Performance Excellence-Physician Enterprise

Introductory Comments:

The healthcare industry is at a crossroads. Consumerism, regulatory requirements, payer requirements, employer demands and other factors are driving forces for change in service delivery. Now is the time to get it right. We need to reduce cost, control utilization, streamline delivery of care, deliver care in a manner that exceeds patient expectations at all times, manage the health status of the communities we serve and demonstrate continuous improvement in achieving best in class clinical outcomes.

The industry, as a whole, needs to focus on the “Triple Aim” (low cost, service oriented and high quality). In doing so, we cannot neglect that we can only navigate the course to achieving value based results with a high performing team of leadership representatives, management representatives, physicians, other clinical providers and staff, thus achieving the “Quadruple Aim.”

We must engage and empower our clinical and non-clinical workforce to maintain professional satisfaction and reduce the risk of burn-out from expecting more without addressing resource requirements. It is not easy, but it can be framed in a simplified philosophy of Performance Excellence. Performance Excellence (Operations, Service and Clinical) is the gold standard by which healthcare teams will be measured.

“Every job is a self-portrait of the person who did it. Autograph your work with EXCELLENCE.”
- Jessica Guidobono

Is your physician enterprise designed to allow every member of your organization to autograph their work with excellence?

Workforce (physicians, advanced practice providers, clinical and non-clinical staff) engagement at all levels of your organization is essential to move forward in today’s ever-evolving healthcare market. A Performance Excellence Philosophy provides the systematic methodology to engage your workforce in achieving results.

The Baldrige Excellence Framework (Healthcare): As Systems Approach to Improving Your Organization’s Performance empowers your organization to reach its goals, improve results, and become more competitive. The framework consists of the criteria, the core values and concepts, and scoring guidelines to use as reference, to self-assess, or as a basis for external assessment. Whether or not your organization is “award and recognition oriented,” today’s ever-evolving healthcare environment creates to perfect opportunity to take a step back and assess your ability to achieve value based results.

Through active inquiry regarding your organization’s culture, you learn and develop your ability to accomplish what is important to your organization. A community/customer/patient centered philosophy, along with the critical aspects of: Leadership/Governance; Vision/Strategy; Measurement, Analysis, and Knowledge Management (through data analytics); and Operational Work Processes and Process Management, allows you to evaluate how prepared you are to achieve VALUE BASED RESULTS.

Through internal ASSESSMENT you may find that your organization needs external resources to develop the necessary structure and infrastructure to achieve your VISION. Experienced leadership with a demonstrated track record of achieving results within physician enterprise organizations may be difficult to find. You may need Interim Leadership and Management Advisory Services with the Resilience to do the “initial heavy lifting” of positioning your enterprise for high performance.

Today we explore ways to assess your systematic approach for delivering value in your communities.

Assess Your Physician Enterprise through a Systematic Approach

Vision:

You need a systematic approach to assessing your physician enterprise ability to achieve results. You need a framework to deliver value. The challenge is to critically assess to learn how you are accomplishing your vision and strategic priorities. Today we pose several key questions to begin to assess your organization’s readiness to achieve value based results.

Has your organization set a strategic priority for achieving value based results in your physician enterprise?

How has your organization set a strategic priority for achieving value based results? “Value Based Care is Here to Stay”:

Vision and Strategy-Questions to consider:

Is it important to your organization?
Have you established a shared Vision of physician integration to achieve value based results?
Is your organization prepared to create greater value in the communities you serve?
Does your organization have the leadership with the demonstrated competency of RESLIENCE to navigate the path to value?
Do you need Interim Leadership or experienced external advisors to assess and develop your physician enterprise ability to deliver value based results

Please see Assessing Your Vision and Strategies, to begin your assessment: You may also request a copy from: This email address is being protected from spambots. You need JavaScript enabled to view it.

It all begins with LEADERSHIP:

Leadership must promote a systems perspective. A systems perspective means managing all the components of your organization as a whole to achieve ongoing success. A healthcare system has many inter-related, but not always highly integrated, components. Each component must be led and managed to function as a high performing organization within the context of the entire system. Most importantly, your physician enterprise (whether an employed network or Clinically Integrated Network) must demonstrate a successful track record of achieving results.

Assess your leadership and management structure to achieve results:

“Achieve Results-Leadership and Management”

Question to Consider-Leadership:

Do senior leaders lead the organization, consistent with your systematic approach?

Please see Assessing Your Leadership/Management, to begin your assessment: You may also request a copy from: This email address is being protected from spambots. You need JavaScript enabled to view it.

Governance:

How does your governance structure oversee your physician enterprise and address your organizational ability to achieve value based results?

Assess your governance structure to achieve results: "Governance”

Governance - Questions to Consider:

How does your organization ensure responsible governance of the physician enterprise?

How does your governing achieve accountability for:

  • senior leaders’ actions
  • strategic plans
  • fiscal accountability
  • transparency in operations
  • selection of governance board members and disclosure policies for them, as appropriate
  • independence and effectiveness of internal and external audits
  • protection of stakeholder and stockholder interests, as appropriate
  • succession planning for organizational leadership

Please see Assessing Your Governance, to begin your assessment: You may also request a copy from: This email address is being protected from spambots. You need JavaScript enabled to view it.

Knowledge Management/Transfer through Data Analytics:

How do you measure, analyze, and then improve organizational performance?

Assess your Performance Measures to achieve results: "Knowledge Management/Transfer through Data Analytics”

Questions to Consider - Performance Measures:

How do you track data and information on daily operations and overall organizational performance?

How do you select, collect, align, and integrate data and information to use in tracking daily operations and overall organizational performance; and track progress on achieving strategic objectives and action plans?

Please see Assessing Your Knowledge Management/Transfer through Data Analytics, to begin your assessment: You may also request a copy from: This email address is being protected from spambots. You need JavaScript enabled to view it.

Operations Management/Process Management:

How do you design, manage and improve your key health care services and work processes?

Assess your Work Processes/Process Management Methodology to achieve results: “Process Management-Achieve Value Based Results”

Questions to Consider-Work Processes/Process Management:

How do you design, manage, and improve your key health care services and work processes?

