Take you and your organization to the next level issue

14Winter 2014

Physician Must-Havesreg What Physicians Want and How to Provide ItBy Quint Studer founder Studer Group author of A Culture of High Performance Achieving Higher Quality at a Lower Cost

Operating in a More Transparent World QampA with Dr Jeffrey Turnbull chief of staff The Ottawa Hospital Ottawa ON CAN

What Right Looks Like5 Tips for High Impact Physician Goalswith David Dunlap president amp CEO William Carroll MD chair Dept of Orthopedic Surgery and Priscilla Holtzclaw chair Dept of Family Medicine Roper St-Francis Healthcare Charleston SC

The Hidden Costs of Declining Physician Engagement by Dan Smith MD FACEP Studer Group coach international speaker and practicing emergency physician

7 Ways to Improve Access and Reduce No-Shows with Dianna Prachyl vice president community health JPS Health Network Fort Worth TX

4

6

7

8

SELF-TESTAre your physicians aligned and engaged

RESULTS

First Canadian Edition

Whatrsquos the most important thing we need to gain physician engagement and alignment

Publisher BG PorterBGPorterstudergroupcom

Editor-in-ChiefBekki KennedyBekkiKennedystudergroupcom

Managing EditorChristina RomaacutenChrisRomanstudergroupcom

Editorial TeamDottie DeHartDottieDeHartstudergroupcomLaura KoontzLauraKoontzstudergroupcom

Art DirectorSara HarrisSaraHarrisstudergroupcom

HARDWIRED RESULTSregStuder Group Websitewwwstudergroupcom

Interested in sharing these articlesVisit wwwstudergroupcomhardwiredresults to view an electronic version of this issue of Hardwired Resultsreg For permission to reprint contact SaraHarrisstudergroupcom

Hardwired Resultsreg is a publication of Studer Group 913 Gulf Breeze Parkway Suite 6 Gulf Breeze FL 32561 (850-934-1099) and is published for organizations that work with Studer Group Hardwired Resultsreg accepts no advertising

Fire Starter PublishingCopyright copy 2014 Studer GroupAll Rights Reserved

Contributors OU Physicians (Studer Group partner since Oct 2007) Lynn Mitchell MD MPH CMO TR Lewis MD pediatric core medical director

Roper St Francis Healthcare (Studer Group partner since Apr 2005) David Dunlap president amp CEO William Carroll MD chair Dept of Orthopedic Surgery Priscilla Holtzclaw chair Dept of Family Medicine

JPS Health Network (Studer Group partner since Aug 2009) Dianna Prachyl vice president community health

The Ottawa Hospital (Studer Group partner since June 2009) Dr Jeffrey Turnbull chief of staff

Studer Group - CanadaBrookfield Place - TD Canada Trust Tower161 Bay Street 27th FloorToronto ON M5J 2S1 Phone 4165722081

Winter 2014 ISSUE 14 HARDWIRED RESULTSreg | 1

PHYSICIANS EXCEL AT MANAGING CHANGE BUT WANT A SEAT AT THE TABLE

MESSAGE FROM OUR CEO AND PRESIDENT

S ince our founding in 1999 Studer Grouprsquos mission statement has always included physicians While our mission remains the same in todayrsquos environment it has

become increasingly more complex to provide a great place for physicians to practice medicine

No matter what sort of arrangement an organization has with their physicians there are greater complexities with things like cost pressures and transparency of data that are impacting not only the organization but physicians as well Our founder Quint Studer is working on his next book specifically written for physicians regarding the future they have inherited In it he addresses the fact that physicians are working in an environment much different from when they first began practicing medicine

The good news is that in the research and writing process wersquove learned what works well and what right looks like What organizations need more than ever is close alignment with physicians and hospital leadership This includes having systems in place that provide physicians with direct feedback key measurement data (that is accurate and transparent) and input from physicians on key organizational initiatives

This issue of Hardwired Resultsreg shares results best practices and ldquohow-tosrdquo from organizations from around the country leading us into the future It also addresses key focus areas such as physician engagement reducing no-shows tips on running a great practice and operating in a more transparent world

