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Engaging Physicians for Successful Cultural Transformation Scott Nygaard, MD, Becky Pollins, RN & Mo Kasti, MS March 10, 2018

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Engaging Physicians for Successful Cultural Transformation

Scott Nygaard, MD, Becky Pollins, RN

& Mo Kasti, MS

March 10, 2018

2

DISCLOSURE STATEMENT

None of the presenters have actual or potential conflicts of interest in any way in relation to this

presentation.

Purpose

Share our ongoing journey of transforming the culture for the patient through physician

leadership

3

Agenda

1. Who We Are

2. Where We Were

3. What We Are Doing

4. What We Are Experiencing

5. Where We Are Going

4

• Located in Southwest Florida since 1916

• 3rd largest public health system in US

– No tax support

– Special district of Florida Legislature

– Publicly elected board

• Largest public health system in Florida without benefit of local tax support

• Lee County’s largest employer

– 13,100 employees, 1,400 physicians, 4,500 volunteers

• More than one million patient encounters annually

• $54.8 million charity care

• $308 million community benefit

• $1.7 billion NPSR

• 4.1 % OM

• Florida Safety Net Health System

• 4 acute care hospitals, 2 specialty hospitals, and 1 employed physician group

MissionOur mission is to be a trusted

partner empowering healthier lives through are and compassion

VisionOur vision is to inspire hope and be a national leader for health and healing

5

Who We Are

• Founded in 1993 with 1 physician and 7 employees

• Today we have:

• 610 providers

• 340 physicians

• 77 practice locations

• Annual visits of 1,364,000

• Started as a house of brands, now master branded

• Number and geographic access changing

• Moving toward PCP/Advanced provider model

• Culture change of MVV, Compact, Accountability

6

Our Employed Medical Group

LPG Performance

Area Before 2010 Now

Physician GrowthAdvanced Providers

16562

385225

Patient Visits 698,271 1,364,000

Net Revenue $95,408,619 $120,910,432

EngagementGrand MeanLeader Index

74.2471.96

81.9482.33

Urgent Care: CG-CAHPS Rate Provider

68.6 83.9 (82nd Percentile)

Access: Increased weekend hours resulting in: • Site 1: 75% reduction in urgent care use.• Site 2: 25% reduction in urgent care and a 34.8% reduction in ED visits.

7

Where We Were: Cultural Symptoms

• TRUST was very low or not present

• Us versus them mindset

• Independent medical staff to a fault

• No agreed upon mutual expectations

• No structure that unified employed physicians - house of brands strategy

• Lack of transparency - a lot of data but not organized in way that was meaningful to physicians

• Meetings did not equal physician input or engagement

• No strategy for physician leadership development

8

Where We Were: Patient Focus Groups

“We are in the business of providing what matters most to

patients.”

Employees Patients

Friendly, SmileCourteousCheerful

ConvenienceReminders

Welcoming,Warm Greeting

Eye ContactKeep Informed

PrivacyClean

ExplanationListeningFollow-up

Meet my needsTake time with meRespect my time

Tender TouchFriend

Advancedpreparation before

arriveTreat me like family

Call ahead for delays

Greet me by nameCaring

ThoroughInvest in

RelationshipCompassion

WarmKnowledgeable

about my situationAmenities

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Where We Were: How We Got Started

1. Extensive Training

2. Evaluation of ROI

– Training creates awareness only

3. Learning by doing - One-on-One Physician Coaching

– Need for hardwiring new habits

4. Patient experience pilots

TOP BOX

BASELINE

POST IMPLEMENTATION 3 MONTHS LATER

OVERALL SATISFACTION WITH PHYSICIAN 58.5 86.7 CG-CAHPS PROVIDER COMMUNICATION 47.4 84.1

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Commitment to Culture Transformation

Leadership Signals

Organizational Signals

Hardwiring New Habits

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What Is Culture?

• A system of beliefs and rules that govern behavior.

• “The culture of a company is the behavior of its leaders. Leaders get the behaviors they exhibit & tolerate. You change the culture of a company by changing the behavior of its leaders.”

