Clinical and Administrative Medical Leadership: Enhancing Rehabilitation Care

Delivery

Alan K. Novick, MD

Rehabilitation Medical Director

Memorial Rehabilitation Institute

Disclosures

I have no financial disclosures

Employed by Memorial Healthcare System

ObjectivesUnderstand the physiatrist’s role in developing an integrated delivery system of care and how integrated care can improve outcomes

Understand the impact of different practice models (private practice, employed or contracted) on developing an integrated system of care and program development

Identify leadership skills that can impact delivery of care and potentially maximize program growth

Understand difference between medical director and medical leadership

Start a conversation!

The Role of Medical Director

The Young Physiatrist as Medical Director - Know What to Expect, "The Making of a Medical Director" course. 55th Annual Assembly of the American Academy of Physical Medicine and Rehabilitation, Miami Beach, FL November l993

The Changing Role of the Medical Director, American Academy of Physical Medicine and Rehabilitation 62nd Annual Assembly: San Francisco, CA Nov 2000

Medicare Medical Director Guidelines

Provides services to the rehabilitation unit and to unit’s inpatients for at least 20 hours per week

Is a doctor of medicine or osteopathy

Is licensed under State law to practice medicine or surgery

Has had, after completing a 1 year hospital internship, at least 2 years of training or experience in the medical management of inpatients requiring rehabilitation services

CARF Medical Director Guidelines

CARF Medical Director Guidelines

Role of Medical Director

Clinical– Direct patient care– Oversight of program

care

Administrative– Adherence to policies

CARF

Joint Commission

– Marketing– Leadership

Provide direction

Leadership“If your actions inspire others to dream more, learn more, do more and become more, you are a leader”– John Quincy Adams

“Innovation distinguishes between a leader and a follower”– Steve Jobs

“Leadership is the capacity to translate vision into reality”– Warren Bennis

Case Example: Integrated Leadership

Memorial Healthcare System– Journey from fragmented rehabilitation care to

an integrated systemHow?

Why?

Benefits?

Hollywood Memorial Hospital 1991

Safety net hospital

Opened 1953

753 beds

26 bed inpatient rehab unit– Expanded to 36 beds

Memorial Healthcare System

Memorial Healthcare System 2006

5 Hospitals

3 Outpatient Therapy Centers

1 Nursing Home

1 Inpatient 36 bed Rehab Unit

12/06 System acquired Hollywood Medical Center– 336 bed hospital– 1 mile from MRH– 33 bed Rehab Unit

Memorial Healthcare System

MRHS

MRH

Development of a Rehab Hospital

Proposal to build 1 unit– Inefficient to have 2 units so close– Overcrowded in main hospital

Clinicians worked with architects

Opened 69 bed state of the art unit 6/09

Accomplishments

Built out new unit

High patient satisfaction scores

Excellent outcome measures – D/C home– FIM gains– Low D/C to SNF and return to acute

Volume growth approx 20% – ADC increased from 36 to 45

Trouble in Paradise

Phone call

“Can you come to a meeting now?”

“We want to go in a different direction”

Leadership FailuresMedical Director– Failed to recognize needs of organization– Lack of understanding of mechanism to implement

change– No education of Director’s value (self promotion)

Administration– Director without access to decision making

Common Failures– Lack of trust– Poor communication

Crossroads

Meeting with CEO of healthcare system – “What would you do?”

Vision Statement

Vision Statement

Vision

Objectives

Action Plan

Vision Statement

Vision: The Rehabilitation Institute of South Florida will provide a world class continuum of family and patient centered rehabilitation care for not only the residents of south Broward County but also the Southeastern United States

Vision Statement: ObjectivesDevelop the Rehabilitation Institute of South Florida to the level of a world class institution meeting all rehabilitation best practice standards

Achieve and maintain patient clinical outcome data at levels exceeding nationally recognized benchmarks as well as maintain patient satisfaction at the highest percentage

Develop and maintain external stakeholders (referring physicians, insurance carriers, etc.) to ensure appropriate patient census and enhanced revenues

Develop new product line and reorganize current structure to improve market visibility and scope of service

Create environment to retain and attract most outstanding therapy, nursing and medical staff with high employee satisfaction and engagement

Memorial Healthcare System

Outpatient Therapy Centers

Memorial Manor (SNF)

IRF

Vision Statement: Action Plan

1. Reorganization of current organizational/leadership structure (6 months)– Allows branding and consistent product lines

across the continuum of care – Develop methodology and systems to utilize

entire continuum of care to diminish hospital readmission rates (6 to 12 months)

Branding

Branding

Branding

Branding

Vision Statement: Action Plan2. New product line development– Physician led sub-specialty clinics located in

outpatient therapy centers/ MRHS (1 year)– Expansion of outpatient service lines (stroke, brain

injury, orthopedics, industrial medicine, etc.)Identification of current therapists’ expertise (3 months)

