a physician leader’s role in becoming a high performing ... · physician leadership forum...

©Truven Health Analytics Inc. All Rights Reserved. 1

Byron C. Scott, MD, MBAAssociate Chief Medical Officer, Truven Health Analytics

A Physician Leader’s Role In Becoming A High Performing Health System


Objectives

Learn key factors in the development and success of physician leaders in health systems today

Learn key characteristics of high performing health systems and the journey to measure leadership impact

Learn how two health system physician leaders drive performance and consistency across multiple hospitals


Key Factors In The Development And Success Of Physician Leaders In Health Systems Today

Willingness to serve and take on more responsibility in leadership & management

Organizational commitment to physician leadership development

Training & Education in Healthcare Management & Leadership



Develop Competencies Value Based Healthcare Health Analytics, Quality, & Patient Safety Population Health Patient Experience New Payment Models Process Redesign—LEAN

Consider formal education MBA MHA MPH MS Healthcare Quality MS Population Health



Hospitals & Health Systems willingness to have physicians more involved in leadership and performance improvement CMO VPMA CQO CMIO

Foster ways to engage patients, nurses, physicians, and other clinical staff Listen & Learn Collaborate Educate



Constantly improving and learning new ideas Someone, somewhere has probably already solved a

problem you are having

Network & Collaborate within Organizations Physician Leadership Forum American Hospital Association American Association for Physician Leadership American College of Healthcare Executives

Use data and analytics to help you succeed Measure quality & performance Benchmarking to other top performers Analytics to measure and evaluate leadership impact


Contact Information

Byron C. Scott, MD, MBA

Associate Chief Medical Officer

Truven Health Analytics

[email protected]

312-533-3512


Jean ChenowethSenior Vice President, Performance Improvement & 100 Top HospitalsTruven Health Analytics

The 100 Top Hospitals: The Journey to Measure Leadership Impact


The 100 Top Hospitals: The Journey To Measure Leadership Impact

23 year development and field testing effort Balanced scorecard theory – Norton & Kaplan,

Harvard University Academic validation Correlated with Baldrige best practices Objective statistical analysis - public data only Peer-reviewed methodologies Compares peers in 5 hospital classes for

actionable benchmarks Scalable

Key Insights From Measuring Journey

To assess whole organization, it is necessary to assess both

Longitudinal Cross-sectional

Measurement of reliability requires measure of alignment of outcomes, prices

100 Top Hospitals National Balanced Scorecard


HOW CLOSE TO RELIABILITY ARE WE NOW?SETTING NATIONAL BENCHMARKS FORCONSISTENT IMPROVEMENT AND PERFORMANCE

Quintile Performance Key:

Quintile Percentile Range

Performance Level

1 >80 to 100 Best2 >60 to 803 >40 to 604 >20 to 405 > 0 to 20 Worst

HOSPITAL KEY

* Note: Mortality, complications and patient safety include 3 years of trend data (2010 – 2012) and average length of stay include 4 years (2009-2012)

2009 – 2013 IMPROVEMENT AND RESULTANT 2013 PERFORMANCE

12

34

5

678

9 101112

13 1415

1617

0

20

40

60

80

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0 20 40 60 80 100

2013 Performance

2009

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ate

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1 ADVOCATE CONDELL2 ASPIRUS WAUSAU3 CHRISTIANA CARE4 DELRAY MEDICAL5 DOCTORS HOSPITAL6 FORT MADISON COMM7 GREER MEMORIAL8 HAMILTON MEDICAL9 HEARTLAND REGIONAL10 LITTLE COMPANY OF MARY11 MERCY HOSP ANDERSON12 METHODIST SUGAR LAND13 PROVIDENCE HOSPITAL14 RENOWN SOUTH MEADOWS15 RIVERSIDE METHODIST16 ST JOSEPHS HOSP17 SUTTER GENERAL HOSP

2015 EVEREST WINNERS


RELIABILITY – THE GOAL FOR ALL PROVIDERSIT IS STILL A WORK IN PROGRESS

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2

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6 7

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1213

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1617

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MORTALITY

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ate

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30 DAY READMISSIONS

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INPATIENT. EXPENSE/DISCHARGE

PATIENT SAFETY

20132013

20132013


2015 OHIOHEALTH HOSPITAL ALIGNMENT COMPOSITE SCORE: ALIGNED, HIGH BALANCED PERFORMANCE

ALIGNMENT SCOREOHIOHEALTH 21.8BENCH 26.2PEER 27.3


RESULTANT 2013 PERFORMANCE

RESULTANT 2013 PERFORMANCE

222 52 52 52 52 52 52 52 3 5

1 2 3 51 2 3 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 5

44444444444444 5

2 4 52 4 52 4 52 4 52 4 52 4 52 4 52 3 4 5

1 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 5

5 YEARIMPROVEMENT

5 YEARIMPROVEMENT

2013 HEALTH OF CALIFORNIA HOSPITAL INDUSTRYHOW RELIABLE IS PERFORMANCE?

5

PERFORMANCE

1IMPROVEMENT

41% HIGH PERFORMANCE

40 %LOW PERFORMANCE


APPLYING DEFINITION OF RELIABILITY - - -ONLY 26% OF HOSPITALS ARE HIGH PERFORMERS

HIGH RELIABILITYHIGH RELIABILITYPERFORM IMPROVE

GOOD POTENTIALGOOD POTENTIALPERFORM IMPROVE

FALLING BEHINDFALLING BEHINDPERFORM IMPROVE

POOR RISKPOOR RISKPERFORM IMPROVE

HIGH PERFORMANCEHIGH PERFORMANCEPERFORM IMPROVE

1 11 11 11 11 11 11 11 11 11 11 11 11 21 21 21 21 21 21 21 21 21 22 12 12 12 12 12 12 12 12 22 22 22 22 22 22 22 22 22 22 22 22 22 22 22 2

