I like the idea of involving a coach to help the two individuals in this scenario. This also helps to remove you from the middle of the situation. We have a designated physician leader coach for our organization and in this situation each individual would likely need to meet with her for 3 sessions, perhaps 2 separate sessions each and then bring them together for the third session in the same room (or some variation in this based on the coach’s assessment). Having an objective outside perspective could help analyze and de-stress the situation quite a bit while also helping them to understand the work needs to happen with them working together.
Great questions. I would suggest an open data gathering phase first asking for input from the 2 different location teams around the biggest pain points for each location and some new ideas how to improve them. This way you can engage the teams in thinking about their biggest current challenges and some potential solutions. Then I would share the feedback with each location team with some specific recommendations that you plan to try based on the team direct feedback data.
Integration of the different location staff teams sounds like it will be a gradual process. One idea would be a combination of some in person introduction events, perhaps a couple social hours, and possibly a shared initiative across both sites where the sites could potentially work together on designing a new process together or comparing their two different workflows in a given area and try to compare the workflows to find the best approach together.
First 30-60 days I would likely use for information and perspective gathering, and then the 60-90 day time to share what you have learned in aggregate back to the two teams.
Is there is a way to create a sense of interconnectedness across the two sites for the physicians? Does one site do some things better than the other? Could the physicians meet in person a few times to talk about ways to improve their workflows and schedules, for instance share the EMR productivity tips to improve the quality and efficiency of their documentation flow. Are there a couple EMR superusers who could share ideas with the groups together? Also, having a once a month or every other month physician update page by you could help to communicate major topics relevant to the two groups together, this helps to bring them together in a team identity over a simple team communication approach.
One major initiative that has made a significant positive difference have been establishing and educating about the expectations in the Just Culture approach across our health system. This has been combined with multiple event review teams across the departments that then refer concerning individual physician behavioral events to the peer review committees for each department.
The other approach that has helped is to modify the initial orientation process for all physicians starting in an employed role with the health system. During the orientation, the core values and behaviors of the health system are clearly shared with each physician as expectations, and the Just Culture introducation has also been incorporated into the orientation process as well. One hopeful future addition to this orientation process is a stream-lined re-orientation of all those physicians already on staff at the health system (both employed and private practice physicians).
We have had some success with developing a few different inpatient care service agreements. There was a defined expectation of continuous access to specialty care in the hospital, including overnight and weekend on call coverage. The private physician groups had designated physician leaders who met with the health system leadership to design the incentives together based on national quality metrics and also based on shared value metrics some of which the private physicians proposed specific to each specialty based on the physicians’ opinions about what defined high quality specialty care in the hospital and some of which the health system proposed based on hospital care quality metrics that are measurable and specific to each speciality. A few of the specific incentive elements included: clinical documentation expectations that articulated specific follow up plans for each patient (including outpatient transition and follow up plans), rapid access appointments for patients seen in the ER to help facilitate efficient outpatient follow up appointments with specialists within 1-2 weeks, and establishment of safety and quality databases with metrics specific to each specialty that were incorporated into OPPE for the physicians in the hospital.
One potential idea would be to try to better understand the typical user experience in each clinical department (ideally with a sample of some of the efficent, high quality documenters as well as the less efficient documenters who struggle with technology) and then try to optimize that department specific user experience within the defined limits of the EHR. That would require trying to use some of the user experience data that you have (if it is available) and potentially some user survey data to help define the range of experiences on the EHR for each clinical department. If clinical departments could then identify a couple super-users that would then give active, meaningful input into improving the user experience their department team members, this approach could help improve engagement and decrease some of the frustration within each clinical department. I suspect one of the challenges will be the variable (or lack of) adaptability of the EHR to each clinical department. It is worth exploring.
Hoag Health in California is doing some great things with their focus on Clinical Institutes and IPUs. Based on the talk I heard from Dr. Michael Brant-Zawadzki from Hoag (Executive Medical Director of the Neurosciences Institute at Hoag), it sounds like they are relatively far along with their Neuro Institute/IPU and also with their Heart and Vascular Institute/IPU model development. He would be a good person to reach out to at Hoag to find out who to talk to at Hoag about their CV IPU model. He was very open to sharing what has worked well for them and what has not worked well.
It would be great to see the VA partner with a start up company to work on the idea that Igor brought up with a patient engagement initiative with text and/or email based reminder system prior to appointments. There is a start up called Medumo out of Boston that has been working with several different groups on helping to decrease no shows prior to procedures, and Medumo has had some great results in the Boston health systems. Medumo’s platform goes straight to text or straight to email so there is no separate app involved . There are other start ups with app based reminders prior to appointments as well (Twistle is an app based patient engagement platform option). These reminders could help with the appointments, ensuring labs are completed prior to the appointments if needed, and also help to drive increased survey response rates if needed.