Clinical and Administrative Medical Leadership: Enhancing Rehabilitation Care
Delivery
Alan K. Novick, MD
Rehabilitation Medical Director
Memorial Rehabilitation Institute
ObjectivesUnderstand the physiatrist’s role in developing an integrated delivery system of care and how integrated care can improve outcomes
Understand the impact of different practice models (private practice, employed or contracted) on developing an integrated system of care and program development
Identify leadership skills that can impact delivery of care and potentially maximize program growth
Understand difference between medical director and medical leadership
Start a conversation!
The Role of Medical Director
The Young Physiatrist as Medical Director - Know What to Expect, "The Making of a Medical Director" course. 55th Annual Assembly of the American Academy of Physical Medicine and Rehabilitation, Miami Beach, FL November l993
The Changing Role of the Medical Director, American Academy of Physical Medicine and Rehabilitation 62nd Annual Assembly: San Francisco, CA Nov 2000
Medicare Medical Director Guidelines
Provides services to the rehabilitation unit and to unit’s inpatients for at least 20 hours per week
Is a doctor of medicine or osteopathy
Is licensed under State law to practice medicine or surgery
Has had, after completing a 1 year hospital internship, at least 2 years of training or experience in the medical management of inpatients requiring rehabilitation services
Role of Medical Director
Clinical– Direct patient care– Oversight of program
care
Administrative– Adherence to policies
CARF
Joint Commission
– Marketing– Leadership
Provide direction
Leadership“If your actions inspire others to dream more, learn more, do more and become more, you are a leader”– John Quincy Adams
“Innovation distinguishes between a leader and a follower”– Steve Jobs
“Leadership is the capacity to translate vision into reality”– Warren Bennis
Case Example: Integrated Leadership
Memorial Healthcare System– Journey from fragmented rehabilitation care to
an integrated systemHow?
Why?
Benefits?
Hollywood Memorial Hospital 1991
Safety net hospital
Opened 1953
753 beds
26 bed inpatient rehab unit– Expanded to 36 beds
Memorial Healthcare System 2006
5 Hospitals
3 Outpatient Therapy Centers
1 Nursing Home
1 Inpatient 36 bed Rehab Unit
12/06 System acquired Hollywood Medical Center– 336 bed hospital– 1 mile from MRH– 33 bed Rehab Unit
Development of a Rehab Hospital
Proposal to build 1 unit– Inefficient to have 2 units so close– Overcrowded in main hospital
Clinicians worked with architects
Opened 69 bed state of the art unit 6/09
Accomplishments
Built out new unit
High patient satisfaction scores
Excellent outcome measures – D/C home– FIM gains– Low D/C to SNF and return to acute
Volume growth approx 20% – ADC increased from 36 to 45
Trouble in Paradise
Phone call
“Can you come to a meeting now?”
“We want to go in a different direction”
Leadership FailuresMedical Director– Failed to recognize needs of organization– Lack of understanding of mechanism to implement
change– No education of Director’s value (self promotion)
Administration– Director without access to decision making
Common Failures– Lack of trust– Poor communication
Vision Statement
Vision: The Rehabilitation Institute of South Florida will provide a world class continuum of family and patient centered rehabilitation care for not only the residents of south Broward County but also the Southeastern United States
Vision Statement: ObjectivesDevelop the Rehabilitation Institute of South Florida to the level of a world class institution meeting all rehabilitation best practice standards
Achieve and maintain patient clinical outcome data at levels exceeding nationally recognized benchmarks as well as maintain patient satisfaction at the highest percentage
Develop and maintain external stakeholders (referring physicians, insurance carriers, etc.) to ensure appropriate patient census and enhanced revenues
Develop new product line and reorganize current structure to improve market visibility and scope of service
Create environment to retain and attract most outstanding therapy, nursing and medical staff with high employee satisfaction and engagement
Vision Statement: Action Plan
1. Reorganization of current organizational/leadership structure (6 months)– Allows branding and consistent product lines
across the continuum of care – Develop methodology and systems to utilize
entire continuum of care to diminish hospital readmission rates (6 to 12 months)
Vision Statement: Action Plan2. New product line development– Physician led sub-specialty clinics located in
outpatient therapy centers/ MRHS (1 year)– Expansion of outpatient service lines (stroke, brain
injury, orthopedics, industrial medicine, etc.)Identification of current therapists’ expertise (3 months)
Reorganize outpatient therapy centers to a disease specific treatment model (6 months)
Recruit expertise in areas of deficit therapist talent (1 year)
