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A Three-Pillar Approach to Physician Engagement

Dr. Fred Hosler, senior vice president and chief medical officer at Alegent Health, describes how his company engages their physicians.

Our physicians informed us of the necessary elements to engage them and to have them significantly assist us in achieving the results we desired. It came down to creating some standardization. Eighty-seven percent of our 1,200 physicians practiced at multiple facilities. They found that they would walk into any given facility and they would have different tools, different sets of reminders, different processes and different forms. Consequently, that translated into more time and more frustration. Additionally, our physicians asked for feedback on their performances in a way that they could understand. Physicians also wanted us to show them how this improved the outcomes and their patients’ experience. They wanted to know that there is some science behind this. In doing those things, we did see a sense of ownership as well as a willingness of accountability for the oversight and monitoring. But that wasn’t everything. We needed to go deeper because it wasn’t just about the physicians, it was getting to the barriers for providing quality at the point of care.

To do this, we initiated a program that we referred to as “CPR for the Alegent 20.” It was based around three pillars: awareness, education and intervention. Awareness came as we began to look at how care is delivered. What’s the interaction? We’re organized into silos that, while they interact, don’t necessarily communicate effectively between one another. We found that within our institutions the Alegent 20 was felt to be a quality department program. Even within the quality department, there was not uniform accountability for achieving the results. For example, the care managers or case managers were not involved in the process changes necessary to achieve the results. There was a wide diffusion of resources. People were performing multiple disconnected fragmented activities.

Secondly, we found out that no one really knew what the core measures were or why were we doing this. Most people had heard about them vaguely, but for many of those individuals, the tools were another form and there was a very deep and broad lack of awareness of the point of the forms, much less how they translated back to improved care for the patients. There was a very deep lack of understanding. The final piece was a reaffirmation of the fact that the importance to the physicians — who were disconnected at that point — was a significant gap. We recognized that before we created or designed interventions, we needed to deal with the educational piece.

We started a blitz throughout our nine hospitals. There was standardized messaging to educate staff about the point of doing this. Why do the core measures matter? What is the basis for those things? We found it wasn’t so much about all of the things that we weren’t doing right, it was all the various activities that we were doing in the silos that didn’t communicate with one another. So we sent a consistent message to our physicians, to line staff, to managers. We explained the basis in science or evidence that led to these things, and asked what barriers to implementation they faced. We started with our own system staff and individual hospital staff. We created a buzz everywhere throughout the organization, originating in the senior management level of the system and driven down through. Everybody was talking about the core measures. There was nothing incremental about what we did. We made some radical changes organizationally, not only in structure but also in how we did this. We created posters, articles and various memory joggers. When we felt like we were fairly successful in at least making people aware of these issues and their importance, we created training modules. We made it possible for line staff to have access to computer-based training (CBT) modules. We provided incentives for them if they completed the training modules, and we created recognition for exemplary performance for units in which 100 percent of their staff completed training. We had an enormous amount of buy-in. The expectation was set forth by management. We had over 90 percent completion of the CBT modules, all of which were further education and reinforcement of the basis — evidenced-based care, why core measures matter and how they improve patient outcomes.

We quickly followed that up with focused intervention. We focused all of our resources on those areas, and from a management perspective, we heard from the staff about all of these other things we’re doing. Aren’t they important? Of course they were important, but we continued to reaffirm what came out of the decision accelerator, which was if we can’t get these things right we’re not going to be able to get anything right. We need the staff working side by side with the physicians providing attention to identification of core measures. When patients were admitted, staff went to physician offices with pre-admission information. The physician offices notify us when they have a patient who they think may be included in the core measures group. Once the patients were admitted, we had a standardized set of stickers, checklists and tools that both the physicians and the staff would use. It was a common set. They developed and deployed them together, involving not only the care management staff in the quality department but the line staff in daily predischarge rounds of all patients that were going to be in the core measures or Alegent 20 area. Tools were simplified and standardized.

Source: Engaging Physicians in Pay for Performance: Promoting Partnerships That Align Data, Dollars, Care & Quality, September 2008

Engaging Physicians in Pay for Performance: Promoting Partnerships That Align Data, Dollars, Care & Quality

In this special report, two industry leaders chronicle the development of mutually beneficial provider-plan partnerships in PFP. They identify practice workflow issues that can derail physician participation in PFP and provide inside details on how they have engaged physicians in PFP programs and sustained motivation for continued participation.

Engaging Physicians in Pay for Performance: Promoting Partnerships That Align Data, Dollars, Care & Quality is available from the Healthcare Intelligence Network for $137 by visiting our Online Bookstore or by calling toll-free (888) 446-3530.

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