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Leadership for Great Patient Flow

Leadership for Great Patient Flow. Thom Mayer, MD, FACEP, FAAP President and CEO BestPractices, Inc 800-910-3796 Email: tmayer@best-practices.com. Cycle Times Reduced Variation, Increased Predictability, and Improved Forecasting

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Leadership for Great Patient Flow

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  1. Leadership for Great Patient Flow Thom Mayer, MD, FACEP, FAAP President and CEO BestPractices, Inc 800-910-3796 Email: tmayer@best-practices.com

  2. Cycle Times Reduced Variation, Increased Predictability, and Improved Forecasting Systems Thinking Service Transitions Alignment of Incentives Empowered providers Exceeding Expectations Demand Capacity Management Defining the Elements of Flow

  3. This isn’t Quantum Physics…

  4. Strategic Optimism

  5. Flow happens…But it doesn’t “just happen!”

  6. At a fundamental level, this is ALL Change All change requires LEADERSHIP.

  7. All meaningful and lasting change is driven by INTRINSIC motivation

  8. Leadership Myth #1 • TRYING TO LEAD PHYSICIANS IS LIKE TRYING TO HERD CATS!

  9. “Without resistance, there is no meaningful change.” Joan Kyes

  10. Leadership is the art of “resistance management.”

  11. Tom Peters • Leadership at its best is a discovery process, a mutual discovery process. The best leaders are the best learners. They empower others to pursue journeys of importance to places neither could have initially have imagined.

  12. Uneasy rests the head that wears the crown.Shakespeare

  13. There is some one Myth for every man, which, if we but knew it, would make us understand all that he did and thought.

  14. Russia is a riddle wrapped in a mystery inside an enigma.

  15. What Winston Really Said… • I cannot forecast to you what Russia will do. It is a riddle wrapped in a mystery inside an enigma: but perhaps there is a key. That key is Russian national interest.

  16. Leadership Skills #1 and #2#1 What is the One Myth for this person?#2 What is in this person or group’s self-interest?

  17. Rule #1 and Rule #2 RULE # 1 Always do the right thing for the patient. RULE # 2 Do the right thing for the people who take care of the patient RULE # 3 Never confuse Rule #1 and Rule # 2…

  18. BestPractices’ VisionCreating the FUTURE of Emergency MedicineThrough Our Commitment to- • The SCIENCE of Clinical Excellence • The ART of Customer Service • The BUSINESS of Execution

  19. What’s the difference between Leadership and Management?Do the differences REALLY make any difference?

  20. The Wisdom of John Kotter • Leadership is the development of vision and strategies, the alignment of relevant people behind those strategies, and the empowerment of individuals to make a vision happen, despite obstacles. This is in contrast to management, which involves keeping the current system operating through planning, budgeting, organizing, staffing, controlling and problem-solving.

  21. Envisioning Strategies Alignment Empowerment Direction setting Execution Planning Budgeting Organizing Staffing Controlling Problem Solving Leadership Management

  22. The Wisdom of John Kotter (Cont’d) • Leadership works through people and culture. It’s soft and hot. Management works through hierarchy and systems. It’s harder and cooler. The fundamental purpose of management is to keep the current system functioning. The fundamental purpose of leadership is to produce change, especially non-incremental change.

  23. Management deals with WHAT IS, the cold hard realities of our practice.Leadership deals with WHAT COULD (MUST) BE, with the future we must become

  24. Most companies are over-managed and under-led.John Kotter

  25. The Wisdom of Warren Bennis • Managers do things right-Leaders do the right thing.

  26. Steven Covey Managers are experts at getting the troops to efficiently cut their way through the jungle. Leaders climb a tree, survey the terrain, and proclaim, “Wrong jungle!”

  27. There is no sense doing well that which we should not be doing at all.

  28. So Which Would You Rather Be… • A LEADER ? • A MANAGER ?

  29. The Wisdom (?) of Thom Mayer • If managers do things right and leaders do the right things, ED medical directors must do both-every day of their lives

  30. If that is true, one of our central challenges will always be answering this question-Is this a leadership issue or a management issue?

