Lifelong Physician Competency Development

1. Lifelong Physician Competency Development Association of Professors of Gynecology and Obstetrics March 1, 2013

2. Agenda • The Evolving Physician Alignment Landscape • Developing Physician Leaders • AHA’s Physician Leadership Forum • Lifelong Competency Development

3. Hospitals employ more than 259,000 physicians, up 31% from 2000. Number of Physicians Employed by Hospitals, 2000-2010 SOURCE: Health Forum, AHA Annual Survey of Hospitals 1998-2010. 3

4. Hospitals report nearly 45% of privileged physicians employed or under contract Percent of Privileged Physicians by Type of Relationship, 2010 Source: Analysis of AHA Annual Survey data for community hospitals, 2010. Hospitals were asked to report the total number of physicians on the medical staff except those with courtesy, honorary and provisional privileges. Residents or interns are not included. Employed physicians are either direct hospital employees or employees of a hospital subsidiary corporation. Individual contract physicians are under a formal contract to provide services at the hospital and group contract physicians are part of a group (group practice, faculty practice plan or medical foundation) under a formal contract to provide services at the hospital.

5. Percent of hospitals reporting participation in a joint venture has nearly doubled from 2004 to 2010. Percent of Hospitals Reporting That They Are Participating in a Joint Venture Arrangement with a Physician or Physician Group, 2004-2010 • Source: Analysis of AHA Annual Survey data for community hospitals 2004-2010. A joint venture arrangement is defined as a contractual arrangement between two or more parties forming an unincorporated business. The participants in the arrangement remain independent and separate outside of the venture’s purpose.

6. Hospitalist care has more than doubled Percent of Hospitals Reporting That Hospitalists Provide Care in Their Hospital, 2003-2010 • Source: Analysis of AHA Annual Survey data for community hospitals 2003-2010.A hospitalistis a physician whose primary professional focus is the care of hospitalized medical patients (through clinical, education, administrative and research activity).

7. Affordable Care Act (ACA) Readmissions HACs Bundling ACOs Value-Based Purchasing Physician – Hospital Alignment Better Care Coordination Better Quality and Patient Safety Greater Efficiency

8. Physician Leadership Vision Administrative Clinical Institutional management Patient management

9. Environmental Pressures Environmental Pressures Administrative Clinical Institutional management Patient management

10. Environmental Pressures Environmental Pressures Administrative Clinical Institutional management Patient management Transformed Vision Clinical Management Population management

11. Reframing the Discussion Structure and Control Accountability and Performance

12. CONCEPTS OF LEADERSHIP The role of the leader is evolving from a top-down approach to a more collaborative approach Source: Catherine D. Serio, PhD, Ted Epperly, MD, Physician Leadership: A New Model for a New Generation: Today's leaders need more than vision and a high IQ. FamPractManag. 2006 Feb;13(2):51-54.

13. Physician Leaders – Key Competencies Technical knowledge and skills Knowledge of healthcare Problem-solving prowess Emotional intelligence Communication A commitment to lifelong learning Source: Stoller JK. Developing physician-leaders: Key competencies and available programs. J Health Admin Ed, Fall 2008

14. Characteristics of Physician Leaders • Physicians moving into leadership positions at hospitals and large health systems should be able to: • See the big picture beyond the patient at hand. • Collaborate with people at all levels of the health system. • Appreciate multiple perspectives. • Think long term. • Convince a significant number of people of the validity of an idea without issuing orders. • Be comfortable making some people unhappy. • Communicate and listen well. Source: Hospitals' new physician leaders: Doctors wear multiple medical hats, Victoria Stagg Elliott, AMA News, amednewsPosted April 4, 2011.

15. Environmental Pressures Environmental Pressures Administrative Clinical Institutional management Patient management AONE HPOE PLF Transformed Vision Clinical Management Population management

16. The case for action – AHA’s Physician Leadership Forum AHA member hospitals employing more physicians Varying relationships and degrees of integration between hospitals and physicians Limited resources for physicians to improve and redesign care delivery Little recognition by physicians of AHA as a resource for leadership development Need to increase awareness and credibility of AHA with physician community

17. Strategic Framework Goal Advance physician relationships with member hospitals to transform care delivery and improve the health of patients and communities. Physician Engagement Strategies Education Quality and Patient Safety Leadership Development Advocacy and Public Policy

18. Services Bi-weekly e-newsletter to 7000 subscribers Co-branded with several state associations www.ahaphysicianforum.org website Bi-monthly webinars Clinical Integration Practice Management Physician Compensation Co-sponsored educational conferences

19. Education Team-Based Leadership Conference, 2011 Team-Based Health Care Delivery Guide: Lessons from the Field

20. Education • Creating the Hospital of the Future Conference, July 2012 • Monograph, Fall 2012

21. Lifelong Learning: Physician Competency Development • Key Questions • How can we affect physician education and development to move to the next generation of health care delivery? • What is the current level of success in preparing physicians during residency to practice in today’s health care environment?

22. ACGME/ABMS Competencies • Medical knowledge – demonstrate knowledge about established and evolving biomedical, clinical, and cognate sciences and the application of this knowledge to patient care. • Patient care – provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. • Practice-based learning and improvement – must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. • Systems-based practice – demonstrate awareness of and responsibility to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. • Professionalism – demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. • Interpersonal and communication skills – demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their families, and professional associates.

23. Skills Needed • Leadership training • Systems theory and analysis • Use of information technology • Cross-disciplinary training/multidisciplinary teams • Understanding and respecting the skills of other practitioners • Additional education around: • Population health management • Palliative care/end-of-life • Resource management/Medical economics • Health policy and regulation • Interpersonal and communication skills • Less “captain of the ship” and more “member/leader of the team” • Empathy/Customer service • Time management • Conflict management/performance feedback • Understanding of cultural and economic diversity • Emotional intelligence

24. Gaps across all governance groups

25. Greatest Gaps and Least Evident System-Based Practice: Provide cost-conscious, effective medical care Communication Skills: Effective information exchange System-Based Practice: Coordinate care with other providers Communication Skills: Work effectively with health care team Most Important Patient Care System-Based Practice: Promote patient safety Medical Knowledge Communication Skills: Work effectively with health care team Key Observations

26. Recommendations – Hospitals and Health Delivery • Hospital Role • Foster and support competency development • Inter-professional training and teams • Feedback and tools for improvement • Peer dynamics, medical staff requirements • Involvement in business of health care • Full involvement of all physicians (including students and residents) in quality and safety improvement projects • Delivery System Role • Move from individual to population health • Greater use of health information technology • Alignment of incentives to competencies • Ability to add/amend/delete competencies as health care changes

27. Recommendations – Education, Training, and Development • Education • Broaden reach of medical school admissions • Decompress educational load and broaden modes of education • Ingrain all competencies into value structure of training • Implications of different career paths on educational structure • Post-Graduate Training • Inter-professional training strengthens care delivery • Quality and patient safety need to be an integral part of residency programs • Health care is practiced in a wide variety of environments • Focus on patient wishes • Ongoing Professional Development • Ease transition from residency to practice • Use of continuing education to focus on competencies • Professional society influence

28. Physician Core Competencies • Report released July 2012 • Next Steps • Joint effort with ACGME to host a stakeholder workgroup that brings together all the accrediting groups and those involved in education and training of physicians. • The group has begun work to create a more systematic approach to physician development over a lifetime.

29. Questions/Comments John R. Combes, MD Senior Vice President, American Hospital Association President, Center for Healthcare Governance Chicago, IL 312-422-2117 jcombes@aha.org www.ahaphysicianforum.org