Dear East Coat Connection,
To answer your first question, I may have to piss some of the physician in the group, so apology in advance.
1) How do you champion physician engagement to own clinical problems and be accountable for quality and patient safety.
Institution like hospitals cannot relay only on positive reinforcement. Once the benchmark for any Performance Indicator is set by the administration, all team player should abide by the roles and principles that govern this PI in order to achieve the minimum requirement or bench mark or national or interneuional average to be attained. So, physician should held accountable for sub optimal performance or not finishing their duties in timely manner such as filling their medical records by deadline then the chief of staff will issue a suspension memo for that particular doctor because also you do not to hold their colleagues accountable for their underperformance.
We had a surgeons had issues with hand sanitization before or sometimes after examining patients. First verbal warning did nit do any change believe or not, but when he get his first written warning after documentation by video tape that he did not wash his hands before entering patient room, the attitude changed 180 degree.
2)Value based arrangements are a strategic priority. How do you align with the providers to share the risk.
Like was mentioned before by, mission of your institution should be reinforced in orientation sessions (that you need to give it time f days like couple of days), during start of work (let HR be actively involved with new physician), then email and SMS reminders about key issues like hand sanitization, even let your team create Day for a problem you are struggling with and make it an event and ask all to participate like if you had a couple of insidence of HIPPA Violation, make HIPPA day.
It seems you have a unique situation. In our institution, the PA/NP step up if physician like our hospitalist get sick or injured.
May sure you that they arE not burned out or under payed. Both make human whatever they are depressed, not happy to come to work, inefficient and break tea spirit.
I will answer your questions one at a time:
1. How do you make the leadership (the bean counters) understand that productivity simply cannot be in RVUs in the future?
If you are working in academic institution will be different if you are working for non profit or for profit hospitals.
So, everything go back to the mission statement of the institution you are working at.
In academics, it is acceptable that physician RVU to be lower than private practice given the two extra roles that each physician have in their plate including research and teaching. And even some have administrative roles. So, even physician with different roles may have varying RVU in same subspecialty. If this is your situation, then you need to convince the administration and remind them about the mission of academic institution.
2. How do we restructure Physician compensation (at least what do we tell them that is convincing) to account for declining RVUs but bring in other set of measures?
Best trick that a lot of institution use is physician incentives. Meaning you can use RVU standards or other such as Time Value Unit (TVU). However, this is a sword with two edges; for example, few physician will increase their RVU on the expense of patient outcome quality which you can control by abiding solid to the Performance Indicator related to their jobs with accountability so include their patient satisfaction as a factor in their compensation.
3. What could the other measures be (patient satisfaction for example) ?
Patient outcome, patient survey and satisfaction, M&M, infection rates for surgeons and interventionist, readmission rate post discharge from CCU for cardiologist, patient recall in ED .
I agree with Siona. Each phase described before: starting being an individual contributor, to a leader, to a leader of leaders then to a leader of an entire business; will be a struggle in the beginning to you till you mature in your role. I meant with time you will acquire skills and the knowledge that will put you in the right prospective.
So, time and patience are the keys.
It seems you are having problem with only few; the ones that were promoted without taking into consideration other aspects of the job. So, I will target each one in person to person meetings and put an action plan with time tables. So, you teach them to be accountable.
One thing I will not do, is to demote them without giving them a chance which you start in your office. Believe me, you may demote a person that you will notice in the future that he is a leader material.
Again, uniformity is a tool of transparency
Salaries should be same, uniforms should be the same and parking to all or none.
Dear Belgium friend,
We faced the same scenario before.
Asking peer reviewers to submit anonymous review of their colleague was a no-no. Even to the present time here in the USA, you hear little bad mouthing of doctors concerning other doctor, but very few end up in written complaint.
the way we approached was drastic as usual, we mentioned that any reported time out violation will end up in doctor temporary suspension even it was done once. The compliance was overwhelming.
So, sometimes you need to take drastic measures to correct a safety behavior. And remember this measure not only protect the patient but protect the doctor also from being sued and to keep his reputation as good as possible.