We hope you find it helpful in your journey of physician alignment integration and engagement and will also let us know your feedback and input too Thank you for making a difference not only for those who receive care but also for those who practice medicine

Yours in service

BG Porter

HEALTHCARE FLYWHEELreg

Use these tools from Studer Group to

standardize results across your organization

Log ontowwwstudergroupcom for learning on related

topics

Speakers are available to present on this topic

at your organizationContact

genevievestudergroupcom

Learn from best practices tested in

over 850 healthcare organizations

(For Studer Group partners only)

LOOK FOR THESE SYMBOLS EVERY ISSUEWE INVITEYOURFEEDBACKStuder Group encourages you to share your comments feedback and suggestions Please send comments to BG Porter at BGPorterstudergroupcom

2 | HARDWIRED RESULTSreg Winter 2014 ISSUE 14

Physician Must Have 1 Involve Physicians in Goal SettingPhysicians are data-driven Yet research shows they have not typically received data about individual performance clinical outcomes or patient survey data1 Now they suddenly have access to data points but the data is often not timely or actionable for them to use

We find that physicians make excellent partners in moving organizational performance around these crucial metrics when they understand why the data is relevant goals are well-aligned and cascaded and there are a manageable number of metrics Then physicians really ldquogetrdquo it In turn health systems know that physicians are key players in ensuring patients move quickly through the system (reducing cost per adjusted discharge and increasing capacity) This also helps physicians align with organizational goals

Physician Must Have 2 Round on PhysiciansThis tactic is integral to providing physicians with a place where it is satisfying to practice medicine Rounding for outcomes with the physician is more than having a relationship itrsquos having a relationship that leads to higher physician engagement It also addresses the lowest rated area in physician satisfaction surveys administrative responsiveness

Frequency is vital Our data finds that if physicians are rounded on once a month using the prescribed model of rounding physician engagement will be in the top 15 percent and many times in the top 10 percent If physicians are rounded on once per quarter physician engagement will be in the top

25 percent If physicians are rounded on every six months only once a year or never their engagement is typically 50 percent or lower

OU Physicians Oklahomarsquos largest physician group with 830 credentialed providers in 63 clinic locations uses a robust process where CEO Brian Maddy and CMO Lynn Mitchell MD MPH round together on their three ldquocore medical directorsrdquo for primary care adult clinics and pediatric clinics Rounding is then cascaded down to front-line physicians with wins and challenges captured in rounding logs Items that need fixing are rolled up into a stoplight report that is posted shared widely at meetings and on OU Physiciansrsquo intranet so everyone is current on the status of what they reported Since FY 2008 their team has moved patient satisfaction from the 8th to the 78th percentile Net revenue is also up 47 percent over the same period

Physician Must Have 3 Focus Fix and Follow UpWhen rounding one way to address administrative responsiveness is through Focus Fix and Follow up When a physician has a concern or complaint document any issues that are raised address them and communicate back to the physicians what you did to solve the issue

To take Focus Fix and Follow-up to the next level begin by identifying physicians who have the most influence on hospital operations (eg through their role impact on revenue) Then divide them into four quadrants based on support for change so you can focus on their unique drivers to maximize impact (To learn more visit wwwstudergroupcomFocusFix)

Physician Must-Havesreg What Physicians Want and How to Provide It

by Quint StuderAdapted from Quint Studerrsquos book A Culture of High Performance Achieving Higher Quality at a Lower Cost

hat do physicians want While the particulars vary creating better places for physicians to practice medicine always requires knowing what they want and providing it Our experience shows physicians want four basic things quality efficiency input and appreciation

to start This is the foundation for building a deeper relationship

The Five Must-Haves for PhysiciansTo ensure physicians are fully engaged in creating a culture of high performance Studer Group has identified five ldquoMust-Havesregrdquo These are defined as the tactics tools and techniques that need to be implemented in order to achieve the desired outcomes as set by the organization or the leader