1 31 31 31 31 32 32 32 32 32 32 32 32 32 32 3

3 13 13 13 13 13 13 23 23 23 23 23 23 23 24 14 14 14 14 14 24 24 25 15 15 15 15 25 25 25 25 25 2

1 41 41 41 41 41 41 41 41 41 41 41 51 51 51 52 42 42 42 42 42 42 42 42 42 42 42 42 52 52 52 52 52 53 33 33 33 33 33 33 33 33 33 33 31 NA1 NA2 NA2 NA

3 43 43 43 43 43 43 43 43 43 43 53 53 54 34 34 34 34 34 34 34 44 44 44 44 44 44 44 44 44 44 44 44 54 54 54 54 54 54 54 54 55 35 35 35 45 45 45 45 45 45 45 45 45 45 45 45 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 55 53 NA3 NA3 NA3 NA3 NA3 NA3 NA4 NA4 NA4 NA4 NA4 NA4 NA5 NA5 NA5 NA5 NA5 NA

19.4% 6.3% 13.5% 20.3% 40.5%

61% RISKY26% RELIABLE

A Physician Leader's Role in Becoming a

High Performing Health System

Jamie Grebosky, MD SMNovember 13, 2015

AHA’s Physician Leadership Forum

Changes in UninsuredOregon reduced by 27%

From 20% to 14.5%

What is the Physician’s Role in a High Performing Health System?

Identification of opportunityCulture of border crossingExecution of improvements

Several key factors set the stage for success

Culture of Quality • Chairman of Board and Quality Committee is a

Physician• Medical Staff cares about reputation

Scanning the environment• Performance Improvement team scans for areas of

improvementEngage Medical Staff through formal and informal

channels• Quality Committee• Medical Executive Committee• Discussions with Medical Directors

Senior Leader Buy-in

Set preliminary quality agenda with CEO of health system

Cascade through Hospital/Ambulatory CEO’s through MEC’s and Medical Directors as well as Nursing Leadership

Crossing Borders

Collaboration with Nursing Green Teams

• CAUTI

Reduction in CAUTIFacility

2015 CAUTI

SIR

2016CAUTI

SIR

DecileRank

National SIR

AACH INS INS N/A 1.180

RRMC 1.037 0.798 5th 1.180

TRMC 0.539 0.248 2nd 1.180

Data Source: CMS HAC Reduction ProgramSIR: Standardized Infection RationINS: Insufficient data to calculate result

Result Transparency

Balanced Scorecard Weekly Clinical Outlook Monthly Dashboard

Vehicles for Improvement

MORC• PSI-90• Mortality

Patient Throughput

Reduced Asante PSI-90 Score

0.12

0.04

0.00

0.10

0.20

0.30

Pre(Jul14-Dec14)

Post(Jan15-Jun15)

Rat

e pe

r 1,0

00

Reduced by 63.9%

2016VBP PSI-90 Composite(Performance Period: Oct 15, 2012 through Jun 30, 2014)

Facility Performance Index

National Threshold

National Benchmark

AACH 0.5068 0.6162 0.4500

RRMC 0.3811 0.6162 0.4500

TRMC 0.3090 0.6162 0.4500

Reduction in Mortality

4.4%

2.9%

0%

1%

2%

3%

4%

5%

Pre(Dec13-Jul-14)

Post(Nov14-Apr15)

Rat

es

Reduced by 33.8%

Unweighted Composite: AMI, HF, COPD, PN & STK

Reduction in ED Throughput

Data Source: CMS ED-1 measure (sample weighted average)

269

250

232

210

220

230

240

250

260

270

280

2013 2014 2015

Med

ian

Tim

e (M

inut

es) Reduced

by 13.9%

Physician’s Role?

Identification of issues Execution of improvements Culture of border crossing

OhioHealth and Physician EngagementThe Key to Success for Delivering Value in Today’s Changing Healthcare World

Bruce Vanderhoff, MD, MBASenior Vice President and Chief Medical Officer

Physician Engagement at OhioHealth

• Ensuring a culture of engagement is a strategic priority.

• 80% of our physicians practice independently.

• Since 2009, we have enjoyed exceptional scores in Press Ganey’s national Physician Partner Survey.

5

Healthcare Business Model Shift

6

EPISODIC CARE VS.

MANAGING CHRONIC CONDITIONS

Physician Engagement at OhioHealth

• We have employed and independent physicians on our medical staff.

• A culture of engagement is crucial.

• Transparency

• Physicians occupy top leadership roles at our care sites and across the system.

7

What sets us apart?

• Physician Leadership Academy

• Clinical Guidance Councils

• Health4 – clinically integrated network

8

Implementation of EPIC at OhioHealth

• The Physician Strategy Group was formed.

• Our physicians had a crucial role in the process – from vendor selection through implementation.

• As a result, we had a smooth transition and our medical staff was engaged through the process.

9

Pathways to Value

• Led by our Clinical Guidance Councils.

• The catalyst for changing our model of care.

• Currently involves 20 pilot initiatives.

• Each is designed to help improve health and wellness, while also reducing health plan costs.

11

To successfully deliver value into the future, we must continue to:

Invest in building strong partnerships with physicians

Improve quality efforts.

Be innovative.

12

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