  31. Management is about coping with complexity-leadership is about coping with change. No one has yet figured out how to manage people into battle-they must be led.John Kotter

  32. The Case for Flow –Case History #1 • The CEO, with whom you have an excellent relationship, says to you over your monthly lunch: • “Thom, I’m getting far too many complaints about delays in the ED. It’s just taking too long to see a Doctor. I think we need to look at adding more physician coverage. Here’s an article on a 30 minute guarantee I think we need to develop!”

  33. Is this a Leadership Issue or a Management Issue?

  34. What do the data say? What is the key piece of data with regard to Doc delays? Do you routinely monitor that information? What are the component elements of ED delay? Input-Throughput-Output Faced with the data, what do they mean? Should the focus be on gimmicks or substance? What will be the impact on the ED staff of an intrinsically imposed guarantee? If a change is made, how do I motivate the staff behind this change? Management Leadership

  35. The Case for Flow-Case #2 • At your monthly meeting of the emergency physicians, one of your docs says, “Every morning at 9 AM, we have 3-5 patients present at triage, but they don’t get into the rooms until 10-10:30. Just send them back!” • In other words. “Direct to Room !” or Triage ByPass

  36. Is this a Leadership Issue or a Management Issue?

  37. What’s the source of resistance? Boundary management Stakeholder analysis Vision Rewarding teams What do the data say? Information flow Why not? Data vs Why? What does JCAHO say? What is the VOC? “Bed turns” and “patient velocity” Leadership Management

  38. Case History #3 • “Thom, I just got an interesting call from one of your competitors. I usually don’t take those calls, but this one talked his way past Becky. They claim to have the highest pay rates in all of emergency medicine, which allows them to recruit the best emergency physicians in the business. I know you’ve told me you have a couple of openings on your staff. I’ve heard some of your Docs complaining they haven’t had a raise. Maybe you should take a look at their model.”

  39. What Do the Data Tell Us? • The collection and monitoring of data are a management function Are their docs better paid? • The interpretation and envisioning of data are a leadership function Does high pay = Good Docs? • Each of these functions must be integrated in order to answer this massive issue intelligently Patient velocity, patient satisfaction, patient safety, risk reduction…

  40. Questions on Leadership and Management?

  41. Fundamental Test for Flow • “You can accomplish anything in life, provided that you don’t mind who gets the credit.” • “I wonder how far Moses would have gotten in the desert if he had taken a poll.” • “The only new thing in life is the history you don’t know.” Harry S Truman

  42. Bill Russell-Invisibility • The most powerful test of a leader is how influential they are when they are NOT there. • The power of invisibility is the most neglected concept in leadership • To do so, the message must be VERY powerful and masterfully presented

  43. The Cold, Hard Reality of EM • I really don’t care how your ED works when you are there. • I care how it works when you’re not there.

  44. Case History #4 • Your ED group is a democratic, open-books, ‘We few, we happy few, we band of brothers.’ You believe this is the only real practice model for EM. • However, your CEO has insisted on a performance clause in your contract tied to customer satisfaction scores. • Despite an aggressive CS focus, two of your eight partners have basement-dwelling scores-and they are getting worse

  45. Is this a leadership issue or a management issue? • Which skills will be most important in resolving this problem? • Do you have the “right people on the bus?” • Are they in the right seats? • What are the brutal facts? (The Stockdale Paradox)

  46. Defining Success • Don’t let life be a surprise to you • Winning is never enough • The Wisdom of Rabbi Zusya • Churchill’s advice-begin with the end in mind

  47. Leading ChangeJohn Kotter 1. Increase urgency 2. Build the guiding team 3. Get the vision right 4. Communicate for buy-in 5. Empower action 6. Create (invent?) short-term wins 7. Don’t let up 8. Make change stick

  48. Change ManagementAbraham Maslow

  49. Change ManagementKurt Lewin • Driving Forces versus Restraining Forces • Why? Vs Why Not? • Thrust versus Gravity • Thrust must exceed gravity for motion to occur • Driving forces must exceed restraining forces for change to occur • HOWEVER, THE KEY IS IN REDUCING RESTRAINING FORCES NOT IN INCREASING DRIVING FORCES

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