W

Access Our Leader

Rounding Toolkit

Learn everything you

need to know about

effective rounding

on employees and

physicians at

wwwstudergroupcom

ldrrounding

1Physiciansrsquo Views on Quality of Care Findings from the Commonwealth Fund National Survey of Physicians and Quality of Care Anne-Marie J Audet Michelle M Doty Jamil Shamasdin amp Stephen C Schoenbaum

Winter 2014 ISSUE 14 HARDWIRED RESULTSreg | 3

Quint Studer is the founder of Studer Group and the author of seven books including A Culture of High Performance Achieving Higher Quality at a Lower Cost

About Studer Group Physician Coaching

Studer Grouprsquos physician coaching

supports physician leaders in

hospital and clinic settings so they

can close gaps for measurable

improvement in patient experience

clinical quality safety and access

to hardwire a culture of high

performance Learn more at www

studergroupcomphycoaching

Physician Satisfier Action

Physicians want to know their patients are receiving quality care and a great patient experience They also want to reduce the time it takes to follow-up and address patient and family complaints

1 Quality

Physicians want to work with team members who have the information needed to discuss their patients at hand Over the course of a day this efficiency will save the physicians 30 minutes or more

2 Efficiency

Physicians need a seat at the table to provide input when decisions are being made that affect clinical outcomes Round on physicians and consistently ask them ldquoDo you have everything you need to provide excellent care to your patientrdquo Also meet with hospitalists each month as they operate with physicians on a daily basis

Physicians value a ldquothank yourdquo and acknowledgement when things are going well They also want to see follow-through on their input in the form of tangible actions

3 Input

4 Appreciation

Source Physician Satisfiers ndash January 2001 Journal of the American Medical Association

Physician Must Have 4 AIDETregAIDETreg is an acronym that represents the five fundamentals of patient communication (Acknowledge-Introduce-Duration-Explanation-Thank You) When employees are skilled in AIDET the physician-employee interactions become more effective resulting in higher organizational performance

When physicians use this tactic it reduces patient anxiety and increases patient compliance Helping physicians learn how to use AIDET has a dramatic positive impact on both clinical outcomes and the patient experience while also aligning physician behaviours with employees who use AIDET (Studer Group partners can visit our Learning Lab at wwwstudergroupcomAIDETtips to download AIDETreg for Providers Quick Tips)

Physician Must Have 5 Reward and RecognizeIt is easy to think that because of the nature of a physicianrsquos work that they donrsquot need reward and recognitionhellipthat the value and the impact they have goes without saying However this is not true Donrsquot underestimate the importance of reward and recognition to a physician I can think of dozens and dozens of times where a heartfelt thank you note forged an important bond retained a physician who was thinking about leaving or earned important trust and confidence in shared values Express your genuine specific appreciation and I guarantee yoursquoll make a physicianrsquos day (and if you include their staff itrsquos a double win)

All of us who work in healthcaremdashno matter what our employment status is where we are or what we domdashare a part of ldquothe great patient care teamrdquo We need to create operational frameworks that allow all members of our team (including physicians) to execute in a way that truly hardwires excellence The Physician Satisfierrsquos outlined below remind us what physicianrsquos want The Must Haves make it all come together

4 | HARDWIRED RESULTSreg Winter 2014 ISSUE 14

HR Physician alignment can be challenging Since physicians are not employed in Canada how do you ensure engagement and alignment

JT Physicians are independent contractors in here in Canada who are credentialed at the hospitals and so must comply with hospital policies Thatrsquos really the only hook that I haveand taking that kind of action would entail a substantial legal battle There are regulatory colleges but the bar for taking action is too low

Whatrsquos been far more effective in engaging and aligning physicians is recognition thank yoursquos and explaining how changes we ask them to make are in the best interest of their patients Thatrsquos always been the number one thing that galvanizes physicians in my experience

HR TOH has developed a physician engagement agreement that is signed by each of your 1200 affiliated physicians How does that work

