENCE?SERVICE EXCELLENCE?
Source: The Gallup Organization, August 2007
Americans’ Image of Americans’ Image of Business and IndustryBusiness and Industry
Access Problems: Three of Four Adults Have Difficulty Access Problems: Three of Four Adults Have Difficulty Getting Timely Access to Their Doctor Getting Timely Access to Their Doctor
Potential Waste: One-Third of Adults Experience Potential Waste: One-Third of Adults Experience Duplicative or Unnecessary CareDuplicative or Unnecessary Care
17
26
32
0 10 20 30 40
Percent reporting that it is very difficult/difficult
Docotrs ordered a test that had been donealready
Doctors recommended unnecessary treatment orcare
Either/both of the above
Copyright BLI 2003Copyright BLI 2003
Five Keys to Cultural ExcellenceFive Keys to Cultural Excellence
Culture will eat Culture will eat strategy for lunchstrategy for lunch
(every day of the week)!(every day of the week)!
An organization’s culture is the shared An organization’s culture is the shared philosophies, ideologies, values, assumptions, philosophies, ideologies, values, assumptions,
beliefs, attitudes and norms that knit the beliefs, attitudes and norms that knit the organizational members together.organizational members together.
Culture guides the way employees of the Culture guides the way employees of the organization act and think as they go about organization act and think as they go about doing their jobs.doing their jobs.
Culture is about the little Culture is about the little “around-here-isms”.“around-here-isms”.
What Is Organizational Culture?
A Culture of Accountability A Culture of Accountability Requires Two Things:Requires Two Things:
1. A “maniacal” commitmenta. Philosophicalb. Behavioral
2. Tools and practices that support accountability
What drives patient satisfaction?What drives patient satisfaction?
Speed of registration process…………...81 %Speed of registration process…………...81 % Courtesy of the nurses/assistants...........79 %Courtesy of the nurses/assistants...........79 % Courtesy of receptionist..........................78 %Courtesy of receptionist..........................78 % Nurse/assistant’s concern for problem....78 %Nurse/assistant’s concern for problem....78 % Friendliness of person taking call............76 %Friendliness of person taking call............76 % Length of time doctor spent with you.......75 %Length of time doctor spent with you.......75 %
IT”S the LITTLE THINGSIT”S the LITTLE THINGS
Elevator etiquette.Elevator etiquette.
Lost Families and patients.Lost Families and patients.
Speak first, SMILE.Speak first, SMILE.
Service RecoveryService Recovery
Tell the Story's, the ones about staff Tell the Story's, the ones about staff caring about the patients and their caring about the patients and their families.families.
Culture change is a long term Culture change is a long term process.process.
Celebrate the employee that makes it Celebrate the employee that makes it happen. happen.
Medicare refuses to Medicare refuses to pay for hospital pay for hospital
errors…errors…
We must cooperate
We have to cooperate
We are forced to cooperate
Why it is important to share HCAHPS data…
Consumer access to data
Media overage
Volume, revenue, reputation implications
Reimbursement: Inpatient Prospective Payment System
Reinforce your organization’s mission, vision and valuesSource: http://www.hcahpsonline.org/trainingmaterials.aspx
87%87% of doctors report of doctors report overall morale has declined overall morale has declined during the past 5 years.during the past 5 years.
60%60% of doctors report their of doctors report their enthusiasm for practicing enthusiasm for practicing medicine has dropped.medicine has dropped.
Kaiser Family Foundation Kaiser Family Foundation StudyStudy
So what makes it so difficult??So what makes it so difficult??Physicians
Collegial
Tactical
Short/medium timelines
Customer orientation
Clinical accountability
Track team
Personal investment of funds
Hospital Administrators
Hierarchical
Strategic
Medium/long timelines
Operational orientation
Economic accountability
Football team
Organizational investments
So how do we get
aligned??
10.70%
18.20%
26%
30.10%
43.10%
45%
Misinformed patients
Recordsmanagement
Time spent withpatients
Rising rates ofobesity
Cost of healthinsurnace
Cost of malpracticeinsurance
Driving Docs Crazy Doctors were asked to rate the frustration caused by certain issues. Their greatest frustrations: the cost of malpractice insurance and of
health insurance.
Source: Thomson Reuters, Health Leaders Media August 2008
In five years, I see myself working...
42.60%
58.10%
25.30%For my current practiceFor my current practice
In medical practice managementIn medical practice management
For an integrated delivery or hospital systemFor an integrated delivery or hospital system
Overall percentage of respondents who rated these issues as 4 or 5 on a 1-5 scale, with 1 meaning “zero probability” and 5 meaning “extreme probability”
Physician ConcernsPhysician Concerns
• Concerned about competence of nursing service
• Frustrated with administrative decisions
• Trust issues
• Poor staffing
• Administration makes decisions without MD input
Physician ChallengePhysician Challenge
1. Time, how can we save it?
2. Irritants, how can we reduce them?
3. Point of contact, identify for you hospital.
4. Review point of contact for each type of
physician.
