Dr. Steve Berkowitz presents why we need physician leadership and why

1. Hospital - Physician Leadership How your hospital can succeed despite what will or willnot happen in Washington Steven M. Berkowitz, MD Chief Medical Officer St. David’s HealthCare Austin, Texas 512-415-6095 Steve.berkowitz@stdavids.com

2. Clinical Integration ModelsSame Old Wine in a Brand New Bottle ?

3. Previous “Deal Killers” in Integration Strategies Risk Contracts /Capitation Physician Employment Collective Bargaining (Antitrust)

4. Previous “Deal Killers” in Integration Strategies Risk Contracts /Capitation Physician Employment Collective Bargaining (Antitrust)

5. “Deal Killers” in Integration Strategies Let’s get back to basics What is the best model for your organization? Any hand’s a winner…. Any hand’s a loser !!

6. What can we Learn from the Airline Industry ? Today’s Pilots A nice, boring flight !! MUCH safer !! HIGH reliance on systems and multidisciplinary support

7. The Health Care Team Medicine is a Team effort…. …..Why do we insist on playing Solo!

8. Developing physician leadership Techniques for hospital-physician interactions The role of the Board in the quality agenda Delivery Models

9. Developing physician leadership Techniques for hospital-physician interactions The role of the Board in the quality agenda Delivery Models

10. Developing physician leadership Techniques for hospital-physician interactions The role of the Board in the quality agenda Delivery Models

11. Board Board Administration Medical Staff Administration Medical Staff The Interactions of the Leadership Team

12. Identifying the Physician Leader Being a physician does not automatically make one a leader !

13. The Physician Leader Overcoming Perceptions Words of Wisdom-- Clifford J. Harris, M.D. 1984: To the practicing physicians you are seen as a *&$#% administrator….. to the administrators, you are seen as a *&$#% physician Even if you are a top notch physician, at best, you will only retain 50% of your credibility with your physician colleagues.

14. The Physician LeaderOvercoming Perceptions My first lesson in Medical School: “ “ Quote…non physician administrator

15. Why Choose to Become a Physician Leader? New challenge Personal growth/ achievement Ability to impact total health care team Desire to be part of the decision making process Patient quality advocate

16. Why NOT to Become a Physician Leader “Burned out” on clinical medicine Get off the call schedule, better life style Looking for a way to ease into retirement Personal agendas/ vendettas

17. Continuum from Clinician to Physician Leader

18. Physician Barriers to Change “I’ve always done it this way !!” “Just wait, next month there will be another article telling us to do it the opposite way !!” “In my experience ( of ____ years) , I have found that….” “At our institution we do it this way !!” “No one is going to tell ME how to practice medicine” “Where did you get your MD !!”

19. Physician Leadership Development Program -- A Hospital System Example 1. Identify and Develop Key Physician Leaders Annual Senior Management / MEC Review Process what are the physician leadership needs how to better engage the staff physicians at the facility incorporate existing best practices (internal and external) on how to identify and groom physician leaders identify future physician leaders

20. Physician Leadership Development Program -- A Hospital System Example 2. Medical Leadership Development Plan Quarterly “curriculum” for physician leaders. technical:finance, basic hospital operations, budgeting, medical management, utilization review, data analysis, statistical non-technical:conflict resolution, negotiating skills, problem solving, customer service Annual leadership meeting with prominent national speaker Off site CME conference for key physician leaders.

21. Leadership Development ProgramA Hospital Example 3. Measurement Plan Determine performance measures technical:Length of stay, incorporation of best practices, medical costs, patient satisfaction scores, core measures non-technical:conflict resolution, negotiating skills, problem solving, customer service Incorporation of these performance measurements into the annual evaluation/ compensation of the physician

22. Key Attributes of the Successful Physician Leader Maximizes credibilitywith both physicians and administrators Equallycomfortable with technical skills and business skills Maintains a passionfor clinical medicine Maintains allegiance to the BIGpicture, not simply a physician advocate

23. Developing physician leadership Techniques for hospital-physician interactions The role of the Board in the quality agenda Delivery Models

24. Board Board Administration Medical Staff Administration Medical Staff Examples of Interactive Models

25. Power versus Influence The Interactions of a Multidisciplinary Team

26. The Physician as Part of a Multidisciplinary Team The historical interactive style:

27. The Administrator as Part of a Multidisciplinary Team The historical interactive style:

28. The Physician as Part of a Multidisciplinary Team The better approach:

29. The Administrator as Part of a Multidisciplinary Team The better approach:

30. Hospital / Physician Integration Strategies - HOSPITAL + - + PHYSICIANS

31. Brief Digression…. ….The Revolutionary Model of Copernicus The sun, NOT the earth as the center of the solar system

32. Two Dysfunctional Models That Typically Exist in Health Care

33. A Third Dysfunctional Model That Exists in Health Care

34. The Consumer-Centric Model

35. Hospital / Physician Integration StrategiesBottom Line: In the minds of many physicians, the taking care of the patient has now taken a backseat to the increasing hassles of non-patient care !!

