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I like the above responses! I have worked for a few organizations, and my current organization has been changing the % weight of our formal goals as to how it relates to our annual performance eval. One year our “goal grid” was 100% our performance eval. The next year it was 80% and the other 20% was leadership behavior/external contributions, and this year it is 50% with the other 50% being leadership behavior.
I’m a big fan of 50/50, with 50% being on organizational/system/department level goals, and 50% being on your personal leadership and behaviors.
We do this for all leaders, supervisors and above, and with physician leaders.
Another best practice is to tie your goals to the overall mission/goals of the organization. If patient satisfaction is a goal, everyone in a direct patient care area should have a patient satisfaction goal. If quality is one, everyone should have a quality goal. At our organization, we share goals across direct patient care areas and support areas, so that we can try to align our work throughout the year.

On May 11, 2018, lwilt commented on Reshapping a large hospital :

The first thing I would want to do is do a listening tour and meet with the board, the medical and research community, department chairs, research heads, and the affiliated medical school.
This institution sounds like it is positioned for a turnaround, and it is well recognized and is in a good location, but needs someone to lead it to the future. It can be hard to lead into the future without knowing what different stakeholders view as the future, so listening would be key.

Another component would be to ensure that you have the right team in place to execute on the vision, once it is established. If the CEO and the executive team are disconnected and morale is low, those would be things that need to change, and you would need new leaders in place to demonstrate that change.

My initial thought would be – IPUs should be developed outside of the medical university center, but, once established, should quickly be integrated into them. This is much more complex, but in general, I agree with your summarization that innovating outside has advantages for rapid innovation, and then disadvantages later on. To try to capitalize on the advantages, I think development could occur outside. There are a few things I would try to do, though, while still developing outside:
1. Set up a “steering committee” or board to oversee the IPU development, with members of the medical university center on it, so that they can stay engaged and bought into the concept while it is being developed
2. Encourage the team developing the IPU to recognize what the medical university center can bring to the table, and how best to engage with them. Most people developing IPUs acknowledge that while their work is innovative, it is not comprehensive, and it needs to be partnered with other, broader organizations. For example, the point about stricter privacy legislation, the IPU should be able to “borrow” this expertise from the university.
3. Determine early on what success looks like, and then, create a plan for how to transition the IPU back into the medical university center once it achieves success.

Another thought would be to have one steering committee/group oversee all the IPU development, if there are many going on, so that knowledge can be shared across the board. And then, if many IPUs are being developed, it would be great for IPU project leads to share best practices and lessons learned with the groups developing new ones. This steering committe could help facilitate this too. Best of luck!

On May 11, 2018, lwilt commented on How to build a Dashboard. :

Hi! This sounds like a great project and a cool initiative, and it seems like it could be the basis for other service lines or centers of excellence to build something similar. With that in mind:
1. How is registration being completed today? I would assume that it is occuring in a different system? So one way to approach it could be to reduce duplicative work, by putting it in line with the EMR. I also think that putting this information in the EMR could have the potential to enable PROMs down the line, too. And then, if none of those work, I think you could make the case that it is a better experience for the patient to have all of the data in one system, so people should be able to buy in to that.

2 and 3. I think that these items could go hand in hand. I imagine that someone in a part of your organization has expertise in the different databases, and they would love the opportunity to work on a cool, innovative project. If you could partner with them to assess what needs to be done, then it makes the case easier to bring for budget and prioritization from upper management.

Finally, I would recommend that you tie this dashboard to a strategic goal, whether it’s transparency, quality, financial, or the overall excellence of the program. And then, much of the work can be done using a design thinking approach, and evaluating “why” we want to measure something and what it will help us improve or monitor. Once you can get those items down to 2-3 goals and how it ties to your strategic initiatives, I think getting IT budget and buy-in will be easy to obtain.

On May 11, 2018, lwilt commented on Developing Care Bundles for Complex Spine Surgery :

I find the best way to start is to find other organizations who have entered into this type of initiative before and learn from them.
One place to start may be the CMS site that has all the Bundled Payments for Care Improvement (BPCI) organizations listed:
Some of the 48 DRGs listed there in the qualifying BPCIs are for spine, although will need your experience to understand if those are the correct ones.

Another place I like to look is to review the IHI clinical pathway resources:

And then, I think you use Epic, and I would recommend to review the clinical programs and past user’s group presentations to see if anyone has done this before.

But I think you’re first idea is spot on – to engage with the physician group to garner their support and buy-in, and to have more folks participate in the development of this program!

The only other question I would ask is “what does success look like?” Getting a clear definition of success, and for your customer (patient, payor, other physicians, etc.) will be important to keeping the program on the right path. Best of luck!