Engaging Physicians for Successful Cultural Transformation. Scott Nygaard, MD, Becky Pollins, RN & Mo Kasti, MS March 10, 2018

Transcription

1 Engaging Physicians for Successful Cultural Transformation Scott Nygaard, MD, Becky Pollins, RN & Mo Kasti, MS March 10, 2018

2 DISCLOSURE STATEMENT None of the presenters have actual or potential conflicts of interest in any way in relation to this presentation. 2

3 Purpose Share our ongoing journey of transforming the culture for the patient through physician leadership 3

4 Agenda 1. Who We Are 2. Where We Were 3. What We Are Doing 4. What We Are Experiencing 5. Where We Are Going 4

5 Who We Are Located in Southwest Florida since rd largest public health system in US No tax support Special district of Florida Legislature Publicly elected board Largest public health system in Florida without benefit of local tax support Lee County s largest employer 13,100 employees, 1,400 physicians, 4,500 volunteers More than one million patient encounters annually $54.8 million charity care $308 million community benefit $1.7 billion NPSR 4.1 % OM Florida Safety Net Health System 4 acute care hospitals, 2 specialty hospitals, and 1 employed physician group Mission Our mission is to be a trusted partner empowering healthier lives through are and compassion Vision Our vision is to inspire hope and be a national leader for health and healing 5

6 Our Employed Medical Group Founded in 1993 with 1 physician and 7 employees Today we have: 610 providers 340 physicians 77 practice locations Annual visits of 1,364,000 Started as a house of brands, now master branded Number and geographic access changing Moving toward PCP/Advanced provider model Culture change of MVV, Compact, Accountability 6

7 LPG Performance Physician Growth Advanced Providers Area Before 2010 Now Patient Visits 698,271 1,364,000 Net Revenue $95,408,619 $120,910,432 Engagement Grand Mean Leader Index Urgent Care: CG-CAHPS Rate Provider (82 nd Percentile) Access: Increased weekend hours resulting in: Site 1: 75% reduction in urgent care use. Site 2: 25% reduction in urgent care and a 34.8% reduction in ED visits. 7

8 Where We Were: Cultural Symptoms TRUST was very low or not present Us versus them mindset Independent medical staff to a fault No agreed upon mutual expectations No structure that unified employed physicians - house of brands strategy Lack of transparency - a lot of data but not organized in way that was meaningful to physicians Meetings did not equal physician input or engagement No strategy for physician leadership development 8

9 Where We Were: Patient Focus Groups We are in the business of providing what matters most to patients. Employees Friendly, Smile Courteous Cheerful Convenience Reminders Welcoming, Warm Greeting Eye Contact Keep Informed Privacy Clean Explanation Listening Follow-up Meet my needs Take time with me Respect my time Patients Tender Touch Friend Advanced preparation before arrive Treat me like family Call ahead for delays Greet me by name Caring Thorough Invest in Relationship Compassion Warm Knowledgeable about my situation Amenities 9

10 Where We Were: How We Got Started 1. Extensive Training 2. Evaluation of ROI Training creates awareness only 3. Learning by doing - One-on-One Physician Coaching Need for hardwiring new habits TOP BOX BASELINE POST IMPLEMENTATION 3 MONTHS LATER OVERALL SATISFACTION WITH PHYSICIAN CG-CAHPS PROVIDER COMMUNICATION Patient experience pilots 10

11 Commitment to Culture Transformation Leadership Signals Organizational Signals Hardwiring New Habits 11

12 What Is Culture? A system of beliefs and rules that govern behavior. The culture of a company is the behavior of its leaders. Leaders get the behaviors they exhibit & tolerate. You change the culture of a company by changing the behavior of its leaders. Dick Brown, Former CEO of EDS 12

13 What We Now Believe? We believe that performance excellence is driven by cultural excellence. Evidence demonstrates that the best outcomes are achieved by the best behavior. To change behavior requires change in thought! Culture is built and reinforced by effective leadership, especially physician leadership 13

