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Session #14: Entering Shared Risk for Community Hospitals Through Physician Engagement

This session explores the engagement level of physicians in community hospitals and discusses strategies to achieve patient-centered excellence.

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Session #14: Entering Shared Risk for Community Hospitals Through Physician Engagement

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  1. Pre-Session Poll Question Session #14: Entering Shared Risk for Community Hospitals Through Physician Engagement Greg Stock, CEO Thibodaux Regional Medical Center Mark Hebert, MD, FACS Surgical Specialist Thibodaux Regional Medical Center Which stage best describes the engagement level of the majority of physicians in your organization? Aversion Apathy Engaged Unsure or not applicable

  2. Thibodaux Regional Medical Center Number of hospitals/clinics/providers: 185-bed regional medical center, 1200 employees, 150 active staff physicians. Healthcare Model: Parish Hospital (similar to county hospital). Mission: To provide the highest quality, most cost-effective healthcare services possible to the people of Thibodaux and surrounding areas. Strategic focus: Achieve Patient-Centered Excellence. “To improve is to change; to be perfect is to change often.” -Winston Churchill

  3. Thibodaux’s Journey • Survive and Thrive • Independent, community hospital • Compete with larger healthcare systems • Triple Aim • Data-driven collaboration between physicians and hospitals • Lean Organization • Experts at identifying and addressing waste in hospital processes, workflow, etc. • Hospital-wide Six Sigma implementation in 2000 • Hospital-wide Lean implementation in 2002 • DIGs: Designed to resolve staff issues quickly and effectively • DMAIC: Define, Measure, Analyze, Improve, and Control • The Next Step In the Journey • Reducing clinical variation with physicians (process improvement) • Culture is King • Physician leadership and engagement • Adding data and analytics to the arsenal

  4. Outstanding Patient Satisfaction • The Beacon of Excellence Award for OP Services • Top 3 hospitals in the nation • Guardian of Excellence Award for OP & Home Health* • *Formerly the Summit Award

  5. Outstanding Patient Satisfaction • High HCAHPS Scores • HealthGrades IP Patient Experience Award • Top 5% in the country

  6. Leapfrog Safety Score Measures • Foreign Objects Retained After Surgery • Pressure Ulcer–Stage 3 and 4 • Falls and Trauma • Central Line Blood Stream Infections • Catheter Associated Urinary Tract Infections • Surgical Site Infections • Collapsed Lung due to Medical Treatment • Breathing Failure after Surgery • Postoperative Blood Clots in Legs and Lungs • Wounds Splitting Open after Surgery • Accidental Cuts or Tears from Medical Treatment • Readmissions • Length of Stay • CPOE Implementation

  7. Top Clinical Quality

  8. Top Clinical Quality

  9. Financial Strength & Integrity

  10. 32% Reduction in Total Hospital Acquired Infections in 6 years 85% Reduction in 6 Years!

  11. 83% Reduction in 6 Years!

  12. “Triple Aim” • Great Patient Experience • Excellent Clinical Quality • Cost-Effective Care

  13. Passion As A Value Performance From The Heart

  14. The Opportunity • What baseline measures, quantitative or qualitative, did you track that helped illustrate the pain point? • Severe Sepsis • Mortality rate at the beginning of care transformation initiative: 11%(National average 14-18%) • Months into deployment maintaining a 7%mortality rate • How and why has this been a problem, pain point, or opportunity that you chose to prioritize? • The Next Step on the Journey: Sepsis Mortality • Consistent, sustained, top performance • Strengthen physician engagement • What current processes or technologies, if any, were you previously using to address the issue? • Lean Principles • Three-systems approach: • Content system in place • Lacking robust measurement system • Engagement and sharing of data

  15. Quality and cost: An inverse relationship No compliance to bundle – cost goes up Full compliance to bundle (better quality outcomes) – cost goes down

  16. Poll Question #2 • Which do you feel would be the most important element in your organization to increase physician engagement? • Create a culture of continuous improvement and collaboration • Develop a shared vision and strategy • Address concerns regarding quality improvement initiatives in a timely fashion • Data and analytics that are useable, comprehensive and drive action

  17. The “How” • Steering Team • Triad of physician leaders • Participation and support critical to drive change • Assisted in the selection of care processes to address • What tools did they have (EDW? Quality improvement? Analytics? Resources?) • Lean Principles • Comprehensive database • Interventions • Outcome measures – cost, quality (mortality/LOS), patient experience • All anchored in the Triple Aim • What was your initiative goal? • Reducing clinical variation to lower serious sepsis mortality rates and contain cost • Drive tangible increases in physician engagement • What were the success measures you established up front, and what were your targets to track and report? • Early Recognition: Increase utilization of the early recognition protocol in the ED with 90% compliance to identified practice measures • ED Sepsis Triage Protocol: Increase utilization of the sepsis triage protocol for patients with initial SIRS criteria and suspected sepsis from 61% to 75% • Physician Evaluation: Physician evaluation for UNSTABLE patients meeting SIRS criteria and suspected infection within 15 minutes from arrival, and evaluation for STABLE patients meeting SIRS criteria and suspected infection within one hour from arrival

  18. The “How” • How did you collect, validate, and analyze the data? • Cross-functional workgroup team met weekly • Validated algorithm used to identify at-risk patients • What was the intervention(s) chosen and why? • Three and Six Hour Bundle Compliance • Improve early recognition of sepsis • How did the team collaborate with and get buy in from others (leaders, sponsors, clinicians, front-line workers) to implement the intervention? • Relationship, relationship, relationship • Like a marriage, each partner gives 100%—100% • Appealed to physician’s passion for medicineand easing patient suffering • Commitment from executive leadership to drive responsible change • More efficient/lower costs ≠ slash-and-burn cost-cutting, holding back care to meet cost expectations • Physicians as evangelists • 1:1 physician communication critical to success • Sharing sepsis success story with entire organization • How did you deploy and implement the intervention? (training, education, materials, etc.) • Training on new Advanced Application, Dashboards, and Protocols

  19. Future Plans • What issues will the team address next? • Speed but not blinding speed • Evolution of culture of continuous improvement and collaboration • Preserve the gains from sepsis initiative and keep moving forward • Acceptance of change becomes the norm • Drive true care transformation • Rigorous and honest conversations about cost/reducing waste • Patient and quality always at the forefront • Wellness as a priority • Groom future physician leaders • Seamless transition of progress and process over time • Ensures continuous engagement with executive leaders

  20. Lessons Learned Physician leadership is essential to success Physician-to-physician communication 100% commitment from physicians and executive leadership; it’s not a 50%—50% relationship Cost is NOT a four-letter word Data must be easy to access, digest, communicate, and make actionable

  21. Analytic Insights Questions & Answers A

  22. Choose one thing… Write down one thing will you do differently after hearing this presentation

  23. Thank You

  24. Session Feedback Survey • On a scale of 1-5, how satisfied were you overall with this session? • Not at all satisfied • Somewhat satisfied • Moderately satisfied • Very satisfied • Extremely satisfied What feedback or suggestions do you have?

  25. Upcoming Speakers 3:45 PM – 4:35 PM • Delivering Excellence at Stanford Health CareAmir Dan Rubin, President and CEO, Stanford Health Care 4:35 PM – 5:00 PM • The Future World of Value-Based Healthcare (Documentary featuring Michael Porter)Caleb Stowell, MD, Vice President, Research and Development, International Consortium for Health Outcomes Measurement (ICHOM, Senior Researcher, Harvard Business School) Location Grand Ballroom Grand Ballroom

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