Dick Brown, Former CEO of EDS

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What We Are Doing

Strategy & Line of Sight

DyadStructure

Hiring & Onboarding

Accountability

OperationalExcellence

Culture of Caring

TargetedDevelopment

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What We Are Doing

Strategy & Line of Sight

• Specific strategy for physician engagement

• Line of sight operating mechanism for cascading strategy

• Listening tours

Dyad Structure

• Dyad partnership model that cascades to front-line

• Clearly defined responsibilities for clinical and operational leader

• Quarterly dyad leadership meetings

Hiring & Onboarding

• SKS assessment • Physician onboarding

program• Compact• Physician Academy

Accountability

• Job descriptions • Physician evaluations• Cultural fit required• Compensation model

redesigned

Targeted Development

• 360 Assessments• Team interventions• Natural Leadership• Physician Leadership

Institute • Coaching • Quarterly PLI alumni

sessions

Culture of Caring

• Culture of Caring Advance

• Post advance support

Operational Excellence

• Patient Centered Medical Home

• Lean Deployment• Population Health

15

Dyad Leadership

Purpose: To build high performing dyad partnerships through enhanced collaboration, coordinated actions and communication in

support of the LPG strategic plan

Defined as an administrative leader & physician leader closely partnered in a

shared & complementary decision making relationship.

Benefits

1. Experience & studies demonstrate significant success

2. Enhances physician engagement, trust & participation

3. Ensures optimal melding of physician perspective with operational expertise

4. Broadens perspectives of leaders

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Strategic Direction & Alignment

Vision & Direction

Execution

Dyad Leadership

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AccountabilityDyad Leadership

Job Descriptions

Roles and Responsibility Activity

Physician Site lead & Practice Director/Manager

Reviewed each others job descriptions

Identified for each duty where you are (fully developed, partially

developed, needs developed)

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Behavior Expectations

Leader of SymphoniaDeliver performance evaluations in a way

that creates engagement

Quarterly DevelopmentDyad Leadership

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Culture of Caring Advance

1. All day interdisciplinary workshop serves as a catalytic event

2. Highly interactive

3. Create a culture of caring and healthy relationships by first focusing on ourselves and our colleagues in order to provide a compassionate caring environment for our patients

4. Good to Great strategy

5. Deep immersion in the patient experience

6. Deep immersion of the health of individual and collective culture

7. Impact of mood on performance and correlation to experience as well as outcomes

What We are Experiencing

1. Pull from employed physician group to system-wide approach

2. Traditional mindset of being held captive has shifted

3. Physician repeated participation

4. Physician led conversations

5. Natural spread of dyad model

6. Physicians requesting partnership & support

20

Culture of Caring Advance

21

Physician Leadership InstitutePartnering with CTI

22

Physician Leadership InstitutePartnering with CTI

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Leading with Strategy Healthcare trends Healthcare Financial Acumen Business Acumen: Think like an Owner Strategic Planning and Execution Leading Change and Innovation Sales and Marketing Managing your Practice and Service Line

Leading for Results Planning and Resource Management Productivity and Capacity Optimization Leading Quality and Safety Process (Lean

Six Sigma) Effective Project Management Medical Staff Operations Running productive Meeting

Leading Self Courage and Character Resilience Trust, Accountability, and Teamwork Social/emotional intelligence Engaging Others Adaptability Stewardship

Leading People Collaborative Leadership (Horses) Effective Conflict Resolution Effective Communication and Influence Courageous Conversations Creating and Sustaining High Performing

Teams Coaching and Performance Development

HUMAN DOING HUMAN BEING

Physician Leadership InstitutePartnering with CTI

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Collaborative Leadership: Building Relationships that Get Results

