Healthcare Collaboration » Physician Engagement

Collaborative Quality

Kenneth Cohn — Sun, 13 May 2012 00:57:41 +0000

Dr. Cohn facilitating Chief Quality Officer Roundtable

Last week, I had the privilege of facilitating the Health Care Roundtable for Chief Quality Officers, where I also presented on engaging physicians to improve quality and safety outcomes.

The passion and dedication of the members of this group impressed me. Despite being firmly in the middle of resistant practitioners and rapidly changing federal, state, and local mandates, they proudly showcased ongoing efforts that have improved care for their communities.

Their activities reflect the art and science of blending processes and people skills because of the importance of persuasion and influence and lack of effectiveness of command and control.

We spent considerable time discussing advances in health information technology because, as one participant said, “Behaviors that aren’t hardwired into order sets don’t persist.”

Through this facilitation effort, I learned that chief quality officers are a relatively new group of passionate physicians and non-physicians connected by a common desire to make a difference in patients’ lives. They are true front-line warriors for collaborative quality. I encourage all my readers who know quality officers to send them a link to this post, so that they will consider joining this roundtable and sharing their insights. Anyone desiring more information about the next meeting November 8-9, 2012 in Las Vegas should contact emilydye@earthlink.net.

As always, I welcome your input to improve healthcare collaboration where you work.

Kenneth H. Cohn

Disclosure:

I have not received any compensation for writing this content.

Collaborative Quality is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Ken on Twitter, Facebook or Google+.

The Blessings of Healthcare Collaboration

Kenneth Cohn — Sun, 26 Feb 2012 15:41:22 +0000

Dr. Cohn Facilitating ACHE Seminar Practical Strategies for Engaging Physicians

Ten days ago, I had the pleasure of facilitating my ACHE seminar Practical Strategies for Engaging Physicians. What made it so enjoyable was the mixture of senior- and mid-career healthcare leaders who shared their experience with my two faculty co-presenters, Dr. Robert Schott, a cardiologist/ physician executive, and Mr. Peter Pavarini, a lawyer and thought leader in financial collaboration strategies.

A healthcare leader with 38 years of experience told me that he still makes time to go to the Operating Room and watch surgeons perform operations. At the end of the procedure, he asks, “Doctor, did you have all the resources that you needed to perform the operation?”

No one has ever refused his request to watch an operation. When surgeons mention something that would help them do the procedure better or more safely, he makes sure that his staff acts upon it immediately. Such processes build transparency and trust using quick wins.

I find it gratifying that someone with 38 years of experience still makes time for face-to-face dialogue with his physicians and admits that there are subjects on which he does not have all the answers and can benefit from co-mentoring. As my kids tell me, “Dad, ASSUME makes an ass out of U and ME.”

The blessings of healthcare collaboration, as spelled out in the newly formed Association for Healthcare Collaboration, are in the following diagram which depicts the virtuous cycle of collaboration producing improved financial and clinical outcomes, easier recruiting and retention, and outstanding programs, people, and facilities that enhance collaboration:

The Blessings of Healthcare Collaboration

As always, I welcome your input to improve healthcare collaboration where you work.

Kenneth H. Cohn

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

The Blessings of Healthcare Collaboration is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Ken on Twitter, Facebook or Google+.

Redefining Physician Engagement

Kenneth Cohn — Fri, 27 Jan 2012 22:05:23 +0000

Dr. Cohn facilitating retreat on physician engagement

I believe that there are no coincidences in life. So, the night before the retreat, when the outgoing Medical Staff President served me a beer, I found a two-word summary for my one-page biographical sketch, loose cannon.

We began with physicians, an administrator, and Board Chair discussing what the journey of engagement meant to them.

The CEO, leveraged his knowledge of furniture-making, telling us that what strengthened a three-legged stool, are the spindles that connect the three

Connecting spindles strengthen a stool

legs. He made the healthcare analogy that the spindles of transparency, a shared mission and vision, and continued communication strengthened the interdependent legs of the medical staff, administration, and Board.

The Chief Medical Officer summarized his web search on physician engagement by saying that it represented the intersection of four overlapping circles: clinical integration, alignment, loyalty, and satisfaction. He added that the definition of engagement is two-sided, with a pledge (as in marriage) and a battle (as in engaging the enemy). I gave a national perspective of case presentations on redefining physician engagement, ending with the spindles of connect, collaborate, succeed.

