Disclosure. Janice Piazza, MSN MBA No Disclosures

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1 Disclosure Ron Amedee, MD No disclosures Volunteer member ACGME Institutional Review Committee (IRC) Content of this presentation represents only my current institutional GME practices as DIO of Ochsner Health System Janice Piazza, MSN MBA No Disclosures

2 Leadership A Pathway to CLER Success Presented by the Ochsner GME Leadership Dyad Ronald Amedee, M.D., FACS DIO, Ochsner Health System Janice Piazza, MSN, MBA AVP, GME Ochsner Health System SES056 ACGME Annual Conference February 27, 2015

3 Ochsner Health System Located in New Orleans, serving the Gulf South Region 12 Hospitals 40 Clinic locations 4 Fitness Centers 900 employed physicians/ 80 medical specialties 16,000 Employees 1.4 Million Patient Contacts annually 400,000 Unique Patients $2 Billion in Net Pt Revenue 375 Residents in 27 programs 600 Residents Rotators from joint / affiliate programs UGME : 800 student months Nursing : 900 students Allied Health : 400 students Ochsner Clinical School, University of Queensland

4 Objectives Understand the leadership competencies that can positively impact GME programs that will lead to CLER success Identify areas of strength and opportunities for improvement in leadership competencies Develop a strategy to implement tomorrow that will begin to build the bridge across system silos 4

5 What we are really going to do! Share some basic information about leadership and perhaps a different way of thinking about leadership skills as they apply to CLER imperatives Share our story and perhaps provide some ideas that will help you think about this somewhat differently At its core : its really just a Performance Improvement Project So let s get started! 5

6 Start with the End in Mind :CLER Imperative AHA survey : Found the newly trained physicians were deficient in the areas of communication, use of systems based practice and interprofessional teamwork, and highlighted the need to education US physicians, residents, and fellows to address quality improvement this next generation of physicians needs the skills to be able to lead changes in our nation s health care organizations, both large and small CLER Pathways to Excellence -pg 2 Since the CLER assessments are based not only on what is taught, but what is actually practiced at the bedside, progress within any of the pathways can only be achieved through the joint efforts of the GME leadership and executive and clinical leadership at the clinical site. CLER Pathways to Excellence -pg 7 6

7 One last imperative : The majority of the pathways and the properties CAN NOT BE ACHIEVED without a close partnership between the GME leadership, and the highest level of executive leadership at the clinical site CLER Pathways to Excellence pg 8 No small task -- Where do we start? 7

8 The Ochsner Journey WE SERVE, HEAL, LEAD, EDUCATE & INNOVATE 8

9 Have you ever said/heard : Do they even know who we are? Do they know what we do? Do they know how valuable we are? What would they do if all of the house staff stayed home tomorrow? Education has always been a part of our mission what don t they understand? Your Goal is to integrate Academics and Operations!!!!! 9

10 Engagement and Partnership begins with Relationship Relationships are based on Trust 10

11 How we earned our place at the table Understanding the system and its inter- related parts and where were our points of integration Aligned our vision what s important to you is important to us Prove our value beyond the $$$ - be a differentiator Utilized our CLER visit preparation to engage and establish our relationship Drove a shared mental model 11

12 But Watch what you Wish For!!!! Operating Reviews (monthly) Strategic Plans Evaluated based on operational metrics Prove your value how does what you do contribute to over all outcomes Incentive based on your contribution to the organization shared incentives 12

13 What is a Mental Model / Shared Vision According to Senge, mental models are conceptual frameworks consisting of generalizations and assumptions from which we understand the world and take action in it. Let s test and example -- We may not even know that these mental models exist or are affecting us. Things to Consider : Who are your stakeholders What are your core values and beliefs Who are you competitors What Goals do you strive to achieve How do you measure your success 13

14 What is your mental model? 14

15 Table Exercise Part 1 Capture your mental model / shared vision for your education enterprise What s at the core Who are the stakeholders What are your metrics of success 15

16 Table Exercise Part 2 How does your model change what you are seeking a shared vision with Executive Leadership What s at the core Who are the stakeholders What are your metrics of success 16

17 Ochsner Model : as presented by W. Thomas CEO, Ochsner Health System 17

18 Why Mental Models and Shared Vision Matter Leads to a Shared Vision of what can be Provide focus in a world of too many priorities Better outcomes for all who share the vision Can support request for needed resources Contributes to development as a learning organization Will lead to CLER Success 18

19 What Leadership Competencies are Required? What do you consider Core Leadership Competencies? 19

20 Leadership Competence How do you define leadership competencies? cluster of related abilities, commitments, knowledge, and skills that enable a person (or an organization) to act effectively in a job or situation. Competence indicates sufficiency of knowledge and skills that enable someone to act in a wide variety of situations. Because each level of responsibility has its own requirements, competence can occur in any period of a person's life or at any stage of his or her career. 20

