1. 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.
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The Seven Pillars Model
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2. 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.
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3. 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.
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4. Purpose
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5. 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.
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6. Engagement
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7. 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.
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8. 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.
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9. Communication
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10. Communication: Language
The Language of Clinical Practice Implementation
Standardization
Positive Deviance & Best Practice
Structure, Process, Outcomes
Diffusion of Innovation
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11. 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
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12. Infrastructure
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13. 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.
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14. Infrastructure: People
Physician Lead
Nursing Lead
Administrative Representative
Data Analyst
Research Analyst
Multidisciplinary Representatives
Administrative Assistant
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15. Infrastructure: Process
Regular Meetings
Maintain Agenda and Meeting Minutes
Established Reporting Structure
Communication Plan
Data Review
Goal Setting
Work-flow
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16. Infrastructure: Technology
Electronic Medical Record
Risk-adjustment & Benchmarking Capability
Centralized Storage for Documents
Tele-conferencing Capability
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17. Infrastructure: Culture
Quality Improvement Program
Recognition Awards
Truven, Baldridge, Healthgrades, etc.
Clinical Practice Supportive Environment
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18. Accountability
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19. 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.
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20. 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
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21. Leadership
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22. 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.
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23. Performance Improvement
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24. 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
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25. Performance Improvement
SMART Goals
Specific
Measurable
Achievable
Realistic
Time Bound
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26. Dashboard
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27. QUESTIONS
Please contact Dr. Terry Loftus at or visit his website at
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