14 What We Are Doing Dyad Structure Operational Excellence Hiring & Onboarding Strategy & Line of Sight Culture of Caring Accountability Targeted Development 14

15 What We Are Doing Strategy & Line of Sight Hiring & Onboarding Accountability Operational Excellence Specific strategy for physician engagement Line of sight operating mechanism for cascading strategy Listening tours SKS assessment Physician onboarding program Compact Physician Academy Job descriptions Physician evaluations Cultural fit required Compensation model redesigned Patient Centered Medical Home Lean Deployment Population Health Dyad Structure Dyad partnership model that cascades to front-line Clearly defined responsibilities for clinical and operational leader Quarterly dyad leadership meetings Targeted Development 360 Assessments Team interventions Natural Leadership Physician Leadership Institute Coaching Quarterly PLI alumni sessions Culture of Caring Culture of Caring Advance Post advance support 15

16 Dyad Leadership Purpose: To build high performing dyad partnerships through enhanced collaboration, coordinated actions and communication in support of the LPG strategic plan Defined as an administrative leader & physician leader closely partnered in a shared & complementary decision making relationship. Benefits 1. Experience & studies demonstrate significant success 2. Enhances physician engagement, trust & participation 3. Ensures optimal melding of physician perspective with operational expertise 4. Broadens perspectives of leaders 16

17 Dyad Leadership Strategic Direction & Alignment Execution Vision & Direction 17

18 Dyad Leadership Accountability Job Descriptions Behavior Expectations Roles and Responsibility Activity Physician Site lead & Practice Director/Manager Reviewed each others job descriptions Identified for each duty where you are (fully developed, partially developed, needs developed) 18

19 Dyad Leadership Quarterly Development Leader of Symphonia Deliver performance evaluations in a way that creates engagement 19

20 Culture of Caring Advance 1. All day interdisciplinary workshop serves as a catalytic event 2. Highly interactive 3. Create a culture of caring and healthy relationships by first focusing on ourselves and our colleagues in order to provide a compassionate caring environment for our patients 4. Good to Great strategy 5. Deep immersion in the patient experience 6. Deep immersion of the health of individual and collective culture 7. Impact of mood on performance and correlation to experience as well as outcomes What We are Experiencing 1. Pull from employed physician group to system-wide approach 2. Traditional mindset of being held captive has shifted 3. Physician repeated participation 4. Physician led conversations 5. Natural spread of dyad model 6. Physicians requesting partnership & support 20

21 Culture of Caring Advance 21

22 Physician Leadership Institute Partnering with CTI 22

23 Physician Leadership Institute Partnering with CTI HUMAN DOING Leading with Strategy Healthcare trends Healthcare Financial Acumen Business Acumen: Think like an Owner Strategic Planning and Execution Leading Change and Innovation Sales and Marketing Managing your Practice and Service Line Leading for Results Planning and Resource Management Productivity and Capacity Optimization Leading Quality and Safety Process (Lean Six Sigma) Effective Project Management Medical Staff Operations Running productive Meeting HUMAN BEING Leading Self Courage and Character Resilience Trust, Accountability, and Teamwork Social/emotional intelligence Engaging Others Adaptability Stewardship Leading People Collaborative Leadership (Horses) Effective Conflict Resolution Effective Communication and Influence Courageous Conversations Creating and Sustaining High Performing Teams Coaching and Performance Development 23

24 Physician Leadership Institute Partnering with CTI 24

25 Physician Leadership Institute Partnering with CTI Collaborative Leadership: Building Relationships that Get Results 1. Building trust begins with learning about what others care about and value 2. There is no one size fits all approach to engaging people 1. Speak to values and motivators of people involved 3. Successful influence is situational 4. Most successful path to success is through the door of trust 5. Somatic Intelligence creates better access to awareness of self, others and your environment 25