JT Actually it was originally proposed by our Medical Advisory Committee (MAC) They wanted the hospital to show them more respect and communicate better with them We used a very iterative process beginning by asking them what elements theyrsquod like to see in such a compact and then conducting a number of physician focus groups Imagine our surprise when we recognized that what physicians wantedmdashquality compassion partnership and respectmdashmatched the hospitalrsquos vision and values And yet they felt that things were often done ldquotordquo them instead of ldquowithrdquo them

Of course we had to clarify that ldquocommunication and respectrdquo did not always mean physicians would get the outcome they preferred but they would have substantial input in the decision process and share ownership of the solution (When you sign off on the budget you must defend the budget) When several raised concerns about using the agreement as a tool to discipline I reminded them that we already had policies in place for that The engagement agreement is a proactive way to set the bar highermdashfor administrators and physiciansmdashto ensure mutual accountability

What was interesting though was that when we asked them about the things that irritated them they were little thingsmdashlike lack of door hooks in the doctorrsquos loungemdashthings that cost essentially no time or money to fixmdashbut created much good will from physicians when we addressed them

Operating in a More Transparent WorldQampA with Dr Jeffrey Turnbull chief of staff The Ottawa Hospital Ottawa ON CAN

Download a copy of TOHrsquos Physician

Compact

What do hospitals and physicians commit to specifically in a physician compact Studer Group partners can download a copy of TOHrsquos agreement at wwwstudergroupcomTOH

anadian hospitals do an excellent job of reporting and publicly sharing quality metrics and patient satisfaction with physicians hospitals and emergency departments Whatrsquos more they operate in a transparent environment and focus on

delivering higher quality at a lower cost Here Jeffrey Turnbull MD FRCPC chief of staff at The Ottawa Hospital (TOH) and former president of the Canadian Medical Association shares his thoughts on creating and sustaining a culture of high physician engagement in a transparent world

C

ldquo Whatrsquos been far more effective in engaging and

aligning physicians is recognition thank yoursquos

and explaining how changes we ask them to make are in the best

interest of their patientsrdquo

Winter 2014 ISSUE 14 HARDWIRED RESULTSreg | 5

Canadian College webinarvideo

Studer Group is honored to partner with the Canadian College of Health Leaders to publish The Power of Engagement Creating The Culture That Gets Your Staff Aligned amp Invested by Studer Group Founder Quint Studer and Studer Group Canadian Coaches Mitch Hagins and Bonnie Cochrane The article focuses on employee engagement and creating alignment across the organization

Save the Date Mitch Hagins and Bonnie Cochrane will also host a webinar The Power of Employee Engagement Creating A Culture That Drives Results on May 13th at 2pm ET

Visit wwwcchl-cclsca to learn more

Jeffrey Turnbull MD FRCPC is chief of staff at The Ottawa Hospital (TOH) a 1149 bed academic hospital with two campuses and 1300 physicians in Ontario Canada

HR And how does accountability for physicians work at TOH

JT Administration and physicians are accountable to each other Evaluations are sequenced to coincide with the credentialing cycle At that time they will complete an evaluation on how well they felt the hospital did in upholding its commitment Since vice presidents have scorecards that measure their performance we designed one for the MAC as well that measures baselines and goals with respect to metrics around quality patient-centredness and patient satisfactionhellipthings that physicians can influence Those targets then cascade down to department heads and then individual physicians

For example there is a much higher degree of public accountability and transparency in Canada And at TOH wersquove gone a bit beyond that even You can find our C Difficile MRSA VRE and mortality rates right on our website at wwwottawahospitalonca located under ldquoreportingrdquo on the ldquoQuality amp Safetyrdquo tab on the home page

So physicians are accountable for things they can impact With respect to infection rates physicians are responsible for hand hygiene and appropriate use of antibiotics We set targets around those and track compliance including the use of hand hygiene auditors and an antibiotic team Doctors who donrsquot comply or respond to extra training are quickly escalated to their department head and after that directly to me

In the end I think the fundamentals remain the same in American and Canadian healthcare Each of us wants to be treated with respect be included in processes that are fair and transparent in our workplaces and be acknowledged for the value we contribute