Reorganize outpatient therapy centers to a disease specific treatment model (6 months)

Recruit expertise in areas of deficit therapist talent (1 year)

Evaluate market for expansion of number of outpatient therapy centers. Expansion would allow for a larger service area and improved Rehabilitation Institute of South Florida community brand recognition (6 months)

Vision Statement: Action Plan– Evaluate feasibility of a day treatment program (3 months) and if

feasible, development and implementation of program (18 to 24 months)

– Evaluate feasibility of a disabled driving program (3 months) and if feasible, implementation of program (18 months)

– Expansion of inpatient service lines

Increase inpatient rehabilitation available beds to appropriate market needs ( 2 years)

Develop and implement a TCU (18 months)– Develop a community transition program or find organizations

with which to partner to provide the service (2 years)– Develop an industrial rehabilitation program (18 months)

Dedicated workers’ compensation coordinator for system

Return to work program

Develop in conjunction with occupational medicine

Vision Statement: Action Plan3. Development of non-clinical services– Disabled athlete/sports program

Host focus groups of community providers of services and representatives of the disabled community to determine wants and needs to best position Memorial for success (6 months)

Recruitment of a leader (Recreational therapist) for the program (12 months)

Implementation of program (18 months)

Identification of a sponsor/donor (ongoing)

Adaptive Sports and Recreation Program

Adaptive Sports and Recreation Program

Scuba

Water aerobics

Tennis

Bowling

Wheelchair Basketball

Adaptive Sports and Recreation Program

Vision Statement: Action Plan– Disability resource center which is available on web page and physically

within the institute

Identify and strengthen community affiliations such as Stroke Association, Parkinson’s Foundation, Florida Brain Injury Association and others (6 months)

Strengthen existing support groups (6 to 12 months)

Develop a formal peer visitor program including ability for peers to visit patients in acute care facilities (6 to 12 months)

Recruitment or identification of current employee to develop and maintain resource center (6 months)

– Develop a quarterly electronic newsletter to patients and stakeholders discussing current rehab issues and Memorial’s position on rehab care, success stories and new programs (12 months)

– Provide information regarding issues of concern for the disabled community (1 year)

Housing and transportation

Legal issues

Caregiver concerns and equipment

Recreation and leisure

Vision Statement: Action Plan

4. Continuing Education– Develop rehabilitation

annual symposium with national quality speakers (2 years)

– Continue to host multiple therapy/nursing conferences for specialized training/certification (ongoing)

Develop calendar of all Memorial rehabilitation educational opportunities or conferences on web site (1 year)

Vision Statement: Action Plan

5. Growth/Marketing– Development of a quarterly report to stakeholders as

to the composite outcomes of their patients as well as the general outcomes of our rehabilitation program (6 months)

– Strengthen existing referral patterns and develop new relationships (ongoing)

– Improve transition between different levels of care to ensure patients remain in the Memorial Healthcare System for each level (6 months)

Vision Statement: Action Plan6. Development of a rehabilitation research program– Recruitment of an appropriate research coordinator to

assist with development of new research projects and assist with current research projects (6 months)

– Identify national world class rehabilitation research organizations and develop relationships to begin joint research projects (18 months)

– Include research projects and any positive results in published outcome reports and electronic newsletter (18 to 24 months)

– Publish research in nationally recognized journal (3 years)

Implementation

Outpatient Therapy Centers

Memorial Manor (SNF)

IRF

Implementation

Rehabilitation Steering Committee– Members

Administration

Directors of outpatient rehab programs, IRU, SNF and home health

Medical Director– Meet Frequently– Report progress and plans to organization leaders

Technology Task Force

Program Impact

Volume Growth

Improved transitions of care

Improved patient care

More available resources– Adaptive Sports and Recreation– Adaptive Driving– Advanced Technologies

Improved Reputation

Physician Impact: Employment

Benefits– Less financial risk

Able to add physicians

Improved satisfaction– Employed physicians able to be marketed– Better benefits (Insurance, retirement, malpractice)– Improved alignment of physician/hospital system

interests

DisadvantagesPotential less control

– Financial– Decision making

Future

Graduate Medical Education– Planned PM&R residency 2017

Expansion of Physician Staff and clinical programs

Adaptive Driving

Building out additional 17 IRU beds

Opening of Solarium

Medical Leadership

Essential for program growth and operation

Limited experience in medical training– Search for mentors and courses

ConclusionTips learned the hard way– Never act in anger– Understand power structure

Helps with implementation

– Don’t settle for the usualThink outside the box

– No excuses!– Embrace change– Always update those in power about progress

and accomplishments

Conclusion