The Seven Pillars Model The Robotics Program A presentation based on The Robotics 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 Program structure drives performance. Less structured Robotics Programs had a complication rate that was 46% greater than Robotics Programs that were highly structured. Less structured Robotics Programs were found to have costs that were 37% higher compared to highly structured programs. If you want to improve patient care, resource utilization and cost, then develop a highly structured Robotics Program. Independent study at a large integrated delivery network. Copyright © 2016 - Loftus Health, LLC - www.LoftusHealth.com

Comparison of Programs Comparison of the observed to expected complications between highly structured Robotics Programs (>75%) and less structured Robotics Programs (<75%). Comparison of the observed to expected cost between highly structured Robotics Programs (>75%) and less structured Robotics Programs (<75%). 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 Stakeholder Groups Robotics Committee Medical Staff Agenda/Minutes Medical Staff Utilize Medical Staff Services & Newsletter C-Suite Consistent message as with Medical & Nursing Staff Nursing & Ancillary Staff Utilize system process already in place Community Coordinate with Marketing & Public Relations 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 Anesthesia Representative Multidisciplinary Representatives CVT, ENT, Gen-Surg, OB/Gyn, Urology Data Analyst 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 Credentials & Privileges Copyright © 2016 - Loftus Health, LLC - www.LoftusHealth.com

Infrastructure: Technology Robot/Case Mix Alignment 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 Epicenter/Center of Excellence Quality Awards Robotics Supportive Environment Copyright © 2016 - Loftus Health, LLC - www.LoftusHealth.com

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

Accountability Which Model? Medical Staff Model Administrative Model Pros: Established infrastructure, Established governance, Strong ties to Medical Staff Leadership Cons: Potential for interdepartmental squabbles, Nursing & Administration typically do not have voting rights, may not be effective at changing operational practices Administrative Model Pros: Multidisciplinary approach promotes inclusivity among stakeholders, Strong ties to C-Suite, Greater access to resources and data, greater support for operational changes Cons: May lack adequate skills around organizing physician meetings, Inexperience with dyad leadership model can create conflict among the dyad leadership Best model reports to both the Medical Leadership (MEC) and Administrative Leadership (C-Suite) 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 Community Work with Marketing & be ready with elevator speech. Robotics Committee 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 Level System Operating Room Medical/Surgical Unit Surgeon/Team Metrics Utilization Volume Throughput Cost Quality 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 Example 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