The Clinical Practice Program The Seven Pillars Model: A presentation based on The Clinical Practice Program: A How-to-Guide for Physician Leaders on Starting Up a Successful Program, by Terrence J. Loftus, MD, MBA. Copyright © 2016 – Loftus Health, LLC. – www.LoftusHealth.com. The Seven Pillars Model Copyright © 2016 - Loftus Health, LLC - www.LoftusHealth.com

The Seven Pillars: Are higher level elements that differentiate successful programs from unsuccessful programs. Serve as a foundational structure for successful program building. Focuses leadership on the organizational elements required to build a successful program. Are transferable from program to program. Help healthcare leaders become successful by building a useful skill- set that produces better quality, improved utilization and cost savings. Copyright © 2016 - Loftus Health, LLC - www.LoftusHealth.com

The Seven Pillars Purpose: Understanding why our program exists. Engagement: Motivating stakeholders to achieve success. Communication: Educating and learning through mutual feedback loops. Infrastructure: Building a strong foundation for effectiveness and sustainability. Accountability: Ensuring responsibility through informed governance. Leadership: Building trust in competent and inspirational leaders. Performance Improvement: Getting better through intentional effort. Copyright © 2016 - Loftus Health, LLC - www.LoftusHealth.com

Purpose Copyright © 2016 - Loftus Health, LLC - www.LoftusHealth.com

Purpose To identify opportunities for quality improvement and affect clinical practice change to improve patient care. To develop the resources, financial reserve and skill sets needed to improve clinical operations and care delivery. To find the right balance between quality and cost that will lead to the delivery of excellent patient care and a great work environment for those who provide that care. To evolve into a Clinical Practice Program that will become fully integrated into population health management. In summary, it is because a formal organized approach to clinical practice implementation produces better outcomes at a lower cost compared to not having a program. Copyright © 2016 - Loftus Health, LLC - www.LoftusHealth.com

Engagement Copyright © 2016 - Loftus Health, LLC - www.LoftusHealth.com

Ten Rules for Physician Engagement Rule #1: If you want physician engagement, then avoid behaviors and language that are known to disengage them. Rule #2: If you want physician engagement, then proactively mitigate the effects of unavoidable actions that are considered disengaging to physicians. Rule # 3: If you want physician engagement, then start with what they are already engaged in doing. Rule #4: If you want physician engagement, then help them solve a problem they are already attempting to solve. Rule #5: If you want physician engagement, then appeal to their sense of fairness and what is right for the sustainability of their practice, their service line or even the hospital in which they practice. Copyright © 2016 - Loftus Health, LLC - www.LoftusHealth.com

Ten Rules for Physician Engagement Rule #6: If you want physician engagement, then appeal to their interest and passion for science. Rule #7: If you want physician engagement, then appeal to their competitive spirit. Rule #8: If you want physician engagement, then empower them to create their own solutions. Rule #9: If you want physician engagement, then listen to them when they are upset, because they are already maximally engaged and may be harboring ideas worth considering. Rule #10: If you want physician engagement, then communicate with words that positively reflects the things they value. Copyright © 2016 - Loftus Health, LLC - www.LoftusHealth.com

Communication Copyright © 2016 - Loftus Health, LLC - www.LoftusHealth.com

Communication: Language The Language of Clinical Practice Implementation Standardization Positive Deviance & Best Practice Structure, Process, Outcomes Diffusion of Innovation Copyright © 2016 - Loftus Health, LLC - www.LoftusHealth.com

Communication: Stakeholders Clinical Practice Council Agenda & Meeting Minutes Medical Staff Utilize Medical Staff Services & Newsletter C-Suite & Senior Management Consistent message as with Medical & Nursing Staff Nursing & Ancillary Staff Utilize system process already in place Copyright © 2016 - Loftus Health, LLC - www.LoftusHealth.com

