My only other thought to the excellent suggestion above: if it is clear that patient is gong home the next day (or very close to clear), incentivise MD/APPs to write pre discharge orders the evening before. May use RVUs for discharge orders written prior to 9 am.
I like the answer above. In addition, think about stock option/ownership program for top performing midlevel employees. This could be tied to perfomrance and time with company.
Tough situation as it appears to me that there are financial challenges in the system, thus the amount of funds potentially available for awards for perfect attendance may be limited. However, if you could find some funds, I would propose a 3 tiered system for 100%, >95%, >90% days worked (or perhaps even make distinction on when the day off was taken- i.e. Fri/Mon vs other days, with or without sufficient notice etc). But the real challenge seems to be overall state of the enterprise.
In my previous employer, we have successfully implemented base+ RVU-based bonus program. At the beginning of the fiscal year, we looked at the previous year numbers and made 90% of that as base level. If you were above 15% more over base, you were eligible for bonus-about 10% of annual salary prorated and pain quarterly. However, we never discussed the system prior to implementation, neither had a feedback sessions after implenetation, so not sure how people responded or liked it.
Very challenging situation. It has really been surprising for me to find out at my current employment place in NYS how much the compensation transparency drives resentment. My advice would be to be transparent about overall financial situation-what comes in and what and how is spent, but NOT to the level of individual.
I wonder if you could develop a positive reinforcement structure where using EHR would be rewarded financially? I.e. if your notes are done by 4 business days/95% of time, you receive x $/quarter? The engagement of the department presidents have to be assured from the top leadership- i.e. IT is unlikely to be able to truly engage someone who is not under their supervision. Sounds like the top leadership needs to analyze the situation, see if there are potentally resources lost because of the lack of engagement, or resources to be gained when engagement is full and take action.
Happy staff makes for the other components to align. If the people working in the environment are not satisfied- for whatever reasons, the whole structure will not work. One way to at least attemt to have more job satisfied staff is to truly engage them in decision making as much as feasible and openly explain where that is not possible. Including open and honest discussion on difficult decisions.
The dashboard is potentially a valuable tool. However, it should not create another chore for the physician within already busy clinic day. Thus, if part of the dashboard is a function to click when patient is placed in room, seen by RN, seen by MD, ready for checkout etc., have a centralized person click these functions on behalf of the clinician who simply verbally reports where they are going, that the patient is ready for checkout etc.
Using quite outstanding IT at VHA, I would propose sending text/email several times prior to the appointment -perhaps 72, 48, 24 hrs and the day of. These would ask and require response from the patient. If there is no response, call. If there is no response, I wonder if you could simply assume that patient will be no show and double book there. Or run a pilot to see how many of “nonresponders” are no shows at the end and then decide on double booking policy/timing when the double book will be done etc. In case both patients show up, it should be possible to deal with these unless it is more than 1-2 /day.
This is also a problem in our organization, one that I have not encountered in my previous places of work in Texas and Tennessee. Ideally, creating a positive reinforcement/incentive model where stakeholders will receive monetary (or similar) incentive if the goals were achieved may help. In our hospital, we are now giving $5,000/year (in $1,250/quarter achievement) to MDs, and $2,000/year ($500/quarter) to NP/PAs when notes are done 95% within 4 business days from encounter. The question is whether there are resources which could be allocated to these incentives.