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PRACTICING EXCELLENCE:How to Align Physicians in a
Shared Agenda
Stephen C. Beeson MDStuder Group Medical Director
Sharp Rees-Stealy Medical Group
The Objective of our Time
Create physicians that will align with organizational efforts to execute positive
outcomes in quality, safety, cost- effectiveness, the patient experience and evidence-based care
The Physician Change Equation
Physician Behavioral
Change
Physician Buy-in
Physician Training
Performance Feedback
Performance Incentive
Effective Physician
Leadership
Trust in Hospital
LeadershipManagement of misaligned
Behaviors
Recognition
Selection and Orientation
Visibility of Organizational
Culture
Physicians Align When
They trust those leading the effort
There is compelling evidence this is necessary
Their role is clear and well articulated
Physician leaders amplify the alignment message
They are invested to “get it done”
The destination is about a mission they can “back”
Those around them seem to be doing it
Diagnostic Criteria for Physician Engagement
Physicians are aware and support organizational goals
Physicians actively involved in quality, safety, and service initiatives
Physician behaviors are consistent with the organizational “signature”
Physicians will say/do something if standards are breeched
What We Need Physicians To Do:
Comply with evidence, clinical protocols and order sets
Deliver the patient experience
Manage cost of care
Support the group mission
Foster system safety
4 Tactics to Create Physician Alignment
Creating physician buy-in
Building physician trust
Aligning physician leadership
Training physicians
Tactic #1: Creating Buy-in
He who has a compelling enough Why, can overcome any How
Basic Truths about Buy-in
If physicians resist or protest, it is likely related to ineffective buy-in
This is a key leader responsibility and ability
How Do You Create Buy-in For:
The patient experience
Cost reduction
A culture of safety
Reduction of variance
Guidelines for Creating Buy-in
Believe it yourself
Know the evidence
Translate data to stories
Be intense
How Do You Know If You Have Made the Case Sufficiently?
Physicians are asking when it will happen
The uptake for initiatives is fast
Powerful group sentiment that “we must do this”
Leaders have articulated an irresistible future
Vocal resistors are seen as outliers
Tactic #2: Creating Physician Trust
If physicians don’t trust those that lead them, they will, at best, become indifferent and
uninvolved in organizational efforts.
More likely, they will protest and resist efforts to defend their differing agenda.
Trust Defined
“The state of readiness for unguarded interaction with someone or something”
Tenants of Trust
Capacity for trusting
Perception of competence
Perception of intentions
TRUST BUILDER: Including Physicians in Strategic Planning and Goal Setting
Strategic planning is setting the course for the future
Defining an overarching vision
Identifying strategies and actions to execute the vision
Setting system goals
Allocation of resources
Why Include Physicians:
The dialogue and process of planning is as important as the plan itself
Physician will own and support a plan they help create
Open and responsive dialogue fosters physician trust
Planning for a collective future will reduce physician suspicion of administrative activities
TRUST BUILDER: Survey Physicians
To deliver an effective treatment plan, leaders must diagnosis what physician issues need to be fixed
If we could fix three issues for you tomorrow, what would those be?
1.
2.
3.
Leadership
to
Physicians
TRUST BUILDER: Medical Staff Hotline
We are here to provide you the best place to care for patients, 24 hours a day, 365 days a year. If
there is anything that falls short of what you need, let us know and we will do what is necessary to make it right. Our leadership team will respond and communicate a response within 48 hours of
your call. Guaranteed.
TRUST BUILDER: Physician Recognition
Recognizing physicians for contributions, involvement and going above and beyond is one of the simplest and most effective ways to build physician trust with leaders and loyalty to a system
Tactic #3: Aligning Physician Leadership
“Leadership has been identified as the most important ingredient in transformational
improvement.”
From Joint Commission Resources presentation; Executive quality improvement survey results.
Journal of Patient Safety. 2 March 2006
The Role of the Physician Leader
Create and project a specific destination
Create consensus around that destination
Create goals to verify “arrival” at the destination
Deploy and manage strategies to execute goals
Measure, report and communicate progress
Convey expectations
Manage low performance
Recognize high performance
The True Role of a Leader
To get others to do what must be done because they want to do it
The Pathway to Effective Physician Leadership
Selecting Physician Leaders
Developing Physician Leaders
Leader Selection
First who, then what
Signs of the Wrong Leaders
Defenders of “physician turf”
Indifferent or disinterested
Changes position depending on who they are talking to
Fail to respond when there is a clear violation to the system way of doing things
Physician Leader Selection Criteria:
Intensity and passion for the mission and loyalty to the system
A desire to lead
Respected by colleagues
Has led something in the past
Can defend a position in face of resistance
Physician Leader Selection Criteria
Strong presenter and ability to communicate in a straight-forward fashion
Subject matter expert (or willing to learn)
An ability to convey performance expectations to others
Personal connection to those around them
Guiding Leader Selection Principles
Clear position responsibilities
Appointment/election process promotes leaders that have a high probability of success
Take time for this - get it right
Physician Leadership Development
We didn’t learn this during medical school or residency
Trainable Physician Leadership Skills
How to present and communicate a compelling Mission and Vision
How to make the case for change
How to round on colleagues
How to run a meeting
How to manage a disruptive colleague
How to recognize high performance
Understanding the external health care environment
Physician Leadership Development
Invest in the development of the physician leadership team
Physician Leadership Academy
Creates shared, simultaneous learning
Participation is required for that part of the leadership team
Training Works When:
We believed the change was important (buy-in)
The destination is crystal clear (vision)
There was a compelling need to change (current performance)
We knew how to do the change (training)
Expectations were clear and disseminated (behavioral standards)
Our change effort was measured and reported back
Leader Performance Predictors
Proper leader selection
Development of skills to execute
Clear description of responsibilities
Assigned goal set for full time leaders in area of responsibility
Leader assessment by the execution of goals
Performance transparency among the leadership team
A Leader’s Self Reflection…
Do I love the work that I do?
Do I convey a sense of hope?
Do I honor my word?
Am I interested in others?
Do others trust me?
When things go poorly, how do I respond?
Action From Today
In order to “Align Physicians” one must first diagnose physician relations
Outreach to physician for inclusion in organizational strategy
Develop communication mechanisms to convey mission, strategy and results
Invest in training and developing physician leaders