1

Physician Leadership and Incentives to Sustain Change

Michael Gilbert, MDAssociate Medical Director

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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

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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

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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

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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

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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

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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

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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

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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

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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

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Outcomes

Patient Satisfaction in Telephone Calls

78

80

82

84

86

88

90

92

Jun-

06

Jul-0

6

Aug-0

6

Sep-0

6

Oct-

06

Nov-0

6

Dec-0

6

Jan-

07

Feb-0

7

Mar

-07

Apr-0

7

May

-07

Jun-

07

Jul-0

7

Aug-0

7

Sep-0

7

Oct-

07

Nov-0

7

Dec-0

7

Jan-

08

Feb-0

8

Mar

-08

Apr-0

8

May

-08

Jun-

08

Jul-0

8

% S

ati

sfa

cti

on

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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

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Quarterly Provider Reports

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Transparency of Data

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Provider Level Data

Access by Provider/Site Team August and September 2008

0 5 10 15 20 25 30 35

Live Well Live Healthy Class

Consultation

CENTER FOR HEALTH PROMOTION

Mammograms

Sodaro, David

Lekawa, Sajee

Cho, Stanley

Morley, J ames

Madrid, Philip

Osburn, Stephen

Andersen, Athena

Althoen, Sinda

Kellogg, Frank

Smith, G Scott

Cho, Laura

Gilbert, Michael

Long, Dennis

Rosen, Norman

J oe, Steven

Tsai, J erry

Rabinowitz, Sam

Park, J ong

Quimbo, Generoso

Pro

vid

er/

Sit

e

3NA

Regular OFV Sept 08 Regular OFV August 08Site Average Sept Site Average August 08

Goal: 3 days or less

=Meeting goal

Wait Times by Provider/Site July & August 2008

0 10 20 30 40 50 60

Cho, Stanley

Sodaro, David

Ballentine, Renee

Radjabian, Shima

Osburn, Stephen

Winkelman, John

Kellogg, L. Frank

Althoen, Sinda

Andersen, Athena

Nichols, Ivan

Rosen, Norman

Joe, Steven

Park, Jong

Quimbo, Araceli

Tuvera, Fernando

Kreng, Virany

Quimbo, Generoso

Cho, Laura

Ing, Arlene

Pro

vid

er/S

ite

Time in Minutes

July 08 Wait Times

August 08 Wait Times

Goal: 25 minutes

or less

:

August 08 Site Average

July 08 Site Average

= Meeting goal

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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