Private podiatric medical practice

1. 2 • Wholly owned subsidiary of public corporation • Manage vascular center • Consultant, Nursing, Interventional Radiology • Private podiatric medical practice • CORP • Screen all HD center patients • Coordinate DPM referrals /appointments if (+) screen • DPM • Examination • In-office diagnostic vascular tests • (+) PAD = conservative treatment or refer to LLC • LLC • Angiogram • Endovascular intervention at vascular center • Refer to vascular • surgery if • necessary • CORP • Administrativesupport • Coordinate DPM & LLC communication • Schedule patients for IR at vascular center 1 3 • LLC members = Competing nephrology private practices • Established for ownership of outpatient vascular center 4 For more information: jlabovitz@westernu.edu CONCLUSIONS This project was designed to develop and implement a multi-disciplinary care team to screen, evaluate, and treat PAD in hemodialysis patients. INTRODUCTION Hemodialysis patients have numerous medical needs and account for significant healthcare costs. Peripheral arterial disease (PAD) significantly increases admissions, amputations, morbidity, and mortality in hemodialysis patients. • Amputations increased • Mortality increased PAD is frequently under-diagnosed and many times high-risk patients are not evaluated for PAD. OBJECTIVES RESULTS: STRUCTURAL & PROCESS OUTCOMES REFERENCES Changes made to the initial phase based on team experiences/input led to greater success, team satisfaction. Learning organizations are more likely to achieve success. This program failed due to a lack of: • Communication • Consensus building • Leadership qualities within one unit Leadership from each unit was based on role prior to program development. Leaders by title have a name, whereas leaders who influence others get results. When implementing integrated care models the following are critical: • Have leaders for each unit • Have the influential leaders, not just leaders based on title • Account for complexity of business structures and personal dynamics within and between clinical and functional units RESULTS: CLINICAL OUTCOMES Western University of Health Sciences, College of Podiatric Medicine Valuing Leadership and Organizational Learning when Implementing a Multi-disciplinary Care Team Jonathan Labovitz, DPM Dow AW, DiazGranados D, Mazmanian PE, et al. Applying organizational science to health care: A framework for collaborative practice. Academic Medicine 2013; 88(7): 1-6. Edmondson, AC. Strategies for learning from failure. Harvard Business Review 2011 (April): 48-55. Kouzes J and Posner B. The Leadership Challenge: How to make extraordinary things happen in organizations, 5th ed. San Francisco: Jossey-Bass, 2012. Spath, PL. Leading your healthcare organization to excellence: A guide to using the Baldridge Criteria. Chicago: Health Administration Press, 2004: pp. 207-212. CARE TEAM & INTEGRATED DELIVERY MODEL PROGRAM IMPLEMENTATION • Consultant for wholly owned subsidiary of public corporation (CORP) developed care model and was on-site for implementation of the multi-disciplinary care plan for managing PAD in hemodialysis patients • Clinical team = • Nephrology (competing practices in LLC) • Interventional radiology (1099 for LLC) • Podiatric medicine (private practice) • Feedback from CORP/clinical unit leadership prior to finalizing program for pilot • Pilot screening phase at two hemodialysis centers • Feedback from staff during screenings and feedback from clinical units after screening • Outcomes Assessment • Clinical = clinical data from screenings • Structural/Process = data from screenings and interviews of care team leaders