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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