6 | HARDWIRED RESULTSreg Winter 2014 ISSUE 14

hen Roper St Francis Healthcaremdasha system with more than 90 clinics in Charleston SCmdashdoubled the number of its physicians in 2009 cracking the code on physician alignment and accountability became top priority (The organization currently performs

in the top decile of physician and employee engagement with many Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) composites above the 90th percentile)

Four years ago Roper St Francis began using Studer Grouprsquos Leader Evaluation Managerreg (LEM) software to identify and track objective measurable goals for its leaders including hospitalists ldquoSince all leaders were already being evaluated on the LEM it was a natural next step for us to move all physicians and providers to Studer Grouprsquos new Provider Feedback Systemrdquo explains David Dunlap president and CEO at Roper St-Francis ldquoMetrics are designed uniquely for physiciansrdquo (The Provider Feedback System (PFS) is an adjusted version of the LEM that is physician-centric)

1 Begin the transition sooner rather than later Donrsquot wait until maximum reimbursement penalties under Medicarersquos Value-Based Purchas-ing Program hit in FY2014 Give physicians time to adjust by beginning performance feedback now

At Roper St Francis Physician Partners the ortho-pedic group took the lead on their own ldquoWe col-lectively decided it was our job to advance the or-thopedic line for quality patient carerdquo explains Dr William Carroll chair Dept of Orthopedic Sur-gery at Roper St Francis Mount Pleasant Hospital and chair of the Physician Partners Communication Committee ldquoSo all the orthopedic specialties came together and decided on performance metricsrdquo

2 Use individual feedback to drive broader goals Frequently Studer Group finds gaps in the ways goals cascade between the organization and physician practice patterns And often these occur in two key drivers of organizational financial per-formance cost efficiency and patient perception of care ldquoOur hospitalists reduced length of stay for observation patients (with LOS greater than 24 hours) by 60 percent over two yearsrdquo adds Dunlap ldquoThis was a direct result of ensuring their individ-ual evaluation goals were aligned with those of the organization to track performance on this metricrdquo

3 Sometimes less really is more Avoid the temptation to inundate your physicians with too many (or wildly complex) goals Having data isnrsquot the problem In fact we are often data rich and knowledge poor Making the measures meaning-ful is the challenge Thatrsquos why Studer Group finds that six to 10 metrics are plenty ldquoPhysiciansmdashand all leadersmdashwant goals that show clear priorities with actionable information so they know where to focus and how to have an impactrdquo explains Dan Smith MD Studer Grouprsquos medical director

4 Engage physicians in metrics selection Physicians must be involved in which metrics have the most meaning After all providers drive so much of bottom line financial performance Once an appropriate ldquomenurdquo of metrics has been developed that reflect organizational priorities gain buy-in and focus by asking for input (eg ldquoWhich of these metrics best represents the quality outcomes you deliver as an ED physicianrdquo)

5 Establish both common and personalized measures The most effective approach is a com-bination of goal metrics that are common across the organization and individualized according to medical specialty (eg rate of return to primary care providers) Weights also vary For example post-surgical infection rates might be weighted heavily for surgeons because of the financial im-pact to the organization (Tip Weight a goal at least 30 percent to reflect urgency)

What Right Looks Like5 Tips for High Impact Physician Goals

with David Dunlap president and CEO Dr William Carroll chair Dept of Orthopedic Surgery and Dr Priscilla Holtzclaw chair Dept of Family Medicine Roper St-Francis Healthcare

W

And most importantly Move away from the ldquorear view mirror approachrdquo Physicians donrsquot want to hear about what they shouldrsquove done differently at year-end when itrsquos too late They want regular feedback about what they can do now

ldquoBy nature physicians are competitive and data-drivenrdquo explains Roper Chair of Family Medicine Dr Priscil-la Holtzclaw ldquoThey want to be a lsquo5rsquo on every performance metric If you give them baseline data early provide evidence for best practices and coach them with tools and training you will achieve exceptional outcomes for your community and organizationrdquo

