The Medical Director's Role: Leading Improvement Initiatives and Setting Standards of Care

1. The Medical Director’s Role at VUMC: What is it Really All About? Lynn E. Webb, Ph.D. May 25, 2011

2. WARNING: The following presentation contains content which may be considered warm and fuzzy. Viewer attention is advised.

3. A Little History: 1993 “Can Academic Medicine be Competitive in New Environment?” “Managed Care Threatens AMC’s” Reduce costs to be competitive Improve service to meet customer expectations (Note: Quality and Safety not invented yet or we assumed it!)

4. VUMC Design Team Create Patient Care Centers that are accountable for achieving goals in Patient Care Physicians must participate more actively in leadership at every level of the organization

5. The Physician-Administrator Leadership Team - VHVI

6. “ Attributes of Successful Physician / Administrator Leadership: An Empirical Approach” ___________________________________________________________________________________________________________________________________ Webb, Lynn E. American College of Medical Practice Executives (ACMPE) College Review. Volume 18.Number 1 (Spring 2001): 24-38. The emergence of the integrated health care delivery system is creating new demands on the physician-administrator relationship. This paper examines the relationship between selected attributes of the physician/administrator leadership (PAL) team and the team’s perceived success in performing its leadership functions.

7. Cardiovascular Position Descriptions Departmental Leadership Team Positions Manager and Medical Directors Cardiovascular Patient Care Center Leadership Team The leadership team of the cardiology services areas will include a Medical Director and a manager. The team is responsible for the creation of a patient focused, high performance, high commitment work team which supports the mission, vision and credo of the Cardiovascular Patient Care Center and the Clinical Enterprise. The leadership team will collaborate to meet the established goals of the Patient Care Center and the Clinical Enterprise of Vanderbilt University Medical Center.

8. Excerpts for VHVI Medical Director Job Descriptions: • Develop standards of care • Manage physician clinical performance and behavior • Develop annual goals • Lead improvement initiatives

9. As a medical director, how do I spend most of my time? • Leading improvement initiatives • Developing and monitoring annual goals • Setting standards of care • Dealing with physician performance and behavior 7 Countdown

10. How do I spend most of my time? • Leading improvement initiatives • Developing and monitoring annual goals • Setting standards of care • Dealing with physician performance and behavior

11. Where do I get my authority? • My job description • Dr. Churchwell tells me I have authority. • My ability to persuade people to do things. • What authority? 7 Countdown

12. Where do I get my authority? • My job description • Dr. Churchwell tells me I have authority. • My ability to persuade people to do things. • What authority?

13. “Excellence comes from the leadership of those who have the greatest impact on the conduct of others.” “When physician leaders take active ownership, express support, and lead service and quality efforts, these efforts take on a sense of greater importance” Steve Beeson, M.D. Engaging Physicians

14. “ Balancing Systems and Individual Accountability: A Case of the Wrong Blood ” ___________________________________________________________________________________________________________________________________ Gerald B. Hickson, MD, Ilene N. Moore, MD, JD, James W. Pichert, PhD, Manual Benegas, JR., JD. Healthcare leaders face three challenges in balancing systems and individual accountability. …most importantly, leaders must determine how to create a healthcare enterprise in which systems are least likely to fail and humans hold themselves accountable, that is to say, accept responsibility for their actions in achieving outcomes.

15. Effective Physician Leaders: Demonstrate a value system that always places the interests of patients first. Provide inspiration AND accountability Achieve excellence primarily through influence, example, and relationships

16. The “Art of Influencing” You make choices every time you interact with someone Consider every interaction an opportunity to influence and have an impact Your choices make or break the opportunity and the impact it has!

17. The TOP 10 Ways… for Having More Influence as a Medical Director (or Quality Officer!) than You Could Have Ever Imagined

18. 10. This is about you, not “them” Video

19. 9. Be Present and Engaged

20. 8. Be Authentic AND Humanistic

21. 7. Be Curious, not Judgmental

22. 6. Assume & Respect Separate Realties toward a Shared Vision

23. 5. Desired Performance Means: Desired Results + Desired Behavior

24. 4. Provide timely, clear, specific, and consistent feedback

25. “Feedback Sandwich” for Formal Feedback Events “You do these [specific] things very well.” “You should work on these [specific] items.” “I know you want to improve because that is the kind of person you are.”

26. Practice Group Comparison

27. Individual Provider Assessment

28. Inpatient Physician Feedback

29. Feedback Can Get Results

30. 3. Have Purposeful Conversations

31. ABCD For “Purposeful” Conversations

32. 2. It’s so hard when I have to, And so easy when I want to. - Annie Gottlier It’s About Culture

33. 1. Be a COACH, rather than an ENFORCER.

34. To Accomplish Vision VHVI Must Be: • Best place to receive care for patients • Best place to practice medicine for physicians • Best place to work for employees • Led by: • Highly Effective Physician-Administrator Team

35. CASE #1: Process change required At a management team meeting, there is an agreement for a necessary process or system change that will require all team members, including physicians, to make considerable changes to work flow. What is the medical director’s responsibility in this change process?

36. What Impacts the Management Team? Trust Unity on Major Goals Clarity of roles Transparent and Frequent Communication “Rules of Engagement” for Decision Making Perceived as a Unified Team Administrative leaders become more effective when they are supported by visible, engaged, and participatory physician leaders.

37. CASE #2 Two physicians have expressed concerns to you about perceived low morale of unit/clinic staff and that staff just seem to be “going through the motions”. They feel it is impacting patient satisfaction as well as clinic efficiency. What action should you take?

38. What Impacts Employees? Clear expectations and individual feedback (positive and constructive). Constant reminder of mission (i.e. what is important). A highly supportive and respectful environment. Physicians model how employees should interact with patients.

39. CASE #3 The manager approaches you that Dr. _________ consistently fails to respond to pages and phone calls in a timely fashion. Something must be done. What action should you take?

40. What Impacts Physician Colleagues? Establishing trust is a precursor to any durable and meaningful partnerships with physicians. Communicating clear standards and expected behaviors to improving performance. Feedback of objective performance data is highly motivating. Modeling exceptional performance is a must.

41. Impact on Patients Change happens when physicians step away from the intensity of the day and look at care through the eyes of patients. Sustained change happens when physicians consider that, while treatment isn’t always effective, we can still make a positive difference with every patient every time.

42. Hippocratic Oath: I will never do harm to anyone. Vanderbilt Class of 2011 Oath: I will work diligently for the best interest of all patients… and will strive to improve the practice of medicine.

43. Medical Directors and Quality Officers at VUMC “Working hard with people you like to do something that matters for someone else.”

44. References: Beeson, Stephen C. (2009). Engaging Physicians: A Manual to Physician Partnership. Florida: Fire Starter Publishing. Lee, Fred. (2004). If Disney Ran Your Hospital: 9 ½ Things You Would Do Differently. Montana: Second River Healthcare Press. Sasscar, Mark & North, Susan. “The Choice is Yours: Ten Principles of Personal Leaderhip”. LeadQuest Consulting, Inc. http://leadquestllc.com/PDFs/10PrincArtLeaderChoiceisYours11.08.pdf e l e v a t e