Infrastructure Copyright © 2016 - Loftus Health, LLC - www.LoftusHealth.com

Infrastructure Infrastructure is the foundation on which any program will be built. Infrastructure refers to all the people, process, technology and cultural elements that are required for the successful implementation, management and sustainability of a program. The specific elements are categorized according to people, process, technology and culture. Copyright © 2016 - Loftus Health, LLC - www.LoftusHealth.com

Infrastructure: People Physician Lead Nursing Lead Administrative Representative Data Analyst Research Analyst Multidisciplinary Representatives Administrative Assistant Copyright © 2016 - Loftus Health, LLC - www.LoftusHealth.com

Infrastructure: Process Regular Meetings Maintain Agenda and Meeting Minutes Established Reporting Structure Communication Plan Data Review Goal Setting Work-flow Copyright © 2016 - Loftus Health, LLC - www.LoftusHealth.com

Infrastructure: Technology Electronic Medical Record Risk-adjustment & Benchmarking Capability Centralized Storage for Documents Tele-conferencing Capability Copyright © 2016 - Loftus Health, LLC - www.LoftusHealth.com

Infrastructure: Culture Quality Improvement Program Recognition Awards Truven, Baldridge, Healthgrades, etc. Clinical Practice Supportive Environment Copyright © 2016 - Loftus Health, LLC - www.LoftusHealth.com

Accountability Copyright © 2016 - Loftus Health, LLC - www.LoftusHealth.com

Accountability Which Model? Centralized Model Decentralized Model Pros: Scale, Subject matter expertise, greater impact to more patients Cons: Legal issues with coordinating facilities in holding companies, May not be supported by independent medical staffs Decentralized Model Pros: Appeals to more independent medical staffs, May be more desirable for communities with specialized needs, Closer working relationships with physicians and nurses. Cons: Less impact on scale and may not be able to coordinate with other facilities easily. Best model is the one that creates real results and achieves your purpose. Copyright © 2016 - Loftus Health, LLC - www.LoftusHealth.com

Accountability: Governance CPC CPT Gen-Surg Facility 1 Implementation Team Facility 2 Ortho Implementation Team Facility 2 Implementation Team Cardiology Facility 1 Implementation Team Hospitalists CMO & Senior Management CPC: Clinical Practice Council CMO: Chief Medical Officer CPT: Clinical Practice Team Copyright © 2016 - Loftus Health, LLC - www.LoftusHealth.com

Leadership Copyright © 2016 - Loftus Health, LLC - www.LoftusHealth.com

Leadership: Expectations Physicians Value patient care, scientific method, autonomy. They want a say in how they will be expected to practice and clear expectations on performance. Administration Will be held accountable for the success of the business operations. Define and shape their expectations of success in specific terms that appeals to all stakeholder groups. Nursing Value patient care & will be accountable to administration. Understand their incentives and align goals whenever possible. Conflict Resolution Clinical Practice Council Data is a great starting point, since everyone is usually interested in seeing it. Copyright © 2016 - Loftus Health, LLC - www.LoftusHealth.com

Performance Improvement Copyright © 2016 - Loftus Health, LLC - www.LoftusHealth.com

Performance Improvement The Ten Step Plan Establish a Baseline Benchmarking Identify Opportunity Attribution Analysis Evidence Based Medicine Practice Based Medicine Plan & Do Process Measures Outcome Measures Standardize Copyright © 2016 - Loftus Health, LLC - www.LoftusHealth.com

Performance Improvement SMART Goals Specific Measurable Achievable Realistic Time Bound Copyright © 2016 - Loftus Health, LLC - www.LoftusHealth.com

Dashboard Copyright © 2016 - Loftus Health, LLC - www.LoftusHealth.com

QUESTIONS Please contact Dr. Terry Loftus at TerryLoftusMD@gmail.com or visit his website at www.LoftusHealth.com. Copyright © 2016 - Loftus Health, LLC - www.LoftusHealth.com