We discussed our experiences with redefining physician engagement at our round tables and through a process of ritual dissent, a spokesperson took our three-minute summary to three other tables for their input, returning to our table after each round to tell us what he learned. Each time we went through the process, we went deeper and defined our terms more clearly. The insights that we discovered together include:

Conflicting opinions in times of rapid change are inevitable. When properly managed through transparency, predictability, and mutual respect, conflict can build trust.
A social compact that invited physicians to communicate and buy-in could avoid surprises, set ground rules, and guide daily behavior
Chunking long-term tasks into 2-3 week outcome-related milestones, quick fixes that are fixed correctly to the mutual satsfaction of both parties, and celebrating success are ways that we can start now to improve physician engagement.

A senior VP correctly pointed out that physician engagement involves the engagement of all stakeholders to improve care, saying:

Physician engagement is an intentional and deliberate process to bring physicians and other stakeholders together to address problems and continuously improve care and the patient experience.

It is learning and sharing experiences like the one that I have described above that make me feel blessed to do the work that I do. As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

Redefining Physician Engagement is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Ken on Twitter, Facebook or Google+.

Loving Austin

Kenneth Cohn — Sat, 26 Nov 2011 15:55:07 +0000

Recently, I served as a faculty co-presenter at an ACHE fall cluster in Austin, TX. The mnemonic that resonated with the healthcare executives who participated in Practical Strategies for Engaging Physicians was CRITTERS, to enhance clinical integration:

Communication: inviting physicians to provide input before any major decisions are made
Representation: making sure that clinical champions, who have earned their colleagues’ trust, are at the table
Incentives to improve quality and safety, as well as the bottom line
Transparency: helping physicians understand how decisions are made and according to what timelines
Trust: stemming from transparency, so that there are no decision-making surprises
Engagement: meaning two sides coming together in a spirit of inquiry rather than enmity
Reimbursement: involving ways for both sides to increase revenues by enlarging the pie
Speed: understanding that when physicians feel that their time is not respected, they feel personally disrespected

Ladybird Lake: site of Practical Strategies for Engaging Physicians seminar

Guitarist Stevie Ray Vaughn Memorial, Austin, TX

Austin was a conducive setting to reflect, as seen in the photos of walking paths adjacent to the hotel where the seminar took place. The lake was created by the Longhorn Dam of the Colorado River in 1960 and named after Ladybird Johnson when she died in 2007.

With its eclectic music, restaurants, and parks, Austin is a city to which I look forward to returning.

As always, I welcome your input to improve healthcare collaboration where you work.

Kenneth H. Cohn

Disclosure: I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

Loving Austin is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Ken on Twitter, Facebook or Google+.

Collaborative Core Values

Kenneth Cohn — Sun, 16 Oct 2011 22:11:00 +0000

I love working at places that live their values. I spoke at the annual physician retreat at St. Vincent Hospital, Indiana, where as a member of Ascension Health, their core values call them to:

Service of the poor: generosity of spirit for persons most in need
Integrity: inspiring trust through personal leadership
Wisdom: integrating excellence and stewardship
Dedication: affirming the hope and joy of our ministry
Reverence: respect and compassion for the dignity and diversity of life
Creativity: courageous innovation

Dr. Cohn Facilitating Medical Staff Retreat

I spoke on physician engagement, giving examples of physician champions who improved care for their communities by improving clinical outcomes and slashing expenses. I was impressed that physicians and administrators working together in their health system had dropped supply costs from 19% to 14% of net patient service revenue.

Kerry Johson followed, talking about highly reliable healthcare. He is the founding partner of Healthcare Performance Improvement, which was the company that Sentara Healthcare utilized to build a sustainable culture of safety. He pointed out that the medical staff is critical to sustain safety core values and make error prevention the norm. Errors occur most commonly in the process of patient handoffs.

Then, Ann Murtlow discussed the parallels of her turnaround of Indiana Power and Light (IPL) with healthcare challenges. Both cultures need to reinvent themselves to survive in a climate of disruptive change. To rebuild trust, she:

apologized for past mistakes
listened to people’s complaints and encouraged them to improve processes
built a credible team with long-term relationships to the community, media, and city and state leaders
communicate often via face-to-face, electronic, video, and print media
followed through and kept promises
was transparent, fair, truthful, and compassionate

She encouraged everyone in the audience to adopt as core values to:

be courageous
think broadly
enable others
deliver results

The day went by quickly because the audience and the speakers were engaged and fed off one another’s energy. I felt proud to be part of an organization whose outlook and slope are clearly positive.

