lifelong physician competency development association of professors of gynecology and obstetrics...
TRANSCRIPT
Lifelong Physician Competency Development
Association of Professors of Gynecology and ObstetricsMarch 1, 2013
Agenda
•The Evolving Physician Alignment Landscape
•Developing Physician Leaders
•AHA’s Physician Leadership Forum
•Lifelong Competency Development
Number of Physicians Employed by Hospitals, 2000-2010
SOURCE: Health Forum, AHA Annual Survey of Hospitals 1998-2010.
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010100,000
120,000
140,000
160,000
180,000
200,000
220,000
240,000
260,000
280,000
3
Hospitals employ more than 259,000 physicians, up 31% from 2000.
Hospitals report nearly 45% of privileged physicians employed or under contract
Employed 17.3%
Individual Contract 7.2%
Group Contract 20.3%
Not Employed or Under Contract
55.1%
Percent of Privileged Physicians by Type of Relationship, 2010
Source: Analysis of AHA Annual Survey data for community hospitals, 2010. Hospitals were asked to report the total number of physicians on the medical staff except those with courtesy, honorary and provisional privileges. Residents or interns are not included. Employed physicians are either direct hospital employees or employees of a hospital subsidiary corporation. Individual contract physicians are under a formal contract to provide services at the hospital and group contract physicians are part of a group (group practice, faculty practice plan or medical foundation) under a formal contract to provide services at the hospital.
Percent of hospitals reporting participation in a joint venture has nearly doubled from 2004 to 2010.
Percent of Hospitals Reporting That They Are Participating in a Joint Venture Arrangement with a Physician or Physician Group, 2004-2010
Source: Analysis of AHA Annual Survey data for community hospitals 2004-2010. A joint venture arrangement is defined as a contractual arrangement between two or more parties forming an unincorporated business. The participants in the arrangement remain independent and separate outside of the venture’s purpose.
2004 2005 2006 2007 2008 2009 2010
23.7%
28.5%30.7%
35.0%36.9%
39.6% 39.7%
Hospitalist care has more than doubled
Percent of Hospitals Reporting That Hospitalists Provide Care in Their Hospital, 2003-2010
Source: Analysis of AHA Annual Survey data for community hospitals 2003-2010. A hospitalist is a physician whose primary professional focus is the care of hospitalized medical patients (through clinical, education, administrative and research activity).
2003 2004 2005 2006 2007 2008 2009 2010
29.6%33.8%
39.9%44.4%
50.4%55.0%
57.8% 59.8%
Affordable Care Act (ACA)
ReadmissionsHACs
BundlingACOs
Value-Based Purchasing
Better Care CoordinationBetter Quality and Patient Safety
Greater Efficiency
Physician – Hospital Alignment
Clinical
Patient management
Institutional management
Administrative
Physician Leadership Vision
Clinical
Patient management
Institutional management
Environmental Pressures
Environmental Pressures
Administrative
Clinical
Patient management
Institutional management
Environmental Pressures
Environmental Pressures
Transformed Vision
Clinical Management
Population management
Administrative
Reframing the Discussion
Structureand
Control
Accountabilityand
Performance
Traditional ModernLeader crafts vision Group crafts vision that leader
articulates
Leader demands performance Leader inspires performancePaternalistic model Partnership modelEmphasis on leader's intellect Emphasis on leader's emotional
intelligence
Leader seeks to control others Leader seeks to empower, motivate and empathize with others
Team focuses on work arena Team seeks balance between work and home
CONCEPTS OF LEADERSHIPThe role of the leader is evolving from a top-down approach to a more collaborative approach
Source: Catherine D. Serio, PhD, Ted Epperly, MD, Physician Leadership: A New Model for a New Generation: Today's leaders need more than vision and a high IQ. Fam Pract Manag. 2006 Feb;13(2):51-54.
1. Technical knowledge and skills
2. Knowledge of healthcare
3. Problem-solving prowess
4. Emotional intelligence
5. Communication
6. A commitment to lifelong learning
Source: Stoller JK. Developing physician-leaders: Key competencies and available programs. J Health Admin Ed, Fall 2008
Physician Leaders – Key Competencies
Source: Hospitals' new physician leaders: Doctors wear multiple medical hats, Victoria Stagg Elliott, AMA News, amednews Posted April 4, 2011.
Physicians moving into leadership positions at hospitals and large health systems should be able to:
See the big picture beyond the patient at hand.Collaborate with people at all levels of the health system.Appreciate multiple perspectives.Think long term.Convince a significant number of people of the validity of an idea without issuing orders.Be comfortable making some people unhappy.Communicate and listen well.