5 Tips for Getting It Right

What Great Goals Look Like

Want to hardwire physician

goal alignment faster Learn

how Studer Grouprsquos Provider

Feedback System uses a few

high impact metrics to deliver

big on outcomes at

wwwstudergroupcomPFS

Interested in seeing actual

sample goal cascades (and

weights) for a chief medical

officer physician practice

manager and primary care

physician See Chapter 6

of Quint Studerrsquos new book

A Culture of High

Performance

Winter 2014 ISSUE 14 HARDWIRED RESULTSreg | 7

The Hidden Costs of Declining Physician Engagement by Dan Smith MD FACEP Studer Group coach international speaker and practicing emergency physician

Focusing on physician engagement is also crucial because engaged physicians are less likely to leave healthcare Instead they can make substantial and meaningful contributions to the mission clinical outcomes and financial health of their organizations as they serve as partners in supporting long term sustainability The ROI on Physician Engagement Letrsquos do the math Annual physician turnover is at an all-time high of approximately 68 percent1 So how does physician turnover affect an organization When the costs of recruiting start-up and lost revenue generation are figured in the cost to replace a single employed physician often exceeds $500000 (This is without adding in fees for sourcing and advertising interviewing moving and signing bonuses)

An example For a physician that generates $14 million in revenue annually average recruitment costs are $640002 and start-up costs for a replacement physician are $100000 If it takes just four months to replace this single physician it will cost the organization approximately $630000

What is the best solution to avoid these costs Engage physicians in a partnership that truly serves patients and physicians and provides them a great place to practice medicine In turn physicians will feel a sense ownership and alignment to the organization and they can enjoy purpose worthwhile work and making a difference (Note To watch a webinar on building an operational framework for medical staff integration with Quint Studer and George A Ford III MD visit wwwstudergroupcomburnout)

Quick Wins and Final Tips Earlier we mentioned the importance of rounding on physicians to improve engagement (See ldquoPhysician Must-Havesrdquo on page 2) Physicians appreciate the foundations of rounding the opportunity to recognize ones value to the healthcare team the opportunity to provide perspectives and knowing that leaders will follow-up on any issues or concerns When leaders consistently and frequently round physicians are more likely to align and support system priorities

Just as physicians like to provide input they also like to receive feedback and status updates The key here is to be honest and direct If you donrsquot have the answer immediately thatrsquos alright but offer a time frame owner and ensure follow through versus an ldquoIrsquoll get back to yourdquo

Never underestimate the difference that physicians can make A handwritten thank you note preferably with specifics is one way leaders can acknowledge the efforts and worthwhile work of the physician and offer feedback

We are in the midst of continuous changes in healthcare yet one constant is passion Strategies that align and engage physicians become an imperative to fuel that passion and help us achieve the best outcomes for our patients and organizations-

ike most people who chose healthcare as a profession physicians are deeply committed to making a difference in the lives of patients Combine that passion with the demanding and ever changing environment physicians work inmdashand the outcomes that must be

achieved to maximize clinical effectiveness and garner full reimbursementmdashand we understand why maintaining physician engagement and alignment is a critical focus At a time when the demand for physicians is already expected to outpace the supply over the next 12 years we cannot wait to address this opportunity

L

2014 Institute Calendar

Register or check additional dates at wwwstudergroupcominstitutes

Taking You and Your Organization to the Next Level

March 11 - 12 bull Atlanta GA includes physician-focused

pre-conference on March 10

May 28-29 bull Toronto ON CAN includes Emerg pre- conference on May 27

Excellence in the Emergency Department

April 3 - 4 bull Las Vegas NV

Physician Partnership Institute

May 28 - 29 bull Las Vegas NV

includes physician metric post- conference on May 29

Sept 3-4 bull Indianapolis IN includes physician metric post- conference on Sept 4

1 Cejka Search ldquoFinancial Health Check Up Addressing Record Growth in Physician Turnoverrdquo Apr 19 20132 Cejka Search and AMGA 2012 Physician Turnover ndash What You Donrsquot Know Can Cost You white paper