– Non admitting primary care– Admitting primary care– Surgeon– Medicine subspecialty
Hospital-Physician RelationsHospital-Physician Relations
Leadership begins with building a relationship of
trust
The Hospital’s Perspective…The Hospital’s Perspective…
• Loss of historical loyalty to the hospital
• “Volunteerism is dead” mantra
• Competition for ancillary revenues and for high margin clinical services
Most Successful HospitalMost Successful Hospital
• Aligned agenda
Medical Staff
Administration
• Shared Value System
• Financially Dependent
• Culture is well defined
• Strong Leadership
Strategies for Success:Strategies for Success:Be Visible & AccessibleBe Visible & Accessible
ACTIONSACTIONS
CEO and VPs do regular roundsCEO and VPs do regular rounds
Regular “Open Forums” (limited attendance but valuable to Regular “Open Forums” (limited attendance but valuable to those present)those present)
Monthly breakfast meetingsMonthly breakfast meetings
Senior Manager’s office “in” the medical staff loungeSenior Manager’s office “in” the medical staff lounge
31% have Senior Managers who are assigned to physicians to 31% have Senior Managers who are assigned to physicians to maintain on-going relationships (51% very positive impact)maintain on-going relationships (51% very positive impact)
56% Physician Relations Program for members of active staff 56% Physician Relations Program for members of active staff (68% very satisfied)(68% very satisfied)
50% Physician Relations Program for referring physicians 50% Physician Relations Program for referring physicians (54% very satisfied)(54% very satisfied)
Why Working Together is DifficultWhy Working Together is Difficult Physicians control virtually all revenue to hospitals.Physicians control virtually all revenue to hospitals. Reimbursement cuts push physicians into technical Reimbursement cuts push physicians into technical
billing opportunities that have historically been the billing opportunities that have historically been the domain of the hospital.domain of the hospital.
Availability of capital and know-how for ancillary Availability of capital and know-how for ancillary services investment mitigates risks of physician entry.services investment mitigates risks of physician entry.
But…But… Hospitals have the organizational capacity.Hospitals have the organizational capacity. Hospitals are the shepherd of community healthcare Hospitals are the shepherd of community healthcare
interests.interests. Capital availability and know-how are fungible.Capital availability and know-how are fungible.
We need physicians as customers and partners.Without both relationships, we will sub optimize the
opportunity to build a winning medical staff.
We need physicians as customers and partners.Without both relationships, we will sub optimize the
opportunity to build a winning medical staff.
Bottom Line:Bottom Line:We Need Each OtherWe Need Each Other
… The success of healthcare organizations is interdependent on the
success of its physicians.
Failure to cooperate does not remove the interdependence; it just creates a
toxic relationship
Atchinson & Bujak, “Leading Transformational Change”
The FutureThe FutureThe future of healthcare organizations and
physicians is inextricably intertwined.
Hospitals and physicians that create more effective alliances will set the standard for the
future…
…and gain a competitive advantage
Holm C. E. (February 7, 2003). The Challenges of Physician-Health System Partnerships. Chicago:
Health Administration Press.
When We Don’t CooperateWhen We Don’t Cooperate“Disruptive behaviors” linked to…
• Occurrence of adverse events (69%)
• Medical errors (67%)
• Compromised patient safety (58%)
• Impaired quality (68%)
• Patient mortality (28%)Journal of American College of Surgeons (July, 2006)
Key Strategy to Strengthen Key Strategy to Strengthen Physician-Hospital RelationshipPhysician-Hospital Relationship
Daily irritants physician face:
• Waiting for lab/radiology results
• Searching for patient’s nurse
• ‘Sitting out” or delays
• RN not current of patient status
• Hearing complaints from patients about hospital service failures
• Having trouble finding a parking space
• Being “pestered” by medical records for a signature
• Having trouble getting on surgery schedule
Things Not to Say to Things Not to Say to Patients and Family Members Patients and Family Members
about the Medical Staffabout the Medical Staff
1. “Dr. ______ doesn’t make rounds on his/her patients every day… I don’t know when he’ll be in.”
2. “I paged Dr. ______ but he/she doesn’t answer pages all the time… it may be a while, if at all…”
3. “I’ll page him, but he’s not going to do anything” or “ you’ll have to ask him tomorrow.”
4. “He said you’re addicted to narcotics and you can’t have any more.”
5. “Have you considered finding another doctor?”
6. “Let’s wait till he gets up to call him – he won’t like it if I call him in the middle of the night.”
1. “Dr. ______ doesn’t make rounds on his/her patients every day… I don’t know when he’ll be in.”
2. “I paged Dr. ______ but he/she doesn’t answer pages all the time… it may be a while, if at all…”
3. “I’ll page him, but he’s not going to do anything” or “ you’ll have to ask him tomorrow.”
4. “He said you’re addicted to narcotics and you can’t have any more.”
5. “Have you considered finding another doctor?”
6. “Let’s wait till he gets up to call him – he won’t like it if I call him in the middle of the night.”
““Manage Up” Physicians Manage Up” Physicians with Their Patientswith Their Patients
INPATIENT
Overall
Time Spent with physician
Physician concern for worries
Physician kept you informed
Physician friendliness/ courtesy
Physician skill
““Manage Up” Physicians Manage Up” Physicians with Their Patientswith Their Patients
OUTPATIENT SURGERY
Overall
Physician friendliness
Explanations prior to surgery
Information- what was done
Confidence in skill of physician
The Patient Who Says…The Patient Who Says…• Tell me what you know right awayTell me what you know right away
• Answer meAnswer me
• Comfort meComfort me
• Don’t make me waitDon’t make me wait
• Don’t waste my timeDon’t waste my time
• Don’t frighten meDon’t frighten me
The Patient Who Says…The Patient Who Says…
Help me liveHelp me live
Donald M. Berwick, M.D.Donald M. Berwick, M.D.
The Answer…The Answer…It is absolutely clear that the primary differentiator between the average
organization and the exceptional can be defined by one practice
Un-CompromisingUn-Compromising Values & Standards Values & Standards
The Average Organization The Average Organization CompromisesCompromises
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