How do you determine key health care service and work process requirements?

Please see Operations Management/Process Management, to begin your assessment: You may also request a copy from: This email address is being protected from spambots. You need JavaScript enabled to view it.

Results:

A Performance Excellence Philosophy provides the systematic methodology to achieve results. Your organization will achieve value based results with unrelenting commitment from key stakeholders at every level.

You need a simplified approach to creating a culture of Performance Excellence to achieve results:

Question to Consider-Results

What are your health care and process effectiveness results?

What are your health care results and your results for your patient and other customer service processes?

Is your entire workforce engaged in achieving value based results?

Please see Assessing Your Results, to begin your assessment:

Key Take Aways and Next Steps:

  • Assess and adopt a Vision of Value Based Care in your Physician Enterprise
  • Implement a Culture of Performance Excellence
  • Assess your Leadership/Management
  • Assess your Governance
  • Assess your Knowledge Management/Transfer (Data Analytics)
  • Assess your Operations/Process Management
  • Assess your Results
  • You may need external resources to assist in assessment and development
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Performance Excellence Simplified: Achieve Value Based Results

High performing leaders in healthcare organizations of today are challenged with the uncertainty of healthcare delivery in the future. Many hospitals face a challenge among key stakeholders. That challenge is a brand/reputation shift toward value based care. Mission, Vision and Values typically reflect claims of high quality and customer service, but key stakeholders (physicians, patients, families, employers, payers and regulatory bodies) are not buying the slogans of the past. In today's world, healthcare providers must demonstrate that they are living up to the value based equation (low cost, seamless, patient-centric, high quality care). Stakeholder demand and regulatory requirements drive organizations to demonstrate measurable results in cost, service and quality.

Creating a performance excellence environment is a highly successful leadership approach to navigate the ever-evolving imperatives of service delivery. Value based results will be achieved through a leadership philosophy of performance excellence:


Engage your people: Develop Governance, Leadership and Management structures to engage your key players, especially physicians and other clinical thought leaders to lead the effort. Create a shared Vision of Achieving Value Based Results. Now it’s time to execute your shared Vision.


Evaluate your data; identify best practice: Engage all key players in identifying essential metrics to understand your current performance and identify opportunities for improvement in Operational/Financial, Service and Clinical performance.


Know your process and design your process (es): Utilize advanced process management methodologies to identify current processes that yield current results. Establish consistency in your process improvement methodology. Identify best practices. Design your processes to achieve results.

Hardwire/Standardize best practice, process design to ACHIEVE

Sustainable results will be achieved from your Action, if you are focused on Continuous Operating and Quality Improvement. Remember you may FAIL (“First Attempt In Learning”). Establish your culture of Performance Excellence. Start small, simplify, be resilient, be persistent and be unrelenting in your approach to achieving results. Be prepared to embrace “Polarity Thinking.” Every good conversation begins with good listening. Listen to your key stakeholders. Listen to understand, not to respond. Physician integration and value based strategies inherently present divergent opinions. Learn the power of leveraging Inquiry AND Advocacy: two critical leadership competencies. That’s how leaders achieve results.

Value Based Metrics:

The list of potential measures is endless. Identify what is important to your key players. Start with metrics that present and build a common understanding of current performance. Measure, monitor, report, analyse and improve your key metrics, focused on value: Operational/Financial Excellence, Service Excellence, and Clinical Excellence. A comprehensive list of potential metrics is available at: Mike Jones LinkedIn or This email address is being protected from spambots. You need JavaScript enabled to view it.

Key Takeaways:

  • You have highly engaged employees, physicians, patients, family members, community representatives, employers and payers.
  • You have defined a common and shared vision for your organization through gaining knowledge of your key stakeholders’ perspectives
  • You have defined what outcomes you and your organization are trying to achieve in terms of Operations, Finance, Service and Clinical indicators
  • You have measured your current performance
  • Now you want to improve performance:
  • Everything is a process

    Gain an understanding of your current processes

    Identify your best practices

    Design process to achieve best practice performance

    Re-evaluate your performance to see if you are consistently achieving improved performance

    Modify your processes when necessary to consistently achieve higher levels of performance

    Hard-wire your processes to ALWAYS achieve best practice performance

    Never stop monitoring to verify your preferred state performance/outcomes.

    Never stop monitoring to verify your preferred state performance/outcomes.

    Train for it (all Key Players)

    Build consistency of approach

  • Define your performance excellence culture
  • Focus your leadership on the relentless pursuit of performance excellence
  • Adopt your preferred methodology
  • Formalize and standardize your methodology
  • Listen to your key stakeholders
  • Engage all parties in understanding improvement initiatives
  • Gain understanding of performance through data analytics
  • Design processes to achieve desired results
  • Be prepared to Fail, but failing is your F (first), A (attempts), I (in), L (Learning).
  • Achieve success in all you do
  • Demonstrate that you are creating value based outcomes

Next Steps:

  • View Additional Reference Information:
    • In “Be an Inspirational Leader”, author Dan Nielsen portrays the incredible impact of inspirational leadership on your personal, professional, and organizational success. Read Dan Nielsen’s book: “Be An Inspirational Leader: Engage, Inspire, Empower”
    • Management of healthcare providers’ reputation and brand dramatically changes with consumer demand for value. An organization’s reputation is subject to more than marketing campaigns. Social media and ratings services have significant impact on consumer perception of healthcare organizations. If you do not have on-going audits of your on-line presences and ratings, it is wise to complete and assessment and take corrective action, as necessary. To learn more about Reputation and Brand Management view the work of Claire Faucett with engage5w.
    • Learn more about “Polarity Thinking” and the two essential leadership competencies of Inquiry and Advocacy. View the work of leadership coaches James McKenna and Cliff Kayser, sponsored by Wiederhold & Associates.
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Process Management: Achieve Value-Based Results

“If you can’t describe what you are doing as a process, you don’t know what you are doing.” Such a profound quote by W. Edwards Deming, largely recognized as the Father of the Quality Movement. Dr. Deming's famous 14 Points, originally presented in Out of the Crisis, serve as management guidelines. The points cultivate a fertile soil in which a more efficient workplace, higher profits, and increased productivity may grow. These management principles have a direct correlation to navigating the path to achieving results in the uncertain healthcare industry of today.