1. Building trust begins with learning about what others care about and value

2. There is no “one size fits all” approach to engaging people

1. Speak to values and motivators of people involved

3. Successful influence is situational

4. Most successful path to success is through the door of trust

5. Somatic Intelligence creates better access to awareness of self, others and your environment

Physician Leadership InstitutePartnering with CTI

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PLI Projects

1. Identify the role of the physician leader in the care team

2. Develop criteria for Emergency Department (ED) team for inpatient placement of pediatric patients

3. Streamline workflows to maximize time with provider

4. Improve communication between providers and staff to produce better patient outcomes

5. Develop a strategy to ensure success of a new pediatric urgent care center and specialty clinic

6. Develop curriculum for LPG Physician Academy

7. Define partnerships and collaborative roles between ED physicians and hospitalists

Value of Projects

1. Think, plan & execute strategy

2. Shift mindset from giving orders to collaboration and influence

3. Relationship building

4. Organizational navigation

5. Change management

6. Formal presentation skills

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PLI Alumni

Purpose: Expand the network, build relationships across cohorts and continue learning

1. Meet quarterly for 1.5 hours

2. Build relationships across cohorts

3. Provide 45 minutes of learning

1. Crucial Conversations

2. Resilience

3. Teams vs. Teaming

4. Executing on Executive Presence

5. Surfing the Edge of Chaos

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PLI Improvement and Outcomes

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Physician Alignment Versus Engagement

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Alignment Engagement

Physician shares the organizational purpose,vision, goals, strategic and clinical priorities.

Physician fully activated and energized to the point that one is willing to give discretionary effort

Passive to Neutral Active to Proactive, Intentional

Physician acting, deciding and behaving in ways that support the organizational purpose of quality patient care

Physician sees engagement as part of the profession, has a bias for action, is optimistic ,triggers the best in others, willing to be involved and/or involves others.

Key Indicators: • I know the purpose and goals of the

organization • I trust the leadership of Lee Health

Key Indicator: • I am proud to say I practice at Lee Health• I am willing to recommend Lee Health to

my colleague as the place to practice• I am willing to engage

Urgent Care Center Culture 5-Years Ago

• Bottom performer in Patient Satisfaction

• Poor Community Image

• High Turnover

• Bottom performer Employee Engagement

• No communication

• Everyone worked hard in uncoordinated effort

• Patients were last priority

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Their Journey of Culture Transformation

• Recognized we had a problem with our culture.

• Believe they could change

• Strong physician leader & dyad partner

• Shared team vision

• Transparency of data

• Operational excellence focus

• Mindset patient always comes first

• Ongoing culture conversations – daily huddles

• Recognition – ability to recognize and share what others did well

• Strong accountability – low performers

• Hired for cultural fit

• Called physician leadership forward – as leaders of the culture

• The team is engaged, positive and has become a family

• Strong physician Leader

– Role model

– Attributes of a Natural Leader

– Performs at 98th PR in patient experience

– Coaches providers for success

– Addressed low performers

– PLI graduate

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Today

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Journey of Discovery

Old Thinking New Thinking

Leadership style of “push” Leadership style of “pull”

Behavior will change with tell approachBehavior will change & be sustained by inclusion

& when we achieve individual breakthroughs

Leadership model non-inclusive of physicians Dyad leadership model

We have the right organizational incentives Ensure signals drive right behavior & outcomes

Training will change behavior Training will create awareness.

We can fix everything at once A model of focus & discipline

The importance of technical skills - IQ The importance of EQ

Care team centric Patient centric

A focus on volume A focus on value

We can start by fixing the patient experience Fix the culture & patient experience is natural

We can rehabilitate everyone Not everyone is coachable

“Hope is a strategy” “Hope is not a strategy”

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Where We Are Going

• Solid work in ambulatory environment that has been developed & appreciated by LPG (employed) physicians

• Beginning work with BOD & independent medical staff to bring a structure & process that makes them accountable for leading in a manner that support the mission of the organization

• Establishing Compact system-wide & building into hospital culture (credentialing, on-boarding, quality/service experience, cost of care)

• Networking amongst PLI graduates to keep engagement & leadership development investment alive within the organization

• Bring dyad model of leadership to acute care (CMO & CNO). Also new Acute Care Medical Officer working in harmony with a nurse leader, VP of Patient Care Services, to operate the hospital campus

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Questions

Closing: Key Messages

1. A healthy and fit culture sets foundation for organizational change with a particular focus on mood and mindset

2. Dyad Model enables transformation: So go the physicians so goes the organization

3. Clinician to clinician leader, giving orders to collaboration, leadership, and relationship building

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Thank You!