Organizational Restructuring

1. Organizational Restructuring Henry Ford Medical Group Division of Hospitalist Medicine Detroit, Michigan

2. Background • HFHS hospitalist program rapid growth between 2006 – 2009 • average daily patient census grew from 60 to 220 • clinical domains grew from 3 to 10 • geographic areas grew from 3 units in 1 hospital to 10 services in 4 hospitals • physician FTE grew from 14 to 42 • Division of Hospitalist Medicine was formed in January 2008, Peter Watson was appointed Division Head

3. Henry Ford Division of Hospitalist Medicine Clinical Domains • General Medical Inpatient Care • Observation Care • Telemetry/Cardiology • Progressive/Critical Care • Clinical Education • Clinical Research • Surgical Co-Management • Consultative Medicine • Admission Triage/Evaluation • Palliative Medicine

5. Organizational Restructuring • Organize leadership structure to support our diverse areas and domains of practice • State mission, vision and values to guide decisions, planning and growth • Optimize alignment of physician talent with the needs of each area of practice

6. Lessons Applied From Leadership Academy • Strategic planning provided a framework for organizational structure and planning • SWOT analysis allowed us to assess our current position and set operational priorities • Identifying and developing a leadership succession for operational efficiency, sustainability and growth

7. Division of Hospitalist Medicine Mission, Vision and Values: “Coming together is a beginning. Keeping together is progress. Working together is success.If everyone is moving forward together, then success takes care of itself.” -Henry Ford • Mission: • Why are we here? As physicians and health professionals dedicated to high quality inpatient and palliative medicine, we are committed to putting the patient first by consistently providing an outstanding inpatient care experience that we would expect for our families and for ourselves. • What is the essence of what we do? As hospitalists in group practice, we provide expertise in the delivery of inpatient medical care. The key to our success is multidisciplinary collaboration, a dynamic process where different disciplines work together toward common goals —by sharing knowledge, learning and building consensus. Hospitalists manage and coordinate teams providing complex inpatient medical care from admission through all care transitions to discharge and beyond. Hospitalists are natural resources and leaders of multidisciplinary teams within their institutions in the efforts to enhance quality, ensure patient safety, improve outcomes, reduce length of stay, and lower costs. • Vision: • What is our ongoing goal? Through a commitment to excellence in patient care, scholarship, and a culture of collaboration, to become recognized as one of the premier hospitalist groups in the United States. • Values: • The following are some of the behaviors and actions expected of members of the Division of Hospitalist Medicine to support our Mission and Vision of inpatient excellence and collaboration. • We collaborate with our patients and their families by: • Placing the needs and wishes of patients at the center of our activity by caring and comforting them in the same way we want our families and our ourselves treated • Communicating with patients and their families in a compassionate manner and maintaining an environment of shared decision-making and empowerment for the patient • We collaborate with the greater healthcare team by: • Partnering and sharing responsibility with the greater healthcare team including nurses, pharmacists, case managers and other disciplines by integrating their assessments in the care of our patients • Participating in hospital quality improvement initiatives to promote efficient, cost-effective, and safe practices • Advancing the science and education of inpatient medicine through a commitment to research, teaching, and life-long learning • Assuring safe transitions of care for our patients through cooperation with other healthcare providers and community-based services • We collaborate with our physician colleagues by: • Supporting our partners within the hospitalist medicine division by demonstrating the highest standards of clinical care, communication, performance assessment, and teamwork • Continually serving as role models by adhering to the highest standards of clinical and professional conduct • Working closely with other specialties to provide the best care for our patients • Recognizing and supporting the important role of the primary ambulatory physician through effective communication to enhance decision-making and ensure a safe and smooth transition of care

8. Strengths Strong leadership Diversity of expertise Breadth of experience, seasoned senior members Diversity of interests Strong academic faculty Weaknesses Variability in clinical quality Variability in engagement and accountability Inadequate representation in hospital policy-making Needs leadership support structure Needs in-service educational activities Staff turnover Opportunities Strong demand for hospitalist service Direct and substantial impact on hospital operations and objectives Strong medical group brand/reputation Stable medical group patient base Strong multi-specialty support Strong postgraduate medical education programs and structure Threats Weak local economy Unreimbursed care Competing hospitalist groups System’s poor insight of the hospitalist movement Pay for performance SWOT Analysis

9. John Popovich, MD Chair of Medicine Tina Gaines TY Program Sect Anna Lukowski, MD TY Residency PD 21 Residents Peter Watson, MD Division Head of Hospitalist Medicine Brian Boutell Department Administrator Pall Med Team 750 Consults/yr 2 FTE (DR) 3 FTE (NP/SW) HPM Fellows (1) Leslie Bricker, MD Palliative Medicine HPM Program Director David Paje, MD Associate Division Head Detroit Campus Director Marie Dube Hospitalist Coordinator Kelly Dunkerley Specialty Associate II Heidi Gunderson, DO Site Director, Warren Campus Eyad Akhras, MD Section Chief Hospitalist Medicine Site Director, West Bloomfield Saqib Nakadar, DO Site Director, Wyandotte Peter Luyeho, MD UMD, HFH B6 Clifford Kaye, MD UMD, HFH F1 Greg Buran, MD UMD, HFH I5/Observation Warren Campus Team 18-25 pts 5.2 FTE Bloomfield Campus Team 30-40 pts 9.6 FTE Wyandotte Campus Team 35-45 pts 9.6 FTE B6 Team 26 pts 7.4 FTE Ortho Comgt 12-14 pts 1.2 FTE F1 Team 31 pts 2.6 FTE I5 Team 33 pts 7 FTE HF Team 10-14 pts 4.4 FTE

10. Priorities for 2010 • “Culture-building” • Establish standards of practice • Develop program for staff development