Archive for the 'Physicians' Category

The Art of Physician Courtship: Five Things Healthcare Leaders Can Do to Lay the Groundwork for Physician Integration

April 4, 2011

Click the link for a video going into more detail on this topic. Blog Response

It seems we in the healthcare industry constantly hear about the upcoming “marriage” between hospitals and physicians. And while it’s not yet clear exactly what form this partnership is going to take—ACOs, physician employment, or something else entirely—the people in suits and the people in white coats are about to get a whole lot closer.

This raises a very logical question: How can you ever get married when you’ve never enjoyed dating?

No one knows what will happen as pay-for-performance really gets rolling, but it doesn’t matter. Organizations need to get focused on building strong, healthy relationships with their physicians, however they work together right now. (If you don’t lay the groundwork for a solid partnership, can you imagine how unhappy the marriage will be—and how much the divorce will cost?)

The idea is to become the kind of organization that physicians want to partner with. Even if the “marriage” ends up not happening, everyone will be a lot happier in the present.

At Studer Group®, we work with plenty of organizations that get physician integration right. These organizations do very specific things that set them apart:

They understand that, in the hierarchy of physician needs, great patient care comes first. Physicians care about clinical outcomes. Other things matter, too (workload, reward & recognition, the ability to make a living), but knowing patients are well taken care of has to come first. Providing exceptional quality care—every patient in every department every time—can happen only when you have the right culture. And that “culture of always” can happen only when you get the foundation right.

It’s Evidence-Based LeadershipSM—a foundation that gets their goals, behaviors, and processes aligned and working together—that allows them to reduce variances in leadership skills and processes and helps organizations achieve predictable, positive patient outcomes.

They measure physician satisfaction. It’s very simple: If you want to know whether your physicians are happy with your relationship, ask them. It’s amazing how many organizations don’t take the obvious step of diagnosing physician satisfaction. And what’s even more amazing is how many do diagnose it but then fail to act on the results—or even switch vendors rather than look for ways to improve the situation.

If it’s really important to you, you measure it. You diagnose. And you don’t run from the answer.

Once they’ve measured it, they take action to improve it. Rochester General Health System in Rochester, NY, is a great example of physician integration. RGHS took its physician satisfaction results from the 11th percentile to the 90th percentile in a very short amount of time. It did so by measuring one domain at a time—administrative response time, communication, tools and equipment, ease of practicing medicine—and by working with physicians to create a game plan on improving each one.

Their leaders keep in close touch with physicians. Leaders cannot engage their medical staff from an office. To build solid relationships, they need to establish sincere, face-to-face, two-way communication with physicians. This doesn’t just happen. Leaders have to make it happen. That’s why we recommend that leaders build time into their schedules to round on physicians.

We’ve found that when leaders round on physicians once a month, satisfaction results will be in the 87th percentile for likelihood of recommending the hospital to a colleague or patient. If you round quarterly, satisfaction is in the 75th percentile. If you round every six months, or never, it’s in the 50th percentile. So if you’re going to round, you have to do so at least once a quarter to make an impact.

They look for ways to make physicians’ lives easier. Two simple tools we recommend are Got Chart and physician preference cards. The first is a checklist nurses use when they need to call a physician about a patient. It lays out the information the physician wants to know (and in what order) and makes these interactions more efficient (and safer for the patient, too). The second is just what it sounds like: a card the organization creates for each physician to let staff members know which rounding time he prefers, how he prefers to be contacted, and so forth.

As you can see, both tools are very low-tech and easy to use, but they make a big difference in physician satisfaction.

Physician integration isn’t really about ACOs or any other financial structure. It’s about making sure hospitals run well. It’s about making sure patients are given exceptional care, not just some of the time but every time. It’s about creating solid relationships with physicians, so that they want to join forces with you in whatever form the partnership takes.

