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Session #14: Entering Shared Risk for Community

Hospitals Through Physician Engagement

Greg Stock, CEO Thibodaux Regional Medical Center

Mark Hebert, MD, FACSSurgical SpecialistThibodaux Regional Medical Center

Pre-Session Poll QuestionWhich stage best describes the engagement level of the majority of physicians in your organization?

a) Aversionb) Apathyc) Engagedd) Unsure or not applicable

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Thibodaux Regional Medical Center

2

1. Number of hospitals/clinics/providers: 185-bed regional medical center, 1200 employees, 150 active staff physicians.

2. Healthcare Model: Parish Hospital (similar to county hospital).

3. Mission: To provide the highest quality, most cost-effective healthcare services possible to the people of Thibodaux and surrounding areas.

4. Strategic focus: Achieve Patient-Centered Excellence.

“To improve is to change; to be perfect is to change often.”

-Winston Churchill

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Thibodaux’s Journey

3

1. Survive and Thrive• Independent, community hospital

• Compete with larger healthcare systems• Triple Aim• Data-driven collaboration between physicians and hospitals

2. Lean Organization• Experts at identifying and addressing waste in hospital processes,

workflow, etc.• Hospital-wide Six Sigma implementation in 2000• Hospital-wide Lean implementation in 2002• DIGs: Designed to resolve staff issues quickly and effectively• DMAIC: Define, Measure, Analyze, Improve, and Control

3. The Next Step In the Journey• Reducing clinical variation with physicians (process improvement)• Culture is King• Physician leadership and engagement• Adding data and analytics to the arsenal

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Outstanding Patient Satisfaction

The Beacon of Excellence Award for OP Services

• Top 3 hospitals in the nation

Guardian of Excellence Award for OP & Home Health*

*Formerly the Summit Award

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Outstanding Patient Satisfaction

High HCAHPS Scores

HealthGrades IP Patient Experience Award• Top 5% in the country

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Leapfrog Safety Score Measures

• Foreign Objects Retained After Surgery

• Pressure Ulcer–Stage 3 and 4

• Falls and Trauma

• Central Line Blood Stream Infections

• Catheter Associated Urinary Tract Infections

• Surgical Site Infections

• Collapsed Lung due to Medical Treatment

• Breathing Failure after Surgery

• Postoperative Blood Clots in Legs and Lungs

• Wounds Splitting Open after Surgery

• Accidental Cuts or Tears from Medical Treatment

• Readmissions

• Length of Stay

• CPOE Implementation

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Top Clinical Quality

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Top Clinical Quality

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Thi-bo-

daux

Ter-re-

bonne

Ochsner

West Jef-

ferson

Our Lady of

the Lake

East Jef-

ferson

Teche Our Lady of Lour-des

Lafayette

Gen-eral

Reg Grp

Best Prac-tice

$3,000

$3,500

$4,000

$4,500

$5,000

$5,500

$6,000

$6,500

$7,000

$7,500

$4,478

$6,026 $5,914

$6,299$6,427

$5,279 $5,227

$7,105

$5,882$6,016

$4,923

Medicare Cost per Discharge (CMI ADJ) – 2014

Financial Strength & Integrity

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85% Reduction in 6 Years!

32% Reduction in Total Hospital Acquired Infections in 6 years

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83% Reduction in 6 Years!

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“Triple Aim”

• Great Patient Experience• Excellent Clinical Quality• Cost-Effective Care

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Passion As A Value

Performance From The Heart

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The Opportunity

14

1. What baseline measures, quantitative or qualitative, did you track that helped illustrate the pain point?

• Severe Sepsis• Mortality rate at the beginning of care transformation initiative: 11%

(National average 14-18%)• Months into deployment maintaining a 7% mortality rate

2. How and why has this been a problem, pain point, or opportunity that you chose to prioritize?

• The Next Step on the Journey: Sepsis Mortality • Consistent, sustained, top performance• Strengthen physician engagement

3. What current processes or technologies, if any, were you previously using to address the issue?

• Lean Principles• Three-systems approach:

• Content system in place• Lacking robust measurement system • Engagement and sharing of data