Deming’s 14 Points for Leadership/Management

While traditionally applied to product manufacturing, Deming theory has direct application across multiple industries, especially when rising consumer and regulatory requirements demand greater value. View healthcare service delivery as a product in high demand from consumers (patients, families and others). Expectations of lower cost and superb quality, delivered in a highly patient-centric and service-oriented environment, create an imperative healthcare systems must meet to remain relevant.

    Healthcare leaders are served well when focusing on Deming’s 14 Points:
  1. Create constancy of purpose toward improvement of product and service, with the aim to become competitive, to stay in business and to provide jobs.
  2. Adopt the new philosophy. We are in a new economic age. Western management must awaken to the challenge, must learn their responsibilities, and take on leadership for change.
  3. Cease dependence on inspection to achieve quality. Eliminate the need for massive inspection by building quality into the product in the first place.
  4. End the practice of awarding business on the basis of a price tag. Instead, minimize total cost. Move towards a single supplier for any one item, on a long-term relationship of loyalty and trust.
  5. Improve constantly and forever the system of production and service, to improve quality and productivity, and thus constantly decrease costs.
  6. Institute training on the job.
  7. Institute leadership (see Point 12 and Ch. 8 of Out of the Crisis). The aim of supervision should be to help people and machines and gadgets do a better job. Supervision of management is in need of overhaul, as well as supervision of production workers
  8. Drive out fear, so that everyone may work effectively for the company. (See Ch. 3 of Out of the Crisis).
  9. Break down barriers between departments. People in research, design, sales, and production must work as a team in order to foresee problems of production and usage that may be encountered with the product or service.
  10. Eliminate slogans, exhortations, and targets for the work force asking for zero defects and new levels of productivity. Such exhortations only create adversarial relationships, as the bulk of the causes of low quality and low productivity belong to the system and thus lie beyond the power of the work force.
    1. Eliminate work standards (quotas) on the factory floor. Substitute with leadership.
    2. Eliminate management by objective. Eliminate management by numbers and numerical goals. Instead substitute with leadership.
  11. Remove barriers that rob the hourly worker of his right to pride of workmanship. The responsibility of supervisors must be changed from sheer numbers to quality.
  12. Remove barriers that rob people in management and in engineering of their right to pride of workmanship. This means, inter alia, abolishment of the annual or merit rating and of management by objectives (See Ch. 3 of Out of the Crisis).
  13. Institute a vigorous program of education and self-improvement.
  14. Put everybody in the company to work to accomplish the transformation. The transformation is everybody's job.

The focus of this article is to bring home the reality that EVERYTHING IS A PROCESS. “If you cannot describe what you are doing as process, you do not know what you are doing.”

Physician alignment, integration and engagement in integrated delivery systems are essential elements in navigating the complexity of healthcare service delivery. Healthcare organizations need a simplified approach to realize organizational vision of comprehensive and successful alignment and integration strategies. Creating a common Vision is essential. Healthcare organizations that focus on a vision of “maximizing success in the ever-evolving healthcare industry through physician alignment and integration” will ultimately build capability to meet and exceed consumer expectations in navigating the path to value-based care. Today’s ever-evolving healthcare industry requires a comprehensive Vision of Integration. Execution of the Vision is best achieved through a Leadership Philosophy of Performance Excellence.

The first key element in fostering a culture of performance excellence is to define the “WHAT” that constitutes excellence, frequently referred to as “the Triple Aim” of healthcare:

  • Operating/Financial Excellence (low cost, highly efficient and cost effective service delivery),
  • Service Excellence (service delivery exceeding patient and family expectations), and
  • Clinical Excellence (best clinical outcomes for every patient and patient population).

The next essential element of a performance excellence culture is to define the “HOW” the organization will be led through:

  • Stakeholder Engagement
  • Knowledge Management/Knowledge Transfer
  • Process Management

Organizations will not only achieve the “triple aim”, but will enhance performance through achieving the “quadruple aim” of healthcare. In addition to achieving traditional value-based results, a culture of performance excellence will yield higher levels of provider satisfaction and engagement while redefining service delivery. As highlighted in previous articles:

  • Value Based Care is here to stay and healthcare organizations must overcome multiple organizational gaps that may contribute to not fully realizing a vision of success in a high performing integrated delivery system. Here
  • Key Stakeholder Engagement is essential to execution of a common Vision:
    • Physician Stakeholders (as well as others) should be engaged in organizational Governance, especially among healthcare providers, is essential to success in a value based environment. Here.
    • Physician Stakeholders should also be engaged in Leadership and Management to achieve sustainable results. Here.
    • Knowledge Management/Knowledge Transfer
      • A common understanding of performance is best achieved through measuring, monitoring, reporting and analysis of key outcomes: Operational, Service and Clinical Metrics (Data Analytics) Here.
      • Opportunities for performance improvement are quickly identifiable when using data analytics in evaluating current outcomes.Here.

This article expands on development of a Philosophy of Performance Excellence to achieve a vision of success through Performance Management. Measuring, monitoring, reporting, analyzing and improving performance begins with defining key metrics to create a common understanding. Internal and external benchmark measures are available through a variety of sources to build an improved understanding of: Operational/Financial, Service, and Clinical Performance. Now you need a methodology to achieve your desired outcomes.

