This is an excellent post and a dilemma that we all go through. I believe moving towards value based incentives is the way to go and making it part of the salary is usually the approach taken. Now, you have to begin with a small % and move up slowly to give a chance to people to adapt. The discharge planning piece has to be own by the plan or hospital and the Utilization Management team. We have a score cards from CMS of the facilities that scores are higher and the patients pick them. We have aligned those facilities with our own incentives like reduction readmit, so we all have the same goals.
We have seen a decrease in ED utilization.
First is that you have to set clear expectations of what is expected. Second, obtain feedback from the providers of what is blocking them to be more efficient or motivated and then remove those barriers. Once you have improved processes and define your culture with clear expectations, then you can move into corrective actions. Some people with jump in and buy into the culture but you will lose some of them and that is OK.
How to navigate with our feet in two different canoes? That’s the dilemma that we confront. We need to continue and grow our group to manage population health to grow our fee for service volumes and keep those physicians busy doing what they would like to do. The bigger the net the more fish we will catch.
Thanks for the feedback!
A few years ago we began our “Just Culture” journey with patient centered transparency. As long the behaviors are not “criminal” or related to substance abuse, we implemented a process where every case was reviewed by a senior committee and depending on the frequency, severity of the events, we either requested a letter explaining the events, had a cup of coffee” conversation or brought the individual in front of the committee to explain in person their conduct. When we place the patient first, and remove blame from the process, trying to find the real reason why the outburst, we gain the trust of the physicians and employees.
@SpineDoc, thanks for the feedback and I see your points. About three years ago we started sharing labs and X-ray results automatically 24 hours after they were performed and we’ve had an overwhelming positive response. It has actually help in some cases where doctors missed an interpretation and the patients point it out to the providers. Just the other day speaking with a media person that was covering an event at our organization, I was explaining how the patient portal works and the fact that we automatically release results within 24 hours. That person, thinking out loud, stated: it makes sense, why wouldn’t doctors across the board want this? The patients (consumers) own their records and they are entitled to get the results immediately, or at least at a recent time from when they were done.
Patients understand and expect an explanation of the results from the physicians and they come prepare with questions based on what the tests revealed. Can the terms be confusing to them? Probably, but that’s when we step in with our expertise and simplify for them.
I agree. Thank you Lisa!
I agree Paul! Thanks for the feedback.
Thank you for the feedback!
I agree with Rawn. For a service line to be successful we have to align the goals, the budget and incentives. The service line has to act as one unit and develop protocols around standards of care (efficient processes of care to get best outcomes), reduce cost by minimizing variation in supplies, common budgets but with regional goals. Not every region is the same and we have to be nimble enough to adapt and adopt best practices.
We must also align efforts around recruiting and allocate resources to areas in need and sometimes, develop a plan to cross cover.
This can only be achieved with everyone’s buy in, not just the leaders. The challenge is how to make a compelling argument to make that happen.
Thank you for the feedback