Sincerely,

Quint Studer

Quint Studer, CEO

Studer Group

http://www.studergroup.com/

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What Physicians and Others Can Do to Celebrate National Doctors Day

March 30, 2011

Physicians do great work every day. I know and work with many extraordinary healers, and I see their dedication and diligence firsthand. And yet, so many of us (yes, I am a physician, too!) are so busy caring for our patients and our own families that we have little time to reflect on our own accomplishments. Fortunately, we have Doctors Day—today, March 30—as an opportunity to take a breather and consider what we do well…and what we might do better.

Here are a few of my suggestions for physicians and other healthcare professionals who support them.

For doctors:

  • Take a moment to pause and think about all the good you have done over the course of your career. The lives saved, the lives improved, the care you gave to patients even when you couldn’t cure them.
  • Remember the “big picture” when the frustrations of the healthcare environment start to close in on you. Healing and helping others is a calling, and the good work you do makes up for the headaches that come with practicing medicine.
  • Remember that we have limitations. Make sure that you realize and accept your own.
  • Spend time with your family. They are also important, and time passes much too quickly. Don’t work your life away.
  • Take care of your own health. The phrase “Physician, heal thyself” came about for a reason. I didn’t appreciate the wisdom of this advice until my own health began to suffer.
  • Remember to practice kindness, empathy, and gratitude with patients, staff, and everyone around you. It’s the only way you will ever be happy.

For doctor supporters:

  • Take a moment to think about how the doctors you know have helped patients. Chances are a physician has made a huge impact on your life and on the lives of people you love.
  • Thank them for their work. Doctors don’t always hear those two little words—thank you—and when they do, it truly means a lot.
  • Manage up doctors with patients. This will show that we are all on the same team.
  • Do whatever you can to make a doctor’s day easier. Be as efficient as possible with reports and other information you provide them. In the end, this will benefit patients, too.
  • Remember that treating doctors with kindness, empathy, and gratitude will enhance your own happiness and the quality of the environment you work in.

Of course, you probably have your own ideas to add to the list. Just please do something for yourself or a physician you care about to commemorate this special occasion. Thanks to all of you who work so hard to provide exceptional care every day.

Warm regards,

Barbara Loeb, MD

How Much Evidence Is Enough?

February 11, 2011

If it doesn’t directly impact clinical care, is it still worth doing? That’s the question I was recently asked while speaking to a physician group.

(Before I go any further, let me say that I welcome having my beliefs questioned. It’s one of the benefits of being able to travel all around the country and interact with so many wonderful people. I have many opportunities to learn and to become better.)

Anyway, a physician in the room stated that he did not believe the patient satisfaction survey was of much value due to the fact that it does not impact clinical outcomes. He also felt that a patient could be very satisfied, yet not receive good clinical care.

Let me address the second comment first. I agree. It is possible for patients to rate their care high in a survey and still not receive great clinical care. This is where an organization’s values come in. I don’t know of any organization that feels good if patient satisfaction is high and quality is not.

The inverse is also true. Many times an organization’s clinical quality can be excellent but other issues can lead patients to feel they did not receive excellent clinical care.

My comment the other day to a group of physicians in an academic medical center was, “Let’s have the patient’s perception of care match the clinical quality you are providing.”

Now, let’s go back to the challenge that started this blog entry: My first attempt to link the survey to the issue of clinical care was to read the questions. How well was your pain managed? How well were your needs responded to? How well were your questions answered? How well were things explained to you? How well were your home care instructions explained? I explained that I feel each of these can impact clinical care.

The physician disagreed, stating that these issues still may not change the clinical outcome. I then said, “So if a patient’s clinical outcome will not be impacted, then you don’t want your patient’s pain managed? Nor call lights answered?” The physician answered that of course he would want these steps to be taken.

That’s when it hit me. While I can connect the dots and also show more research that indicates a connection between patient satisfaction and clinical outcomes, the evidence really isn’t the point. There are times when even if actions do not impact the clinical outcome, certain behaviors and actions still need to be done.

Hospice caregivers do great work. Do their efforts change the clinical outcome? My first grandchild was stillborn. While the care and support given to my son and daughter-in-law did not change the clinical outcome, were they worthwhile? Yes, without a doubt.

Why do some people fight making some basic changes? I can’t take inventory for others, but based on years of experience, I do have some observations of my own.

