actep2014 ed director

EMERGENCY DEPARTMENT DIRECTOR

ROLE, RESPONSIBILITY AND IMPORTANCE

Piyaporn Thipayarat,MD

Bangkok Hospital Pattaya

1Wednesday, November 26, 14

EMERGENCY PHYSICIAN!!


New Emergency Physicianin Old Emergency Department!!

Introduce yourself

Learn your new ED


Our Emergency Room


Life Saving Equipments


New Emergency Physicianin Old Emergency Department!!

Introduce yourself

Learn your new staff members

Learn your new ED

Build a trust

Set up your own Emergency Department


Developing Leadership and Communication Skills

Implementing Effective Peer Review and Physician Profiling

The Problem Physicians

Interaction That Create/Prevent Malpractice

Customer Relations and Patient Satisfaction

Physician Contracts

Hospital Contracts

Emergency Department Director


New Physician Recruiting and orientation

Productivity and compensation: Measurement and feedback

Effective conflict management

Billing and coding

Reimbursement issues

Staffing and scheduling methodologies



Conduction effective meetings

Risk management

Legally interviewing, hiring and terminating

Containing cost while providing prudent care

Driving hospital quality



Negotiating Skill

Preventing error in emergency medicine

Patient complaint management

Engineering patient flowI: theory, metrics and application, directing change








Physician Contracts

Hospital Contracts




Leadership

It’s as easy at 1,2,3...

But what is 1,2,3??


1. There is some one Myth for every man, which, if we but knew it, would make us understand all that he did and

thought”.

Leadership


The Details of the One Myth

• It’s different for each person

• There are some similarities within specialties (trauma surgeons, orthopedists, pediatricians, internists

• “What excites you most about this?”• “What concerns you most?”• “What would success look like to you and your patients?”• “What role would you like to play as we move forward?”


2. All meaningful and lasting change is driven by INTRINSIC motivation

Leadership


1/27/2011

12

Extrinsic Vs. Natural Change

Forced Change-Extrinsic

Natural Diffusion

Time

Extrinsic Vs. Intrinsic Change

Extrinsic

Intrinsic

Time

1/27/2011

12

Extrinsic Vs. Natural Change

Forced Change-Extrinsic

Natural Diffusion

Time

Extrinsic Vs. Intrinsic Change

Extrinsic

Intrinsic

Time

Intrinsic Motivation


Leadership

3. What is in this person or group’sself-interest?


Leadership Skills 1,2and 3

1. What is their intrinsic motivation ?

2. What is the One Myth for this person?

3. What is in this person or group’s self- interest?


What are the differences between Leadership and Management?

Do the differences REALLY make any difference?


Leadership VS Management

Leadership

EnvisioningStrategiesAlignmentEmpowermentDirection settingExecution

Management

PlanningBudgetingOrganizingStaffingControllingProblem Solving



The fundamental purpose of management is to keep the current system functioning.

The fundamental purpose of leadership is to produce change, especially non- incremental change.

The Wisdom of John Kotter



Managers do things right

Leaders do the right thingThe Wisdom of Warren Bennis


So Which Would You Rather Be...

• A LEADER ?

• A MANAGER ?


If managers do things right and leaders do the right things,

ED medical directors must do both-every day of their lives

1/27/2011

26

HINT!!!!!

Most of the time-it’s BOTH!!!!!

•

Homework Assignment

• What are the 3 biggest problems currently facing your emergency department?

51 28Wednesday, November 26, 14

TeamWork

• Two words which combine to make a far more powerful single concept

• The single best measure of the health and success of your emergency department is the relationship between the doctors and nurses

• Unique in all of healthcare


TeamWork

MD-RN Leaders

• Proactive, positive relationship• MD as the strongest advocate for nurses• Frequent meetings• Supportive relationship• Team goals, team results• Empowerment, not autonomy• Seek and celebrate small victories• Celebrate publicly


MD Leader

• Autonomous

• Authoritarian

• Hierarchical

• Intense, focused time

• Outcomes-driven

• Technical expertise

• Problem Solver

• Linear perspective

RN Leader

• Dependent

• Collaborative

• Communications

• Expanded time

• Process-driven

• Interactive-service

• Critical thinking skills

• Circular perspective

TeamWork


Leadership and Administration

• Align strategic incentives.• Meet frequently-use time judiciously• The power of the carbon copy, email, voice mail• Make them a part of the ED team• If you ask for advice, be sure you’re prepared to take it• Understand the language, philosophy, strategies• Inform them of problems prospectively• Public praise, private problems• Be responsive• If it’s an ED problem, it’s your problem


Leadership and the Medical Staffs

• Meet with the leaders regularly

• Make them a part of the ED team

• Offer concrete, succinct solutions to problems

• Meet on their turf

• Protect your flank-use the cc

• Focus, focus, focus...

• Surprise them

• Adversaries often become the best allies







Physician Contracts

Hospital Contracts



Why Do Peer Review/MD Profiling?

1 Assure that quality is delivered

2 Make JCAHO happy

3 The contract requires us to

4 Make sure we don’t have any “bad” doc

5 Assure the group practices as a group

6 Aligning strategic incentives

7 Protect Your Patient(Patient Safety)

8 Protect Your Practice(Risk Reduction)


Contrasting Peer Review and Profiling

1 Usually set by clinical parameters

2 Done by or on behalf of clinicians

3 Increasingly Evidence-Based

4 Who is going to guide your fate?

5 Done by us

Peer Review Physician Profiling

1.Usually set by hospital

2.Very often done by non-clinicians

3. IT your friend?

4. Often done in the dark

5. Fate is guided by others

6. Done to us


70-80% of errors blamed on the last person to touch the situation.