8 | HARDWIRED RESULTSreg Winter 2014 ISSUE 14

ldquoWe were averaging 100 days for next available appointments across some clinics with less capacity and Board members wanted to know whyrdquo said Dianna Prachyl vice president community health at JPS ldquoWe were averaging 100 days for next available appointments across some clinics with less capacity and Board members wanted to know whyrdquo One culprit A no-show rate that averaged 28 percent across clinics leaving appointment slots unused but also unavailable

Because JPS is also in the midst of implementing a Primary Care Medical Home model of care it adopted a multi-faceted approach to addressing the problem resulting in a $13 million return on investment by halv-ing the number of no-shows alone1 Next available appointments have dropped to an average of 55 days with 40 of primary care clinics currently under 30 days The goal for 2014 is 100 of primary care clinics at 30 days or less with a goal of 14 days for 2016

How JPS Did It

1 Patient-centredness care JPS runs everything from proposed changes in patient flow to the design of its electronic patient portal by real patients at its Patient Family Advisory Council meetings ldquoWe stopped assuming we knew what was best for our patients and asked them insteadrdquo says Prachyl ldquoThey really do know what best meets their needs When we asked about reasons for our high no-show rates they told us that patients didnrsquot feel like anyone cared if they missed their appointmenthellip that some were afraid as they may not have had medical care in a whilerdquo

2 Pre-calls to patients Based on Council input JPS began ldquowarmrdquo pre-visit calls by staff to patients one week in advance of appointments to collect history ask if they need help with transportation answer ques-tions and reschedule appointments if necessary There was a particular emphasis on new patients Three days out all patients receive an automated TeleVox call confirming the upcoming visit Since data showed the most likely no-shows were visits scheduled for months out it was particularly important to touch base with these patients

3 Welcome Clinics The Welcome Clinic is a 30-minute visit for patients new to JPS and enrolled in its charity program Newly enrolled patients receive a welcome flyer ex-plaining the clinic and encouraging them to make an appointment The clinic staffed with registered nurses and patient navigators briefs new patients on availability and locations of extended hours and when to use the ED High risk patients are seen by their new primary care provider within one to two weeks while other patients are scheduled further out With high positive feedback and few no-shows JPS is ex-panding the program

7 Ways to Improve Access and Reduce No-Shows

with Dianna Prachyl vice president community health JPS Health Network Fort Worth TX

hen JPS Health Networkmdasha 537-bed acute care public hospital with 15 affiliated primary care clinics and 100 contracted primary care providersmdashwent live with an electronic medical record 18 months ago volumes plummeted while docs got up to

speed thanks to fewer scheduled appointments But when ED visits continued to rise with lower practice volumes over time JPS did a deep dive to understand why and launched a comprehensive access plan in April 2013

W

See sample practice management tools

See samples of JPSrsquo dashboard individualized patient care card and apology postcard

Studer Group partners can view copies at wwwstudergroupcomphysamples

Centralized standardized

scheduling

Individualized patient

care

Track results

Patient-

care

Improve Accessamp

Reduce No-Shows

Welcomeclinics

Pre-calls

Reward amprecognize

centred

Winter 2014 ISSUE 14 HARDWIRED RESULTSreg | 9

SELF-TEST ANSWERSContinued from back cover

HOW DID YOU RATE

If you answered ldquoyesrdquo

7 or more timesCongratulations Your physicians are actively aligned and engaged Take the next step by ensuring physician and organizational goals are aligned measurable and weighted to maximize effectiveness Learn more about the Provider Feedback System at wwwstudergroupcomPFS or physician coaching at wwwstudergroupcomphycoaching

5 to 6 timesYou consistently demonstrate your commitment to physician engagement and alignment Move the needle even more with these resources on studergroupcom

bull Get dozens of tips and strategies for reducing burnout triggers and improving wellness at wwwstudergroupcomphyburnout to read ldquoPhysician Burnout Preparing for a Perfect Stormrdquo

bull Watch a webinar on building an operational framework for medical staff integration with Quint Studer and George A Ford III MD at

wwwstudergroupcomburnout

bull Get a jump-start on physician engagement when you book a Studer Group physician speaker to customize high impact on-site training for your physicians at wwwstudergroupcomwespeak