21 Leadership Competency Framework The ability to think in terms of systems and understanding how to lead and impact systems The ability to understand the variability of work in planning and problem solving Understanding how we learn, develop and improve Understanding people and why they behave as they do Understanding the interdependence and interaction between systems and variation Giving vision, meaning, direction and focus to the organization Scholtes,

22 Ochsner Leadership Competencies EXECUTION The ability to think in terms of systems and understanding how to lead and impact systems The ability to understand the variability of work in planning and problem solving EMOTIONAL INTELLIGENCE Understanding how we learn, develop and improve Understanding people and why they behave as they do VISION & INNOVATION Understanding the interdependence and interaction between systems and variation Giving vision, meaning, direction and focus to the organization EXPERTISE Know your business and how it impacts the organization 22

23 The Dyad Model - Model for Shared Leadership Emerging in many integrated healthcare delivery systems Provides opportunity for physician engagement Trust : between education (or clinical) and operational leadership supports alignment, and movement toward share goals Shared leadership development model May slow decision making, but the decisions are much more effective Shared Competency 1+1 = 5 23

24 An Example of what a DYAD can do using all of the tools in the box 24

25 Work Plan TimelineiPad Project Design & D Development S 12/13 3 /14 Pre- Intervention Data Collection 2/13 P Implementation P 8/13 9/12 Post Intervention Data Collection D 7/14 D S S 9/14 A 12/14 Roll out to all programs Literature Review to identify best practices 1/15 : House staff identifying opportunities with the technology Begin next cycle : leverage the Technology to support innovation in education Needs Survey How can we further leverage the technology Implementation in Internal Medicine with Resident Champions Expand Proof of concept to Pilot ( 20 residents ) In partnership with IT: Proof of Concept ( 5 residents) Met with an gain support of IT stakeholders. Build Shared Vision for the project Faculty & House Staff survey to determine current understanding / opinions Gap Analysis: Review tools, practices, policies currently in place to that direct use of hand held devices in the clinical environment incorporate into division strategic plan and budget 25

26 Work Plan Timeline Transitions of Care Project Design S & Development Pre- Intervention Data Collection 10/13 Implementation P 1/14 Post Intervention Data Collection 4/14 D 7/14 D A S S 9/14 A 12/14 3/15 Roll out to all programs Implementation in Internal Medicine with Resident Champions Pre implementation education / training Build Tool, Identify metrics and available data sources Assess EMR ( EPIC) functionality that could support defined best practices Faculty & House Staff survey to determine current understanding / opinions Literature Review to identify best practices Publish Begin next cycle : focus mentoring and faculty development Minor modifications to forms Repeat Survey and collect feedback Gap Analysis: Review tools, practices, policies currently in place to Facilitate transitions of care 26

27 Take a closer look.. What are you strengths and weaknesses as a leader - which of the competencies should you strive to develop what is your leadership style and leverage your strengths Do you create opportunities for engagement it won t happen by chance Be introspective Moments of Awareness Be aware of Doors that may open unexpectedly Develop your Dyad 27

28 How to start : Its really just a performance improvement project? Think of developing the partnership in cycles of change Small, manageable activities that lead to the ultimate outcome Identify your allies Use every opportunity to teach and work toward the shared mental model What might be used for metrics Financial impact Employee engagement scores ACGME resident survey scores Improve Quality outcomes impact on Pay For Performance 28

29 Let s start your plan today Individual exercise Tools Plan Take Away 29

30 Mama said there d be days like these 30

31 In Conclusion The rewards far out weigh the risks The Shared Vision is so much more powerful than any singular vision We have the privilege and advantage of working in an organization that values and supports education but we earned it! This takes time, commitment, and courage We hope that you have at least one take away that will help you on this journey! Thank you for your time, attention and participation 31

32 Contact Information Ronald G. Amedee, M.D., FACS Designated Institutional Official Ochsner Health System Janice Piazza, MSN, MBA Assistant Vice President, GME Ochsner Health System

33 References 1. Accreditation Council for Graduate Medical Education. CLER Pathways to Excellence. Available at: AccreditationSystem/ClinicalLearningEnvironmentReviewProgram.aspx 2. Baldwin K., Dimunation N., Alexander J ( 2011 ) Health Care Leadership and the Dyad Model. Physician Executive Journal, July/Aug2011, Vol 37(1): Scholtes, Peter R The Leader s Handbook: Making Things Happen, Getting Things Done. New York: McGraw Hill. 4. Scholtes, Peter R. (1999 ) The New Competencies of Leadership. Total Quality Management, Vol 10, Nos 4&5, 1999, S704-S Senge, Peter M The Fifth Discipline, The Art and Practice of the Learning Organization. New York: Currency / Doubleday 6. Senge P., Kleiner A., Robert C., Smith B., (1994) The Fifth Discipline Fieldbook, Strategies and Tools for Building a Learning Organization. New York: Currency/ Doubleday 7. Zismer D., Brueggeman J., ( 2010 ) Examining the Dyad as a Management Model in Integrated Health Systems. Physician Executive Journal, Jan/ Feb 2010,Vol.36(1)