There is sometimes nothing harder than culture change. If you read Kotter/change management literature, you can follow the steps.
Create the burning platform for change.
Create the common values and live them
Find some quick wins in the first prescriptive period (90 days).
Learn and align with defacto leaders and difference makers of both groups and work through the major hurdles that will destroy any positive momentum.
Align under quality initiatives that all will agree to and get behind.
Rinse and repeat…
When you make this work, there maybe nothing more exhilarating and exciting professionally. Good luck.
This a challenging dilemma that many organizations (in the US) are facing today. Unfortuneately, as Aldo says, you have to paddle both canoes at present. We are developing population health strategies preparing for a completely capitated model of the near or far future while having to live and thrive in the fee for service present. Many of our primary care colleagues are advancing the population health strategies of our organization and we are starting to engage our service line leaders to assist in this endeavor with the full understanding that a majority of our payments and business is based on fee for service.
A similar question and interesting analogy is “how does a company innovate and disrupt its own business when it needs to run its current business optimally to keep producing a very small margin?” Somehow, we have to do both.
I concur with Brian’s comments and many of the responses above. Creating a dedicated team to break down the barriers to discharge is a key to decreasing LOS. This has to be an organizational initiative that engages all of the stake holders. For example, we are a mix of community and employed providers. Our community partners often would round late in evenings vs early AM, causing delays in discharges and a backlog in the ED. This issue had to be addressed at the medical staff level to get fixed. There are a number of good strategies in the above posts. The key ingredient in my opinion is buy in from all stake holders and “esuite” pressure on all parties to effect change.
This is an incredibly complex and challenging question. I have sat on our organization’s compensation committeee for past few years and this issue has been discussed at length. One potential solution is setting the productivity goals at the divisonal or departmental level. This works for bigger departments that work in teams (OB, Anesthesia, Primary Care, Pediatrics, etc..). The value based metrics can be set at the individual or department level as well. These VBMs can be used to align physican and APC groups with non-financial goals of the oragnization (for example: quality, education, access, and cost control). This allows for better functioning teams at the expense of a completely transparent comepensation plan (i.e RVU x $RVU= Compenstaion).
This very issue and many others are being discussed this week at the Sullivan Cotter coinefernce in Florida.
Transparency of definied performance metrics can often drive improvement of your low performers. Creating meaningful performance metrics and making them transparent to your group, organization, or the lay public is powerful tool for change. There are some obvious negatives, but the positives can outweigh the internal angst, especially if low enagement is a factor in the suboptimal performers.
Thanks for your response. Quality is one area that we have been able “push” across regions under a service line strategy/initiative. I agree that many goals come from the “top down” at the regional/divisional level. We will have to continue to work to find common ground between our service lines and divisions. See you tomorrow.
Agreed. We have many of our Centers of excellence at our main women’s center. The challenge is aligning service line and regional strategies as we grow and move into different geographic locations/regions. Thanks for your response.
Thanks Rawn. See you tomorrow.