26 PLI Projects 1. Identify the role of the physician leader in the care team 2. Develop criteria for Emergency Department (ED) team for inpatient placement of pediatric patients 3. Streamline workflows to maximize time with provider 4. Improve communication between providers and staff to produce better patient outcomes 5. Develop a strategy to ensure success of a new pediatric urgent care center and specialty clinic 6. Develop curriculum for LPG Physician Academy 7. Define partnerships and collaborative roles between ED physicians and hospitalists Value of Projects 1. Think, plan & execute strategy 2. Shift mindset from giving orders to collaboration and influence 3. Relationship building 4. Organizational navigation 5. Change management 6. Formal presentation skills 26

27 PLI Alumni Purpose: Expand the network, build relationships across cohorts and continue learning 1. Meet quarterly for 1.5 hours 2. Build relationships across cohorts 3. Provide 45 minutes of learning 1. Crucial Conversations 2. Resilience 3. Teams vs. Teaming 4. Executing on Executive Presence 5. Surfing the Edge of Chaos 27

28 PLI Improvement and Outcomes 28

29 Physician Alignment Versus Engagement Alignment Physician shares the organizational purpose, vision, goals, strategic and clinical priorities. Passive to Neutral Physician acting, deciding and behaving in ways that support the organizational purpose of quality patient care Key Indicators: I know the purpose and goals of the organization I trust the leadership of Lee Health Engagement Physician fully activated and energized to the point that one is willing to give discretionary effort Active to Proactive, Intentional Physician sees engagement as part of the profession, has a bias for action, is optimistic, triggers the best in others, willing to be involved and/or involves others. Key Indicator: I am proud to say I practice at Lee Health I am willing to recommend Lee Health to my colleague as the place to practice I am willing to engage 29

30 Urgent Care Center Culture 5-Years Ago Bottom performer in Patient Satisfaction Poor Community Image High Turnover Bottom performer Employee Engagement No communication Everyone worked hard in uncoordinated effort Patients were last priority 30

31 Their Journey of Culture Transformation Recognized we had a problem with our culture. Believe they could change Strong physician leader & dyad partner Shared team vision Transparency of data Operational excellence focus Mindset patient always comes first Ongoing culture conversations daily huddles Recognition ability to recognize and share what others did well Strong accountability low performers Hired for cultural fit The team is engaged, positive and has become a family Strong physician Leader Role model Attributes of a Natural Leader Performs at 98 th PR in patient experience Coaches providers for success Addressed low performers PLI graduate Called physician leadership forward as leaders of the culture 31

32 Today 32

33 Journey of Discovery Old Thinking Leadership style of push Behavior will change with tell approach Leadership model non-inclusive of physicians We have the right organizational incentives Training will change behavior We can fix everything at once The importance of technical skills - IQ Care team centric A focus on volume We can start by fixing the patient experience We can rehabilitate everyone Hope is a strategy New Thinking Leadership style of pull Behavior will change & be sustained by inclusion & when we achieve individual breakthroughs Dyad leadership model Ensure signals drive right behavior & outcomes Training will create awareness. A model of focus & discipline The importance of EQ Patient centric A focus on value Fix the culture & patient experience is natural Not everyone is coachable Hope is not a strategy 33

34 Where We Are Going Solid work in ambulatory environment that has been developed & appreciated by LPG (employed) physicians Beginning work with BOD & independent medical staff to bring a structure & process that makes them accountable for leading in a manner that support the mission of the organization Establishing Compact system-wide & building into hospital culture (credentialing, on-boarding, quality/service experience, cost of care) Networking amongst PLI graduates to keep engagement & leadership development investment alive within the organization Bring dyad model of leadership to acute care (CMO & CNO). Also new Acute Care Medical Officer working in harmony with a nurse leader, VP of Patient Care Services, to operate the hospital campus 34

35 Questions

36 Closing: Key Messages 1. A healthy and fit culture sets foundation for organizational change with a particular focus on mood and mindset 2. Dyad Model enables transformation: So go the physicians so goes the organization 3. Clinician to clinician leader, giving orders to collaboration, leadership, and relationship building 36

37 Thank You!