Physician Enterprise Executive with a passion for performance excellence and more than 20+ years progressive experience in leadership within integrated delivery systems/hospitals. Highly skilled in: organizational design and development; employed physician practice development; program development; strategic planning and fiscal management. Highly effective leader with strong team building skills and results orientation, seeking opportunities to utilize advanced leadership skills in the transformation and the value-equation of health care services.

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):

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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.

      Connect with Mike on LinkedIn.

      Connect with us on LinkedIn and join our Active Network Program.

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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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