As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

Collaborative Core Values is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Ken on Twitter, Facebook or Google+.

Engage, Collaborate, and Succeed

Kenneth Cohn — Tue, 04 Oct 2011 00:51:00 +0000

I had a wonderful experience last Friday, facilitating a medical executive committee retreat on ways to promote physician engagement at a hospital that has become part of a healthcare system.

As I wrote in Collaborative Engagement, engaged workers strongly agree with the following statements:

This organization really inspires the very best in me
I am willing to put in a great deal of effort beyond what is normally expected to help this organization be successful
I talk up this organization to my friends as a great organization to work for

(Achieving Breakthrough Engagement: Lessons from High-Performing Organizations. 2007. Washington: The Advisory Board Company, p.3.)

Engaged workers:

Exceed expected level of effort
Are inspired to do their best work
Feel part of the greater work community
Make meaningful contributions through their work
Are personally motivated to help their organization succeed

(Achieving Breakthrough Engagement: Lessons from High-Performing Organizations. 2007. Washington: The Advisory Board Company, p.14)

They liked the idea embodied in Appreciative Inquiry, of building on the goodwill engendered by previous efforts, such as preparing for a Joint Commission visit that went well and their move to a new hospital facility.

The goal they share is to build on the efforts of physician champions to move the majority of practicing physicians from renters to owners, rekindling their passion for medicine despite disruptive changes in their lives. They liked the story of the orthopedic surgeon I worked with in the pogo epiphany, who moved beyond blame-storming when he realized that every time that he pointed a finger, three others pointed back at him.

I know that they will engage, collaborate, and succeed. They make me proud to be a fellow-physician.

As always, I welcome your input to improve healthcare collaboration where you work.

Kenneth H. Cohn

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

Engage, Collaborate, and Succeed is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Ken on Twitter, Facebook or Google+.

Collaborative Transformation

Kenneth Cohn — Sun, 25 Sep 2011 16:00:26 +0000

Dr. Cohn speaking to physicians on Dealing with Disruptive Change: The Power of Transformation

Yesterday, I had the honor of speaking at the SEAK Conference on Non-Clinical Careers for Physicians on dealing with disruptive change. Disruptive change, as described by Prof. Christensen*, refers to an innovation that applies a different set of values, displaces an established technology, and creates new markets and value networks. Examples include the computer and telecom industries and healthcare, with minute clinics and digital imaging. On a personal dimension, disruptive change occurs with divorce, job loss, illness, and death. However, some disruptive changes can be joyous, such as the birth of a new child.

As I wrote in Better Communication for Better Care: Mastering Physician-Administrator Collaboration, emotional exhaustion, feelings of depersonalization (decreased empathy), and low personal achievement are common in healthcare professionals. These three domains of the Maslach burnout inventory are the antithesis of engagement, energy, involvement, and efficacy.

Standard intrapersonal recommendations to combat burnout include:

Cultivating a sense of perspective and humor
Vacation
Exercise
Meditation
Seeking counseling when feeling the need to treat symptoms of burnout with alcohol or other habit-forming substances

Standard interpersonal recommendations to treat burnout include:

Respecting colleagues’ nights and weekends off duty
Sharing feelings with others who have related a stressful event or multiple events
Showing concern when colleagues exhibit symptoms of burnout and helping them obtain assistance before patient care suffers

I wonder if the above recommendations treat symptoms rather than causes. The poet Mary Sarton wrote:

There is only one real deprivation, and that is not to be able to give one’s gifts…
The gift turned inward becomes a heavy burden, even a kind of poison
It is as though the flow of life were backed up.

Transformation reflects a major change in form, function, or nature. To me, transformation results from overcoming self-limiting beliefs and taking action on stretch goals at the same time. Transformation is a way to deal with disruptive change proactively rather than feeling that change is done to us rather than by us.

Conferences that allow physicians to bond with peers can help them get back in touch with the reasons that they chose healthcare careers and help to decrease career dissatisfaction and burnout.

As always, I welcome your input to improve healthcare collaboration where you work.