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Quality and cost: An inverse relationship

No compliance to bundle –

cost goes up

Full compliance to bundle (better quality outcomes)

– cost goes down

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Poll Question #2

16

Which do you feel would be the most important element in your organization to increase physician engagement?

a) Create a culture of continuous improvement and collaboration

b) Develop a shared vision and strategy

c) Address concerns regarding quality improvement initiatives in a timely fashion

d) Data and analytics that are useable, comprehensive and drive action

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The “How”

17

1. Steering Team• Triad of physician leaders• Participation and support critical to drive change• Assisted in the selection of care processes to address

2. What tools did they have (EDW? Quality improvement? Analytics? Resources?) • Lean Principles• Comprehensive database

• Interventions• Outcome measures – cost, quality (mortality/LOS), patient experience

• All anchored in the Triple Aim

3. What was your initiative goal? • Reducing clinical variation to lower serious sepsis mortality rates and contain cost• Drive tangible increases in physician engagement

4. What were the success measures you established up front, and what were your targets to track and report?

• Early Recognition: Increase utilization of the early recognition protocol in the ED with 90% compliance to identified practice measures

• ED Sepsis Triage Protocol: Increase utilization of the sepsis triage protocol for patients with initial SIRS criteria and suspected sepsis from 61% to 75%

• Physician Evaluation: Physician evaluation for UNSTABLE patients meeting SIRS criteria and suspected infection within 15 minutes from arrival, and evaluation for STABLE patients meeting SIRS criteria and suspected infection within one hour from arrival

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The “How”

18

5. How did you collect, validate, and analyze the data? • Cross-functional workgroup team met weekly • Validated algorithm used to identify at-risk patients

6. What was the intervention(s) chosen and why? • Three and Six Hour Bundle Compliance• Improve early recognition of sepsis

7. How did the team collaborate with and get buy in from others (leaders, sponsors, clinicians, front-line workers) to implement the intervention?

• Relationship, relationship, relationship• Like a marriage, each partner gives 100%—100%• Appealed to physician’s passion for medicine and easing patient suffering• Commitment from executive leadership to drive responsible change• More efficient/lower costs ≠ slash-and-burn cost-cutting, holding back care to meet

cost expectations• Physicians as evangelists

• 1:1 physician communication critical to success• Sharing sepsis success story with entire organization

8. How did you deploy and implement the intervention? (training, education, materials, etc.)• Training on new Advanced Application, Dashboards, and Protocols

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Future Plans

19

What issues will the team address next?

• Speed but not blinding speed

• Evolution of culture of continuous improvement and collaboration

• Preserve the gains from sepsis initiative and keep moving forward

• Acceptance of change becomes the norm

• Drive true care transformation

• Rigorous and honest conversations about cost/reducing waste

• Patient and quality always at the forefront

• Wellness as a priority

• Groom future physician leaders

• Seamless transition of progress and process over time

• Ensures continuous engagement with executive leaders

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Lessons Learned

20

1. Physician leadership is essential to success

2. Physician-to-physician communication

3. 100% commitment from physicians and executive leadership; it’s not a 50%—50% relationship

4. Cost is NOT a four-letter word

5. Data must be easy to access, digest, communicate, and make actionable

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Analytic Insights

AQuestions &

Answers

21

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Choose one thing…

22

Write down one thing will you do differently after hearing this presentation

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Thank You

23

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Session Feedback Survey

1. On a scale of 1-5, how satisfied were you overall with this session?

1) Not at all satisfied

2) Somewhat satisfied

3) Moderately satisfied

4) Very satisfied

5) Extremely satisfied

2. What feedback or suggestions do you have?

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Upcoming Speakers

3:45 PM – 4:35 PM

16) Delivering Excellence at Stanford Health Care

Amir Dan Rubin, President and CEO, Stanford Health Care

4:35 PM – 5:00 PM

17) The Future World of Value-Based Healthcare (Documentary featuring Michael Porter)

Caleb Stowell, MD, Vice President, Research and Development, International Consortium for Health Outcomes Measurement (ICHOM, Senior Researcher, Harvard Business School)

Location

Grand Ballroom

Grand Ballroom