Lee Ann Odom
wondering if your system has residency programs? or proximity to an established one who would be willing to expand. We have the same struggles. We train over 1000 residents, and no psychiatry program…. how could this be possible??? we’re working on starting a program. We have significant recruiting to do, but believe with the vision we’ve mapped out we will be able to recruit to an academic program versus just recruiting for clinical manpower.
Our 8 hospital system has experienced this. Each hospital had it’s own president and CMO. Although our incentives were 60% system and 40% site, it still didn’t break down the barriers.
In February we had a massive reorg. 8 presidents were reduced to 4, so presidents have multi site responsibility. A president of ambulatory was added to develop new “big box” sites that would not be tied to any of the existing silos (so planning would be objective based on strategy of system, not a particular site) and a president of “shared services” for clinical services was added, so that one person has the responsibility, authority and accountability to drive service line strategy (that happens to be my new role…. I was previously a single site hospital president). The change in behavior in the past two months has been remarkable.
I am unclear if these three hospitals are the only hospitals in the region, or these three are same system/affiliated but there are still other competitors in the region. I think approach may be different if only 3 serving entire region.
Generally, I believe not every hospital can be everything to everyone, and neurosurgery infrastructure expensive to build and duplicate. Need to understand root cause of departures and see if they are system issues, process issues, or person specific.
Since I am from the area and know the market, I’ve been pondering this. Clearly, a great place…. that I have never heard of. You mention stakeholders being both patients and staff, but seems like that stakeholder group needs to get broader to penetrate the market as a place of choice. How are key payors involved? how about employers to work with payors to drive patients to it (narrow network? utilization incentives? etc).
Sometimes when we want to pilot programs that we have little experience in or are concerned that there may be controversy (in provider community), we start with our own employees in our health plan/narrow network. Usually by demonstrating results in that population, we have enough momentum and buy in to then expand.
This was very interesting to me. thinking about the first question you ask (about strategy), after pondering that, I think maybe it’s more about culture. Our organization is largely about data and consistent quality tracking and reporting (in an 8 hospital system). Ultimately, the site presidents are the accountable parties for quality performance. So, those operational leaders develop the plan to fund IT (with the Chief Quality officer at the table). The culture is one that believes IT is a key element to drive outcomes (versus a nice thing to have).
this is a tough one…. not being familiar with health care outside of the United States, so maybe this is a silly suggestion. But, when we’ve had strategic challenges and needed additional support, we’ve had great success leveraging philanthropy. Disney09
Front line team members should have decision making contribution to work flow and process improvement. I also believe that decision making about staffing/FTEs, etc should be pushed down to the lowest possible level, but with any authority comes accountability. it seems like maybe there wasn’t clear expectations around productively, etc. and associated accountability.
Situation does not seem to have an immediate resolution. I think the proven tactics of unblinding outcome data to drive behavior (and outcomes) as well as aligning incentives (pay for quality outcomes) could be work if you could get leadership buy in (like maybe from a chief quality officer). you have to be concerned about your own wellness as you decide if you’re able to stay in your current role.
Our organization initially experienced what you described above (two camps that run parallel, but not together). The functional success was dependent on how well the two people in the dyad got along. It was difficult to understand who really had authority and who was ultimately accountable. Each hospital had a president who reported to the system COO and also had a CMO who reported to the system CMO. That model created two distinctively separate teams. After our new (new to the organization in 2015) came, he changed the reporting structure. There is one accountable person for the performance of the hospital, and that’s the site president. The CMO reports to the president. (note, some of the hospital presidents are physicians. model is not about physician versus non-physician). Although the change initially controversial, it has been very successful for driving overall performance.
Seems like all/most responses suggest a blended or multi dimension model, which is what I would recommend. Threshold for wRVUs is important, but quality and patient satisfaction components also important.
Most of the responses don’t really address the physician satisfaction piece or how preventing burnout links to physician incentive model. Some wellness programs give incentives for participation (like increase CME support, etc).
Thank you very much – the telemedicine for teaching is great!. Also, great point about timing of providers entering scripts.