Evaluate market for expansion of number of outpatient therapy centers. Expansion would allow for a larger service area and improved Rehabilitation Institute of South Florida community brand recognition (6 months)
Vision Statement: Action Plan– Evaluate feasibility of a day treatment program (3 months) and if
feasible, development and implementation of program (18 to 24 months)
– Evaluate feasibility of a disabled driving program (3 months) and if feasible, implementation of program (18 months)
– Expansion of inpatient service lines
Increase inpatient rehabilitation available beds to appropriate market needs ( 2 years)
Develop and implement a TCU (18 months)– Develop a community transition program or find organizations
with which to partner to provide the service (2 years)– Develop an industrial rehabilitation program (18 months)
Dedicated workers’ compensation coordinator for system
Return to work program
Develop in conjunction with occupational medicine
Vision Statement: Action Plan3. Development of non-clinical services– Disabled athlete/sports program
Host focus groups of community providers of services and representatives of the disabled community to determine wants and needs to best position Memorial for success (6 months)
Recruitment of a leader (Recreational therapist) for the program (12 months)
Implementation of program (18 months)
Identification of a sponsor/donor (ongoing)
Vision Statement: Action Plan– Disability resource center which is available on web page and physically
within the institute
Identify and strengthen community affiliations such as Stroke Association, Parkinson’s Foundation, Florida Brain Injury Association and others (6 months)
Strengthen existing support groups (6 to 12 months)
Develop a formal peer visitor program including ability for peers to visit patients in acute care facilities (6 to 12 months)
Recruitment or identification of current employee to develop and maintain resource center (6 months)
– Develop a quarterly electronic newsletter to patients and stakeholders discussing current rehab issues and Memorial’s position on rehab care, success stories and new programs (12 months)
– Provide information regarding issues of concern for the disabled community (1 year)
Housing and transportation
Legal issues
Caregiver concerns and equipment
Recreation and leisure
Vision Statement: Action Plan
4. Continuing Education– Develop rehabilitation
annual symposium with national quality speakers (2 years)
– Continue to host multiple therapy/nursing conferences for specialized training/certification (ongoing)
Develop calendar of all Memorial rehabilitation educational opportunities or conferences on web site (1 year)
Vision Statement: Action Plan
5. Growth/Marketing– Development of a quarterly report to stakeholders as
to the composite outcomes of their patients as well as the general outcomes of our rehabilitation program (6 months)
– Strengthen existing referral patterns and develop new relationships (ongoing)
– Improve transition between different levels of care to ensure patients remain in the Memorial Healthcare System for each level (6 months)
Vision Statement: Action Plan6. Development of a rehabilitation research program– Recruitment of an appropriate research coordinator to
assist with development of new research projects and assist with current research projects (6 months)
– Identify national world class rehabilitation research organizations and develop relationships to begin joint research projects (18 months)
– Include research projects and any positive results in published outcome reports and electronic newsletter (18 to 24 months)
– Publish research in nationally recognized journal (3 years)
Implementation
Rehabilitation Steering Committee– Members
Administration
Directors of outpatient rehab programs, IRU, SNF and home health
Medical Director– Meet Frequently– Report progress and plans to organization leaders
Technology Task Force
Program Impact
Volume Growth
Improved transitions of care
Improved patient care
More available resources– Adaptive Sports and Recreation– Adaptive Driving– Advanced Technologies
Improved Reputation
Physician Impact: Employment
Benefits– Less financial risk
Able to add physicians
Improved satisfaction– Employed physicians able to be marketed– Better benefits (Insurance, retirement, malpractice)– Improved alignment of physician/hospital system
interests
DisadvantagesPotential less control
– Financial– Decision making
Future
Graduate Medical Education– Planned PM&R residency 2017
Expansion of Physician Staff and clinical programs
Adaptive Driving
Building out additional 17 IRU beds
Opening of Solarium
Medical Leadership
Essential for program growth and operation
Limited experience in medical training– Search for mentors and courses
ConclusionTips learned the hard way– Never act in anger– Understand power structure
Helps with implementation
– Don’t settle for the usualThink outside the box
– No excuses!– Embrace change– Always update those in power about progress
and accomplishments