Physicians and other care providers work within a defined process everyday of their lives when addressing and resolving patient needs for care. What is done when presented with multiple patients with complex healthcare needs? SOAP is a traditional approach to addressing patient needs:

The SOAP note (an acronym for subjective, objective, assessment, and plan) is a method of documentation employed by health care providers to write out notes in a patient's chart, along with other common formats, such as the admission note. Documenting patient encounters in the medical record is an integral part of practice workflow starting with patient appointment scheduling, to writing out notes, to medical billing. The SOAP note originated from the Problem Oriented Medical Record (POMR), developed by Lawrence Weed, MD.[1] It was initially developed for physicians, who at the time, were the only health care providers allowed to write in a medical record. Today, it is widely adopted as a communication tool between inter-disciplinary healthcare providers as a way to document a patient’s progress. SOAP notes are now commonly found in electronic medical records (EMR) and are used by providers of various backgrounds. Prehospital care providers such as EMTs may use the same format to communicate patient information to emergency department clinicians. Physicians, physician assistants, nurse practitioners, pharmacists, podiatrists, chiropractors, acupuncturists, occupational therapists, physical therapists, school psychologists, speech-language pathologists, certified athletic trainers (ATC), sports therapists, occupational therapists, among other providers use this format for the patient's initial visit and to monitor progress during follow-up care.

It is a well-defined thought process. Complete a SUBJECTIVE EVALUATION, an OBJECTIVE EVALUATION, an ASSESSMENT and a PLAN. Engage patients and family members when seeking to understand what is happening with a patient (Subjective). Gather facts/data regarding what is happening with a patient through diagnostic procedures (Objective). Review the information gathered and knowledge gained from the evaluations (Assessment) and take action to address what has been presented (Plan). Why not apply a similar process that is highly effective to leadership and management. That is a process management/performance management approach.

Performance Management

The days of simply making claims of high-quality, service-oriented and low cost care delivery are gone. Patients, families, communities, payers, regulatory agencies and other key stakeholders demand proof of performance. Measures of performance should focus on Operations/Financial, Service and Clinical Excellence. Internal and external benchmarking of performance is imperative. Once you understand current performance through data analytics, you need tools to achieve continuous improvement.

There are many theories of performance/process management. Theories and practices have evolved over time. Many are inter-related and draw on common practices. Process Management philosophies include, but are not limited to:

  • Total Quality Management (TQM):
    • Focus on the Consumer
    • Continuous Improvement
    • Quality Improvement
    • Accurate Evaluation
  • Continuous Quality Improvement (CQI):
    • Analyse
    • Refine
    • Improve
  • Plan Do Study Act (PDSA): Model for Improvement: What are we trying to accomplish? How will we know that a change in an improvement? What change can we make that will result in improvement?
    • Plan: Objective, Questions and Predictions, Plan to carry out the cycle (who, what, where, when)
    • Do: Carry out the plan. Document problems and unexpected observations. Begin data analysis.
    • Study: Complete the data analytics. Compare data to predictions. Summarize what you have learned.
    • Act: What changes are to be made? Begin the next cycle.
  • Lean Management:
    • Leadership Commitment to Project (s)
    • Project Charter (Standardized for ease of understanding).
    • Project Tracking (verify milestones)
    • Assign Project Manager
    • Engage Key Stakeholders
    • Communicate Frequently
    • Achieve Results
  • Lean:
    • Waste Reduction
    • Continuous Improvement
    • Respect for People
  • Six Sigma-DMAIC:
    • Define: Define project purpose and scope. Identify high level processes for improvement. Determine customer needs and benefits.
    • Measure: Baseline data on current processes. Pinpoint problem locations and occurrences. Identify potential areas for improvement.
    • Analyse: Identify root causes and validate root causes against captured data. Determine improvements that need to be made.
    • Improve: Implement the improvements that have been determined to address the root causes.
    • Control: Perform before and after analysis. Monitor processes/systems. Document results. Determine next steps/recommendations.
  • Lean/Six Sigma:
    • Lean: focuses on waste reduction by streamlining process
    • Six Sigma: focuses on preventing defects through problem solving
    • Lean/Six Sigma: Lean strengthens Six Sigma-Problem solving plus improving process delivers greater value-based results

The common thread in all methodologies is an unrelenting focus on seeking improved outcomes in everything we do:

  • Cycles of improvement
    • Engaging in a customer focus
    • Understanding key stakeholder perspective
    • Measuring current performance through data analytics
    • Engaging those closest to the work:
      • to define current processes (value stream mapping, flowcharting)
      • to define desired outcomes of current processes
      • to define undesirable outcomes (failures) of current process
      • identify and define best practices
      • identify and define outcomes
      • identify and define preferred processes to achieve best practice performance and outcomes
      • transfer best practices, best practice outcomes and preferred processes to:
        • gain consistency across all players
        • reduce variation in outcomes and results across all players
        • meet and exceed customer expectations at all times
        • reduce cost of service delivery
        • increase throughput in service delivery
        • provide consistent, high-quality outcomes

Performance Management Simplified

High performing leaders in healthcare organizations of today are challenged with the uncertainty of healthcare delivery in the future. Creating a performance excellence environment is the best to navigate the ever-evolving imperatives of service delivery. Value based results will be achieved through a leadership philosophy of performance excellence:


Engage your People


Evaluate your data; identify best practice


Know your process and design your process

Hardwire/Standardize best practice, process design to ACHIEVE

Key Take Aways:

  • You have highly engaged employees, physicians, patients, family members, community representatives and payers.
  • You have defined a common and shared vision for your organization through gaining knowledge of your key stakeholders’ perspectives
  • You have defined what outcomes you and your organization are trying to achieve in terms of Operations, Finance, Service and Clinical indicators
  • You have measured your current performance
  • Now you want to improve performance:
    • Everything is a process
    • Gain an understanding of your current processes
    • Identify your best practices
    • Design process to achieve best practice performance
    • Re-evaluate your performance to see if you are consistently achieving improved performance
    • Modify your processes when necessary to consistently achieve higher levels of performance
    • Hard-wire your processes to ALWAYS achieve best practice performance
    • Never stop monitoring to verify your preferred state performance/outcomes.
    • Pick a methodology for process management (they all work)
    • Train for it
    • Build consistency of approach

Next Steps:

  • Define your performance excellence culture
  • Relentless leadership focus on performance excellence
  • Adopt your preferred methodology
  • Formalize and standardize your methodology
  • Listen to your key stakeholders
  • Engage all parties in understanding improvement initiatives
  • Gain understanding of performance through data analytics
  • Design processes to achieve desired results
  • Achieve success in all you do
  • Demonstrate that you are creating value based outcomes
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Achieve Value-based Results in Healthcare: Knowledge Management/Transfer Through Data Analytics

Physician alignment, integration and engagement in integrated delivery systems are essential elements in navigating the complexity of healthcare service delivery. Healthcare organizations need a simplified approach to realize organizational vision of comprehensive and successful alignment and integration strategies. Creating a common Vision is essential. Healthcare organizations that focus on a vision of “maximizing success in the ever-evolving healthcare industry through physician alignment and integration” will ultimately build capability to meet and exceed consumer expectations in navigating the path to value-based care.

