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The African Queen … Medical Staff and Hospital Administration – Bogart and Hepburn Michael Jellinek, M.D. President, NW

The African Queen … Medical Staff and Hospital Administration – Bogart and Hepburn Michael Jellinek, M.D. President, NWH Chief, Child Psychiatry Service, MGH Professor of Psychiatry and of Pediatrics, Harvard Medical School January 11, 2007 Presentation Objectives …

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The African Queen … Medical Staff and Hospital Administration – Bogart and Hepburn Michael Jellinek, M.D. President, NW

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  1. The African Queen … Medical Staff and Hospital Administration – Bogart and Hepburn Michael Jellinek, M.D. President, NWH Chief, Child Psychiatry Service, MGH Professor of Psychiatry and of Pediatrics, Harvard Medical School January 11, 2007

  2. Presentation Objectives … • Participants will be able to : • identify the key elements in building a strategy for productive communication between the hospital administration and key stakeholders, specifically the process used to engage physician leadership. • understand how two vastly different teams (ie. Medical Staff and Hospital Administration) bridge their differences to implement CPOE • recognize the immediate challenges of implementing CPOE • build a culture of long-term cooperation between administration and medical staff

  3. The African Queen • Rose Sayer – Missionary • Priorities : religion, proper English values, elegance, doing the right thing, “God and Country”, spinster • Charlie Allnut – Local Trader • Priorities : pragmatic, making money, drinking, having fun in a manly manner, “me, myself and I”, freedom of choice - autonomy

  4. What do they have in common? • Both forced onto a small boat, The African Queen, to escape the German invasion. • Both forced to come to terms with each other as they faced external threats – Germans, the river, drought, the Luisa. • Both learn to appreciate each other – fall in love, risk their lives willingly, commit to a higher goal, and succeed.

  5. Defining the issues … • Hospital Administration and Medical Staff, different incentives, different priorities, are facing an external force to undertake a major mission – CPOE. • Is the external force appropriate and legitimate? • Yes – safety, quality, efficiency, variation • Will CPOE help? • Yes – handwriting, transmission speed, pharmacy checks, order sets and quality, efficiency

  6. Defining the issues … How major is CPOE as a mission? Major - change in work flow of patient care, change in method (paper to computer), time consuming, cost (hardware, software, teaching, coverage, updates), involuntary

  7. Working together … Rose and Charlie would have fought among themselves and been killed or captured by the Germans, starved to death on the river, died from the leeches, or drowned – never getting close to sinking the Luisa. What in the culture of a hospital could support collaboration rather than disaster?

  8. Requirements for success … 1. Broad quality and safety program • Forthright peer review at department, medical staff and Board of Trustee level; • Aggressive pursuit of quality/safety agenda pre-problem, post-problem • Clear resolution of conflict policy

  9. Requirements for success … • Transparency • Group decision-making • Role of Chairs • Role of President of Medical Staff, CMO, PHO, Med. Dir. • Joint Trustee Staff • Board of Trustees (20% M.D. membership)

  10. Requirements for success … • Communication • Gang of 9 • ECMS • Medical Staff Meetings • Community Letter • Town Hall Meetings • Access – email, talk, rounding

  11. Requirements for success … • Management Structure • IS, IS/MD • CMO, PHO, Medical Directors • IS Committee • CPOE Implementation Committee • Vendor Responsiveness • Budget Contingency for emerging programming, coverage

  12. Requirements for success … • Clearly defined roles for: • Hospital staff • Hospitalists • PA’s • 6. Key leadership role of primary care • 7. Moving past control by secrecy, favoritism, financial power, “autonomy” of self-interest • 8. Some blind courage

  13. Conclusion … Many missions lie ahead – health care reform, medical costs, integration of more medical IT, public reporting, re-engineering, temptation to deconstruct the hospital of specialists with ancillary opportunities Can we be more like Rose and Charlie? CPOE is a solid challenge to test if we are seaworthy.

  14. Presentation Objectives … • Participants will be able to : • identify the key elements in building a strategy for productive communication between the hospital administration and key stakeholders, specifically the process used to engage physician leadership. • understand how two vastly different teams (ie. Medical Staff and Hospital Administration) bridge their differences to implement CPOE • recognize the immediate challenges of implementing CPOE • build a culture of long-term cooperation between administration and medical staff

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