Characteristics of Physician Leaders
Clinical
Patient management
Institutional management
Environmental Pressures
Environmental Pressures
AONEHPOE
PLF
Transformed Vision
Clinical Management
Population management
Administrative
The case for action – AHA’s Physician Leadership Forum
• AHA member hospitals employing more physicians• Varying relationships and degrees of integration
between hospitals and physicians• Limited resources for physicians to improve and
redesign care delivery• Little recognition by physicians of AHA as a
resource for leadership development• Need to increase awareness and credibility of AHA
with physician community
Strategic FrameworkGoal
Advance physician relationships with member hospitals to transform care delivery and improve the health of patients and communities.
Physician Engagement StrategiesEducationQuality and Patient SafetyLeadership DevelopmentAdvocacy and Public Policy
ServicesBi-weekly e-newsletter to 7000 subscribers
Co-branded with several state associations
www.ahaphysicianforum.org website
Bi-monthly webinarsClinical IntegrationPractice ManagementPhysician Compensation
Co-sponsored educational conferences
EducationTeam-Based Leadership Conference, 2011Team-Based Health Care Delivery Guide: Lessons from the Field
Education• Creating the Hospital of the Future Conference, July 2012• Monograph, Fall 2012
Lifelong Learning: Physician Competency Development
Key Questions
• How can we affect physician education and development to move to the next generation of health care delivery?
• What is the current level of success in preparing physicians during residency to practice in today’s health care environment?
ACGME/ABMS Competencies• Medical knowledge – demonstrate knowledge about established and evolving
biomedical, clinical, and cognate sciences and the application of this knowledge to patient care.
• Patient care – provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
• Practice-based learning and improvement – must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices.
• Systems-based practice – demonstrate awareness of and responsibility to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.
• Professionalism – demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.
• Interpersonal and communication skills – demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their families, and professional associates.
Skills Needed• Leadership training• Systems theory and analysis• Use of information technology• Cross-disciplinary training/multidisciplinary teams
– Understanding and respecting the skills of other practitioners • Additional education around:
– Population health management – Palliative care/end-of-life– Resource management/Medical economics– Health policy and regulation
• Interpersonal and communication skills – Less “captain of the ship” and more “member/leader of the team”– Empathy/Customer service– Time management– Conflict management/performance feedback– Understanding of cultural and economic diversity– Emotional intelligence
Gaps across all governance groups
Medical knowledge
Patient care
Practice-based learning and improvement
Improve patient care practices
System-based practice - Provide cost-conscious, effective medical care
System-based practice - Work to promote patient safety
System-based practice - Coordinate care with other healthcare providers
Professionalism
Interpersonal & communication skills - demonstrate skills that result in effective information exchange
Work effectively with health care team
Use of Informatics
-1.60 -1.40 -1.20 -1.00 -0.80 -0.60 -0.40 -0.20 0.00
GAP
Greatest Gaps and Least EvidentSystem-Based Practice: Provide cost-conscious, effective medical careCommunication Skills: Effective information exchangeSystem-Based Practice: Coordinate care with other providersCommunication Skills: Work effectively with health care team
Most ImportantPatient CareSystem-Based Practice: Promote patient safetyMedical KnowledgeCommunication Skills: Work effectively with health care team
Key Observations
Recommendations – Hospitals and Health Delivery
Hospital Role— Foster and support competency development— Inter-professional training and teams— Feedback and tools for improvement— Peer dynamics, medical staff requirements— Involvement in business of health care— Full involvement of all physicians (including students and
residents) in quality and safety improvement projectsDelivery System Role
— Move from individual to population health— Greater use of health information technology— Alignment of incentives to competencies— Ability to add/amend/delete competencies as health care
changes
Recommendations – Education, Training, and Development
• Education— Broaden reach of medical school admissions— Decompress educational load and broaden modes of education— Ingrain all competencies into value structure of training— Implications of different career paths on educational structure
• Post-Graduate Training— Inter-professional training strengthens care delivery— Quality and patient safety need to be an integral part of
residency programs— Health care is practiced in a wide variety of environments— Focus on patient wishes
• Ongoing Professional Development— Ease transition from residency to practice— Use of continuing education to focus on competencies— Professional society influence
Physician Core Competencies• Report released July 2012
• Next Steps– Joint effort with ACGME to host a
stakeholder workgroup that brings together all the accrediting groups and those involved in education and training of physicians.
– The group has begun work to create a more systematic approach to physician development over a lifetime.
Questions/Comments
John R. Combes, MDSenior Vice President, American Hospital Association
President, Center for Healthcare GovernanceChicago, IL
www.ahaphysicianforum.org