St. Joseph Heritage Medial Group

1. Physician Leadership and Incentives to Sustain ChangeMichael Gilbert, MDAssociate Medical Director

2. St. Joseph Heritage Medial Group • Specialty: 40 primary care providers • Geographic location: Central Orange County • Three clinic sites: Orange, Tustin and Santa Ana • Group Ownership: Physician shareholders • Affiliation: St. Joseph Health Care System

3. Focus on Patient Experience • Chose patient experience to drive our change improvement initiative • Greatest potential for improvement in patient experience • Selected Access as an improvement initiative • Telephone Calls • Appointment Access • Office Wait Times • Measure improvement • Group level: Patient Assessment Survey • Provider level: Avatar International • Monthly survey • Quarterly provider feedback

4. Creating an Infrastructure for Change • Participated in CQC’s Optimizing Performance Series • Formed a Performance Improvement Team • Team charter • Sanctioned by and reports to Board of Directors • Chose high profile physician and administrative leaders as team members: • 4 physicians: BOD member, Dept. Chair, Medical Director • 5 administrators: Directors of Operations, Performance Improvement, Quality, Practice Development & Health Promotion • Full monetary support by administration and medical group

5. Improvement Initiative: 1. Appointment Access 2. Office Wait Times 3. Telephone Access Leadership Strategy: Offering Financial Incentives Imposing Fine System Involving Physicians in the Improvement Process Leadership Strategies

6. Advanced Access Initiative: Financial Incentives • Developed a financial offering through our Provider Service Agreement to motivate providers to partner with administration in opening up schedules • Agreed to and approved by Medical Directors, Board of Directors and senior administrators • Communicated agreement with physicians

7. Advanced Access Outcome • Met with all 40 providers in 4 months • Changed schedules to create more patient accessibility • Cleaned up schedules for: days and hours of patient care, built in physician preferences and convoluted historical restrictions • Resulted in: any/any schedule for all providers, allowing some preferences rather than hard wired restrictions

8. Office Wait Time Initiative: Imposing Fines • Generated reports through AEMR • Published data to physicians • Informed physicians of standard of care • In process of implementing a fine system for providers who consistently arrive late

9. Outcome • Modeled the fine system after a similar system of reporting notification for completion of medical record tasks • Lesson learned: Figure out what works in your medical group for similar problems and replicate it

10. Telephone Access Initiative:Involve Physicians in the Process • Include staff and physicians in the entire initiative from start to finish – Salsa Worker! • Recognize and clean up messiness in the process • Align success in performance improvement initiative with physicians financial operations and quality bonuses • Cut teeth on reporting and transparency

11. Outcomes

12. Data and Reporting • Improvement initiatives should be measurable (CQC tenet) • Data must be: • Accurate to withstand physician scrutiny • Shared at frequent intervals • Presented in provider level detail • Shared with entire team: physician, MA and receptionist

13. Quarterly Provider Reports

14. Transparency of Data

15. Provider Level Data

16. Provider Incentives • Harper Award bonus • Incorporate performance goals into long standing tradition of measuring quality • Provider Service Agreement incentive • Tied in performance goals to physicians financial operations • Promote team incentives • Align physician goals with staff and leadership incentives • MAs and reception staff receive monetary incentive for improvement in key initiatives