For some people, it has to do with not being comfortable. If I am asked to do something that I am not comfortable doing and can come up with a reason not to do it, I have found a way to stay in my comfort zone. For others, I believe it is the fear of failure. They would rather not try at all than try and fail. I believe this is one reason best practices are hard to transfer in healthcare.

Some people may feel they are the voice for others. Have you ever noticed when someone is pushing back, he or she may often say, “Everyone,” “Most people,” or “Others,” rather than coming out and saying, “Here is how I feel.” Still others may feel they need more data before they can make a change.

It’s that last group of people, the data-seekers, who bring me back to the point. How much evidence is enough to make a change worthwhile?

I have come to this conclusion: There are times in life when we do the behavior even though there is not overwhelming research data to support it. We do it because it is the right thing to do. I can think of no reason more powerful than that one.

Sincerely,

Quint Studer

Quint Studer, CEO
Studer Group
http://www.studergroup.com/

Celebrating Doctors

March 30, 2009

“More than the application of science and technology, medicine is a special calling, and those who have chosen this vocation in order to serve their fellowman understand the tremendous responsibility it entails.” With these words spoken 18 years ago, President George H. W. Bush proclaimed March 30th as the annual date to celebrate National Doctor’s Day.  Today, hospitals and patients across the nation will thank their doctors for answering the call to practice medicine. One of the best ways to say “thank you” today is to commit year-round to providing a great place for physicians to practice medicine.

Fundamentally, physicians want four things from the place where they choose to practice medicine:

  • Quality – Physicians want to know their patients are receiving quality care and very good service even when they’re not around.
  • Efficiency – Physicians want a friction-free place to practice medicine where delays, waste and frustration are minimized
  • Input – Ask physicians where they feel the organization should focus to make things run better; fix what can be fixed; and then follow-up to let them know what has been addressed.
  • Appreciation – Physicians value a “thank you” and acknowledgment when things are going well.

Most of our efforts in healthcare to engage physicians center on the first two items: quality and efficiency. This makes good sense – they’re the most tangible and have the most ability to quickly impact outcomes for physicians, patients and the hospital. However, too often we neglect the last two: input and appreciation. That’s unfortunate, since these are the lowest cost, quickest to implement and most sincere ways to demonstrate professional respect and involve physicians in the hospital enterprise. Here are a few tips to get started:

  • Focus, fix, and follow-up. All three are key steps to providing physicians a great place to practice medicine, but failure to follow-up is perhaps the fastest way to breakdown the relationship physicians have with the organization. Here are two examples of how to provide physicians opportunities for input that lend themselves to quick follow-up.
    • Ask physicians to list three issues that act as barriers in the delivery of care for their patients at the hospital. Be sure to also ask them for a potential solution to the problem. Based on the information you collect, publish a simple one-page flyer that lists the issue raised and the action taken.
    • You can create even faster follow-up by using a simple tool like a flipchart or a whiteboard posted in a common area. For example, the OR manager could post a flipchart on a door leading out of the OR with a marker attached by a string. In one column provide a place for physicians to list their barriers, and in the other column the OR manager writes what has been/will be done to address the barrier.
  • Round on physicians. By rounding on physicians, leaders demonstrate care and concern. They will also harvest what’s working well, people to recognize, systems to improve, and tools and equipment that need to be addressed. Here are some questions to ask physicians during rounds:
    • Focus on the Positive: “What is going well today?”
    • Harvest Wins: “Are there any hospital staff or other physicians you feel deserve to be complimented or recognized?”
    • Identify Process Improvement Areas: “What systems can be working better?”
    • Repair and Monitor Systems: “Do you have the help and equipment that you need to care for your patients?”
  • Send thank-you notes. In a study of the top workplace incentives, the number one strategy was handwritten thank-you notes. There’s nothing difficult about the act of writing a thank-you note, but there are better ways to make them effective for physicians and to hardwire them. For example, ask each nurse leader or unit nurse to send one handwritten thank-you note to a physician’s home on a regular basis. Physicians who receive such a note typically seek out the nurse who sent it. In addition to delighting the physicians and strengthening their connection with the nurse who wrote the note, the specific behaviors mentioned in the note will be reinforced. Let the CEO know who is being thanked and why so she can extend her appreciation the next time she sees the physician.
  • Pass along compliments to employees on behalf of physicians. Ask physicians “What is going well?” When Dr. Johnson mentions how much he appreciated the timely lab results in recent weeks, tell the lab manager, “Dr. Johnson wanted you to know how much he appreciates your staff’s on-time lab results over the last month. Please let them know what a difference they are making for physicians.”
  • Spotlight physicians who are making a difference at board meetings. For example, the CEO might say, “Dr. Rivera came in during a day off to work with the OR team to develop surgical preference cards for physicians. This has increased efficiency and reduced costs. As the board chair, I recommend the board write a letter of appreciation to Dr. Rivera.”