Today’s ever-evolving healthcare industry requires a comprehensive Vision of Integration. Execution of the Vision is best achieved through a Leadership Philosophy of Performance Excellence.

The first key element in fostering a culture of performance excellence is to define the “WHAT” that constitutes excellence, frequently referred to as “the Triple Aim” of healthcare:

  • Operating/Financial Excellence (low cost, highly efficient and cost effective service delivery),
  • Service Excellence (service delivery exceeding patient and family expectations), and
  • Clinical Excellence (best clinical outcomes for every patient and patient population).

The next essential element of a performance excellence culture is to define the “HOW” organization will be led through:

  • Stakeholder Engagement
  • Knowledge Management/Knowledge Transfer
  • Process Management

Organizations will not only achieve the “triple aim”, but will enhance performance through achieving the “quadruple aim” of healthcare. In addition to achieving traditional value-based results, a culture of performance excellence will yield higher levels of provider satisfaction and engagement while redefining service delivery.

As highlighted in previous articles:

  • Value Based Care is here to stay and healthcare organizations must overcome multiple organizational gaps that may contribute to not fully realizing a vision of success in a high performing integrated delivery system. Here
  • Key Stakeholder Engagement is essential to execution of a common Vision:
    • Physician Stakeholders (as well as others) should be engaged in organizational Governance, especially among healthcare providers, is essential to success in a value based environment. Here.
    • Physician Stakeholders should also be engaged in Leadership and Management to achieve sustainable results. Here.

This article expands on development of a Philosophy of Performance Excellence to achieve a vision of success through Knowledge Management/Knowledge Transfer. Measuring, monitoring, reporting, analyzing and improving performance begins with defining key metrics to create a common understanding. Internal and external benchmark measures are available through a variety of sources to build an improved understanding of:

  • Operational/Financial Performance,
  • Service Performance, and
  • Clinical Performance.

Knowledge Management/Knowledge Transfer Through Data Analytics

The days of making claims of high-quality, service oriented and low cost care delivery are gone. Regulatory requirements and consumers of healthcare demand demonstrated proof. On October 14, 2016, the Department of Health and Human Services (HHS) issued its final rule with comment period implementing the Quality Payment Program that is part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The Quality Payment Program is intended to improve Medicare by helping you focus on care quality and focusing on making patients healthier (population health management). The Quality Payment Program’s purpose is to provide new tools and resources to help organizations to provide patients with the best possible, highest-value care. The Quality Payment Program has two tracks to choose from:

  • The Merit-based Incentive Payment System (MIPS), and
  • Advanced Alternative Payment Models (APMs).

Healthcare providers are required and must report key measures of performance in order to maintain a competitive edge and to maximize reimbursement for services rendered. Measures of performance should focus on Operations/Financial, Service and Clinical Excellence. Internal and external benchmarking of performance is imperative. The best place to start is to define your measures, based on industry standards. Engaging your Governance, Leadership and Management representatives, as well as other key stakeholders, in defining performance metrics is essential to gain a common understanding. Begin by gathering potential sources of industry standards (see table).

Knowledge Management/Knowledge Transfer Process:

The quest for appropriate data analytics to measure, monitor, report, analyze, improve and control can be challenging. Once sources of industry standards have been identified, engage stakeholders in organization-wide effort to define your measures of Operational, Service and Clinical metrics:

  • Review and select meaningful measures:
  • Verify the organizational capacity to measure, monitor and report measures:
    • Be sure all metrics of performance are measurable.
    • Operational and Financial Metrics are typically readily available, but may not be reported in an intuitive format with full-transparency across the organization and among key stakeholders.
    • Service Metrics (patient engagement) should be standardized using a formal survey tool, administered by a vendor approved for use by The Centers for Medicare & Medicaid Services (CMS).
    • Measures of Clinical Performance may present the greatest challenge:
      • While sources of key measures are readily available, the ability to measure performance across all providers may be limited.
      • Desperate systems in multiple healthcare settings increase complexity of data collection.
      • Clinical information may be captured as free form text and may require manual/human intervention for interpretation.
      • Manual data abstraction may present a high cost alternative to automated reporting.
      • Lack of interoperability of information systems creates complexity.
      • Clinical and claims data are not typically consolidated.
      • The good news is: multiple vendors are available with advanced tools to aggregate data to support your efforts to measure, monitor, report, analyze, improve and control clinical performance.

  • If necessary, select reliable vendors to provide external support for the purposes of understanding measurable performance.
  • Create detailed analytics reports across the organization at the Enterprise, Specialty, Practice Location and Individual Provider levels,
  • Determine baseline performance at all levels,
  • Set routine reporting intervals (daily, weekly, monthly, quarterly and annually), as appropriate,
  • Set levels of performance:
    • minimum level of performance,
    • expected/goal level of performance, and
    • Level of performance exceeding goal.
  • Utilize high level dashboard reporting tools for ease of review and understanding across the organization:
    • A simple “stop light analysis” provides ease of review (see below):

    Click here for Reference Sources.
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    Achieve Results through Physician Alignment, Integration and Engagement: Leadership and Management

    Culture of Performance Excellence: A simplified Approach

    Physician alignment, integration and engagement in integrated delivery systems are essential elements in navigating the complexity of healthcare service delivery. Healthcare organizations need a simplified approach to realize organizational vision of comprehensive and successful alignment and integration strategies. Creating a common Vision is essential. Thomas Edison is quoted as saying “Vision without execution is hallucination.” My expertise in leading physician alignment and integration strategies leads me to believe: “Vision without execution is worse than having no vision at all.”

