1. Performance Improvement: What Leaders Need to Know to Succeed March 15, 2016 Dana Richardson, RN, MHA Dana.richardson@ama-assn.org

2. Introduction PCPI is a non-profit, multi-stakeholder, organization focused on improving the care provided by the health care delivery system –Measurement science –National Quality Registry Network (clinical registries) –Quality improvement program My perspective is based on: –15 years as a acute care nurse in a 350 bed hospital –7 years working for a 350 physician clinic and health plan to develop first QI program –8 years working for a state hospital association to develop first QI program which included public reporting –5 years working at the AMA within the PCPI program Performance improvement is everyone’s business PCPI organizations represent: Accrediting/licensing Consumers/patients Employers Health care professionals Health information technology Health plans Hospitals/clinics Pharmacies Physicians Quality Improvement

3. Health care environment today Health care largest sector of GDP; public & private payers pushed to decrease costs Cost shifting to consumers & providers Quality reporting systems, meaningful use & payment modifier → MACRA Pay for performance without the right measures to evaluate quality or costs High participation costs; seeking ability to collect data through the care process Collection & integration of data from EHR, patients, mobile devices & operational systems Many measures, few measures that matter Lack of leadership support; punitive culture Fragmented local & national Infrastructure to support improvement Lack of time Patient-centered care Chronic disease/aging population Need information at the point of care about “patients like me” Need information for selecting insurance plan, provider & clinician Seeking lower out of pocket costs Affordable care act Triple aim: better health, better health care, appropriate cost Systemization & integration of care Use of EHR/health IT (providers and patients) New diagnostic/therapeutic modalities Data driven decision making System Factors Consumer/ patient Business models Providers/ clinicians

4. Trends I have observed Nearly all health care professional want to do the “right thing” for their patients, but there are many “masters” with poorly aligned incentives There has been a growth in the evidence to support infrastructure development in the acute care setting, but many of the required knowledge bases are still a relatively “new science” or need to be adapted from other sectors Improvement model changing within organizations from the “QI department” to improvement integrated into every department Changing business model is impacting who composes the leadership team and characteristics of leaders –Chief quality officer or systems integration officer part of the leadership team in many organizations –A desired background for a CEO is changing from financial to clinical Most health care professionals have not received the training they need to be successful in performance improvement

5. Core competencies Leadership –Culture –Change management –Innovation Project management Team development and management Improvement methods and tools –PDCA, IHI collaborative model, Lean, Six Sixma –Flow charts, fishbone diagrams –Facilitation Health care delivery system/processes Health care policy Evidence based medicine External and internal payment structures and incentives Clinical informatics –Population health evaluation –Benchmarking –Reporting Socio-ecological determinants of health

6. Connecting the dots Leaders must be able to translate improvement into the language of the people they are speaking to –BOD: impact on reputation, legal status, financials, market, staff, patients and community –Finance: financial impact (cost AND financial benefits) –Information technology: data, HIT system and application requirements –Physicians, nurses and other practitioners: impact on patient outcomes, staff and financials –Communication and marketing: Value to patients, organization and community Leaders need to lead by example and be fully committed to improvement

7. Parting thoughts Many organizations are in the process of developing their improvement infrastructure at the same time that they are addressing other critical needs (e.g. payment reform, technology, systemization, team based care) The need for performance improvement knowledge and expertise is rising quickly –All health care participants need to understand the “basics” –Demand out weighs supply of “trained” experts –Vary few formal training programs, most gain experience through short training programs, certification and “boots on the ground” experience The AMA and PCPI are open to partnering with educators to meet our shared goals of better patient care and higher career satisfaction for health care professionals