Kenneth H. Cohn

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

*Christensen CM, Bohmer R, Kenagy J. (2000). “Will Disruptive Innovations Cure Health Care?” Harvard Business Review, September 2000.

Collaborative Transformation is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Ken on Twitter, Facebook or Google+.

MEC-MAP differences: Possible Uses for the Med Exec Committee and a Medical Advisory Panel

Kenneth Cohn — Sun, 26 Jun 2011 13:30:29 +0000

I apologize for the length of time that has elapsed between posts. While I was on the road for 16 consecutive days, I was preparing for the book launch of Getting It Done: Experienced Healthcare Leaders Reveal Field-Tested Strategies to Improve Clinical and Financial Performance, a compilation of 16 heros’ journeys, in which practitioners busted silos to improve care for their communities. Please join us for a complimentary audio conference Thursday, June 30, 2011, 12 noon EDT. All registrants will receive the mp3 file, so please register by clicking here even if you cannot attend. Seven chapter authors will reveal their insights.

At the beginning of June, I traveled to Buffalo to celebrate my mother’s 85th birthday. It was a joyous occasion that brought together nieces and nephews who have not seen each other in nearly a decade.

Then to San Diego, to present Physician Engagement: Moving from Me to We at the Governance Institute Annual Conference for CEOs, Board Chairs, and Physician Executives. From there, to a midwestern hospital whose physicians issued a vote of no confidence in the CEO. Our listening sessions were like a truth and reconciliation committee for both sides. Many of the physicians were of Asian descent and felt humiliated by public comments, from which we can all learn insights, such as:

Calling a physician by his/her formal appellation to show respect (i.e., Dr.) rather than by first name
Beginning a conversation with the 1 percent of areas of agreement rather than the 99 percent of areas of disagreement
Praising people publicly and discussing concerns privately face-to-face, rather than via email
Demonstrating flexibility
Understanding that for those who grew up in poverty, fear of losing affluence may drive their outlook

Before I left, I made a video of a frequently asked question, “What are MEC-MAP differences, i.e. the differences between the Medical Executive Committee (MEC) and a Medical Advisory Panel (MAP). To watch this three-minute video, please click here.

The two groups are complimentary, not competitive, with the MEC focusing on quality, safety, peer review, and credentialing. The MAP’s strength lies in gathering physician champions to come to consensus on clinical priority setting and strategic planning.

Specific Medical Advisory Panel Projects at hospitals where I have worked include:

Consideration of what services will go into a newly constructed hospital
Medical staff models that align incentives and foster financial collaboration
Ways to decrease supply costs, especially implantable devices and drug formulary expenses
Succession planning for critical physician sections and departments
Physician burnout and retention issues
Ways to improve hospital-wide throughput, for example in perioperative and ICU care
Crisis management, such as when physicians no longer admit patients to the hospital

Please send me questions on hospital-physician relations that you want answered.

As always, I welcome your input to improve healthcare collaboration where you work.

Kenneth H. Cohn

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

MEC-MAP differences: Possible Uses for the Med Exec Committee and a Medical Advisory Panel is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Ken on Twitter, Facebook or Google+.

Collaborative Assistance: How to Help Independent and Employed Physicians at the Same Time

Kenneth Cohn — Sun, 15 May 2011 18:16:55 +0000

One of the most common questions I receive from healthcare leaders involves overcoming the dilemma of how to help independent and employed physicians without favoring one group at the expense of the other. To see the video, please click here.

Use a task force of employed and independent physician champions to suggest ways that the hospital can streamline processes and optimize care, so that everyone can be more productive; when doctors feel that they are making their time count, magical outcomes happen that improve care for the entire community
Develop multidisciplinary institutes and medical staff models that permit a variety of practice infrastructures; for example, centers of excellence in cancer care could promote the benefits of one-call coordination to all patients to arrange appointments with an oncologist, radiation therapist, and surgeon regardless of whether their referring physician is independent or employed by the hospital
In areas of documented community need, a hospital can help both independent and employed physicians to hire new physicians
A multidisciplinary taskforce on physician retention can recommend ways to improve the practice environment before independent and employed physicians leave out of frustration
Hospital leaders can subsidize the costs of electronic health record implementation for independent and employed physicians; for more suggestions on how to engage physicians to adopt and implement health information technology, please click here.