    A vision of developing highly integrated, well-coordinated and person-centric care is essential to success in today’s healthcare market. Best practice in integration and alignment will begin with key stakeholder engagement in executing organizational vision. Physicians, as key stakeholders in care delivery, respond well to a establishing a common vision. Healthcare organizations that focus on a vision of “maximizing success in the ever-evolving healthcare industry through physician alignment and integration” will ultimately build capability to meet and exceed consumer expectations in navigating the path to value-based care.

    Vision

    As previously highlighted in Achieve Results through Physician Alignment, Integration and Engagement: Governance and Value-based Care is Here to Stay, multiple organizational gaps may contribute to not fully realizing a vision of success in a high performing integrated delivery system. This article expands on development of a philosophy of performance excellence to achieve a vision of success. The schematic shown above provides a roadmap for navigating the performance excellence journey toward becoming a fully integrated and well-coordinated care delivery system, focused on the value-based equation of healthcare.

    Vision and Execution

    Today’s ever-evolving healthcare industry requires a comprehensive vision of performance excellence:

    • Operating/Financial Excellence (low cost, highly efficient and cost effective service delivery),
    • Service Excellence (service delivery exceeding patient and family expectations), and
    • Clinical Excellence (best clinical outcomes for every patient and patient population).

    More importantly execution of that vision is imperative. Most healthcare organizations have developed a vision of service delivery that meets the value-based equation of operating/financial, service and quality excellence. Direct employment of physicians and other providers is one model of integration. Other models, including developing a Clinically Integrated Network, create other opportunities for integration and alignment. Either way, it is essential to build a culture of inclusion

    Execution of an organization’s vision for the future is best achieved through fostering and developing a culture of comprehensive performance excellence. Measurable results are achieved when time and energy are devoted to:

    • Key Stakeholder Engagement,
    • Knowledge Management/Knowledge Transfer through data analytics, and
    • Formal Process Management.

    Physicians, as irreplaceable key stakeholders in care delivery, should be engaged in decision making and in charting the course for success. Physicians and other key stakeholders can quickly become disenfranchised when the vision of integration is not well executed. Having physicians actively engaged at the table to participate in decision making is essential. Whether healthcare organizations are focused on growing and developing an employed physician network, or seeking to align and integrate through other means, physicians should be formally and informally engaged in:

    • Governance,
    • Leadership, and
    • Management.

    Previous articles addressed physician engagement in Governance of the Physician Enterprise Organization. This article focuses on physician engagement in Leadership and Management.

    Leadership and Management:

    In addition to active engagement in governance, physician leadership and management is recommended. A dyad leadership model fosters a culture of engagement among physicians and support staff. The model includes physician leaders and operational leaders working in partnership at all levels:

    • Executive Leadership (Physician Executive Leader and Administrative Executive Leader),
    • Operational Leadership (Medical Directors and Operations Directors), and
    • Operational Management (Site Lead Physicians and Operations Managers).

    Physician leaders and managers in the dyad leadership model typically maintain an allocated time in clinical activities, in addition to allocated time in leadership/management activities. The prorated allocation of leadership/management time should be tailored to scope of responsibility and accountability.

    An Operating Team, comprised of dyad partners at the executive and operational leadership level, should meet on a routine basis (weekly or bi-weekly) as a team to share ideas and build consistency within the physician enterprise. The Operating Team maintains accountability and responsibility for translating organization-wide goals and objectives to action. The team ensures that strategy is translated into operations. Action plans and tactics are developed to achieve strategic and operational results.

    The Operating Team should meet with Site Lead Physicians and Site Supervisor/Managers on a routine basis to hard-wire operating norms. Regularly scheduled meetings of all Site Lead Physicians and Site Supervisors/Managers provide an opportunity to share best practices, build consistency and to give the practices a sense of being part of a group practice, as opposed to being isolated in individual practices.

    Executive and operational leadership team members should develop a routine of rounding at all practice locations. Building relationships with practicing physicians, other providers and support staff is essential. Day to day problem solving is best achieved through active engagement of leadership, management and staff. Those who are closest to the delivery of care typically have the most innovative ideas for how best meet the needs of patients/communities services. Routine rounding also provides the opportunity for leadership to engage with patients and families to gain a better understanding of the patient experience.

    An example organizational chart is provided below to give direction to leadership and management structure (see below). It should be noted that functional structure and infrastructure in the organization is most effective with limited layers of leadership and management, maintaining active relationships between leadership and staff. The organizational model is designed to expand horizontally, as opposed to vertically through creation of additional layers. Operational leadership should be tailored to the scope and diversity of specialty types within the group.

    Support functions are essential to success of the physician enterprise. Finance/Accounting, Revenue Cycle, Marketing/Public Relations, Information Technology, Human Resources, Facilities/Maintenance, Purchasing and other support functions may be centralized on an enterprise-wide basis or may be structured in direct support of the physician enterprise. It should be noted that functions are highly specialized in support of a physician enterprise. Whether centralized or in direct support of the physician enterprise, it is essential for operational and executive leadership to engage directly with leadership and management of the support functions to develop a common understanding of organizational needs and performance expectations. It is recommended for support functions to be actively engaged with governance sub-committees.

    Key Take Aways:

    • Active engagement of key stakeholders is essential to fostering a culture of performance excellence
    • Physicians can quickly become disenfranchised when not engaged in developing organizational vision
    • Physician engagement and satisfaction in improved when organizational vision is well executed
    • Execution is best achieved when the organization is focused on performance excellence in operations, service and clinical activities
    • Developing and Fostering a culture of performance excellence requires governance, leadership and management

    Next Steps:

    • Knowledge management and transfer through data analytics:
      • Determine the most important operational, service and clinical data analytics needed
    • Process Management through formal methodologies:
      • Determine the process management for the organization
      • Develop leadership, management and staff to focus on processes to:
        • achieve results,
        • standardize operating norms,
        • reduce variation, and
        • hardwire best practices.

