practicing excellence: how to align physicians in a shared agenda stephen c. beeson md studer group...

PRACTICING EXCELLENCE:How to Align Physicians in a

Shared Agenda

Stephen C. Beeson MDStuder Group Medical Director

Sharp Rees-Stealy Medical Group

The Objective of our Time

Create physicians that will align with organizational efforts to execute positive

outcomes in quality, safety, cost- effectiveness, the patient experience and evidence-based care

The Physician Change Equation

Physician Behavioral

Change

Physician Buy-in

Physician Training

Performance Feedback

Performance Incentive

Effective Physician

Leadership

Trust in Hospital

LeadershipManagement of misaligned

Behaviors

Recognition

Selection and Orientation

Visibility of Organizational

Culture

Physicians Align When

They trust those leading the effort

There is compelling evidence this is necessary

Their role is clear and well articulated

Physician leaders amplify the alignment message

They are invested to “get it done”

The destination is about a mission they can “back”

Those around them seem to be doing it

Diagnostic Criteria for Physician Engagement

Physicians are aware and support organizational goals

Physicians actively involved in quality, safety, and service initiatives

Physician behaviors are consistent with the organizational “signature”

Physicians will say/do something if standards are breeched

What We Need Physicians To Do:

Comply with evidence, clinical protocols and order sets

Deliver the patient experience

Manage cost of care

Support the group mission

Foster system safety

4 Tactics to Create Physician Alignment

Creating physician buy-in

Building physician trust

Aligning physician leadership

Training physicians

Tactic #1: Creating Buy-in

He who has a compelling enough Why, can overcome any How

Basic Truths about Buy-in

If physicians resist or protest, it is likely related to ineffective buy-in

This is a key leader responsibility and ability

How Do You Create Buy-in For:

The patient experience

Cost reduction

A culture of safety

Reduction of variance

Guidelines for Creating Buy-in

Believe it yourself

Know the evidence

Translate data to stories

Be intense

How Do You Know If You Have Made the Case Sufficiently?

Physicians are asking when it will happen

The uptake for initiatives is fast

Powerful group sentiment that “we must do this”

Leaders have articulated an irresistible future

Vocal resistors are seen as outliers

Tactic #2: Creating Physician Trust

If physicians don’t trust those that lead them, they will, at best, become indifferent and

uninvolved in organizational efforts.

More likely, they will protest and resist efforts to defend their differing agenda.

Trust Defined

“The state of readiness for unguarded interaction with someone or something”

Tenants of Trust

Capacity for trusting

Perception of competence

Perception of intentions

TRUST BUILDER: Including Physicians in Strategic Planning and Goal Setting

Strategic planning is setting the course for the future

Defining an overarching vision

Identifying strategies and actions to execute the vision

Setting system goals

Allocation of resources

Why Include Physicians:

The dialogue and process of planning is as important as the plan itself

Physician will own and support a plan they help create

Open and responsive dialogue fosters physician trust

Planning for a collective future will reduce physician suspicion of administrative activities

TRUST BUILDER: Survey Physicians

To deliver an effective treatment plan, leaders must diagnosis what physician issues need to be fixed

If we could fix three issues for you tomorrow, what would those be?

1.

2.

3.

Leadership

to

Physicians

TRUST BUILDER: Medical Staff Hotline

We are here to provide you the best place to care for patients, 24 hours a day, 365 days a year. If

there is anything that falls short of what you need, let us know and we will do what is necessary to make it right. Our leadership team will respond and communicate a response within 48 hours of

your call. Guaranteed.

TRUST BUILDER: Physician Recognition

Recognizing physicians for contributions, involvement and going above and beyond is one of the simplest and most effective ways to build physician trust with leaders and loyalty to a system

Tactic #3: Aligning Physician Leadership

“Leadership has been identified as the most important ingredient in transformational

improvement.”

From Joint Commission Resources presentation; Executive quality improvement survey results.

Journal of Patient Safety. 2 March 2006

The Role of the Physician Leader

Create and project a specific destination

Create consensus around that destination

Create goals to verify “arrival” at the destination

Deploy and manage strategies to execute goals

Measure, report and communicate progress

Convey expectations

Manage low performance

Recognize high performance

The True Role of a Leader

To get others to do what must be done because they want to do it

The Pathway to Effective Physician Leadership

Selecting Physician Leaders

Developing Physician Leaders

Leader Selection

First who, then what

Signs of the Wrong Leaders

Defenders of “physician turf”

Indifferent or disinterested

Changes position depending on who they are talking to

Fail to respond when there is a clear violation to the system way of doing things

Physician Leader Selection Criteria:

Intensity and passion for the mission and loyalty to the system

A desire to lead

Respected by colleagues

Has led something in the past

Can defend a position in face of resistance

Physician Leader Selection Criteria

Strong presenter and ability to communicate in a straight-forward fashion

Subject matter expert (or willing to learn)

An ability to convey performance expectations to others

Personal connection to those around them

Guiding Leader Selection Principles

Clear position responsibilities

Appointment/election process promotes leaders that have a high probability of success

Take time for this - get it right

Physician Leadership Development

We didn’t learn this during medical school or residency

Trainable Physician Leadership Skills

How to present and communicate a compelling Mission and Vision

How to make the case for change

How to round on colleagues

How to run a meeting

How to manage a disruptive colleague

How to recognize high performance

Understanding the external health care environment

Physician Leadership Development

Invest in the development of the physician leadership team

Physician Leadership Academy

Creates shared, simultaneous learning

Participation is required for that part of the leadership team

Training Works When:

We believed the change was important (buy-in)

The destination is crystal clear (vision)

There was a compelling need to change (current performance)

We knew how to do the change (training)

Expectations were clear and disseminated (behavioral standards)

Our change effort was measured and reported back

Leader Performance Predictors

Proper leader selection

Development of skills to execute

Clear description of responsibilities

Assigned goal set for full time leaders in area of responsibility

Leader assessment by the execution of goals

Performance transparency among the leadership team

A Leader’s Self Reflection…

Do I love the work that I do?

Do I convey a sense of hope?

Do I honor my word?

Am I interested in others?

Do others trust me?

When things go poorly, how do I respond?

Action From Today

In order to “Align Physicians” one must first diagnose physician relations

Outreach to physician for inclusion in organizational strategy

Develop communication mechanisms to convey mission, strategy and results

Invest in training and developing physician leaders