In Collaborative Culture, I quoted Dr. Michael Perry, CEO of Freeport Health Network, llinois, where 95% of physicians are employed or under contract to make the point that intetgration of physicians into the hospital or health system requires continual effort to improve the practice environment:

The high percentage of physicians employed by the system by no means indicates that our physicians are any closer to achieving consensus with administration, and we must be intentional about aligning our organizational goals with those of the doctors. The same skills of communication, aligning strategies and goals, and decision making are needed in our situation as are needed in organizations with fewer employed physicians.

As always, I welcome your input to improve healthcare collaboration. Please continue to share your questions with me, so that I can serve your evolving needs.

Kenneth H. Cohn

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

Collaborative Assistance: How to Help Independent and Employed Physicians at the Same Time is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Ken on Twitter, Facebook or Google+.

Collaborative Accountable Care: New Book Review

Kenneth Cohn — Tue, 10 May 2011 19:43:32 +0000

As a new book author, I empathize with anyone writing about healthcare in a time of such dynamic change. Before I review Accountable Care Organizations: Your Guide to Strategy, Design, and Implementation, I need to make a disclosure. I know Marc Bard from a previous century when I was a surgical resident and he was an attending physician on the medical service at the Mount Auburn Hospital, Cambridge, MA. I remember that Marc and his partner had one of the busiest practices and what a pleasure they were to work with. They were not only pleasant but also available and clinically well-grounded. They knew what risks to tolerate and when to hold back.

I do not usually make the time to read 371-page books, but found myself showing up early to doctors’ appointments to arrange protected time to finish this book. It is well-organized and contains a treasure trove of practical information for healthcare organizations at every level of readiness. In fact, a table on page 153 shows key concepts and actions to consider for organizations that are considering forming an Accountable Care Organization (ACO):

Interested organizations should engage physicians in designing and managing integrated clinical functions, such as service lines, and in collaborations to improve operational efficiency, for example, reducing length of stay and readmissions;
Engaged organizations should reward introduction of care pathways in common clinical areas and build physician management in the ambulatory environment
Committed organizations should focus on strengthening inpatient and ambulatory care coordination and implement medical home pilots in partnership with payers

I wrote a big exclamation point next to page 362, where the authors wrote:

While much attention will be paid to organizational structure, it is best to think of the structure like a sports arena. It’s the venue, not the game. Organizational structures do not ensure success, though an ineffective structure can make success much more difficult to achieve.

Those who read my post Collaborative Culture know that I also agree with the point the authors made on page 363:

While culture is often referred to as the “soft side” of healthcare, it is clear that the “hard” outcomes of quality, safety, patient satisfaction, and business performance are dependent on the “soft” elements of organizational culture. Many leaders are quick to discount organizational culture because it is difficult to understand and even more difficult to influence. But culture will ultimately be the difference between success and failure.

The authors encourage us (page 323) that there is no predictable timetable that will work for all organizations and to think of the process as a flywheel that gains acceleration. Once it spins fast enough, the process will reach a self-sustaining speed and will generate confidence on its own.

I enjoyed the case study (p. 265-70) that described the steps that a payer went through to move to value-based contracting:

The payer began by engaging individual specialties in conversations about trends in insurance premiums, administrative costs, utilization, and reimbursement
The data helped all parties address the objectives of maximizing value for patients and their families, the rationale for acting now based on trends of lowered reimbursement, demand for more cost-effective care, and the need to work together to achieve cost and savings targets without compromising quality and safety
The payers and providers established a set of ground rules that assured that all parties would have a voice at the table and that financial bonuses and direct investments to promote quality and efficiency would be made
In return for providing clinical resources to manage care transitions (case managers and infrastructure to support a patient-centered medical home) and administrative simplification, the payer expected providers to manage the total cost of care over time and to commit to achieving access, quality, affordability, and productivity targets in accord with multidisciplinary, evidence-based, team metrics
A year into the initiative, trust and transparency have increased, and momentum is building to support additional investments in improving the practice environment

I encourage all healthcare organizations to buy this book, make reading each chapter part of a monthly ACO journal club, and above all, to use the process to build a safe environment for reflection and learning that will improve care for our communities.

As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn

Disclosure:

I have a material connection because I received a review copy that I can keep for consideration in preparing to write this content.

Collaborative Accountable Care: New Book Review is an original post from Kenneth Cohn, Healthcare Collaboration. If you enjoyed this post, be sure to follow Ken on Twitter, Facebook or Google+.