4 or less timesIf you are reading this issue of Hardwired Results and have completed this self-test yoursquove demonstrated your interest in improving physician engagement

Learn how Studer Grouprsquos Canadian Coaching partnerships can help at wwwstudergroupca

4 Reward and recognition At JPS scores for individual providers are posted where patients can see themmdashin the main hallways of each clinic Yet therersquos little physician pushback due to JPSrsquo culture of high reward and recognition All medi-cal directors participate in Leadership Development Institutes and steering committees to review policies before they are rolled out A physician champion also validates the data and Prachyl publicly recognizes high performers ldquoI had one physician who said shersquod never succeed because her patient population was dif-ferentrdquo she says ldquoBut when she exceeded the 57th percentile it was like she received an Academy Awardrdquo

5 Centralized standardized scheduling By changing the reporting structure of registration staff to report to a central-ized administrative team training and standards for scheduling were streamlined and standardized across all the primary care clinics JPS reduced types of visits (eg newborn well visit) for more provider availability and fewer barriers for patients When providers could view the real data for access challenges in their clinics they agreed to adjust their schedules to meet a standard-ized schedule template that includes two walk-in appointments daily and allows time to respond to patient email for follow-up visits that have been moved to the electronic portal

6 Individualized patient care In October 2013 JPS intro-duced a standardized individualized patient care card that every patient receives upon checking in On the front the patientrsquos arrival and appointment times are noted Patients are requested to ask for an update if a practitioner does not see them within 15 minutes of their appointment time

On the back of the card patients are asked to check the rea-son for their appointment to ensure their needs are met (eg prescription refill form for work referral) Nurses then use the cards to validate these actions were taken In addition every pa-tient who waits 15 minutes or more receives a postcard after his or her visit apologizing for the wait and expressing JPSrsquo commit-ment to improvement

7 Track results Prachyl keeps a current dashboard with key performance metrics for each clinic that includes volumes slot utilization percentage walk-ins no-show rates days until 3rd next available appointment overall provider rating and wait times Baseline data are color coded red or green with a target and action plan for each clinic

ldquoI think the key to our success has been high engagement with our affiliated physiciansrdquo said Prachyl ldquoWhen we make chang-es that might seem difficult we sit down with them and ask lsquoHow can we achieve this goal and still meet your needsrsquordquo

1$116 million ROI based on reducing the number of primary care no-shows from 71691 to 32926 over six months Revenue is based on an average collection rate of $30 per visit

10 | HARDWIRED RESULTSreg Winter 2014 ISSUE 14

YES

NO

YES

NO

SELF-TESTPHYSICIAN ALIGNMENT AND ENGAGEMENTAnswer these questions and see how you rate on page 9

1 Physicians demonstrate their trust and confidence in our hospital leaders

2 We round consistently on physicians to ensure they have input and influence for strong buy-in to new strategies and changes

6 We use measurable weighted evaluation goals to ensure shared accountability with physicians for meeting organizational goals

YES

NO

Taking You and Your Organization to the Next Level

May 28-29Emerg pre-conference on May 27Toronto ON

Learn more at wwwstudergroupcominstitutes

YES

NO

YES

NO

YES

NO

5 We consistently link requested physician behaviours to evidence-based practices for improving clinical quality or operational outcomes

4 We have hardwired a process to ensure physicians understand we are highly responsive to their concerns or complaints

3 There is a strong culture of reward and recognition for all physicians do to make our organization excellent

YES

NO

YES

NO

8 We invest in ongoing training for physicians to maximize their leadership skills and impact on a positive patient experience

7 Our organization has hardwired physician feedback systems and processes to ensure an aligned vision across the organization

Brookfield Place - TD Canada Trust Tower161 Bay Street 27th FloorToronto ON M5J 2S1