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    Achieve Results through Physician Alignment, Integration and Engagement: Governance

    Culture of Performance Excellence: A simplified Approach

    Physician alignment, integration and engagement in integrated delivery systems are essential elements in navigating the complexity of healthcare service delivery. Healthcare organizations need a simplified approach to realize organizational vision of comprehensive and successful alignment and integration strategies. Creating a common Vision is essential. Thomas Edison is quoted as saying “Vision without execution is hallucination.” My expertise in leading physician alignment and integration strategies leads me to believe: “Vision without execution is worse than having no vision at all.”

    A vision of developing highly integrated, well-coordinated and person-centric care is essential to success in today’s healthcare market. Best practice in integration and alignment will begin with key stakeholder engagement in executing organizational vision. Physicians, as key stakeholders in care delivery, respond well to a establishing a common vision. Healthcare organizations that focus on a vision of “maximizing success in the ever-evolving healthcare industry through physician alignment and integration” will ultimately build capability to meet and exceed consumer expectations in navigating the path to value-based care.

    As previously highlighted, multiple organizational gaps may contribute to not fully realizing a vision of success in a high performing integrated delivery system. This article expands on development of a philosophy of performance excellence to achieve a vision of success. The schematic shown above provides a roadmap for navigating the performance excellence journey toward becoming a fully integrated and well-coordinated care delivery system, focused on the value-based equation of healthcare.

    Vision and Execution

    Today’s ever-evolving healthcare industry requires a comprehensive vision of performance excellence:

    • Operating/Financial Excellence (low cost, highly efficient and cost effective service delivery),
    • Service Excellence (service delivery exceeding patient and family expectations), and
    • Clinical Excellence (best clinical outcomes for every patient and patient population).

    More importantly execution of that vision is imperative. Most healthcare organizations have developed a vision of service delivery that meets the value-based equation of operating/financial, service and quality excellence. Direct employment of physicians and other providers is one model of integration. Other models, including developing a Clinically Integrated Network, create other opportunities for integration and alignment. Either way, it is essential to build a culture of inclusion.

    Execution of an organization’s vision for the future is best achieved through fostering and developing a culture of comprehensive performance excellence. Measurable results are achieved when time and energy are devoted to:

    • Key Stakeholder Engagement,
    • Knowledge Management/Knowledge Transfer through data analytics, and
    • Formal Process Management.

    Physicians, as irreplaceable key stakeholders in care delivery, should be engaged in decision making and in charting the course for success. Physicians and other key stakeholders can quickly become disenfranchised when the vision of integration is not well executed. Having physicians actively engaged at the table to participate in decision making is essential. Whether healthcare organizations are focused on growing and developing an employed physician network, or seeking to align and integrate through other means, physicians should be formally and informally engaged in:

    • Governance,
    • Leadership, and
    • Management

    This article focused on physician engagement in Governance of a Physician Enterprise Organization. The article in this series will focus on establishing Leadership and Management Structure to execute the organizational vision.

    Governance:

    Hospital organizations have been inviting physicians to be members of governance structures for many years. In addition to representing medical staff activities, physicians can help foster a physician friendly culture at the board level. Gaining the physician perspective of hospital operations and embracing input will contribute to an environment of high performance. Physicians are typically viewed as customers of hospital based services.

    Governance within a physician enterprise organization (employed model or clinically integrated network) requires a very high level of engagement among physicians. Physician enterprise organizations have a profound impact on a physician’s practice and physician’s entire livelihood. A high level of governance to oversee and provide direction is needed. A physician led governing board is recommended. Physicians should be viewed as key stakeholders and leaders in care delivery.

    While physician governance is recommended, organizations may adopt a formal governing body with corporate bylaws which define scope of responsibility and accountability, or less formal governance oversight in an advisory capacity. Scope of responsibility and accountability of the physician led governance and reserved powers of higher governing authority at a system-wide level must be clearly defined. The majority of governing body membership should be comprised of physician members with predetermined representation from medical and surgical specialties from within the group. Administrative leadership is tasked with facilitating and directing physician governance through a high level of trust and credibility.

    The Governing Body of a physician enterprise organization may be structured to include the physician led board, as well as several sub-committees with defined functional oversight as defined by committee charters:

    • Policy and Procedure
    • Regulatory Compliance
    • Physician/Provider expectations:
      • Productivity
      • Access
      • Guiding principles related to citizenship and behavioural standards
      • Quality performance
      • Service performance
      • Operational/Financial performance.

    Sub-committees of the governing board are recommended to foster a broader level of engagement and participation among physician members of the group. The board may consider delegation of oversight to subcommittees to create focus and subject matter expertise through measuring, monitoring, reporting and improving performance. Sub-committees to consider include:

    • Finance Committee
      • Oversight of provider productivity
      • Oversight of financial measures
      • Capital allocation and approval
      • Oversight of Revenue Cycle

    • Clinical Quality Committee:
      • Regulatory required quality reporting
      • Non-regulatory quality improvement activities
      • Growth Committee:

    • Growth Committee
      • Provider manpower planning
      • Provider recruitment and selection
      • Provider retention
      • Provider engagement and satisfaction
      • New service development

    • Service Excellence/Patient Experience Committee:
      • Patient experience survey process
      • Patient experience expectations
      • Patient experience improvement initiatives

    • Informatics and Automation Committee:
      • System selection
      • System implementation
      • System performance and optimization

    • Physician Compensation Committee
      • Create a common understanding of fair market value for physician compensation models
      • Create incentive based compensation and align with value
      • Communicate broadly among all physician members of the group

    • Payer Relations and Contracting Committee:
      • Contract negotiation
      • Engagement in value-based initiatives

    Key Take-Aways:
    • Active engagement of key stakeholders is essential to fostering a culture of performance excellence
    • Physicians can quickly become disenfranchised when not engaged in developing organizational vision
    • Physician engagement and satisfaction in improved when organizational vision is well executed
    • Execution is best achieved when the organization is focused on performance excellence in operations, service and clinical activities
    • Developing and fostering a culture of performance excellence requires physician engagement Governance of the Physician Enterprise

    Next Steps:

    • Assess and design the Leadership and Management structure of the physician enterprise to enhance the performance excellence culture
    • Knowledge management and transfer through data analytics:
      • Determine the most important operational, service and clinical data analytics needed
    • Process Management through formal methodologies:
      • Determine the process management for the organization
      • Develop leadership, management and staff to focus on processes to:
        • achieve results,
        • standardize operating norms,
        • reduce variation, and
        • hardwire best practices.

