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#HASummit14 Session #14: Entering Shared Risk for Community Hospitals Through Physician Engagement Greg Stock, CEO Thibodaux Regional Medical Center Mark.

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Presentation on theme: "#HASummit14 Session #14: Entering Shared Risk for Community Hospitals Through Physician Engagement Greg Stock, CEO Thibodaux Regional Medical Center Mark."— Presentation transcript:

1 #HASummit14 Session #14: Entering Shared Risk for Community Hospitals Through Physician Engagement Greg Stock, CEO Thibodaux Regional Medical Center Mark Hebert, MD, FACS Surgical Specialist Thibodaux Regional Medical Center Pre-Session Poll Question Which stage best describes the engagement level of the majority of physicians in your organization? a)Aversion b)Apathy c)Engaged d)Unsure or not applicable

2 #HASummit14 Thibodaux Regional Medical Center 2 1.Number of hospitals/clinics/providers: 185-bed regional medical center, 1200 employees, 150 active staff physicians. 2.Healthcare Model: Parish Hospital (similar to county hospital). 3.Mission: To provide the highest quality, most cost-effective healthcare services possible to the people of Thibodaux and surrounding areas. 4.Strategic focus: Achieve Patient-Centered Excellence. “To improve is to change; to be perfect is to change often.” -Winston Churchill

3 #HASummit14 Thibodaux’s Journey 3 1.Survive and Thrive Independent, community hospital Compete with larger healthcare systems Triple Aim Data-driven collaboration between physicians and hospitals 2.Lean Organization Experts at identifying and addressing waste in hospital processes, workflow, etc. Hospital-wide Six Sigma implementation in 2000 Hospital-wide Lean implementation in 2002 DIGs: Designed to resolve staff issues quickly and effectively DMAIC: Define, Measure, Analyze, Improve, and Control 3.The Next Step In the Journey Reducing clinical variation with physicians (process improvement) Culture is King Physician leadership and engagement Adding data and analytics to the arsenal

4 #HASummit14 Outstanding Patient Satisfaction The Beacon of Excellence Award for OP Services Top 3 hospitals in the nation Guardian of Excellence Award for OP & Home Health * *Formerly the Summit Award

5 #HASummit14 Outstanding Patient Satisfaction High HCAHPS Scores HealthGrades IP Patient Experience Award Top 5% in the country

6 #HASummit14 Leapfrog Safety Score Measures Foreign Objects Retained After Surgery Pressure Ulcer–Stage 3 and 4 Falls and Trauma Central Line Blood Stream Infections Catheter Associated Urinary Tract Infections Surgical Site Infections Collapsed Lung due to Medical Treatment Breathing Failure after Surgery Postoperative Blood Clots in Legs and Lungs Wounds Splitting Open after Surgery Accidental Cuts or Tears from Medical Treatment Readmissions Length of Stay CPOE Implementation

7 #HASummit14 Top Clinical Quality

8 #HASummit14 Top Clinical Quality

9 #HASummit14 Financial Strength & Integrity

10 #HASummit14 85% Reduction in 6 Years! 32% Reduction in Total Hospital Acquired Infections in 6 years

11 #HASummit14 83% Reduction in 6 Years!

12 #HASummit14 “Triple Aim” Great Patient Experience Excellent Clinical Quality Cost-Effective Care

13 #HASummit14 Passion As A Value Performance From The Heart

14 #HASummit14 The Opportunity 14 1.What baseline measures, quantitative or qualitative, did you track that helped illustrate the pain point? Severe Sepsis Mortality rate at the beginning of care transformation initiative: 11% (National average 14-18%) Months into deployment maintaining a 7% mortality rate 2.How and why has this been a problem, pain point, or opportunity that you chose to prioritize? The Next Step on the Journey: Sepsis Mortality Consistent, sustained, top performance Strengthen physician engagement 3.What current processes or technologies, if any, were you previously using to address the issue? Lean Principles Three-systems approach: Content system in place Lacking robust measurement system Engagement and sharing of data

15 #HASummit14 Quality and cost: An inverse relationship 15 No compliance to bundle – cost goes up Full compliance to bundle (better quality outcomes) – cost goes down

