1 Physician Leadership and Incentives to Sustain Change Michael Gilbert, MD Associate Medical Director

2 St. Joseph Heritage Medial Group Specialty: 40 primary care providers Geographic location: Central Orange County Three clinic sites: Orange, Tustin and Santa Ana Group Ownership: Physician shareholders Affiliation: St. Joseph Health Care System

3 Focus on Patient Experience Chose patient experience to drive our change improvement initiative Greatest potential for improvement in patient experience Selected Access as an improvement initiative –Telephone Calls –Appointment Access –Office Wait Times Measure improvement –Group level: Patient Assessment Survey –Provider level: Avatar International Monthly survey Quarterly provider feedback

4 Creating an Infrastructure for Change Participated in CQC’s Optimizing Performance Series Formed a Performance Improvement Team –Team charter –Sanctioned by and reports to Board of Directors Chose high profile physician and administrative leaders as team members: –4 physicians: BOD member, Dept. Chair, Medical Director –5 administrators: Directors of Operations, Performance Improvement, Quality, Practice Development & Health Promotion Full monetary support by administration and medical group

5 Leadership Strategies Improvement Initiative: 1. Appointment Access 2. Office Wait Times 3. Telephone Access Leadership Strategy: Offering Financial Incentives Imposing Fine System Involving Physicians in the Improvement Process

6 Advanced Access Initiative: Financial Incentives Developed a financial offering through our Provider Service Agreement to motivate providers to partner with administration in opening up schedules Agreed to and approved by Medical Directors, Board of Directors and senior administrators Communicated agreement with physicians

7 Advanced Access Outcome Met with all 40 providers in 4 months Changed schedules to create more patient accessibility –Cleaned up schedules for: days and hours of patient care, built in physician preferences and convoluted historical restrictions –Resulted in: any/any schedule for all providers, allowing some preferences rather than hard wired restrictions

8 Office Wait Time Initiative: Imposing Fines Generated reports through AEMR Published data to physicians Informed physicians of standard of care In process of implementing a fine system for providers who consistently arrive late

9 Outcome Modeled the fine system after a similar system of reporting notification for completion of medical record tasks Lesson learned: Figure out what works in your medical group for similar problems and replicate it

10 Telephone Access Initiative: Involve Physicians in the Process Include staff and physicians in the entire initiative from start to finish – Salsa Worker! Recognize and clean up messiness in the process Align success in performance improvement initiative with physicians financial operations and quality bonuses Cut teeth on reporting and transparency

11 Outcomes

12 Data and Reporting Improvement initiatives should be measurable (CQC tenet) Data must be: –Accurate to withstand physician scrutiny –Shared at frequent intervals –Presented in provider level detail –Shared with entire team: physician, MA and receptionist

13 Quarterly Provider Reports

14 Transparency of Data

15 Provider Level Data

16 Provider Incentives Harper Award bonus –Incorporate performance goals into long standing tradition of measuring quality Provider Service Agreement incentive –Tied in performance goals to physicians financial operations Promote team incentives –Align physician goals with staff and leadership incentives –MAs and reception staff receive monetary incentive for improvement in key initiatives