After investigation, less than 20% of errors can be attributed to the last person to touch the situation.

The Sharp End of the Stick


Peer Review Process


The 1st Tier of Peer Review

1. Returns within 48, 72 hours

Change in Diagnosis AdmissionChange in therapy

2. Radiology over-reads

3. ECG over-reads

4. Condition on discharge

5. ASA in AMI

6. Beta blocker in AMI?


1. Time Indicators : door to doc, doc-to decision, decision-to-discharge

- Admission-Discharge-Fast Track

2. Quality Indicators- Door to needle-Door to Cath lab-Sepsis bundle

The 2nd Tier of Peer Review


The 3rd Tier of Peer Review

1 Discharge Summaries on all admitted patients

2 Copy of ED medical record to personal physicians

3 Downcoding/incomplete chart reports

4 Complaints/compliments

5 Team time indicators

6 Boarder Hours(Reasons?)

7 Meaningful data trending


Physician Profiling

Clinician Performance Evaluation Summary

Case Review Summary


Physician Profiling

Patient Satisfaction


The 1st Tier of Peer Review

1. Returns within 48, 72 hours

Change in Diagnosis AdmissionChange in therapy

2. Radiology over-reads

3. ECG over-reads

4. Condition on discharge

5. ASA in AMI

6. Beta blocker in AMI?







Physician Contracts

Hospital Contracts




Goal: Discourage Disruptive Behavior

The Physician With a problem are our “special” colleagues

4-6% give us 90% of the problems



Most Common Behavior Problems

# Degrading Comments and Insults

# Yelling

# Cursing

# Inappropriate Joking

# Refusing to Work Together


When does “their” problem becomes “your” problem?


Your Problem

When the behavior creates stressful environment and interferes with other’s effective functioning


Problem Management

* Identify

* Understand

* Investigate(Facts vs Perception)

* Make a Decision

* Intervention

* Disposition

* Communication

* Follow-up


Type of Problems

*Clinically poor

*Insubordination

*Low productivity

*Anger Management

*Sexual Harassment

*Complainers

*Emotional Problems

*Tardiness Dropping shifts

*Personal Hygiene Issues


Do Not let the Problem Physician become the

Problem Director!!







Physician Contracts

Hospital Contracts




"Top box" patient satisfaction scores for Poudre Valley Hospital


Patient Satisfaction and HCAHPS Survey Responses of Patients' Hospital Experiences: Davis Hospital and Medical Center



Understanding Expectations is the Key


The First Reason to Get Customer Service is.....

It Makes Your Job Easier!


Do You Offer Good Customer Service?

It Depends!


Positive

Proactive

Confident

Competent

Compassionate

Communication

A-Team Members

Teamwork

Trust

Teacher

Does whatever it takes

Sense of humor

Moves the meat


B-Team Members

Late

Constant

Complainer

Can’t do

Always surprised

Negative

Reactive

Confused

Poor communication

Lazy


How many B-Team members does it take to destroy

an entire shift?


What’s a good doctor?

Doctor’s courtesy

Doctor Took Time to Listen

Doctor Informative

Doctor’s concern for Comfort


What’s an “A” team nurse?

1. Nurse’s courtesy

2. Nurse took time to listen

3. Nurse’s attention your needs

4. Nurse informative regarding treatment

5. Nurse’s concern your privacy


What’s a good patient?

IntubatedParalyzedOn a ventilatorOrphan (No Family) Speaks our languageDoesn’t come backIn and Out FastWants Only One Thing Compliant (Wants it OUR Way)


What’s the point??





Billing and coding






Recruitment

Retention

Orientation


Orientationessential components

Corporate structureHospitalDepartmental/ClinicalCritical ComponentsChartingPoliciesPatient flowOutsidersEssential Provider scope





Billing and coding





Conflict



Risk management

Legally interviewing, hiring and terminating

Containing cost while providing prudent care

Driving hospital quality



Characteristics of meetings

Well Conducted

Time Efficient

Meaningful

Focused


Objective of meetings

To have or not to have a meeting

How to prepare in advance

How to conduct a meeting

Avoiding traps and terrorists

What to do after the meeting ends


To have or not have....

Is it necessary?

Can it be avoided?

or

Two Reasons for Meetings

- Problem solving- Information Exchange

- Nothing of significance to discuss- No decisions to be made- The leadership doesn’t want/need permission

Reasons to avoid meetings


Setting the Seating


Conduct the Meeting


Concluding the Meeting


Negotiating Skill



Engineering patient flowI: theory, metrics and application, directing change



Patient Complaint Management

Perceived Injury

Perceived Mistreatment

Expectations went Unmet

People complaint because:


What does your administrator want from you?

Problem solvers

Documented evidence

Satisfied customers


What does your ED staff want from you?

Collaboration and Problem Solvers

We must satisfy more than just the patients’ concerns


What does your EMS provider want from you?

They want to be treated like they are worth > $2,000 each time

they come....


Satisfaction defined:

Pre-purchase expectation are met or surpassed

....so...

Creating satisfaction requires meeting, surpassing or lowering expectation


Create DISSATISFACTION by Rising Expectations

SATISFACTION Requires Meeting, and perhaps Lowering Expectation


Create DISSATISFACTION by Rising Expectations

Nurse “ The doctor will be in a minute.”

You “ I’ll be right back.”

Third party “ Just go to the ER and get X-ray.”


Patient Complaint Management


Negotiating Skill



Engineering patient flow: theory, metrics and application, directing change



Engineering patient flow


ED patient flow


Re-engineering patient flow


Let’s build our ED!!


actep2014 ed director

Health & Medicine

emergency room5wednesday

emergency department9wednesday

new physician recruiting

new ed4wednesday

developing leadership

new staff members

lasting change

importance piyaporn