16 #HASummit14 Poll Question #2 16 Which do you feel would be the most important element in your organization to increase physician engagement? a)Create a culture of continuous improvement and collaboration b)Develop a shared vision and strategy c)Address concerns regarding quality improvement initiatives in a timely fashion d)Data and analytics that are useable, comprehensive and drive action

17 #HASummit14 The “How” 17 1.Steering Team Triad of physician leaders Participation and support critical to drive change Assisted in the selection of care processes to address 2.What tools did they have (EDW? Quality improvement? Analytics? Resources?) Lean Principles Comprehensive database Interventions Outcome measures – cost, quality (mortality/LOS), patient experience All anchored in the Triple Aim 3.What was your initiative goal? Reducing clinical variation to lower serious sepsis mortality rates and contain cost Drive tangible increases in physician engagement 4.What were the success measures you established up front, and what were your targets to track and report? Early Recognition: Increase utilization of the early recognition protocol in the ED with 90% compliance to identified practice measures ED Sepsis Triage Protocol: Increase utilization of the sepsis triage protocol for patients with initial SIRS criteria and suspected sepsis from 61% to 75% Physician Evaluation: Physician evaluation for UNSTABLE patients meeting SIRS criteria and suspected infection within 15 minutes from arrival, and evaluation for STABLE patients meeting SIRS criteria and suspected infection within one hour from arrival

18 #HASummit14 The “How” 18 5.How did you collect, validate, and analyze the data? Cross-functional workgroup team met weekly Validated algorithm used to identify at-risk patients 6.What was the intervention(s) chosen and why? Three and Six Hour Bundle Compliance Improve early recognition of sepsis 7.How did the team collaborate with and get buy in from others (leaders, sponsors, clinicians, front-line workers) to implement the intervention? Relationship, relationship, relationship Like a marriage, each partner gives 100%—100% Appealed to physician’s passion for medicine and easing patient suffering Commitment from executive leadership to drive responsible change More efficient/lower costs ≠ slash-and-burn cost-cutting, holding back care to meet cost expectations Physicians as evangelists 1:1 physician communication critical to success Sharing sepsis success story with entire organization 8.How did you deploy and implement the intervention? (training, education, materials, etc.) Training on new Advanced Application, Dashboards, and Protocols

19 #HASummit14 Future Plans 19 What issues will the team address next? Speed but not blinding speed Evolution of culture of continuous improvement and collaboration Preserve the gains from sepsis initiative and keep moving forward Acceptance of change becomes the norm Drive true care transformation Rigorous and honest conversations about cost/reducing waste Patient and quality always at the forefront Wellness as a priority Groom future physician leaders Seamless transition of progress and process over time Ensures continuous engagement with executive leaders

20 #HASummit14 Lessons Learned 20 1.Physician leadership is essential to success 2.Physician-to-physician communication 3.100% commitment from physicians and executive leadership; it’s not a 50%—50% relationship 4.Cost is NOT a four-letter word 5.Data must be easy to access, digest, communicate, and make actionable

21 #HASummit14 Analytic Insights A Questions & Answers 21

22 #HASummit14 Choose one thing… 22 Write down one thing will you do differently after hearing this presentation

23 #HASummit14 Thank You 23

24 #HASummit14 24 Session Feedback Survey 1.On a scale of 1-5, how satisfied were you overall with this session? 1)Not at all satisfied 2)Somewhat satisfied 3)Moderately satisfied 4)Very satisfied 5)Extremely satisfied 2.What feedback or suggestions do you have?

25 #HASummit14 Upcoming Speakers 3:45 PM – 4:35 PM 16)Delivering Excellence at Stanford Health Care Amir Dan Rubin, President and CEO, Stanford Health Care 4:35 PM – 5:00 PM 17)The Future World of Value-Based Healthcare (Documentary featuring Michael Porter) Caleb Stowell, MD, Vice President, Research and Development, International Consortium for Health Outcomes Measurement (ICHOM, Senior Researcher, Harvard Business School) 25 Location Grand Ballroom


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