In the hallways today, take a moment to say “thank you” to the physicians who practice medicine in your organization. Also commit to implementing one new behavior, perhaps one of the ideas above, that you can hardwire so that physicians know how much they are appreciated all year long.

Our mission at Studer Group is to help make health care a better place for employees to work, physicians to practice medicine and patients to receive care. The tips above come from a physician collaboration toolkit available free of charge to partner organizations on our website.  You can find the toolkit and learn more about what we’re doing to help create better places to practice medicine on this resource page: www.studergroup.com/physicians

Yours in service,

Quint

Practicing Excellence

March 18, 2008

I have the great fortune to speak with physicians nationwide about the passion they have for making a difference, especially in the lives of their patients. With Doctor’s Day approaching on March 30, I have asked Dr. Stephen Beeson, Studer Group physician coach and author of Practicing Excellence, to share some thoughts…


Over the past eight years I have had the amazing opportunity and privilege to coach and train thousands of physicians from all over the country. Over the course of these years others and I have worked to distill and refine what works best to engage physicians and improve performance. We have had good results working with health care leaders and physician medical staffs around the country to improve the patient perception of care provided by physicians.It is clear now that performance reigns in health care. HCAHPS, Pay for Performance, and Medicare Reform are now regulating and rewarding organizational performance. Those systems that do better will win. Unfortunately, health care leaders struggle with organizational improvement if systems and leadership are not in place to create vision, measurement, training, and accountability to assemble a culture of performance.

With all this in mind, another challenge is answering the question, “What do we do with our docs?”

Here are suggestions:

  • Align physicians to a Culture of Excellence. Before physicians will change their behavior they must believe the decision to do things differently is based upon logic and evidence. Physician engagement must begin with creating and communicating the case for service as a pathway to improved clinical outcomes, marketplace reputation, malpractice risk reduction, and the quality of his or her own work life.
  • Train physicians using evidence-based behaviors. Evidence-based behaviors are behaviors that predictably improve patient perceptions based on historical health system evidence. Excellence-driven organizations invest in the improvement and development of their physicians using these behaviors that drive outcomes. This tactical training improves physicians’ ability to create patient loyalty, drive compliance with medication regimens and raise the performance of the clinical staff who look to them for leadership. (Click here to access a tool on establishing a first impression with physicians.)
  • Select physicians that fit the culture. You can train and develop a physician to become great, or you can select high performing physicians who match your culture. (The latter is far easier.) Physician selection has historically been an ad hoc process, creating variability and unpredictability of physician performance. Behavior-based interviewing is a mechanism to select for the important physician characteristics that will position your group for success. Behavioral interviewing uses scripted questions that assess physician competencies including teamwork, compassion, clinical judgment and problem solving, communication, and leadership.

Practicing Excellence has always been about providing physicians evidence-based behaviors and guidance that have created results in every environment where they have been implemented. It is important to train physicians not only in how to treat patients, but equally important, how to treat colleagues and staff to develop an environment of teamwork, respect, collegiaty to create and sustain measurable organizational outcomes.

Stephen C. Beeson, MD is a nationally recognized presenter, practicing physician, and author of Practicing Excellence, A Physicians Manual To Exceptional Health Care. Visit www.studergroup.com/beeson.