Embedding a Culture of Improvement with Physicians

1. Embedding a Culture of Improvement with Physicians AMGAOctober 02, 2009 J. Daniel Nelson, MD Associate Medical Director, Specialty Care Beth Averbeck, MD Associate Medical Director, Primary Care HealthPartners Medical Group

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3. 3 ______ Culture Jointly learned beliefs, values, assumptions Shared amongst a group Artifacts: what you see, hear, feel as you’re around others “It’s the way we do things around here” We can choose to manage it or it manages us

4. 4 ___ _ ___ _______ __ ____ ____________ What’s the culture in your organization? Mission Goals and Strategies Leadership Structure Systems Reward and Status Discipline Common Language Group Boundaries

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6. 6 Culture Process

7. 7 ______ _____ Culture Change Case for change - environment Will to change Knowledge and resources Skilled execution Imbed and internalize the change – it’s the new way we do things around here

8. 8 HealthPartners Mission

9. 9 HealthPartners Integrated Care & Financing System

10. 10 A Merger of Mergers

11. 11 HealthPartners Medical Group

12. 12 Dyad Operational Structure

13. 13 Environment and Culture Culture changes Environment or Environment changes Culture

14. Community Environment

15. 15 Minnesota Community Measures HPMG Results

16. 16 Minnesota Community Measures HPMG Results

17. 17 Tiering Medical Groups and Hospitals Quality Experience Cost Patient Incentives

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20. 20 HealthPartners Medical Group Strategic Goals

21. 21 Why Improve? Triple Aim Competitive Advantage Healthcare Reform Recruitment and Retention

22. Building A Culture of Improvement

23. 23 Operating Principles Improvement is Local Care is a Team Sport Leadership Accountability

24. 24 Prepared Practice Teams

25. 25 Improvement Process

26. 26  “What gets measured, gets done.”

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28. 28 Transparency

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30. 30 Our Transparency Journey

31. 31 Nested Data for Improvement

32. 32 Optimal Diabetes Care Measure

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34. 34 Provider Specific Data

35. 35 Patient Panel Data

36. 36 Patient Specific Measures

37. 37 HealthPartners Medical Group Strategic Goals

38. 38 One Physician’s Journey

39. 39 Transparency:Physician Specific Results What are high patient-satisfaction providers doing? What are the key drivers of satisfaction for each question?

40. 40 Patient Experience:Charm Matters Evidence based approach to the patient provider relationship Charm is a set of clinical communication skills that can be taught and mastered Smith, Ann Intern Med 1998 Stein, Permanente J 1998 Charm is a culture that we create

41. 41 435 Charm Masters Pilot

42. 42 HealthPartners Medical Group Strategic Goals Stewardship- Meet budget target and maintain favorable total cost of care Stewardship- Meet budget target and maintain favorable total cost of care

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46. 46 All Improvement is Local How do we accelerate the pace of improvement at the frontline?

47. 47 Methods of Improvement LEAN Reliability Design Plan-Do-Study-Act

48. 48 GOAL: Reliability  Standardize Redundancy Redesign

49. 49 Making a P & J Sandwich Open peanut butter jar Open jelly jar Open bread bag Take out two pieces of bread Lay them separated on table by 4” Pick up knife Use knife to take peanut butter from jar Spread evenly on bread to 1/8” thick Take knife and take jelly from jar Apply jelly on other slice of bread to 1/8” thick Put knife down Pick up bread with peanut butter on it flip it over and place on bread with jelly on it Put peanut butter cap back on peanut butter jar and screw shut Put jelly cap back on jelly jar and screw shut Close bread bag Pick up knife and clean it Place knife back on table

50. 50 Project Examples Forms – decrease MD time Improve patient experience at a clinic Standardize first OB visit Improve efficiency of e-communication Improve use of lower cost H pylori test

51. 51 Improvement Project Choice Start Small

52. 52 “1st OB” Physicians complain that they do not have all the data they need for the first OB visit readily available when they see the patient.

53. 53 “1st OB”

54. 54 “1st OB” To increase the % of OB Providers that respond “Yes” to the question “Do you currently have everything you need for a 1st OB visit when you walk into the room?” from 36% to 50% by 6/1/08.

55. 55 Asked 20 Questions - Top 3 Pre-Visit Planning Focus OB History Medications Medical and Surgical History

56. 56 Improvement Project Choice What’s important to the team

57. 57 Opioid Refills

58. 58 Aim Improve efficiency and increase staff satisfaction with the Schedule II medication refill process.

59. 59 Measure

60. 60 ___ ____ ______ ___ ______ Time Spent Looking for Refills

61. 61 Culture of Improvement

62. 62 HealthPartners Medical Group

63. 63 Physician Satisfaction Survey AMGA 2008

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65. BETH At the end of the day, it’s about delivering value for patients and here is a summary of our journey – you can see we have improved in diabetes and patient experience while lowering their cost BETH At the end of the day, it’s about delivering value for patients and here is a summary of our journey – you can see we have improved in diabetes and patient experience while lowering their cost

66. 66 Key Learning’s You can only get better if you know where you started Involve and engage the team(s), share and steal Use the available data Conflict is opportunity

67. 67 Key Learning’s Start small, spread fast (it’s OK to fail) Common language is important Identify and foster passionate physicians with aptitude The journey never ends

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