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    Value-based Care is Here to Stay

    Simplified Approach through Physician Alignment and Integration

    Value Based Care is defined as provision of services that are low cost, highly efficient, service-oriented and provide the highest quality outcomes. Consumer expectations of values in the healthcare industry will continue to increase. Serving healthcare needs of a community that meet and exceed consumer expectations is complex and multi-faceted. The healthcare industry needs a simplified approach to address complexity and move toward a coordinated care delivery system. Healthcare organizations must first define a compelling vision for coordinated care delivery. Execution of that vision is best achieved through a leadership philosophy of performance excellence.

    The schematic shown below provides a roadmap for navigating the performance excellence journey toward value-based care (see schematic). This introductory article, the first in a series, outlines a vision for maximizing organizational success in the evolving healthcare industry through physician alignment and integration. A consistent and simplified leadership philosophy is provided to assist in execution of a strategic vision. Organizational gaps that may interfere with achieving organizational vision are also identified.

    Vision and Execution:

    The journey begins with:

    • Strategic vision for the future, and
    • Execution of the strategic vision through a leadership philosophy and organization culture of performance excellence.

    The culture of performance excellence focuses on measurable results and outcomes in three main areas:

    • Operating/Financial Excellence,
    • Service Excellence, and
    • Clinical Excellence.

    Performance excellence is best achieved when time and energy are devoted to:

    • Key Stakeholder Engagement,
    • Knowledge Management/Knowledge Transfer through data analytics, and
    • Formal Process Management.

    Organizational Gaps:

    Physicians and other providers are often not fully aligned with hospital organizations. Competing interests among physicians, other providers and hospital organizations may exacerbate misalignment. Hospital organizations know they need physician alignment and integration strategies. Many hospital organizations are unclear regarding scope of physician alignment and integration strategies. Some hospital organizations tend to view integration as a model of employment only, when there is a vast array of physician integration models.

    Each hospital organization possesses a unique climate and organizational culture for effective physician integration. Execution of physician integration strategies may lack depth of understanding. Structure and infrastructure needs for effective strategy execution are often underestimated. Governance, Leadership and Management representation among physicians and other providers is necessary, but often ignored. Significant variation in level of engagement exists among key stakeholders in healthcare delivery. High levels of engagement in organizational change are needed among leadership, management, physicians, other providers and staff, as key stakeholders in the delivery of care. Common understanding among key stakeholders is often lacking.

    Traditional healthcare leaders may have a tendency to exert “control” rather than engage physicians and other providers when focusing on organizational initiatives to improve care delivery. In addition, development of multi-disciplinary teams to focus on organizational initiatives may be difficult. Multi-disciplinary teams are especially prone to experiencing team dynamics of forming, storming, norming and performing. Many organizations have a low tolerance for the highly productive storming phase of team development, especially when physicians are involved. Embracing physician input is imperative.

    Many healthcare organizations have not adopted a meaningful and comprehensive process management methodology. There may be tendency to focus process management efforts within the confines of the hospital organization. Process management initiatives must become much broader in scope, must address care delivery across the entire continuum of care, and must focus on enterprise-wide initiatives, including care delivery in physician offices. Application of a formal and reliable process management methodology is often underestimated. Establishing an enterprise-wide process management approach requires vision, and investment of time and money. Physician stakeholders, being scientifically trained, tend to naturally adopt process management principles. The investment in education and training may be substantial. A multitude of models exist and it may be difficult to select and sustain a consistent approach that is embraced by all key stakeholders.

    There exists an ever-increasing emphasis on service, cost and quality outcomes. Government payers are increasing regulatory requirements, but those requirements may not be universally understood. Variation in understanding among key stakeholders may exist. Non-governmental payers may institute additional requirements and variation adds complexity and lack of common understanding. Employer demand for reduced healthcare costs, while providing service oriented and quality services, creates another set of demands on healthcare providers. Suppliers and vendors to the healthcare industry lack a comprehensive view of what is needed to improve service delivery.

    Traditional hospital based healthcare organizations are deeply grounded in meeting the needs of the communities in which they serve. Traditionally, hospital based organizations have long and established histories of serving patients at times when they are most in need of life saving intervention. Consumers and payers of the healthcare industry expect an effort to create healthier communities and to reduce high cost, episodic and acute interventions. Healthcare systems are not always well positioned to meet comprehensive consumer expectations beyond episodes of care. Healthcare systems have traditionally survived and measured success, based on payment models that encourage utilization of high cost, revenue producing services. The path to managing the health status of communities at lower cost requires engagement and alignment of services outside of the acute care setting.

    Key Take-Aways:

    The future of the healthcare industry is uncertain. Care delivery is complex and multi-faceted with organizational gaps impeding the journey to designing and developing healthcare systems to meet ever increasing consumer expectations of value. The healthcare industry will continue to experience constant pressure to modify and change current care delivery systems to meet rising consumer expectations. Navigating the journey to coordinated care delivery across the full continuum of care requires strong vision for the future and a refined leadership philosophy.

    This article provides a simplified approach to defining a compelling organizational vision. The need for a leadership style and organizational culture of performance excellence are outlined. Gaps in traditional organizational approach are also highlighted. The schematic below provides a roadmap for comprehensive improvement.

    Future articles will provide additional detail related to how to lead the performance excellence journey to achieve an organizational vision of the future.

    Next Step: Evaluate the company’s governance, leadership and management structure to identify opportunities for meaningful formal and informal engagement.

    Performance Excellence Roadmap toward Value Based Care

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