36. Hospital / Physician Integration StrategiesBottom Line: Most of the time, administrators come to the medical staff with “solutions”…. Wouldn’t it be much better if they came to us with “problems” and we worked together to come up with solutions… A Physician

39. cost reduction

41. Some Lessons from History…..Consensus vs. Science Consensus is a political process Science is an evidentiary process

42. Consensus 1492 It was the unanimous consensus of the court that the earth is flat !

43. If you lead by simply promoting the consensus, you are FOLLOWING, not LEADING.

44. Another Brief Digression…. 1620- Somewhere in the Atlantic.…

45. Physician Hospital RelationsA Physician- Hospital Compact Competent Leadership Shared Goals Mutual Sustained Success “for our better Ordering and Preservation, and Furtherance of the Ends…”

46. Leadership Management is doing things right; Leadership is doing the right things. Peter F. Drucker Change

47. Developing physician leadership Techniques for hospital-physician interactions The role of the Board in the quality agenda Delivery Models

48. Board Board Administration Medical Staff Administration Medical Staff Advancing the Quality Agenda

49. What Does the Evidence Tell Us? Five Tips for the Board: Define the Board’s role in quality Quality is more than regulations Find quality champions Incorporate quality into the mission Bring theory into reality Dlugacz, Krasnoff Quality Management Inst., 2007

50. Recommendations from IHI“Getting the Boards on Board” The Goal: Boards in all hospitals will spend at least 25% of their meeting time on quality and safety issues. Boards will have a conversation with at least one patient (or family member of a patient) who sustained serious harm at their institution within the last year.

51. I don’t know anything about Relativity... …but I do know Albert, and you can trust him. Mrs. Albert Einstein Change

52. Trust, but verify. Michail Gorbachov Ronald Reagan Change

53. Variance Analysis-- The Keys: Share the Data ! Decreasethe Variance !

54. The Performance Improvement Process Data, not an Indictment !! Data isNOTDiagnostic !! Sed Rate Analogy

55. The Inverse Relationship between Quality and Spending Baickeret al. Health Affairs web exclusives, October 7, 2004

56. The Five Stages of Death and Dying(and Data !!) Denial !! Anger Bargaining Depression Acceptance !! Adapted from Kubler-Ross

57. Variance Analysis and Intervention Large clinical variances continue to exist amongst physicians and hospitals Variances can and do lead to differences in management, treatment, and outcomesfor the patient

58. Variance Analysis and Intervention A process must be developed to investigate these variances in an objective, non-judgmental manner An identified variance is not necessarily good or bad-- it is simply an observation Physicians must assume a leadership role in the data evaluation and management team

59. Bottom Line……... Unexplainedvariance is the Basis of the Quality Improvement Process !!

60. Variance Analysis and Intervention The great majority of “outlying” physicians are good physicians who have developed a particular style of practice which can be madeevenbetter!

61. Leadership Hell, there are no rules here– We're trying to accomplish something. Thomas A. Edison Change

62. Working Together to Move the Quality Agenda A Proven Methodology to Improve Clinical Outcomes

63. The Clinical Improvement Process 1. Verify that the problem is significant Potential impact on patients Opportunity for improvement 2. Incorporate the evidence-based processes Education- physicians, medical team Adoption- treatment modifications or new guidelines 3. Determine what outcomes should be tracked Identify and measure the few key outcomes Provide ongoing feedback to the medical team 4. Respect the data– Take it to the next level Pursue outliers and new opportunities to further improve

64. Developing physician leadership Models for hospital-physician interactions The role of the Board in advancing the quality agenda

65. Change Just the facts ! Detective Sgt. Joe Friday

66. Change If the other guy’s getting better, then you’d better be getting better faster than that other guy’s getting better… …Or you’re getting worse. Tom Peters Change

67. Developing physician leadership Techniques for hospital-physician interactions The role of the Board in the quality agenda Delivery Models

68. Clinical Integration ModelsSame Old Wine in a Brand New Bottle ?

69. Clinical Integration ModelsSame Old Wine in a Brand New Bottle ?

70. Accountable Care Organizations Definition: An ACO is a health care provider organization that is accountable for meeting the health needs of a defined population, including the total cost of care and the quality and effectiveness of services.

71. Accountable Care Organizations Structurally, ACOs will look different, but would share Three Guiding Principles: 1. Local accountability for a defined population of patients 2. Payment reform based on shared savings 3. Performance and outcome measurement

72. Accountable Care Organizations Functional Capacity Categories: Manage the full continuum of care starting with the concept of a medical home Financially integrated with both commercial and public payers An IT platform for proactive patient management A physician and hospital leadership team Process improvement capabilities

73. Accountable Care Organizations How do we get there: Understand the difference between Market and Mandate Specifically define your core business Develop a methodology to get better and more efficient at that business Recognize your stakeholders Then….. Work with your stakeholders to develop an infrastructure that satisfies the criteria of an ACO

74. Developing physician leadership Techniques for hospital-physician interactions The role of the Board in the quality agenda Delivery Models

75. Change Change To the world you may be just one person, But to one person you may just be the world.Unknown Change