PRACTICING EXCELLENCE: How to Align Physicians in a Shared Agenda Stephen C. Beeson MD Studer 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 Leadership Management 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

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